STRATEGIES FOR FACIAL NERVE PROTECTION DURING PAROTID GLAND SURGERY, A PROSPECTIVE STUDY: USING THE TRAGAL POINTER, POSTERIOR BELLY OF DIGASTRIC AND MASTOID TIP AS LANDMARKS FOR FACIAL NERVE TRUNK IDENTIFICATION IN PAROTID SURGERY.

Background: In order to decrease the likelihood of facial nerve paralysis and address postoperative issues, our goal was to share our experience with parotid surgery. Methods: A 2 year research involving 40 patients with parotid edoema was conducted. Prior to the procedure, a cautious clinical assessment, an examination of the patient's medical history, and a facial nerve evaluation were carried out. These 40 patients (24 men and 16 women) who had parotid edoema underwent parotidectomy using techniques for an antegrade strategy over a period of two years. Results: Each of the 40 patients had a superficial parotidectomy. Thirteen patients (32.5%) exhibited impairments in facial loss of nerve mobility, with seven having HB II (17.5%), four having HB Scale III (10%), and six having HB IV (15%). The majority of patients (18/30 patients) in this study showed significant recovery between four to six months following the procedure of surgery (mean time for recovery: 7 months), and patients affected had recovered in the time duration of 11 months of parotidectomy. Conclusion: To reduce the likelihood of transient facial nerve paresis, the following safety measures were used in this investigation “vertical retraction” to lower the possibility of traction injuries. Bipolar diathermy was performed after the nerve trunk was located, and surgical sutures (5/0 polyglactin) were used to create hemostasis. With a sensitivity of 67% and a specificity of 13%, FNAC remains the investigation of choice. The numerical outcomes of the many parameters that were evaluated show that they are consistent with research from previous studies and the medical literature. Recommendation: The techniques discussed in the study if employed can significantly reduce the risk of facial nerve dysfunction. Thus, while performing Parotid gland surgery the technique should be employed

Small-signal stability analysis of hybrid power system with quasi-oppositional sine cosine algorithm optimized fractional order PID controller

This article deals with the frequency instability problem of a hybrid energy power system (HEPS) coordinated with reheat thermal power plant. A stochastic optimization method called a sine-cosine algorithm (SCA) is, initially, applied for optimum tuning of fractional-order proportional-integral-derivative (FOPI-D) controller gains to balance the power generation and load profile. To accelerate the convergence mobility and escape the solutions from the local optimal level, quasi-oppositional based learning (Q-OBL) is integrated with SCA, which results in QOSCA. In this work, the PID-controller's derivative term is placed in the feedback path to avoid the set-point kick problem. A comparative assessment of the energy-storing devices is shown for analyzing the performances of the same in HEPS. The qualitative and quantitative evaluation of the results shows the best performance with the proposed QOSCA: FOPI-D controller compared to SCA-, grey wolf optimizer (GWO), and hyper-spherical search (HSS) optimized FOPI-D controller. It is also seen from the results that the proposed QOSCA: FOPI-D controller has satisfactory disturbance rejection ability and shows robust performance against parametric uncertainties and random load perturbation. The efficacy of the designed controller is confirmed by considering generation rate constraint, governor dead-band, and boiler dynamics effects

Tension band wiring of fracture distal end of clavicle: Favorable clinical outcome among the patients

Background: A fracture of the clavicle is common traumatic injury. It can be classified into middle third, medial third, and distal third fractures. Around 10–15% of clavicle fractures occur in the distal third. The ideal method of fixation in distal third clavicle fracture remains controversial till date. Aims and Objectives: The clinical outcome of the patients having fracture of the distal end clavicle using rigid fixation with tension band wiring (TBW) with Kirshner wires and SS wire to be assessed instead of other conventional procedures. Materials and Methods: Eight patients of Neer type II closed distal-third clavicle fracture of <3 weeks of duration were included in our study. The fractures were reduced by open reduction and fixed with TBW with two K-wires and SS wire. Results: The mean average age of patients was 41.87 years. All fractures united clinically and radiologically. The mean average time of union was 12 weeks. There was two case of hardware prominence, no fracture related complications. One case of superficial infection was found in study. All of them regained near normal range of motion, and the mean average constant Murley score for distal clavicle fracture at the end of 1 year was 88. At the end of 1 year follow-up, all patients had reached their pre-injury performance levels. Conclusion: There was an encouraging result with TBW in distal third clavicle fracture in our study. This technique is simple with lesser need of expertise and is also cost effective

Wernicke’s encephalopathy precipitated by neuromyelitis optica spectrum disorder and Graves’ disease: A tale of clinical and radiological dilemmas

Background Neuromyelitis optica spectrum disorder (NMOSD), an autoimmune astrocytopathy, may share common clinico-radiological features with Wernicke's encephalopathy (WE). A variant of NMOSD, known as area postrema syndrome (APS), that presents with intractable hiccups and associated vomiting, might lead to the depletion of nutrients if not detected and treated early. Autoimmune thyroid disorders (i.e., Graves’ disease) may be associated with NMOSD. Rarely, thyrotoxicosis can give rise to thiamine depletion and WE. Case presentation Here, we present a case of untreated hyperthyroidism in an Indian female who presented with thyrotoxicosis and later developed WE, possibly also contributed by NMOSD (APS)-induced recurrent vomiting. The patient recovered with antithyroid drugs, parenteral thiamine, and immunomodulatory therapy. The possible pathogenic mechanisms have been discussed. Conclusion Our case establishes the importance of considering NMOSD variants in metabolic encephalopathy, especially if neuroimaging is suggestive and in the backdrop of another autoimmune disorder

Analysis of Technical Efficiency of Indian Banking Sector: An Application of Data Envelopment Analysis

<p>The proactively evolved banking regulations in the Indian Banking sector under the authorative directive of the Reserve bank of India (RBI) has often brought about a change in the business strategy, capital structure and operations of the banks in the Indian banking sector. During these events of continuous change and adoption of Basel norms, we analyse the efficiency of the Indian banking sector with using Data Envelopment Analysis across three economic eras and across  the different ownership structures. The determinants of efficiency are selected on the basis of intermediation approach. We also attempt to identify whether the inefficiency arises from managerial incompetence or improper size and resource allocation. From our analysis, we identify the main cause of inefficiency in the Indian Banking sector to be arising out of improper size allocation..</p

Superconductivity in two-dimensions from the Hubbard model to the Su-Schrieffer-Heeger model

We study unconventional superconductivity in two-dimensional systems. Unbiased numerical calculations within two-dimensional Hubbard models have found no evidence for long-range superconducting order. Most of the two-dimensional theories suggest that the superconducting state can be obtained by destabilizing an antiferromagnetic or spin-liquid insulating state. An antiferromagnet is a half-filled system because each site has one electron or hole. However, in anisotropic triangular lattices, numerical calculation finds pairing enhancement at quarter-filling but no long-range superconducting order. Many organic superconductors are dimerized in nature. Such a dimer lattice is effectively half-filled because each dimer has one electron or hole. Some theories suggest that magnetic fluctuation in such a system can give superconductivity. However, at zero temperature, we performed density matrix renormalization group (DMRG) calculations in such a system, and we find no superconducting long-range order. We also find that the antiferromagnetic order is not necessary to get a superconducting state. Failure in explaining superconductivity in two-dimensional systems suggests that only repulsive interactions between electrons are not sufficient, and other interactions are required. The most likely candidate is the electron-phonon interaction. However, existing theories of superconductivity emphasize either electron-electron or electron-phonon interactions, each of which tends to cancel the effect of the other. We present direct evidence from quantum Monte Carlo calculations of cooperative, as opposed to competing, effects of electron-electron and electron-phonon interactions within the frustrated Hubbard Hamiltonian, uniquely at the band-filling of one-quarter. Bond-coupled phonons and the onsite Hubbard U cooperatively reinforce d-wave superconducting pair-pair correlations at this filling while competing with one another at all other densities. Our work further gives new insight into how intertwined charge-order and superconductivity appear in real materials

Quasi-oppositional differential search algorithm applied to load frequency control

AbstractIn this article, quasi-oppositional differential search algorithm (QODSA) is proposed for finding an optimal and effective solution for load frequency control (LFC) problem in the power system. Initially, original DSA is employed for fine-tuning of the secondary controller of LFC system and then, quasi-oppositional based learning (Q-OBL) mechanism is integrated into the original DSA to enhance the convergence speed and to find a better solution of LFC problem. To validate the effectiveness of proposed QODSA, four widely used interconnected power system networks are designed and analyzed. The superiority of the proposed method is established by an extensive comparative analysis with other existing evolutionary algorithm’s (EA) using transient analysis method. A critical investigation of simulation results reveals that the proposed QODSA gives simple and better solution compared to original DSA and other reported algorithms. To study the robustness of QODSA, two different random load patterns are projected and results confirm the robustness of the designed controllers. To add some degree of nonlinearity, generation rate constraint and governor dead band effects are considered and their consequence on the system dynamics has been examined. Finally, sensitivity analysis is performed with a wide variation of system parameters

Application of backtracking search algorithm in load frequency control of multi-area interconnected power system

This paper introduces a new powerful evolutionary algorithm called backtracking search algorithm (BSA) for solving load frequency control (LFC) problem in power system. Initially, two-area non-reheat thermal power plant is considered and gains of PI/PID controllers are optimized using BSA. This paper compares BSA’s effectiveness in solving LFC problem with the performances of other optimization techniques reported in the literature. Nonlinearities of power system such as reheater, governor dead band, boiler dynamics and generation rate constraint are included in the system modeling to identify the system stability and its performance is compared with craziness based PSO technique. Additionally, two more test systems namely three-area and four-area hydro-thermal plant with nonlinearity are considered to demonstrate the efficiency of proposed algorithm. The comparative analysis of the performances indicates that the proposed controller gives better results than other techniques available in the literature. Sensitivity analysis showed robustness of proposed controller under loading and parameter uncertainty

ANATOMICAL VARIATION OF RLN ENCOUNTERED DURING THYROID SURGERIES IN TRIBAL POPULATION OF JHARKHAND.

Introduction: The anatomy side and front of the neck, the pharynx, the laryngeal structures, and any anatomical variations in the persistent nerve must be understood before performing thyroid surgery. Both the surgeon and the patient find thyroid surgery challenging due to the architecture of the lower laryngeal nerve. Due to the consequent diversity of anatomical changes, identification and dissection are challenging and delicate. These changes are causes of the persistent nerve’s susceptibility. The various anatomical differences that have been described in the literature are related to the nerve itself and the path that it takes around nearby organs. Method: During thyroid surgeries, RLN was encountered patients attending the OPD in RIMS, Ranchi during the period of Aug 2022 - July 2023 duration. All patients underwent standard electrocardiography, lung ventilation function testing, clinical biochemistry, hematologic, and coagulation function assessments. All of the included patients' clinically significant vocal cord impairments were ruled out by preoperative laryngoscopy. Results: In total, 100 individuals who had thyroid surgery on time were comprised of the research. The median age of the 55 women and 45 men who participated in this prospective study was 45.0 years (range, 13-81 years). 120 RLNs, including 65 left- and 55 right-side nerves, were dissected; 65 individuals underwent unilateral exposure, and 39 underwent bilateral exposure. Conclusion: The recurrent nerve has several different anatomical variations, and the discovery is frequently made intraoperatively. During thyroid surgery, the operator should always be aware of anatomical variance. Regardless of the initial strategy, the surgeon's vigilance and skill prevent recurrence injury even when the recurrent nerve has unexpected anatomical changes