Otocephaly: a case report

A case of otocephaly was reported in 26±4 week’s female fetus during routine fetal autopsy at GMCH, Chandigarh, India. Mother was 25 years old, second gravid. The first child is one year old normal male baby. Present pregnancy resulted in spontaneous abortion. Antenatal history, past history, family history and medical history of mother was not suggestive of any ethiological factor responsible for the defect. The external examination showed 2 vessels in umbilical cord. There was anteroposterior lengthening of skull, mouth was in the form of a proboscis with a small opening in the centre, the right ear was absent. The left pinna was low placed and had small tags. On internal examination oral cavity was found small with hypoplastic mandible, tongue was absent (aglossia), thoracic cavity was small, left lung was absent, right lung had only single lobe, heart dilated with normal position of major vessels, In abdominal cavity gut was opening in a dilated cloaca like chamber. X-ray examination revealed small hypoplastic mandible and maxilla. Otocephaly is a rare lethal syndrome of microstomia, agnatia and ear anomalies. Other anomalies associated are holoprosenxcephaly, skeletal, genitourinary, cardiovascular system, endocrine gland hypoplasia etc. The differential diagnosis includes Treacher Collins syndrome, Goldenhar syndrome and Mobius syndrome. The etiology, incidence, causative factors of this case will be discussed in light of available literature

Mossbauer Study of Acetate & Chloride- Acetate of Fe(III)

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Management of tibial plateau fractures with compromised soft tissue using hybrid external fixator

Tibial plateau fractures with high energy trauma are complex injury due to its precarious soft tissue envelope. High energy trauma has high incidence of open fractures, articular depression, fracture comminution and displacement, soft tissue injury, and neurovascular compression. It is often difficult to achieve and maintain reduction and commonly predisposes to secondary arthritis. Hybrid external fixator minimizes the iatrogenic soft tissue damage, provides adequate fixation of the fracture, permits early range of motion, easy wound care and leave no large implant in subcutaneous position. This study was performed to evaluate the functional and radiological outcome with this procedure. In this case series, prospective study of 15 cases of tibial plateau fractures were treated with hybrid external fixator at tertiary care teaching hospital in southern Rajasthan from July 2018 to June 2019. The functional and radiological outcome was assessed by Rasmussen functional and radiological score. The mean interval between surgery and union was 16 weeks (range 13 to 18 weeks). Rasmussen functional results were acceptable in 13 cases (86.66%) comprising excellent in 9 (60%), good in 4 (26.66%), and fair in 2 (13.33%). Rasmussen radiological results were acceptable in 13 cases (86.66%) comprising excellent in 9 (60%), good in 4 (26.66%), and fair in 2 (13.33%). Minimal internal and hybrid external fixation for management of tibial plateau fracture with compromised soft tissue is more biological, require less surgical time, less hospital stay, very effective in compromised soft tissue, highly cost effective and has minimal complications with good functional outcome

Histogenesis of developing human fetal stomach

Background: Human stomach is a highly specialised organ with distinct types of glands and microscopic features for its physiological activity. This study aimed to assess the chronological order in the development of different layers and the cyto-differentiation of various glandular cells in 50 fetuses from 12 weeks of gestation till term.Methods: Tissue was taken from cardiac, body and pylorus to investigate with light and confocal microscopy.Results: The gastric gland formation began as an indentation of the surface epithelium, gastric pit and simultaneous development of glandular buds in the mucosa. The pyloric glands preceded the development of cardiac and gastric glands showing retro cranial sequence of development. In contrast, the muscularis externa showed the classical craniocaudal model of development with oblique layer in the cardiac region by 14 weeks and body region by 16 weeks of gestation. The parietal cells were well developed by 12 weeks and the chief cells by 16 weeks with prominent secretory granules. In addition, the pyloric sphincter was a clearly defined anatomical sphincter developed by whorling of the inner circular layer at the pyloric end of the stomach evident from 12 weeks of gestation.Conclusions: The results showed that the significant cellular morphogenesis occurred between 12-20 weeks of gestation. This aggregated data will serve as a catalyst in the understanding intricacy of embryogenesis, pathogenesis tracing of congenital anomalies and invention of new drugs

Resource optimization through process re-engineering of inhalational therapy unit at a tertiary care public hospital

Background: Salaries, supplies and machinery account for bulk of public funding necessitating efficient utilisation. Studies suggest that process re-engineering helps improve cost, quality, service, and speed. Disbanded once and re-commissioned, a centralized Inhalational Therapy Unit (ITU) banked and provided portable mechanical ventilators to the inpatient wards. A demand for new ventilators from ITU led to the present study involving its critical review and cost analysis.Methods: An interventional study was conducted at a large tertiary care public hospital in India from April 2015 to June 2015. Critical review of process of providing portable ventilators and cost analysis were conducted. Review of records of and interview with ITU personnel and nursing staff were carried out. Fundamental rethinking and radical redesign of the process was done with attention to human resource, costs, space and actual medical equipment utilization. Two fundamental questions of process re-engineering were deliberated upon: “Why do we do what we do?” “And why do we do it the way we do?” Fundamental rethinking for new process was organized around the outcome.Results: Average utilization coefficient was 6.2% (3.3% to 12.1%). Ventilators utilized per day were 1.43. Expenditure on salaries was INR 315000 per month and INR 10500 per day. Low utilization offered low value for expenses incurred. All activities in ITU focused on “provision of ventilators” (outcome) and the old rule was, “If one needed a ventilator one must contact ITU”. Since nurses were using the “outcome” and performed activities of arranging, they were handed-over the ventilators (based on utilisation patterns). ITU was disbanded, human resource and space were re-allocated to various hospital areas (costs tied were done away with) with no adverse effect on hospital functioning.Conclusions: Process re-engineering led to improved healthcare delivery, curtailed delays in hospital processes, optimised costs involved in human resources and medical equipment

Impact of Sustainable Finance on MSMEs and other Companies to Promote Green Growth and Sustainable development

Purpose: Sustainable Finance (SF) contributes to better development and better Finance for Economic growth. Sustainable development is protecting and restoring the ecological system. SIDBI, NITI Aayog, and World Bank facilitate Sustainable Finance to encourage businesses to grow from Small Medium Enterprises to large Industries to make an enormous global impact. As per the World Bank estimate, adversely affect the standard of living of the population and climate change will reduce India’s GDP by nearly 3%. For tracking the climate protection performance of the country, the CCPI tool is used. The Key sustainable finance providers to companies and MSME’s are Banks, Corporations, International Financial Institutions, Institutional Investors, International organizations through Financial Instruments Climate Funds, Green Bonds, Impact Finance, Social bonds, Microfinance, SIDBI Sustainable Finance Scheme for funding, NABARD, and Make in India. MSMEs, and SMEs involved in the Projects Solar Power Plants, renewable energy, Green Machinery, Waste Management, Electric Vehicles (EV), Clean Energy, Recycle, Poverty alleviations, and Energy conservation, and India is committed to achieving Net Zero Emissions by 2070. During the Climate summit in Glasgow, India accepted for Five –Point climate ‘panchamrit, or pledge’ towards climate change and Climate Finance. As per the Environment ministry. India needs $280 billion for green infrastructure and the government of India proposed the creation of a Social Stock Exchange, Europe Investment Bank (EIB) with SBI. RBI has considered Green and Sustainable projects should be put under Priority Sector Lending (PSL) to support GE (Green Economy) growth and to meet the SDG (Sustainable Development Goals) and ESG (Economic, Social, Environment) guidelines for fundraising. Methodology / Design /Approaches: In this article theoretical concepts are used in the analysis of various financing Mechanics for green production and Sustainable development. Findings and results: The effectiveness of sustainable finance or Climate finance required for MSME and Companies for greener production infrastructure and government of India missions on climate Change, Regular to boost the ESG to promote sustainable development and Economic growth. Originality/value: Analysed the various articles and case studies and prepared the model required for sustainable fiancé for green growth in India

Scrub Typhus Presenting as Subdural Hemorrhage with Normal Platelet Counts: A Rare Case Presentation

Scrub typhus is a common zoonotic disease with high case fatality rate. The clinical presentation of this disease may vary from acute febrile illness, thrombocytopenia, gastrointestinal manifestations, coagulopathy to neurological manifestations. The common neurological manifestations are meningitis and meningoencephalitis, whereas subdural hemorrhage, cerebrovascular accident, i.e., intracerebral hemorrhage, infarct, subarachnoid hemorrhage, etc. are among rare neurological presentations. Scrub typhus-induced neurological disease should be investigated to provide a timely and appropriate diagnosis and to reduce the mortality in complicated scrub typhus infection. Here we report a case of scrub typhus complicated with subdural hemorrhage admitted in our hospital