In the pre-vaccination era, diphtheria was a leading cause of childhood mortality. With the introduction of routine childhood immunization, paediatric care and improved hygiene status the disease has been almost completely eradicated in many developed countries. On the contrary developing countries, still account for 80-90% of the global burden. Retrospective analysis of 52 cases of diphtheria over a period of 12 years at a tertiary referral hospital was carried out. They were analyzed for mortality and morbidity trends, immunization status, microbiological confirmation rates and antidiphtheritic serum (ADS) administration. Incidence in those over 5 years was 59.61%. Only 11.54% cases were either partially or fully immunized. The case fatality rate was 36.53%. Culture was performed only in 17 cases whereas ADS was administered in only 16 cases. In conclusion, the occurrence of diphtheria even in those immunized highlights the flaws in the present immunization program. Poor immunization coverage, lack of ADS, antibiotic resistance are the main reasons for re-emergence of diphtheria.

Hearing loss as a side effect in patients with head and neck malignancies with chemoradiation is frequently ignored. Its effects on auditory functions are less studied and there are studies done on animals which are less reliable. The present study was undertaken to identify the type of hearing loss and also to quantify the degree of hearing loss in these patients. A prospective, descriptive study was undertaken in histologically proven head and neck cancer patients treated with cobalt 60 teletherapy who received a dose of 60-66 Grays (Gy) over a period of 6-7 weeks with concurrent Cisplatin 30 mg/m 2 once weekly for 6 weeks. The study included 40 patients (80 ears) undergoing chemoradiation. A baseline pure tone audiometry and impedance audiometry was performed in all the cases prior to the therapy and the same was repeated immediately after the completion of treatment, at 8 and 16 weeks. The changes in pure tone level thresholds and impedance from baseline were correlated with the dose of radiation and chemotherapy. Sensori neural hearing loss (SNHL) and conductive hearing loss was observed in 82.5 and 17.5 % respectively. At the end of 16 weeks, SNHL was found in 27.5, 72.5 and 82.5 % at 2, 4 and 8 kHz respectively. In addition, Eustachian tube dysfunction and Otitis media with effusion was observed in 10 and 7.5 % of patients respectively which lead to conductive hearing loss. Further, it was noted that SNHL in patients with high risk site malignancy (81.8 %) was alarmingly higher compared with low risk site malignancy (18.1 %). The hearing loss at 62, 64 and 66 Gy in comparison to 60 Gy was statistically significant. Hearing loss, specially SNHL was the predominant finding in our study with [80 % of patients showing the inner ear damage due to irradiation of head and neck malignancies. Although, all the frequencies like 2, 4 and 8 kHz were significantly affected, SNHL was more marked in the latter two frequencies. Nearly, 90 % of the patients who had SNHL belonged to high risk site category of head and neck malignancies. Increasing the radiation dosage was directly proportional to the degree of hearing loss with the dose more than 60 Gy causing significant injury to the middle and inner ear.

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Background and Aims:Airway management in anaesthesia for maxillofacial surgical procedures is tricky at times when the nasal/oral routes are contraindicated or are impossible. Tracheostomy as an alternative inherits its own complications. We present a case series of the submandibular route for tracheal intubation as an alternative.Methods:The procedure was performed in ten selected adult patients with maxillofacial/mandibular fractures associated with a fracture of skull base or nasal bone. All of them were medically stable with no need of intensive care or mechanical ventilation in post-operative period.Results:Submandibular intubation in all ten patients of panfacial fractures allowed uninterrupted surgical techniques with a secured airway. All patients were reverted to oro-tracheal tube at the end of surgery as immediate maxillomandibular fixation was not necessary. The patients were extubated after recovery from anaesthesia before they left the operating theatre. One patient in the post-operative period had a superficial infection of incision site that responded well to local treatment. No other complications were encountered in the intra-operative or post-operative period.Conclusion:In complex maxillofacial injuries, when oral or nasal intubation hampers surgeon's field of view, submandibular intubation offers an effective alternative to short-term tracheostomy along with small risk potential. There is a need to emphasise its regular application in such cases so that technique can be mastered by both surgeons and anaesthesiologist.

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Imitation learning is a promising approach to help robots acquire dexterous manipulation capabilities without the need for a carefully-designed reward or a significant computational effort. However, existing imitation learning approaches require sophisticated data collection infrastructure and struggle to generalize beyond the training distribution. One way to address this limitation is to gather additional data that better represents the full operating conditions. In this work, we investigate characteristics of such additional demonstrations and their impact on performance. Specifically, we study the effects of corrective and randomly-sampled additional demonstrations on learning a policy that guides a five-fingered robot hand through a pick-and-place task. Our results suggest that corrective demonstrations considerably outperform randomly-sampled demonstrations, when the proportion of additional demonstrations sampled from the full task distribution is larger than the number of original demonstrations sampled from a restrictive training distribution. Conversely, when the number of original demonstrations are higher than that of additional demonstrations, we find no significant differences between corrective and randomly-sampled additional demonstrations. These results provide insights into the inherent trade-off between the effort required to collect corrective demonstrations and their relative benefits over randomly-sampled demonstrations. Additionally, we show that inexpensive vision-based sensors, such as LeapMotion, can be used to dramatically reduce the cost of providing demonstrations for dexterous manipulation tasks. Our code is available at https://github.com/GT-STAR-Lab/correctivedemos-dexterous-manipulation.

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BACKGROUND Abdominal tuberculosis has been a common disease that poses challenge for the diagnosis of disease, as vague symptoms of the disease always lead to delay in diagnosis. This disease can be called as an imitator of other abdominal pathologies. A high index of doubt is necessary to make early and accurate diagnosis. Abdominal involvement can occur in body at various places like gastrointestinal tract, solid viscera, peritoneum and lymph nodes. Numerous investigations have to be used to help in making the accurate diagnosis of abdominal tuberculosis. Accurate diagnosis in early pathogenic stage and starting of antitubercular therapy and surgical treatment are important to prevent complications leading to morbidity and mortality of patients. Patients having long term symptoms are often weak debilitated, anaemic, malnourished, chronically ill and underweight which may be due to cachexia. METHODS This is a prospective observational study conducted from March 2016 to March 2018, in Mahatma Gandhi Medical College Associated M.Y. Hospital, among 47 patients with a diagnosis of abdominal tuberculosis confirmed histopathologically. RESULTS Maximum patients in our study belonged to 20 to 40 yrs. age group. 27% were males and 72 % were females. 8% patients were treated conservatively and 91 % patients were offered operative treatment. Majority of patients presented with symptoms of abdominal pain (85%), abdominal distension (85%), vomiting (74%), weight loss (74%), fever (17%), alteration in bowel habits (21%) and lump in abdomen (6%). Most common findings were of primary perforations (68%), adhesions (46%), plastered abdomen (34%), ileocecal mass and ileocecal junction perforation (6%). Ileal and jejunal strictures were minor findings. In majority of patients, ileostomy (83%) was performed as life saving measure, adhesiolysis was done in 68%, primary closure of perforation (25%), resection and anastomosis (8.5%). CONCLUSIONS Since the clinical presentations of abdominal tuberculosis are very non-specific and vague and the diagnostic criteria are limited, diagnosis has to be supported by additional tests and by retrospective analysis with reference to clinical patterns and underlying diseases. We also emphasize the importance of histopathological examination in establishing the diagnosis in poor resource settings.