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A 56-year-old male patient presented with a slow-growing, elevated, smooth, white corneal mass. The mass was excised by performing an alcohol-assisted keratoepitheliectomy and sent for histopathological examination. Subepithelially, closely packed spindle cells in \"feather-stitched\" or storiform pattern were seen. Immunohistochemically, the cells stained negatively for CD-34 and S-100 and focal positivity was seen for vimentin. Based on the morphology and immunochemical staining, a diagnosis of corneal fibroma was made. No recurrence was seen. Corneal fibroma is an exceedingly rare, benign tumor and possibly lies on the same spectrum as corneal keloid and hypertrophic cicatrix. Surgical resection is usually curative.

Cervical cancer is the most common cancer among females in India. Cervical cancer usually spreads by local extension and through the lymphatic drainage to the lymph nodes. Hematogenous spread, the mechanism responsible for distant metastases, is rarely seen in cervical malignancies. In this communication, we report a case of a 45-year-old woman who presented with unilateral decrease in vision of 3 months duration. She was found to have a serous retinal detachment with underlying diffuse, subretinal yellowish-cream colored infiltrates in the right eye, suspicious of choroidal metastases. Systemic evaluation showed disseminated systemic metastases arising from a primary adenocarcinoma of the cervix. In this communication, we review all the documented cases of metastases to the eye and adnexa arising from cervical cancer and their clinical characteristics. Unilateral choroidal metastasis arising from an adenocarcinoma of the cervix is extremely rare with only one previous documented case. Although uncommon, choroidal metastasis may be the presenting feature of primary cervical malignancy. Furthermore, cervical malignancy must be ruled out in women who present with orbital or choroidal metastases arising from unknown primary.

Purpose: To image trabeculectomy blebs using anterior segment optical coherence tomography (AS-OCT), and to correlate the bleb morphologic features at one month postoperatively with bleb function at six months. Materials and Methods: This prospective, observational study included 56 eyes undergoing trabeculectomy with MMC, followed up for minimum of six months. Postoperatively, bleb imaging was done using AS-OCT at one and six month. Bleb morphology was assessed for bleb wall reflectivity, bleb pattern in multiform reflectivity, visibility of drainage route and presence of hyper-reflectivity area. Bleb function was considered successful if IOP was <18 mmHg without medication at six month. Bleb morphology one month postoperatively was correlated with bleb function at six months. Results: At six months successful bleb function was noted in 44 (81.5%) eyes. Morphology of bleb at one month showed uniform bleb wall reflectivity in 6 eyes (11%) and multiform wall reflectivity in 48 eyes (89%). In eyes with multiform wall reflectivity, microcysts with multiple layers was seen in 26 eyes (48%), microcysts with subconjunctival separation in 12 eyes (22%) and only microcyst in 10 eyes (19%). When bleb features at one month were correlated with the bleb function at six months, logistic regression analysis revealed that blebs with multiform reflectivity with multiple internal layers with microcysts were associated with higher chances of success (P < 0.001). Conclusion: AS-OCT demonstrated early bleb morphological features that may be used to predict the functioning of a bleb. Multiform bleb wall reflectivity with a pattern of multiple internal layers and microcysts was associated with increased chances of success of a bleb.

Context: Surveys have reported color fading as the most frequent reasons patients given for disliking their prostheses. Aim: The aim of the study is to compare the color variation between two maxillofacial silicone elastomers after subjecting them to extraoral aging conditions. Subjects and Methods: A total of 80 samples were made from M511 Maxillofacial Rubber (Part A: Part B = 10:1) and Z004 Platinum Silicone Rubber (Part A: Part B = 1:1) and divided into two main Groups A and B (40 each). These main groups were then subdivided into five subgroups (A1B1, A2B2, A3B3, A4B4, and A5B5) (n = 8); outdoor weathering, acidic perspiration, sebum (for 6 months), and neutral soap and disinfectant (for 30 h), respectively. Baseline L*a*b* values were recorded. The samples were subjected to the extraoral aging conditions, and the L* a*b* values were recorded after the aging period using a spectrophotometer. Statistical Analysis: The intergroup comparison was done by Kruskal-Wallis test, whereas the intragroup comparison was done by Mann-Whitney test. Results: All groups exhibited visually detectable, mean color differences that ranged from 3.06-5.21, except for A4B4. There was no statistical significance between the two materials when subjected to extraoral aging conditions. Conclusions: Visually perceptible and clinically unacceptable color changes occur when exposed to various extraoral aging conditions except for neutral soap solution immersion, for which values of Δ E* were clinically acceptable (ΔE < 3). It can be said for all practical purposes, clinically, the choice between M511 Maxillofacial Rubber (Part A: Part B = 10:1) and Z004 Platinum Silicone Rubber (Part A: Part B = 1:1) would yield more or less the same results, with unacceptable norms in terms of color stability under extraoral aging conditions.

Traumatic amputation of a finger leads to psychological instability, functional loss, and poor esthetics. When surgical reconstruction in patients is not possible, prosthesis provides psychological, functional, rehabilitative, and esthetic restoration. Despite the availability of advanced skills, the best of materials and laboratory support, sometimes the anatomy of the defect, may be a hindrance in furnishing a better prosthesis. In the present case report, a defect with complete loss of stump was restored using customized ring-stump assembly, which helped to enhance the fit and retention of the prosthesis along with fulfilling the functional demands of the patient.

Defects of fingers or hands due to congenital reasons or trauma can be a catastrophic setback to an individual physically, emotionally, and psychologically. An artificial finger prosthesis is a lucrative option to camouflage such defects. The anatomy of the residual stump of the defect is of extreme importance and will dictate the mode of retention to be used, and the level of esthetics one can expect. Despite the availability of the advanced skills, best of materials, and laboratory support, sometimes, the anatomy of the defect may be a hindrance in furnishing a better prosthesis. This case report describes a cost-effective and simple approach of rehabilitation of a partially amputated finger with bulbous distal anatomy using a custom-made ring-wire substructure and maxillofacial silicone, thereby striking a balance between adequate retention and optimal esthetics.

BackgroundGastrointestinal bleeding (GIB) has been reported to be more common in patients with chronic renal failure and end-stage renal disease requiring hemodialysis with higher mortality than in the general population. Limited epidemiological data exist on the annual number of hospitalizations, demographic variation, cost of care, and outcomes for GIB in patients with acute kidney injury (AKI) requiring and not requiring hemodialysis (HD). The main objective of this study was to analyze the trends of GIB in patients with AKI requiring HD and those not requiring HD during hospitalization.Methods and ResultsWe analyzed the National (Nationwide) Inpatient Sample (NIS) database for all subjects with a discharge diagnosis of AKI as the primary or secondary diagnosis during the period from 2001 to 2011. Subjects with a discharge diagnosis of hemodialysis and GIB were then identified from the pool and trends were analyzed. A significant rise in the annual number of hospitalizations with AKI was found with a greater proportion being discharged without HD. From 2001 to 2011, there were 19,393,811 hospitalizations with a discharge diagnosis of AKI of which 1,424,692 (7.3%) received HD (HD group), whereas 17,969,119 (92.7%) did not receive HD (non-HD group) (p < 0.0001). The male gender was more commonly affected by GIB than the female gender in both groups (p < 0.0001). The cost of care per hospitalization for GIB patients in the HD group increased over the study period with average found to be $61,463 (adjusted for inflation, p < 0.0001), whereas for GIB patients in the non-HD group, it showed a slight decrease in trend with the average found to be $28,419 (p < 0.0001). All-cause mortality was higher for GIB patients in the HD group (38.1%) than in the non-HD group (25.1%) (p < 0.0001).ConclusionsGIB is more common and associated with higher all-cause inpatient mortality in patients receiving HD in comparison to non-HD patients.

There is an increasing trend of malocclusion among children, so it is necessary to identify the cause of the tooth wear so that the orthodontist can treat the patient accordingly. It is necessary to determine the wear patterns of different malocclusions. Therefore, the aim of our study was to compare the patterns of tooth wear among two categories of Angle’s class II malocclusions, i.e. class II division 1 and class II division 2.The sample consisted of 100 pretreatment orthodontic patients in the age group of 15–25 years with Angle’s class II malocclusion and were divided into following two groups: (a) Group 1: 50 subjects with full cusp Angle’s class II division 1 malocclusion. (b) Group 2: 50 subjects with full cusp Angle’s class II division 2 malocclusion. Clinical examination of the patients for tooth wear was done supplemented with dental casts, intraoral photographs and intraoral radiographs. Then each group was assessed for severity of tooth wear according to modified tooth wear index (TWI) given by de Carvalo Sales-Peres et al. Scores were subjected to statistical analysis and the pattern of tooth wear among the two groups of class II malocclusion was compared. A correlation between the gender of the patient and the tooth wear was also determined. The level of statistical significance (p-value) was less than 0.05.The class II division 1 subjects showed statistically greater wear on the occlusal surfaces of the maxillary canines, first, second premolar and first molar, and the occlusal surfaces of the mandibular first molars. The class II division 2 subjects showed statistically greater tooth wear on the labial surfaces of the mandibular central and lateral incisors, the incisal surface of maxillary and mandibular incisors, the palatal surfaces of the maxillary second premolars, first and second molars. In class II division 1 subjects, the tooth wear was significant on the buccal surface of maxillary canines, occlusal surface of mandibular first premolars and second molars in males. In class II division 2 subjects, the tooth wear was significant on the buccal surface of mandibular canines, palatal surface of maxillary central incisors in females and palatal surface of maxillary first premolars in males.The results of this study suggested that the two categories of Angle’s class II malocclusion have different tooth-wear patterns. The wear patterns were different in both the sexes. Men showed higher occlusal wear scores than did women. The findings also suggest that tooth wear in relation to malocclusion is physiologic and is due to dissimilar interocclusal arrangement.

Doubly salient reluctance machines (DSRMs) can be classified into conventional switched reluctance machines (SRMs) and mutually coupled switched reluctance machines (MCSRMs). These machines have numerous advantages ranging from uncomplicated and low-cost manufacturing, rugged operation, operational reliability, and durability. Every machine topology has its challenges which need to be overcome with appropriate engineering ideas and solutions. The potential of these machines is still untapped because of the lack of a system-level approach to design, model, and control these machines. The practice to work with every component of the electric motor drive in a disconnected manner has a negative effect on the development of a high-performance DSRM drive. Unlike permanent magnet or induction machines, DSRMs are highly non-linear and their performance depends on the machine excitation method and current control. Therefore, an integrated approach is more critical for DSRMs since the machine design and the design of an electric drive for DSRMs are coupled and drastically affect each other. This dissertation presents a system-level approach for the electromagnetic design of the DSRMs and develops control algorithms which are designed based on the constraints and the requirements of an application. The dissertation focuses on the novel electromagnetic design and optimization of MCSRMs for torque ripple minimization. The design process is followed by unique methodologies to model DSRMs, which include an analytical, lookup table based machine model, and a small-signal model based on the Net Flux Method (NFM). Subsequently, the developed models are utilized to design different types of current control algorithms. Furthermore, a design strategy to profile phase currents for these machines is presented, which is complemented with extensive analytical analysis to estimate the current capability of the entire motor drive.This work focuses on addressing the challenges that are prohibiting the industrial adoption of DSRMs for high-performance applications. Addressing the issue of high torque ripple is one of the major contributions of the research presented in this dissertation. Different topologies of DSRMs are analyzed and a novel rotor design is presented which can reduce torque ripple to as low as 3.6% while also providing the flexibility to drive these machines using conventional two-level voltage source inverters. In addition, high-fidelity and simplistic models detailed in this research based on the novel concept of NFM are capable of predicting torque ripple with high precision, thus reducing dependencies on finite element tools and reducing real-time characterization of DSRMs. The effect of current controllers on the dynamic performance of these machines is addressed and comprehensively analyzed for proper selection of controllers based on the needs of the application. The current profiling method to minimize torque ripple and the analytical methods to estimate the dynamic current capability of the motor drive, while considering the constraints of the system such as the dc-link voltage, bandwidth of the current regulator show the effectiveness of the system-level approach to address the challenges of the DSRM drives for high-performance applications.The complete analysis and the system-level design approach presented in this dissertation provides the fundamental tools for designing and analyzing DSRMs and subsequently developing high-performance current controllers for these machines. The machine and controller development framework established in this research can be utilized further for developing electric drives with more advanced features for DSRMs.