Administering general anesthesia to patients with Mandibular angle fractures – Achtung

Mandibular angle fractures accounts for about 23 – 42% of all mandibular fractures, most of which require open reduction and internal fixation under general anesthesia especially cases with bilateral fractures. Such fractures can pose serious challenges to both, the surgeon and the anesthetist as they present with restricted mouth opening and intraoral edema leading to restricted access and can be catastrophe due to excessive intraoral bleeding during laryngoscopy and intubation causing absolute failure to ventilate the patients. This communication presents various factors apart from elucidating what can go wrong during those critical moments of securing the airway in mandibular angle fractures

Increasing inequality in India: a silent subject?

With more than a quarter of the population living below the international poverty line, even after twenty-five years of economic reforms, it is imperative that inequality becomes omnipresent in economic-political discourse and policy in India, writes Anmol Agarwal

Treatment Modalities of Unicystic Ameloblastoma - A Case Series

Unicystic ameloblastoma is a unique variant of conventional ameloblastoma which has considerably less recurrence rate than its counterpart. Unlike conventional ameloblastoma which mostly requires aggressive management, unicystic ameloblastoma has different treatment modalities which can be conservative or aggressive depending upon the histological nature of the tumor. We report five cases of unicystic ameloblastoma with different treatment modalities with long term follow up and satisfactory results

The hard realities of a sweet life: curbing the damaging effects of India's relationship with sugar

With a host of other countries assessing the usefulness of similar taxes, it is safe to say that the fight against obesity and fizzy drinks has certainly begun. In order to tackle high sugar intake in India, subtle taxes like the ones imposed on fizzy drinks are warranted, write Anmol Agarwal and Suchika Chopra

Adenoid cystic carcinoma of the buccal mucosa: A rare clinical presentation

Of malignant tumors with a propensity to invade the perineural space, adenoid cystic carcinoma of the salivary glands is perhaps a well-known entity. Adenoid cystic carcinoma (ACC) is a rare, slow growing malignant salivary gland tumor that is characterized by indolent, locally invasive  growth with high propensity for local recurrence and distant metastasis. Upto 50% of these tumors occur in the intraoral minor salivary glands usually in the hard palate. Buccal mucosal tumors are relatively rare. The purpose of this article is to discuss an unusual case of adenoid cystic carcinoma of the buccal mucosa and review the pertinent literature

A quest for measuring intra operative blood loss in Maxillofacial surgery

Aim: To find out a simple, standardized method to measure intra-operative blood loss during major oral surgical procedures which alerts the clinicians to manage untoward outcomes in time. Materials & Method: Patients who underwent surgical intervention for various dentofacial deformities, maxillofacial pathologies, maxillofacial trauma under general anesthesia via an intra oral approach from Jan 2014 – Aug 2015 were included in the study. Thirty such patients belonging to the above entities were randomly categorized into 2 groups of 15 each based on the method of measuring the intra op blood loss. In Group A the blood loss was measured by Sahlis method and in Group B, the blood loss was measured by cyanomethemoglobin method. All the procedures were performed via an intra oral approach under general anesthesia. Results: The amount of intra operative blood loss measured through Sahli’s method appeared to be insensitive and not standardized. However, the one measured through Cyanomethemoglobin method was more accurate, standardized and easy to perform. Conclusion: Cyanomethemoglobin method is an accurate, reliable, chair side, inexpensive, easy to perform, standardized technique to measure the intra operative blood loss in the recent times

Clinical approach to Megaliths of Salivary glands – Our Experience

Sialolithiasis is commonly found in middle age patients though to some extent have been reported in children also. It is the most common disease of salivary gland, the symptoms of which develop as a consequence of obstruction of the duct secreting the saliva. It involves the submandibular gland predominantly though other major gland involvement has been reported. Management of the sialolithiasis usually entails exfoliation via milking, invasion of the duct of the associated gland or complete excision of the involved gland

Learning to Automate Follow-up Question Generation using Process Knowledge for Depression Triage on Reddit Posts

Conversational Agents (CAs) powered with deep language models (DLMs) have shown tremendous promise in the domain of mental health. Prominently, the CAs have been used to provide informational or therapeutic services (e.g., cognitive behavioral therapy) to patients. However, the utility of CAs to assist in mental health triaging has not been explored in the existing work as it requires a controlled generation of follow-up questions (FQs), which are often initiated and guided by the mental health professionals (MHPs) in clinical settings. In the context of `depression\u27, our experiments show that DLMs coupled with process knowledge in a mental health questionnaire generate 12.54% and 9.37% better FQs based on similarity and longest common subsequence matches to questions in the PHQ-9 dataset respectively, when compared with DLMs without process knowledge support. Despite coupling with process knowledge, we find that DLMs are still prone to hallucination, i.e., generating redundant, irrelevant, and unsafe FQs. We demonstrate the challenge of using existing datasets to train a DLM for generating FQs that adhere to clinical process knowledge. To address this limitation, we prepared an extended PHQ-9 based dataset, PRIMATE, in collaboration with MHPs. PRIMATE contains annotations regarding whether a particular question in the PHQ-9 dataset has already been answered in the user\u27s initial description of the mental health condition. We used PRIMATE to train a DLM in a supervised setting to identify which of the PHQ-9 questions can be answered directly from the user\u27s post and which ones would require more information from the user. Using performance analysis based on MCC scores, we show that PRIMATE is appropriate for identifying questions in PHQ-9 that could guide generative DLMs towards controlled FQ generation (with minimal hallucination) suitable for aiding triaging. The dataset created as a part of this research can be obtained from: https://github.com/primate-mh/Primate2022