In Search of the Optimal Surgical Treatment for Velopharyngeal Dysfunction in 22q11.2 Deletion Syndrome: A Systematic Review

<div><h3>Background</h3><p>Patients with the 22q11.2 deletion syndrome (22qDS) and velopharyngeal dysfunction (VPD) tend to have residual VPD following surgery. This systematic review seeks to determine whether a particular surgical procedure results in superior speech outcome or less morbidity.</p> <h3>Methodology/ Principal Findings</h3><p>A combined computerized and hand-search yielded 70 studies, of which 27 were deemed relevant for this review, reporting on a total of 525 patients with 22qDS and VPD undergoing surgery for VPD. All studies were levels 2c or 4 evidence. The methodological quality of these studies was assessed using criteria based on the Cochrane Collaboration's tool for assessing risk of bias. Heterogeneous groups of patients were reported on in the studies. The surgical procedure was often tailored to findings on preoperative imaging. Overall, 50% of patients attained normal resonance, 48% attained normal nasal emissions scores, and 83% had understandable speech postoperatively. However, 5% became hyponasal, 1% had obstructive sleep apnea (OSA), and 17% required further surgery. There were no significant differences in speech outcome between patients who underwent a fat injection, Furlow or intravelar veloplasty, pharyngeal flap pharyngoplasty, Honig pharyngoplasty, or sphincter pharyngoplasty or Hynes procedures. There was a trend that a lower percentage of patients attained normal resonance after a fat injection or palatoplasty than after the more obstructive pharyngoplasties (11–18% versus 44–62%, p = 0.08). Only patients who underwent pharyngeal flaps or sphincter pharyngoplasties incurred OSA, yet this was not statistically significantly more often than after other procedures (p = 0.25). More patients who underwent a palatoplasty needed further surgery than those who underwent a pharyngoplasty (50% versus 7–13%, p = 0.03).</p> <h3>Conclusions/ Significance</h3><p>In the heterogeneous group of patients with 22qDS and VPD, a grade C recommendation can be made to minimize the morbidity of further surgery by choosing to perform a pharyngoplasty directly instead of only a palatoplasty.</p> </div

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Rancang Bangun Sistem Informasi Tempat Pemakamam Umum Pondok Rajeg Bogor Berbasis Web

The use of information technology has a very broad scope. One of them is in the field of funeral. Funeral is often a "backward" issue in this life. Even if we look at our "nature" as human beings, we will all experience what is called death. The thing we need to prepare for death besides worship is that we need to prepare our final rest right. We often forget this, even though if we see the phenomenon that the world mortality rate is increasing every day, even Indonesia is one of the countries with a very high mortality rate. The high mortality rate is not in line with the number of locations or burial places available. This has become a problem that must be solved and become a problem that is quite serious and needs serious handling. One of the solutions to this problem is the use of information technology to record the overall mortality rate and also record the availability of existing locations to bury it. That way the government can monitor every problem that exists and can provide solutions that can be disseminated easily by utilizing information technology, the author uses the Waterfall method to facilitate the process of needs analysis until testing the design of building information systems public cemetery (TPU) Pondok Rajeg Bogor

Dietary patterns and the risk of coronary heart disease among Jordanians: A case-control study.

Dietary pattern and lifestyle have been reported to be significant risk factors in the development of coronary heart diseases (CHD). The contribution degree of these dietary risk factors in CHD development in non-westernized countries is unclear. This study aimed to evaluate several dietary choices and their potential association with CHD. A case-control study was conducted at Prince Hamza Hospital, a referral center for coronary angiography in Amman, Jordan. Four-hundred patients referring for elective coronary angiography with clinical suspicion of coronary artery disease were enrolled. Data was collected using interview-based questionnaires. Dietary patterns were derived using Principal Component Analysis. Multivariate logistic regression was used to estimate the relationship between dietary choices and CHD. Three dietary patterns were identified. The "Healthy Dietary Pattern", which presented a diet rich in olive oil, fruits, vegetables, legumes, whole grains, fish, and low meat intake, was associated with a significant decrease in the odds of CHD (OR = 0.53, 95% CI = 0.28-0.98). The "High-Fiber Pattern", which is mainly composed of legumes and bulgur, significantly reduced the odd of CHD (OR = 0.55, 95% CI = 0.27-0.92) for the fourth quartile compared to the first one. No significant association was found between CHD and the "Western Dietary Pattern", which is loaded with refined grains, sweets and deserts, sugary drinks, and deep fried foods. The "Healthy Dietary Pattern" and the "High-Fiber Pattern" were associated with a decrease in odds of CHD among Jordanians

Lessons for rabies control and elimination programmes: a decade of One Health experience from Bali, Indonesia

This Review discusses the advancements made and challenges remaining in One Health around endemic and emerging zoonotic diseases, food safety and food security, antimicrobial resistance, wildlife diseases, and other issues that impact health such as poverty. It highlights the added value of using a One Health approach to coordinate, collaborate, and communicate across multiple sectors and disciplines to address complex health threats at the human-animal-environment interface with the goal of improving health for all. This issue also provides innovative ideas to apply a One Health approach toward the following areas: strengthening human and animal health systems, One Health mechanisms and activities to enhance subnational, national, regional, and global health, synergising tools for capacity assessment and One Health operationalisation across sectors, better integrating wildlife and environmental health, disaster response, reduction of poverty, prevention and control of zoonoses, and progress toward rabies elimination. Collaboration using One Health principles could greatly increase trusted networks for coordination across sectors, help improve global health outcomes, and reduce health threats. Barriers to One Health can be significant and typically include institutional capabilities and culture, poor communication and information sharing across sectors, limited personnel resources, and budgetary constraints. Fortunately, the need for multisectoral, One Health collaboration at the local, national, regional, and global levels is being recognized and steps are being taken to implement and operationalise One Health. Multiple success stories of One Health in action exist and provide real-world examples of the benefits of using a multisectoral, One Health approach. This review aims to shine a light on successes, remaining challenges, and implementation of a multisectoral, One Health approach to decrease the global disease burden in people and animals while promoting environmental health

High Salt Diet Affects the Reproductive Health in Animals: An Overview

Salinity is a reliable issue of crop productivity loss in the world and in certain tropical and subtropical zones. However, tremendous progress in the genetic improvement of plants for salinity tolerance has been made over several decades. In light of this, halophytic plants can be used as animal feeds and have promising features because they are a good feed resource. However, the main constraint of saline pasture systems is the extreme concentration of NaCl salt in drinking water and forage plants for grazing animals. Ecological reports revealed that excess diet salt causes mortality and morbidity worldwide. Animal fed halophytic forages may have adverse effects on growth performance and reproductive function in males and females due to inducing reductions in hormone regulation, such as testosterone, FSH, LH, and leptin. It was indicated that high salt intake promotes circulating inflammatory factors in the placenta and is associated with adversative effects on pregnancy. This review focuses on the scientific evidence related to the effect of high salt intake on growth performance, spermatogenesis, sperm function, and testicular morphology changes in male animals. In addition, the review will also focus on its effect on some female reproductive features (e.g., ovarian follicle developments, placental indices, and granulosa cell function)

Intraoperative pharmacologic opioid minimization strategies and patient-centred outcomes after surgery: a scoping review protocol

This is a scoping review that will examine clinical trials evaluating the impact of pharmacologic intraoperative opioid minimization practices on patient-centred outcomes and identify potential promising pharmacologic opioid minimization strategies

All optical full adder based on intramolecular electronic energy transfer in the rhodamine-azulene bichromophoric system

peer reviewedCharge and electronic energy transfer (ET and EET) are well-studied examples whereby different molecules can signal their state from one (the donor, D) to the other (the acceptor, A). The electronic energy transfer from the donor (Rh) to the acceptor (Az) is used to build an all-optical full adder on a newly synthesized bichromophoric molecule Rh-Az. The results are supported and interpreted by a full kinetic simulation. It is found that the optimal design for the implementation of the full adder relies in an essential way on the intramolecular transfer of information from the donor to the acceptor moiety. However, it is not the case that the donor and the acceptor each act as a half adder

Effectiveness of dexmedetomidine during surgery under general anaesthesia on patient-centred outcomes: a systematic review and Bayesian meta-analysis protocol

Introduction Dexmedetomidine is a promising pharmaceutical strategy to minimise opioid use during surgery. Despite its growing use, it is uncertain whether dexmedetomidine can improve patient-centred outcomes such as quality of recovery and pain.Methods and analysis We will conduct a systematic review and meta-analysis following the recommendations of the Cochrane Handbook for Systematic Reviews. We will search MEDLINE, Embase, CENTRAL, Web of Science and CINAHL approximately in October 2023. We will include randomised controlled trials evaluating the impact of systemic intraoperative dexmedetomidine on patient-centred outcomes. Patient-centred outcome definition will be based on the consensus definition established by the Standardised Endpoints in Perioperative Medicine initiative (StEP-COMPAC). Our primary outcome will be the quality of recovery after surgery. Our secondary outcomes will be patient well-being, function, health-related quality of life, life impact, multidimensional assessment of postoperative acute pain, chronic pain, persistent postoperative opioid use, opioid-related adverse events, hospital length of stay and adverse events. Two reviewers will independently screen and identify trials and extract data. We will evaluate the risk of bias of trials using the Cochrane Risk of Bias Tool (RoB 2.0). We will synthesise data using a random effects Bayesian model framework, estimating the probability of achieving a benefit and its clinical significance. We will assess statistical heterogeneity with the tau-squared and explore sources of heterogeneity with meta-regression. We have involved patient partners, clinicians, methodologists, and key partner organisations in the development of this protocol, and we plan to continue this collaboration throughout all phases of this systematic review.Ethics and dissemination Our systematic review does not require research ethics approval. It will help inform current clinical practice guidelines and guide development of future randomised controlled trials. The results will be disseminated in open-access peer-reviewed journals, presented at conferences and shared among collaborators and networks.PROSPERO registration number CRD42023439896