Optimizing electrode implantation in sacral nerve stimulation—an anatomical cadaver study controlled by a laparoscopic camera

Background and aim: Sacral nerve stimulation is the therapy of choice in patients with neurogenic faecal and urine incontinence, constipation and some pelvic pain syndromes. The aim of this study is to determine the best insertion angles of the electrode under laparoscopic visualization of the sacral nerves. Materials and methods: Five fresh cadaver pelvises were dissected through an anterior approach of the presacral space, exposing the ventral sacral roots. Needles and electrodes were inserted into the S3 foramen. Both right and left sides were used, with the traditional percutaneous procedure. The validation was done by a laparoscopic camera controlling the position of the needle and electrode on the nerve. The angles were assessed with a goniometer and were confirmed in two living patients. Results: The mean angle of insertion in the sagittal plane was 62.9 ± 3° (range, 59-70). In the axial plane, the mean angle for the left side was 91.7 ± 13.5° (range, 80-110) and 83.2 ± 7.7° for the right side (range, 75-95). These angles resulted in the optimal placement of the leads along the S3 sacral root, in all these cases. Conclusions: This study allows direct visualization during the placement of the needle and electrode, thus permitting accurate calculations of the best angle of approach during the surgical procedure in sacral nerve stimulation. These objective findings attempt to standardize this technique, which is often performed with the aid of intra-operative fluoroscopy but still leaving a lot to chance. These insertion angles should help to find more consistent and reproducible results and thus improved outcome in patient

Workplace Accidents among Nepali Male Workers in the Middle East and Malaysia: A Qualitative Study

There are many Nepali men working in the Middle East and Malaysia and media reports and anecdotal evidence suggest a high risk of workplace-related accidents and injuries for male Nepali workers. Therefore, this study aims to explore the personal experiences of male Nepali migrants of unintentional injuries at their place of work. In-depth, face-to-face interviews (n = 20) were conducted with male Nepali migrant workers. Study participants were approached at Kathmandu International Airport, hotels and lodges around the airport. Interviews were transcribed and analysed using thematic analysis. Almost half of study participants experienced work-related accident abroad. The participants suggested that the reasons behind this are not only health and safety at work but also poor communication, taking risks by workers themselves, and perceived work pressure. Some participants experienced serious incidents causing life-long disability, extreme and harrowing accounts of injury but received no support from their employer or host countries. Nepali migrant workers would appear to be at a high risk of workplace unintentional injuries owing to a number of interrelated factors poor health and safety at work, pressure of work, risk taking practices, language barriers, and their general work environment. Both the Government of Nepal and host countries need to be better policing existing policies, introduce better legislation where necessary, ensure universal health (insurance) coverage for labour migrants, and improve preventive measures to minimize the number and severity of accidents and injuries among migrant workers

Establishing jujube trees in sub-Saharan Africa: response of introduced and local cultivars to rock phosphate and water supply in Burkina Faso, West Africa

Abstract In the Sahel zone, there is an increasing interest of farmers in conserving and enriching tree diversity on their farms as a source of food and income. Ziziphus mauritiana Lam. is one of the tree species farmers maintain on their farms. Even though the local variety of Ziziphus mauritiana Lam. was ranked as one of the most preferred species, it produces small fruit whereas farmers are interested in varieties producing bigger and tasty ones. A factorial experiment in a split split-plot design was carried out to assess the performance of three introduced cultivars of Indian jujube in Burkina Faso. Investigated factors were irrigation (irrigated with 30 l plant À1 week À1 , non-irrigated), rock phosphate containing 25% P 2 O 5 (0 and 150 g P plant À1 ) and cultivar (Gola, Seb, Umran, and local variety as control). Eighteen months after planting, Umran responded positively to irrigation and rock phosphate treatments by displaying the tallest height (313 cm) and the biggest collar diameter (6.4 cm). Gola gave the largest crown diameter (316 cm) at 18 months and the highest fruit production at the first (15.3 kg tree À1 ) and second (71.6 kg tree À1 ) fruiting seasons in the irrigated and fertilized treatment. The local variety was less productive compared to the introduced cultivars. In terms of income generation irrigated and fertilized Gola and irrigated Umran showed the highest potential after two fruiting seasons with net revenues of F CFA 2,526,915 and F CFA 1,930,546 per hectare respectively. Therefore, Umran and Gola may be recommended in intensive subSaharan peri-urban systems while Seb needs further investigation to improve its water and nutrient use efficiency through either better timing of water and fertilizer application or symbiotic association with arbuscular mycorrhizal fungi