Smile outcomes when using masseteric nerve-based nerve transfers versus direct muscle neurotization in facial palsy patients

Background: When dealing with a weak smile, nerve transfer is a viable strategy. We evaluated outcomes of masseteric nerve to facial nerve transfers and compared them with direct muscle neurotization (DMN). Methods: In a retrospective cohort study of 20 patients (n = 20), we compared nerve transfer versus DMN over a 6-year period (2016–2021). Outcomes were measured using the validated Sunnybrook score, Ackerman Smile Index, and Terzis scores. Statistical analysis was performed using the Wilcoxon sign rank and Mann-Whitney U tests. Results: Comparing pre- versus postoperative scores after nerve transfers, there was a significant improvement in median overall Sunnybrook score (24 versus 47, P = 0.043), lip elevation (1 versus 2, P = 0.046), open mouth smile (1 versus 3, P = 0.003), and Terzis scores (1 versus 3, P = 0.005), with no difference in resting symmetry (−15 versus −5; P = 0.496). Compared with DMN, there was no difference in median Terzis score improvement from preoperative to postoperative state (2 versus 1, P = 0.838), median smile improvement (2 versus 2, P = 0.838), resting symmetry (10 versus 5, P = 0.144) or overall Sunnybrook score (23 versus 21, P = 1.000). Lip elevation improvement was in favor of nerve transfers (1 versus 0, P = 0.047). Conclusions: This is the first study evaluating nerve transfer neurotization of smile-mimetic muscles and comparing the outcomes with DMN, with masseteric nerve as donor. Nerve transfer leads to improved facial mimetic function, smile excursion and open mouth smiles, as does DMN, with improvement in lip elevation in favor of nerve transfer. Nerve transfer was preferred for more severe smile weakness

A comparison of outcomes between finger and pulp replantation/revascularization in a single centre

Background: Supermicrosurgery has allowed the replantation/revascularization of the pulp, but how does this currently compare with more proximal digit replantation/revascularization? Methods: In a retrospective case study over a 5-year period at our institute, a total of 21 patients (n = 21) had either finger or pulp replantation-revascularization posttrauma. All pulp replants had a single-vessel anastomosis viz., “artery-to-artery” or “artery-to-vein” only, with venous outflow dependent on the skin-shave technique, while more proximal replants had both arterial and venous anastomoses. Age, sex, ischemic time, handedness, smoker status, and injury-replant interval were compared between the two groups, with all procedures performed by a single surgeon. The outcome parameters studied were length of hospital stay, timeline for wound healing, viability, and functional outcomes. Results: Our patients consisted of 18 men and three women, of which 14.3% were smokers and 85.7% were right-handed. There were 11 finger replantation/revascularizations (n = 11) versus 10 pulp replantation/revascularizations (n = 10). The average age of digit replantation/revascularization patients was 44.8 years compared with 26.4 years in pulp replantation/revascularization patients (Student t test, P = 0.04). Mean ischemia time in digital replants was 67 minutes versus 32.3 minutes in pulp replantation/revascularization (Student t test, P = 0.056). Digital replantation/revascularization was viable in 72% of cases versus a 90% viability in the pulp subcohort. Conclusions: In our patient cohort, pulp replantation/revascularizations produced better postoperative viability. Where supermicrosurgery expertise is available, pulp replantation/revascularization should be considered a worthwhile option when compared with digital replantation/revascularization

Workplace factors associated with mental health of healthcare workers during the COVID-19 pandemic: an international cross-sectional study

BACKGROUND: The association of workplace factors on mental health of healthcare workers (HCWs) during the COVID-19 pandemic needs to be urgently established. This will enable governments and policy-makers to make evidence-based decisions. This international study reports the association between workplace factors and the mental health of HCWs during the pandemic. METHODS: An international, cross-sectional study was conducted in 41 countries. The primary outcome was depressive symptoms, derived from the validated Patient Health Questionnaire-2 (PHQ-2). Multivariable logistic regression identified factors associated with mental health outcomes. Inter-country differences were also evaluated. RESULTS: A total of 2,527 responses were received, from 41 countries, including China (n=1,213; 48.0%), UK (n=891; 35.3%), and USA (n=252; 10.0%). Of all participants, 1343 (57.1%) were aged 26 to 40 years, and 2021 (80.0%) were female; 874 (34.6%) were doctors, and 1367 (54.1%) were nurses. Factors associated with an increased likelihood of depressive symptoms were: working in the UK (OR=3.63; CI=[2.90-4.54]; p<0.001) and USA (OR=4.10; CI=[3.03-5.54]), p<0.001); being female (OR=1.74; CI=[1.42-2.13]; p<0.001); being a nurse (OR=1.64; CI=[1.34-2.01]; p<0.001); and caring for a COVID-19 positive patient who subsequently died (OR=1.20; CI=[1.01-1.43]; p=0.040). Workplace factors associated with depressive symptoms were: redeployment to Intensive Care Unit (ICU) (OR=1.67; CI=[1.14-2.46]; p=0.009); redeployment with perceived unsatisfactory training (OR=1.67; CI=[1.32-2.11]; p<0.001); not being issued with appropriate personal protective equipment (PPE) (OR=2.49; CI=[2.03-3.04]; p<0.001); perceived poor workplace support within area/specialty (OR=2.49; CI=[2.03-3.04]; p<0.001); and perceived poor mental health support (OR=1.63; CI=[1.38-1.92]; p<0.001). CONCLUSION: This is the first international study, demonstrating that workplace factors, including PPE availability, staff training pre-redeployment, and provision of mental health support, are significantly associated with mental health during COVID-19. Governments, policy-makers and other stakeholders need to ensure provision of these to safeguard HCWs’ mental health, for future waves and other pandemics

Illustrating a new global-scale approach to estimating potential reduction in fish species richness due to flow alteration

Changes in river discharge due to human activities and climate change would affect the sustainability of freshwater ecosystems. To globally assess how changes in river discharge will affect the future status of freshwater ecosystems, global-scale hydrological simulations need to be connected with a model to estimate the durability of freshwater ecosystems. However, the development of this specific modelling combination for the global scale is still in its infancy. In this study, two statistical methods are introduced to link flow regimes to fish species richness (FSR): one is based on a linear relationship between FSR and mean river discharge (hereafter, FSR-MAD method), and the other is based on a multi-linear relationship between FSR and ecologically relevant flow indices involving several other flow characteristics and mean river discharge (FSR-FLVAR method). The FSR-MAD method has been used previously in global simulation studies. The FSR-FLVAR method is newly introduced here. These statistical methods for estimating FSR were combined with a set of global river discharge simulations to evaluate the potential impact of climate-change-induced flow alterations on FSR changes. Generally, future reductions in FSR with the FSR-FLVAR method are greater and much more scattered than with the FSR-MAD method. In arid regions, both methods indicate reductions in FSR because mean discharge is projected to decrease from past to future, although the magnitude of reductions in FSR is different between the two methods. In contrast, in heavy-snow regions a large reduction in FSR is shown by the FSR-FLVAR method due to increases in the frequency of low and high flows. Although further research is clearly needed to conclude which method is more appropriate, this study demonstrates that the FSR-FLVAR method could produce considerably different results when assessing the global role of flow alterations in changing freshwater ecosystems

Prevalence and impact of gastrointestinal helminths on body weight gain in backyard chickens in subtropical and humid zone of Jammu, India

Necropsy of gastrointestinal tract of 125 free-range chickens from a subtropical and humid zone of northwestern India revealed four nematode spp. (Ascaridia galli, Heterakis gallinarum, Capillaria spp. and Cheilospirurahamulosa) and four cestode spp. (Raillietina cesticillus, Raillietina echinobothrida, Raillietina tetragona and Amoebotaenia cuneata) The overall prevalence of the helminth parasites was 72.0%. Amongst various helminth species encountered in the region, A. galli emerged out as the most prevalent, followed by H. gallinarum, R. cesticillus and R. echinobothrida. The impact of helminthic infections on body weight gain in growing chickens was investigated. One hundred growing chickens, aged 40 days were randomly assigned to two groups (treated and untreated controls) of 50 birds each. The birds in treated group were given fenbendazole at 7.5 mg per kg body weight in drinking water, while the birds in other group served as untreated controls. At the end of the 90 days of the field trial, the mean body weight gain of untreated controls was 1232.2 ± 7.28 g (13.7 g/day) compared with 1617.6 ± 5.43 g (18.0 g/day) in the treated group. It was associated with a significantly (P < 0.05) higher mean worm burden (32.92 ± 6.12) in untreated controls than the treated group (2.46 ± 1.14). The prevalences of helminthic species and their impact on body weight gain in growing backyard chickens have been discussed

Seasonal prevalence of gastrointestinal helminths in sheep and goats of middle agro-climatic zone of Jammu province

A total of 1920 faecal samples of sheep (960) and goats (960) of stationary flocks of the middle agro-climatic zone of Jammu province were examined, out of which 67.24 % animals were positive for helminthic infections. The different nematodes observed were strongyles (50.1 %), trichurids (12.1 %) and Strongyloides spp. (4.2 %). Trematode ova recorded were of amphistomes (8.3 %), Fasciola spp. (8.2 %) and Dicrocoelium spp. (5.4 %). No significant difference was observed between the infection level in sheep (68.54 %) and goats (65.94 %) which could be attributed to mixed grazing and sharing of pastures/sheds. Significantly (p < 0.05) higher infection was observed in monsoon as compared to winter. Strongyles were predominant during all the seasons, but significantly (p < 0.05) higher infection was observed in monsoon as compared to winter. Coproculture studies revealed that Haemonchus contortus (61.18 %) predominated during all the seasons, followed by Trichostrongylus spp. (13.67 %), Ostertagia spp. (12.17 %), Strongyloides spp. (4.14 %), Oesophagostomum spp. (3.84 %) and Bunostomum spp. (3.83 %). Eggs per gram of faeces (EPG) were the highest (sheep 1883.33 ± 117.6 and goats 1800 ± 110.21) during monsoon and the lowest during winter (sheep 640 ± 41.29 and goats 556.67 ± 33.01). Two peaks of EPG (the first in May and the second in August) were recorded during the 1 year study period. Infection was significantly (p < 0.05) higher in young (73.22 %) as compared to adults (61.25 %). Females showed a higher infection (73.33 %) as compared to males (61.14 %). The effect of prevailing agro-climatic conditions on the prevalence of gastrointestinal helminths has been discussed

Comparative Evaluation of Efficacy, Safety and Haemostatic Parameters of Enoxaparin and Fondaparinux in Unstable Coronary Artery Disease Pharmacology Section

ABSTRACT Aim: To compare the safety and efficacy of Enoxaparin (EX) and Fondaparinux (FD) in patients with Unstable Coronary Artery Disease (UCAD). Materials and Methods: A prospective, open label, randomized comparative study was designed to study the comparative efficacy and safety of EX and FD in UCAD patients. Recovery, recurrence, major and minor bleeding and biochemical investigations were evaluated and compared among two arms. Results: The baseline demographic characteristics were similar in both groups, with mean age of 56.05 and 56.05 years in EX and FD group respectively. Recovery was equal in two arms. Recurrent MI or angina was seen numerically more in EX group, but it did not statistically vary from that in the FD group. Incidence of haemorrhage was similar in both groups at 9 days, but at 30 days, EX showed a higher incidence (p&lt;0.05). Deaths were prevented in both the treatment arms. Bleeding parameters such as BT, CT and platelet count were not altered in both groups. Conclusion: FD appeared to be better than EX in efficacy, as was indicated by a numerically more decrease in recurrence of angina or MI. FD regimen group also had better safety profile, as there was no incidence of haemorrhage at 30 days Therefore, we conclude that FD is an attractive option than EX in UCAD patients

Microbiological and functional outcomes after open extremity fractures sustained overseas: The experience of a UK level I trauma centre

Background Open extremity fractures carry a high risk of limb loss and poor functional outcomes. Transfer of extremity trauma patients from developing countries and areas of conflict adds further layers of complexity due to challenges in the delivery of adequate care. The combination of extensive injuries, transfer delays and complex microbiology presents unique challenges. Methods A retrospective review was conducted to analyse the surgical and microbiological themes of patients with open extremity fractures transferred from overseas to our institution (Imperial College NHS Trust) between January 2011 and January 2016. Results Twenty civilian patients with 21 open extremity fractures were referred to our unit from 11 different countries. All patients had poly-microbial wound contamination on initial surveillance cultures. Five patients (25%) underwent amputation depending on the extent of osseous injury; positive surveillance cultures did not preclude limb reconstruction, with seven patients undergoing complex reconstruction and eight undergoing simple reconstruction to achievewound coverage. Hundred percent of patients demonstrated infection-free fracture union on discharge. Conclusion Patients with open extremity fractures transferred from overseas present the unique challenge of poly-microbial infection in addition to extensive traumatic wounds. Favourable outcomes can be achieved despite positive microbiological findings on tissue culture with adequate antimicrobial therapy. The decision to salvage the limb and the complexity of reconstruction used should be based on the chance of achieving meaningful functional recovery, mainly determined by the extent of bony injury. The complexity of reconstruction was based on the predicted long-term functionality of the salvaged limb

Structure model index does not measure rods and plates in trabecular bone

Structure model index (SMI) is widely used to measure rods and plates in trabecular bone. It exploits the change in surface curvature that occurs as a structure varies from spherical (SMI = 4), to cylindrical (SMI = 3) to planar (SMI = 0). The most important assumption underlying SMI is that the entire bone surface is convex and that the curvature differential is positive at all points on the surface. The intricate connections within the trabecular continuum suggest that a high proportion of the surface could be concave, violating the assumption of convexity and producing regions of negative differential. We implemented SMI in the BoneJ plugin and included the ability to measure the amounts of surface that increased or decreased in area after surface mesh dilation, and the ability to visualize concave and convex regions. We measured SMI and its positive (SMI+) and negative (SMI-) components, bone volume fraction (BV/TV), the fraction of the surface that is concave (CF), and mean ellipsoid factor (EF) in trabecular bone using 38 X-ray microtomography (XMT) images from a rat ovariectomy model of sex steroid rescue of bone loss, and 169 XMT images from a broad selection of 87 species' femora (mammals, birds, and a crocodile). We simulated bone resorption by eroding an image of elephant trabeculae and recording SMI and BV/TV at each erosion step. Up to 70%, and rarely less than 20%, of the trabecular surface is concave (CF 0.155 – 0.700). SMI is unavoidably influenced by aberrations from SMI-, which is strongly correlated with BV/TV and CF. The plate-to-rod transition in bone loss is an erroneous observation resulting from SMI's close and artefactual relationship with BV/TV. SMI cannot discern between the distinctive trabecular geometries typical of mammalian and avian bone, whereas EF clearly detects birds' more plate-like trabeculae. EF is free from confounding relationships with BV/TV and CF. SMI results reported in the literature should be treated with suspicion. We propose that EF should be used instead of SMI for measurements of rods and plates in trabecular bone

A Randomized Controlled Trial to Assess the Effects of Competition on the Development of Laparescopic Surgical Skills

Background Serious games have demonstrated efficacy in improving participation in surgical training activities, but studies have not yet demonstrated the effect of serious gaming on performance. This study investigated whether competitive training (CT) affects laparoscopic surgical performance. Methods A total of 20 novices were recruited, and 18 (2 dropouts) were randomized into control or CT groups to perform 10 virtual reality laparoscopic cholecystectomies (LCs). Competitiveness of each participant was assessed. The CT group members were informed they were competing to outperform one another for a prize; performance ranking was shown before each session. The control group did not compete. Performance was assessed on time, movements, and instrument path length. Quality of performance was assessed with a global rating scale score. Results There were no significant intergroup differences in baseline skill or measured competitiveness. Time and global rating scale score, at final LC, were not significantly different between groups; however, the CT group was significantly more dexterous than control and had significantly lower variance in number of movements and instrument path length at the final LC (p = 0.019). Contentiousness was inversely related to time in the CT group. Conclusion This was the first randomized controlled trial to investigate if CT can enhance performance in laparoscopic surgery. CT may lead to improved dexterity in laparoscopic surgery but yields otherwise similar performance to that of standard training in novices. Competition may have different effects on novices vs experienced surgeons, and subsequent research should investigate CT in experienced surgeons as well