Preservation of parathyroid glands during thyroid and neck surgery

The parathyroid glands are situated in close proximity to the thyroid gland. They have an important endocrine function maintaining calcium and phosphate homeostasis in the body by the secretion of parathormone (PTH), which is responsible for this function. The parathyroid glands are commonly damaged during thyroid surgeries. This could lead to transient or permanent hypoparathyroidism in 30% of cases. Preservation of the parathyroid glands, is an important and integral part of thyroidectomy and other surgical interventions in the neck. The main principle underlying this is a thorough understanding of parathyroid anatomy in relation to the thyroid gland and other important structures in the area. There can also be significant variation in the anatomical location of the glands. Various techniques and methods have been described for parathyroid preservation. They include intraoperative identification utilizing indocyanine green (ICG) fluorescence, carbon nanoparticles, loupes, and microscopes. The techniques of surgery (meticulous capsular dissection), expertise, central compartment neck dissection, preoperative vitamin D deficiency, extent and type of thyroidectomy are the risk factors associated with damaged thyroids, inadvertent parathyroidectomy and subsequent hypoparathyroidism. Parathyroid Autotransplantation is a treatment option for inadvertent parathyroidectomy. Ultimately, the best way to assure normal parathyroid function is to preserve them in situ intraoperatively undamaged

In vivo measurement of surface pressures and retraction distances applied on abdominal organs during surgery

This study undertook the in vivo measurement of surface pressures applied by the fingers of the surgeon during typical representative retraction movements of key human abdominal organs during both open and hand-assisted laparoscopic surgery. Surface pressures were measured using a flexible thin-film pressure sensor for 35 typical liver retractions to access the gall bladder, 36 bowel retractions, 9 kidney retractions, 8 stomach retractions, and 5 spleen retractions across 12 patients undergoing open and laparoscopic abdominal surgery. The maximum and root mean square surface pressures were calculated for each organ retraction. The maximum surface pressures applied to these key abdominal organs are in the range 1 to 41 kPa, and the average maximum surface pressure for all organs and procedures was 14 ± 3 kPa. Surface pressure relaxation during the retraction hold period was observed. Generally, the surface pressures are higher, and the rate of surface pressure relaxation is lower, in the more confined hand-assisted laparoscopic procedures than in open surgery. Combined video footage and pressure sensor data for retraction of the liver in open surgery enabled correlation of organ retraction distance with surface pressure application. The data provide a platform to design strategies for the prevention of retraction injuries. They also form a basis for the design of next-generation organ retraction and space creation surgical devices with embedded sensors that can further quantify intraoperative retraction forces to reduce injury or trauma to organs and surrounding tissues

Examining the Role of the Health Belief Model Framework in Achieving Diversity and Equity in Organ Donation Among South Asians in the United Kingdom

Organ donation continues to be low among ethnic minorities in the United Kingdom (UK), especially within the South Asian community, with a disproportionate number of patients of South Asian ethnicity awaiting organ transplants. In 2020/21, Minority Ethnic (ME) patients comprised almost a third of the national transplant waiting list, highlighting the continued imbalance between the need for transplants in South Asian communities and the availability of suitable organs. Median waiting times for transplants show that, generally, white patients wait less time than ME patients; Only 39.5% of ME families consented to proceed with deceased organ donation when approached compared to 69% of white families. How to increase awareness among the South Asian community on the scarcity of organ donors continues to be a growing challenge facing the healthcare system in the UK and globally. This article reflects on the education strategy implemented using the Health Belief Model. It provides a detailed framework with which to consider the rationale that led to a specific behaviour, in this case organ donation among the three major ethnicities (i.e., Indian, Pakistani, Bangladeshi) within the South Asian community as part of a single study

Pinwheel valence bond crystal ground state of the spin-1/ 2 Heisenberg antiferromagnet on the shuriken lattice

We investigate the nature of the ground state of the spin-12 Heisenberg antiferromagnet on the shuriken lattice by complementary state-of-the-art numerical techniques, such as variational Monte Carlo (VMC) with versatile Gutzwiller-projected Jastrow wave functions, unconstrained multivariable variational Monte Carlo (mVMC), and pseudofermion/pseudo-Majorana functional renormalization group (PFFRG/PMFRG) methods. We establish the presence of a quantum paramagnetic ground state and investigate its nature, by classifying symmetric and chiral quantum spin liquids, and inspecting their instabilities towards competing valence bond crystal (VBC) orders. Our VMC analysis reveals that a VBC with a pinwheel structure emerges as the lowest-energy variational ground state, and it is obtained as an instability of the U(1) Dirac spin liquid. Analogous conclusions are drawn from mVMC calculations employing accurate BCS pairing states supplemented by symmetry projectors, which confirm the presence of pinwheel VBC order by a thorough analysis of dimer-dimer correlation functions. Our work highlights the nontrivial role of quantum fluctuations via the Gutzwiller projector in resolving the subtle interplay between competing orders

Survey of Animal Trypanosomosis and Biting Flies in Parts of Alkaleri Local Government Area of Bauchi State, Nigeria

A survey of tsetse and animal trypanosomosis was carried out in five settlements: Lim, Birim, Yuli, Kungibar and Yankari game reserve of Alkaleri Local Government Area of Bauchi state, Nigeria. A total of 448 blood samples were collected between February and March, 2008. Blood samples were examined for trypanosomes using Giemsa stained thick and thin smear method and the Haematocrit Centrifugation Techique (HCT). The results obtained showed that the overall prevalence of trypanosomosis and other haemoparasites in the study area was 51%. Trypanosoma vivax was the most predominant trypanosome species found (39.1%) and is statistically significant in male than in female (p< 0.05). Vector investigation in the study areas showed, that a total of 77 biting flies were caught using Biconical and Nitse traps.Glossina tachinoides was the most abundant vector with a catch of 60(78.8%);Glossina palpalis 10(13.0%); Tabanids 3(4.0%); Stomoxys 3(4.0%) and Chrysop 1(1.0%).The parasites have no significant difference (p>0.05) between different  settlements where samples were collected. The public health importance of this survey is discussed. Keywords: Tsetse, Trypanosomosis, Game reserve, Public health importance

A Successful Treatment of Encapsulating Peritoneal Sclerosis in an Adolescent Boy on Long-term Peritoneal Dialysis: A Case Report.

Encapsulating peritoneal sclerosis (EPS) is a rare life-threatening complication associated with peritoneal dialysis (PD). EPS is characterized by progressive fibrosis and sclerosis of the peritoneum, with the formation of a membrane and tethering of loops of the small intestine resulting in intestinal obstruction. It is very rare in children. We present a case of a 16-year-old adolescent boy who developed EPS seven years after being placed on continuous ambulatory peritoneal dialysis (CAPD) complicated by several episodes of bacterial peritonitis. The diagnosis was based on clinical, radiological, intraoperative and histopathological findings. The patient was successfully treated with surgical enterolysis. During a 7-year follow-up, there have been no further episodes of small bowel obstruction documented. He still continues to be on regular hemodialysis and is awaiting a deceased donor kidney transplant. EPS is a long-term complication of peritoneal dialysis and is typically seen in adults. Rare cases may be seen in the pediatric population and require an appropriate surgical approach that is effective and lifesaving for these patients

Effects of coronavirus disease pandemic on tuberculosis notifications, Malawi

The coronavirus disease (COVID-19) pandemic might affect tuberculosis (TB) diagnosis and patient care. We analyzed a citywide electronic TB register in Blantyre, Malawi and interviewed TB officers. Malawi did not have an official COVID-19 lockdown but closed schools and borders on March 23, 2020. In an interrupted time series analysis, we noted an immediate 35.9% reduction in TB notifications in April 2020; notifications recovered to near prepandemic numbers by December 2020. However, 333 fewer cumulative TB notifications were received than anticipated. Women and girls were affected more (30.7% fewer cases) than men and boys (20.9% fewer cases). Fear of COVID-19 infection, temporary facility closures, inadequate personal protective equipment, and COVID-19 stigma because of similar symptoms to TB were mentioned as reasons for fewer people being diagnosed with TB. Public health measures could benefit control of both TB and COVID-19, but only if TB diagnostic services remain accessible and are considered safe to attend.Peer reviewe