Adverse Effects of Injectable Facial Fillers: A Maxillofacial Approach to Management

Adverse effects of dermal facial fillers are increasingly posing a difficult treatment dilemma. Although broadly non-toxic synthetic fillers act as foreign bodies in the tissues eliciting a host response, even many years after administration. Adverse outcomes, ranging from chronic lymphoplasmacytic inflammatory reactions to granulomatous reactions have been documented in the literature1. High aesthetic demands, lack of existing scars for access and unavailable treatment history can compound the difficulty. Furthermore, we are increasingly encountering adverse effects in patients treated outside the United Kingdom (UK). Here we present a case report demonstrating our experience in the management of these problems

Nematicidal Properties of Medicinal Plants against Root-Knot Nematode - A Systematic Review

Plant parasitic nematodes are small roundworms that feed on plants and damage them. The most serious among them was root-knot nematodes that found in cultivated crops throughout the world. Root-knot nematode infection in plants has become the biggest issue nowadays due to the significant agricultural losses. The greatest barrier to environment-friendly crop production in modern agriculture is the reliance on chemical nematicides for crop protection. Instead of using hazardous chemical nematicides, it should be encouraged to apply plant-based nematicides. The mechanism of root-knot nematode infection and eco-friendly management strategies were covered in this review. This information should be done in this area so that eco-friendly and cost-effective controlling measures against root-knot nematodes

Developing early practice

Developing early practic

Evaluation of physico-chemical and microbial parameters on water quality of Narmada River, India

The present study was carried out to ascertain the quality of water at western zone of Narmada River of Madhya Pradesh (India). Due to heavy discharge of harmful and deleterious substances in river, the biological, chemical and physical characteristics of water have changed to a considerable extent. The objectives of this study were to find out the changes in physico-chemical nature as well as biological health of Narmada River. A thorough study was done on the basis of prevailing seasons. The deterioration of water quality was noticed at lower site of water body in a particular season as low temperature, dissolved oxygen and higher concentration of content of chlorine, etc., all pointing towards the nutrient enrichment. This evaluation will be immensely helpful to estimate the effect of impoundments on the quality of water, fisheries development and reservoir management policy. The microbial analysis was also conducted in terms of most probable number (MPN) of total coliforms in water sample and its highest value (1239) was reported from downstream of Omkareshwar dam site of Narmada River. Water quality index of all sites of Narmada River was calculated for three seasons, viz. summer, monsoon and winter and it was found to be highest (123) at Koteshwar dam site of river in monsoon season and the lowest (70) was observed in water of upstream of Omkareshwar dam during winter. The suitable correlation coefficients were calculated for 7 pairs of variables and correlation matrices were then established seasonally.Key words: Impoundments, water quality index, dissolved oxygen, most probable numbe

Biochemical characterization of thermostable cellulase enzyme from mesophilic strains of actinomycete

A few mesophilic strains of actinomycete were used for detection, extraction and characterization of cellulase enzymes. These strains responded to produce all the three components of cellulase complex (endoglucanase, exoglucanase and â-glucosidase) in balanced quantities. Cellulase activity was determined on solid medium supplemented with 1% carboxy methyl cellulose (CMC). Production of cellulase was detected by the formation of clear or transparent zone around colonies. The greater size of transparent zone has been found proportional to the higher capabilities of the strains for enzymes. The extraction of cellulase enzyme was done in liquid basal medium. The assay of cellulase was observed by measuring the release of reducing sugar (RS) by DNS method. All the three components of cellulase viz. endoglucanase, exoglucanase and â -glucosidase were assayed in terms of CMCase, FPase and cellobiase, respectively and expressed in International units (IU). These strains were further tested for their ability to produce cellulase complex enzyme by growing on a defined substrates as well as on delignified cellulosics. The optimization for â-glucosidase enzyme was carried out by studying the various parameters viz. effect of pH, incubation period and nitrogen sources.Key words: Cellulase, actinomycete, optimization, reducing sugar, carboxy methyl cellulose

Advanced therapeutic dressings for effective wound healing

Advanced therapeutic dressings that take active part in wound healing to achieve rapid and complete healing of chronic wounds is of current research interest. There is a desire for novel strategies to achieve expeditious wound healing due to the enormous financial burden worldwide. This paper reviews the current state of wound healing and wound management products, with emphasis on the demand for more advanced forms of wound therapy and some of the current challenges and driving forces behind this demand. The paper reviews information mainly from peer reviewed literature and other publicly available sources such as the FDA. A major focus is the treatment of chronic wounds including amputations, diabetic and leg ulcers, pressure sores, surgical and traumatic wounds (e.g. accidents and burns) where patient immunity is low and the risk of infections and complications are high. The main dressings include medicated moist dressings, tissue engineered substitutes, biomaterials based biological dressings, biological and naturally derived dressings, medicated sutures and various combinations of the above classes. Finally, the review briefly discusses possible prospects of advanced wound healing including some of the emerging approaches such as hyperbaric oxygen, negative pressure wound therapy and laser wound healing, in routine clinical care

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Investigation into Possible Sources of Tune Jitter in the LHC

The beta function around an accelerator determines the shape and size of the beam. The LHC has demonstrated a beta function control to the 1% level. However as its optics is pushed for increased performance, the measurement techniques are challenged by small perturbations. These measurements can be perturbed by tune jitters that find their origin in power supply ripples and the feed-down effect that stems from the machine’s non-linearities and momentum changes. By extracting machine and orbit data and using accurate models, the effect of these perturbations in recent LHC optics measurements can be evaluated. The factors that contribute to these orbit jitters can also be investigated in order to search for methods to control them. It was found that the feed-down effect in sextupoles caused from orbit jitters is predicted to have a large effect on the tune shift. However the expected results are much more drastic than what is observed so other sources must be affecting the tune. One of the sources of orbit perturbation identified in this thesis is an unwanted activation of the orbit feedback system occurring simultaneously to an AC dipole kick data, potentially generating imprecise corrections