Cerebellopontine epidermoid presenting with trigeminal neuralgia for 10 years: a case report

Trigeminal neuralgia, also called tic douloureux, is a common and potentially disabling pain syndrome, which affects the trigeminal or fifth cranial nerve. The precise pathophysiology of Trigeminal neuralgia remains obscure. The disorder causes extreme, sporadic, sudden burning or shock-like face pain that lasts from few seconds to minutes and can be physically and mentally incapacitating. More than one nerve branch can be affected by the disorder. A 55-year-old female presented with pain over the left side of face for 10 years uncontrolled with carbamazepine. On examination the positive findings were reduced sensation by 25% over the left side of face with House and Brackman grade II facial nerve palsy. The corneal reflex was absent on left side. Magnetic resonance imaging showed left cerebellopontine angle (CPA) mass suggestive of an epidermoid involving the Vth nerve and Gasserian ganglion and extending into the middle cranial fossa. She underwent left suboccipital craniectomy and near total excision of the tumor with decompression of the Vth nerve which was fully engulfed by the tumor. Postoperative the VII nerve palsy increased to grade III and she had 50% loss of sensation over left side. She had no further attacks of pain and hence tapered off the carbamazepine. TN caused by cerebellopontine angle epidermoids is uncommon and should be kept in view in all cases presenting with TN. The aim of surgery for epidermoids is to decompress the cranial nerves and brain stem and not total removal with its attendant morbidity and mortality

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

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

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

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

Enabling Green IoT: Energy-Aware Communication Protocols for Battery-less LoRaWAN Devices

Many IoT scenarios, such as smart cities, wild life monitoring, or smart agriculture, involve thousands of battery-powered devices. The disposal and replacement of such batteries represent an important economical and environmental cost. To realize Green IoT solutions, it is therefore desirable to adopt battery-less energy-neutral devices that can harvest power from renewable sources, such as solar or wind energy and store it in much more sustainable capacitors. The limited and inconstant energy supply and the limited energy storage capacity of such devices, however, require special care in the design of communication and computational processes, which have a major impact on the energy consumption of the devices. In this work, we explore multiple elements that could affect the device energy and communication capabilities of LoRaWAN devices. We propose and compare different energy-aware packet transmission algorithms, and test them in a scenario where values for the harvested power are collected from real testbeds. We show that the number of successfully transmitted packets can be doubled by using an energy-aware design approach

Water absorption, mechanical, and thermal properties of halloysite nanotube reinforced vinyl-ester nanocomposites

Halloysite nanotube (HNT) addition to vinyl-ester resin (VER) is a field yet to contain an in-depth repository of information. This work represents the first study on the development and characterisation of HNT-reinforced VER nanocomposites, and presents findings on their water absorption, mechanical, and thermal properties. VER composites reinforced with HNTs (1, 3, and 5 wt%) were fabricated using high speed mechanical stirring. Weight gain and FTIR spectrum analysis indicated that the addition of 5 wt% HNTs gave perceptible reduction in the water absorption behavior of the samples. Results showed that elastic modulus increased with increasing HNT content. Strength and toughness were also found to steadily increase with increasing HNT content. Favorable strength can be attributable to the large aspect ratio of HNTs, favorable adhesion and dispersion, and the suitable extent of inter-tubular interaction while enhancements to toughness can be attributable to crack bridging, deflection, and plastic deformation mechanisms. Thermal stability of nanocomposites was found remarkably enhanced by the incorporation of HNTs. The thermal stability enhancement and decrease in flammability are attributable to HNT’s barriers for heat and mass transport, presence of iron, and hollow tubular structure