Congenital Cytomegalovirus Testing Outcomes From the ValEAR Trial

OBJECTIVE

To determine the positivity rate of congenital cytomegalovirus (cCMV) testing among universal, hearing-targeted CMV testing (HT-cCMV) and delayed targeted dried blood spot (DBS) testing newborn screening programs, and to examine the characteristics of successful HT-cCMV testing programs.

STUDY DESIGN

Prospective survey of birth hospitals performing early CMV testing.

SETTING

Multiple institutions.

METHODS

Birth hospitals participating in the National Institutes of Health ValEAR clinical trial were surveyed to determine the rates of cCMV positivity associated with 3 different testing approaches: universal testing, HT-cCMV, and DBS testing. A mixed methods model was created to determine associations between successful HT-cCMV screening and specific screening protocols.

RESULTS

Eighty-two birth hospitals were surveyed from February 2019 to December 2021. Seven thousand six hundred seventy infants underwent universal screening, 9017 infants HT-cCMV and 535 infants delayed DBS testing. The rates of cCMV positivity were 0.5%, 1.5%, and 7.3%, respectively. The positivity rate for universal CMV screening was less during the COVID-19 pandemic than that reported prior to the pandemic. There were no statistically significant drops in positivity for any approach during the pandemic. For HT-cCMV testing, unique order sets and rigorous posttesting protocols were associated with successful screening programs.

CONCLUSION

Rates of cCMV positivity differed among the 3 approaches. The rates are comparable to cohort studies reported in the literature. Universal CMV prevalence decreased during the pandemic but not significantly. Institutions with specific order set for CMV testing where the primary care physician orders the test and the nurse facilitates the testing process exhibited higher rates of HT-cCMV testing.

Total temporomandibular joint reconstruction prosthesis in hemifacial microsomia: A systematic review

Hypoplastic asymmetry due to hemifacial microsomia (HFM) often represents the most difficult reconstruction in the craniomaxillofacial clinic. Although autogenous grafts are generally used for temporomandibular joint reconstruction (TMJR), the use of TMJR prostheses is not well established. The aim of this review was to identify, collect and analyse the use of extended TMJR (eTMJR) prostheses in patients with HFM, describing clinical features, surgical procedures and postoperative complications. Online searches of all major databases were performed according to PRISMA guidelines. All studies with HFM patients treated with the eTMJR prostheses were included. Descriptive statistics were used for data analysis. A total of 19 studies, including 08 case studies, 06 case series and 05 retrospective cohort studies, met the inclusion criteria, where a total of 42 HFM patients were reported from 18 countries, mostly from the United States (05; 26%). Fifteen of the 42 cases (~36%) were male. The mean ± SD (range) age of patients in all studies was 19.79 ± 5.81 (9-36) years. The mean ± SD (range) of patient follow-up was 41.30 ± 35.50 (6-136) months. A total of 5 (10.6%) patients were implanted with bilateral eTMJR prostheses. The Pruzansky classification was used in 18 (~89.5%) studies, OMENS classification in 01 (~5%) study, whereas no classification was reported in one study. Only 01 (7.1%) study had documented the eTMJR classification for the prosthesis used. In growing patients with or without a history of failed autogenous tissues, TMJR prostheses may provide a viable alternative. Randomized studies with large cohorts are warranted to validate these preliminary results.

The safety and efficacy of radiofrequency ablation in benign pediatric thyroid disease in the US: An initial case series

Objective

To evaluate the efficacy and safety of radiofrequency ablation (RFA) for benign nonfunctional thyroid nodules or functional lingual thyroid gland in a pediatric population.

Methods

Four pediatric patients (four female; mean age 13.50 ± 4.04, range 8-17 years) with either benign thyroid nodules or mildly obstructive lingual thyroid glands were treated with RFA from 2020 to 2021 were evaluated. The inclusion criteria for RFA therapy were (i) age < 18 years; (ii) benign cytopathological results on ultrasound guided fine needle aspiration; (iii) pressure or pain symptoms caused by the thyroid nodules; (iv) dysphagia or obstruction caused by the lingual thyroid tissue; (v) follow up for >6 months with otolaryngology or endocrinology.

Results

Two patients had benign non-functioning thyroid nodules and two had mildly obstructive functioning lingual thyroid glands. Mean follow up was 10.75 ± 4.79 months. Each patient underwent one RFA session with no complications. For the patients with thyroid nodules, there was >74% reduction in nodule size at last follow up with improvement in neck swelling and pain. For the patients with lingual thyroid glands, both did not have any other functional thyroid gland identified. Both had visible decrease in size of the gland as visualized transorally with improvement in dysphagia and obstructive symptoms when lying flat.

Conclusion

RFA is a safe and effective option for managing benign thyroid nodules and lingual thyroid glands in a pediatric patient population.

Level of evidence

4.

Bedside open tracheostomy in COVID-19 patients - a safe and swift approach

BACKGROUND

Tracheostomy can be performed as an open surgical procedure, percutaneous, or hybrid and forms an important step in the management of patients infected with coronavirus disease 2019 (COVID-19) requiring weaning from mechanical ventilation. The purpose of this article is to share our experience to performing bedside surgical tracheostomy in COVID-19 patients in a safe and effective manner, whilst minimising the risk of viral transmission, to optimise patient outcomes and reduce risk to healthcare professionals.

MATERIAL AND METHODS

As recommended by ENT UK, we prospectively established a COVID Airway Team within the ENT department at Birmingham Heartlands Hospital, consisting of four head and neck consultant surgeons to perform either open-bedside, open-theatre or percutaneous tracheostomy in COVID-19 patients. A specific stepwise method for bedside open surgical tracheostomy was based on ENT UK and British Laryngological Society recommendations.

RESULTS

Thirty patients underwent tracheostomy during the study period (14 bedside-open, 5 open-theatre, 11 percutaneous). Mean duration of mechanical intubation prior to bedside-open tracheostomy was 14.5 days. The average time for open-bedside tracheostomy was 9 minutes compared to 31 minutes for open-theatre. There were no significant tracheostomy related complications with bedside-open tracheostomy. No healthcare professional involved reported acute COVID-19 infection.

CONCLUSIONS

We describe our effective, safe and swift approach to bedside open tracheostomy during the COVID-19 pandemic. Our experience demonstrated a short mean procedural time, with no tracheostomy-related complications and no reported viral transmission amongst the healthcare members involved.

Room temperature bio-engineered multifunctional carbonates for CO2 sequestration and valorization

This contribution reports, for the first time, on an entirely green bio-engineering approach for the biosynthesis of single phase crystalline 1-D nano-scaled calcite CaCO3. This was validated using H2O as the universal solvent and natural extract of Hyphaene thebaica fruit as an effective chelating agent. In this room temperature green process, CaCl2 and CO2 are used as the unique source of Ca and CO3 respectively in view of forming nano-scaled CaCO3 with a significant shape anisotropy and an elevated surface to volume ratio. In terms of novelty, and relatively to the reported scientific and patented literature in relation to the fabrication of CaCO3 by green nano-chemistry, the current cost effective room temperature green process can be singled out as per the following specificities: only water as universal solvent is used, No additional base or acid chemicals for pH control, No additional catalyst, No critical or supercritical CO2 usage conditions, Only natural extract of thebaica as a green effective chelating agent through its phytochemicals and proper enzematic compounds, room Temperature processing, atmospheric pressure processing, Nanoscaled size particles, and Nanoparticles with a significant shape anisotropy (1-D like nanoparticles). Beyond and in addition to the validation of the 1-D synthesis aspect, the bio-engineered CaCO3 exhibited a wide-ranging functionalities in terms of highly reflecting pigment, an effective nanofertilizer as well as a potential binder in cement industry.

Effectiveness of neck stabilization and Contrology training in comparison to conventional therapy amongst individuals with text neck syndrome

OBJECTIVE

Cell phones are carried by 79% of people between 18 and 44 years of age for nearly the entire day. Smartphone users spend an average of three hours/per day on their devices, whereas heavy smartphone users spend 8-10 hours/per day on their devices. Text neck is a dangerous disorder that can accelerate the degeneration of the spine. This study aimed to investigate the efficacy of neck stabilization training vs. Contrology or Pilates training in individuals with Text Neck Syndrome.

PATIENTS AND METHODS

Participants (n=75) with a history of recurrent neck pain in the previous four months, having moderate pain (at least 4/10 on the numeric pain rating scale, NPRS), and constantly using mobile phones (>4 hours/day) were randomly allocated to one of three groups: a control group (neck isometric training) and two intervention groups (neck stabilization training and Contrology). They were assessed for craniovertebral angle (CVA), NPRS, and neck disability index (NDI) at baseline and at 4 weeks post-intervention.

RESULTS

There was a significant difference in the CVA, NPRS, and NDI among individuals with Text Neck Syndrome following intervention as compared to the control. Both the neck stabilization and Contrology training increased CVA and reduced neck pain and neck disability in individuals with Text Neck Syndrome. The two intervention groups showed similar effects in all the clinical outcome measures, suggesting almost equivalent effectiveness in the individuals with Text Neck Syndrome.

CONCLUSIONS

Neck stabilization seems to work better than Contrology training when it comes to increasing the craniovertebral angle, reducing pain intensity, and making it easier for individuals with Text Neck Syndrome to move their necks.

Imaging guidance for cholesteatoma surgery using tissue autofluorescence

Significance

Cholesteatoma is an expansile destructive lesion of the middle ear and mastoid, which can result in significant complications by eroding adjacent bony structures. Currently, there is an inability to accurately distinguish cholesteatoma tissue margins from middle ear mucosa tissue, causing a high recidivism rate. Accurately differentiating cholesteatoma and mucosa will enable a more complete removal of the tissue.

Aim

Develop an imaging system to enhance the visibility of cholesteatoma tissue and margins during surgery.

Approach

Cholesteatoma and mucosa tissue samples were excised from the inner ear of patients and illuminated with 405, 450, and 520 nm narrowband lights. Measurements were made with a spectroradiometer equipped with a series of different longpass filters. Images were obtained using a red-green-blue (RGB) digital camera equipped with a long pass filter to block reflected light.

Results

Cholesteatoma tissue fluoresced under 405 and 450 nm illumination. Middle ear mucosa tissue did not fluoresce under the same illumination and measurement conditions. All measurements were negligible under 520 nm illumination conditions. All spectroradiometric measurements of cholesteatoma tissue fluorescence can be predicted by a linear combination of emissions from keratin and flavin adenine dinucleotide. We built a prototype of a fluorescence imaging system using a 495 nm longpass filter in combination with an RGB camera. The system was used to capture calibrated digital camera images of cholesteatoma and mucosa tissue samples. The results confirm that cholesteatoma emits light when it is illuminated with 405 and 450 nm, whereas mucosa tissue does not.

Conclusions

We prototyped an imaging system that is capable of measuring cholesteatoma tissue autofluorescence.

An institutional review of treatment outcomes in extraosseous Ewing's sarcoma- the largest Asian experience

PURPOSE

To analyze the treatment strategies, outcomes and factors impacting these outcomes in extraosseous ewings sarcoma (EOES).

MATERIAL AND METHODS

A search of the hospital database yielded a total of 109 EOES patients registered in last 10 years out of which 25 patients were excluded from analysis due to incomplete medical records. Demographic and clinical characteristics were reported using descriptive statistics. Overall survival (OS) was taken from the time of diagnosis to death. Patients who were alive or lost to follow up were censored from the survival analysis. A total of 12 clinical and treatment related variables were taken into univariate analysis and those showing significance or a trend towards significance were taken up for multivariate analysis. Further a cluster analysis was done in a quest to find a subgroup which would have a better survival outcome as compared to other clusters. SPSS version 23 was used for statistical analysis.

RESULTS

Chest wall (n=26), lower extremity (n=22) and paraspinal area (n=14) were the common sites involved. Localised swelling (n=43) was the most common presenting symptom and the median time to presentation was 2 months. Overall survival of the entire cohort at 5 years was 52 percent. Stage at presentation had a significant impact (P value<0.001) on estimated median OS (localised 70 months versus 36 months in metastatic stage). Cluster analysis showed that, patients with localised stage at presentation, good response to chemotherapy, negative resection margin and no adjuvant RT had a median survival of 69 months.

CONCLUSION

Judicious use of trimodality treatment in EOES yields optimal results and it also adds significantly onto the scarce literature on this subtype of sarcoma.

Author Correction: Association of monomeric C-Reactive Protein (m-CRP) with hypothalamic neurons after CRP hippo-campal administration in a model of dementia

Correction to: European Review for Medical and Pharmacological Sciences 2022; 26 (22): 8713-8718. DOI: 10.26355/eurrev_202212_30543- PMID: 36524490-published online on December 15, 2022. After publication, the authors applied a correction to the funding statement: The authors extend their appreciation to the deputyship for Research & Innovation, Ministry of Education in Saudi Arabia for funding this research work through the project number (lFP-2020-36). There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/30543.

Aerosol precautions and airway complications: a national prospective multicentre cohort study

The perceived risk of transmission of aerosolised viral particles from patients to airway practitioners during the COVID-19 pandemic led to the widespread use of aerosol precautions, including personal protective equipment and modifications to anaesthetic technique. The risk of these aerosol precautions on peri-operative airway complications has not been assessed outside of simulation studies. This prospective, national, multicentre cohort study aimed to quantify this risk. Adult patients undergoing general anaesthesia for elective or emergency procedures over a 96-hour period were included. Data collected included use of aerosol precautions by the airway practitioner, airway complications and potential confounding variables. Mixed-effects logistic regression was used to assess the risk of individual aerosol precautions on overall and specific airway complications. Data from 5905 patients from 70 hospital sites were included. The rate of airway complications was 10.0% (95%CI 9.2-10.8%). Use of filtering facepiece class 2 or class 3 respirators was associated with an increased risk of airway complications (odds ratio 1.38, 95%CI 1.04-1.83), predominantly due to an association with difficult facemask ventilation (odds ratio 1.68, 95%CI 1.09-2.61) and desaturation on pulse oximetry (odds ratio 2.39, 95%CI 1.26-4.54). Use of goggles, powered air-purifying respirators, long-sleeved gowns, double gloves and videolaryngoscopy were not associated with any alteration in the risk of airway complications. Overall, the use of filtering facepiece class 2 or class 3 respirators was associated with an increased risk of airway complications, but most aerosol precautions used during the COVID-19 pandemic were not.

Association of monomeric C-Reactive Protein (m-CRP) with hypothalamic neurons after CRP hippo-campal administration in a model of dementia

OBJECTIVE

The ensuing ischemia due to the disruption of blood supply to the brain is one of the most common causes of stroke. Evidence suggests a clear association of the ischemic injury with vascular dementia and Alzheimer's disease (AD). In response to the brain ischemia, a cascade reaction starts leading to neuronal damage due to oxidative stress and other inflammatory mediators. A pilot study was done, which showed that following stroke, monomeric-C-reactive protein (mCRP) is expressed in large quantities around the infarcted zone and this CRP is able to induce neurodegeneration and inflammation potentially perpetuating dementia.

MATERIALS AND METHODS

We examined both patient brain samples and excised mouse brain tissue, previously injected with 1.75 mg/mL mCRP into the CA1 area of the hippocampus through the stereotactic surgical procedures and followed them over a period of over 6 months. The distribution of mCRP was examined through immunohistochemistry (mouse anti-human mCRP-specific antibodies 8C10).

RESULTS

We observed a novel finding: those micro vessels close to the injection location were strongly stained with mCRP only in the mice that had been injected with mCRP, indicating that this small blood vessel can spread it throughout the brain.

CONCLUSIONS

mCRP found in the brain after a hemorrhagic stroke promotes damage over a large area via the induction of inflammation and degeneration of perivascular compartments.

Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft with Fixation Using Endobutton at Femoral End and Bioabsorbable Screw at Tibial End

Anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. It can be repaired and reconstructed by open and endoscopic method, the gold standard is, however, endoscopic reconstruction. It is usually reconstructed using bone patellar tendon bone (BPTB) or Hamstring autograft. The graft is supported using endobutton at the femoral end while bioabsorbable interference screw at the tibial end. This study aimed to determine how a certain fixation procedure for quadrupled hamstring autografts worked out. This prospective observational study duration period was 1 year in which 40 patients with ACL injury were treated with arthroscopic reconstruction using hamstring autograft from January 2020 to December 2020 with 6 months follow up after surgery. On the femoral side, an endobutton was used to secure the graft, while the tibial end was secured using a bioabsorbable screw. The International Knee Documentation Committee (IKDC) scoring system was used for prospective evaluation. According to subjective IKDC scoring, 20(50.0%) results were very good, 14(35.0%) were good, 4(10.0%) were satisfactory and 2(5.0%) were bad. In 95.0% patients the state of knee joint is very good compared to preoperative state. Of all the 40 patients underwent ACL reconstruction, 38(95.0%) patients are satisfied with the results of the operation.

Artificial intelligence and tele-otoscopy: A window into the future of pediatric otology

Telehealth in otolaryngology is gaining popularity as a potential tool for increased access for rural populations, decreased specialist wait times, and overall savings to the healthcare system. The adoption of telehealth has been dramatically increased by the COVID-19 pandemic limiting patients' physical access to hospitals and clinics. One of the key challenges to telehealth in general otolaryngology and otology specifically is the limited physical examination possible on the ear canal and middle ear. This is compounded in pediatric populations who commonly present with middle ear pathologies which can be challenging to diagnose even in the clinic. To address this need, various otoscopes have been designed to allow patients, their parents, or primary care providers to image the tympanic membrane and middle ear, and send data to otolaryngologists for review. Furthermore, the ability of these devices to capture images in digital format has opened the possibility of using artificial intelligence for quick and reliable diagnostic workup. In this manuscript, we provide a concise review of the literature regarding the efficacy of remote otoscopy, as well as recent efforts on the use of artificial intelligence in aiding otologic diagnoses.

Effect of season and housing system on hematochemical attributes in rabbits of Southern Punjab, Pakistan

ABSTRACT The present study was conducted to investigate the effect of season and housing system on hematochemical attributes of rabbits in Southern Punjab, Pakistan. Adult healthy rabbits (n=30) were divided into two groups of equal size (n=15). Group I was housed in a modern cage system and group II in traditional colony system for a period of one year. Blood samples of rabbits from both groups were collected in the summer and the winter seasons and analyzed for various hematochemical attributes. Hematochemical attributes including red blood cell (RBC) count, hematocrit (HCT), mean corpuscular volume (MCV), total white blood cell (WBC) count, mixed cells (MID), granulocytes (GRA), glucose and alanine aminotransferase (ALT) were lowered significantly (P<0.05) in the summer in relation to the winter, while mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), creatinine, and cholesterol level were significantly (P<0.05) higher during the summer season. Biochemical attributes as cholesterol, triglycerides and globulin were significantly (P<0.05) lower in the caged rabbits. In conclusion, the summer season caused a significant decrease in most of the hematochemical attributes whereas housing system did not affect most of the hematochemical attributes of the rabbits under the climatic conditions of Southern Punjab, Pakistan.

Recent advances and challenges in 2D/2D heterojunction photocatalysts for solar fuels applications

Although photocatalytic technology has emerged as an effective means of alleviating the projected future fuel crisis by converting sunlight directly into chemical energy, no visible-light-driven, low-cost, and highly stable photocatalyst has been developed to date. Due to considerably higher interfacial contact with numerous reactive sites, effective charge transmission and separation ability, and strong redox potentials, the focus has now shifted to 2D/2D heterojunction systems, which have exhibited effective photocatalytic performance. The fundamentals of 2D/2D photocatalysis for different applications and the classification of 2D/2D materials are first explained in this paper, followed by strategies to improve the photocatalytic performance of various 2D/2D heterojunction systems. Following that, current breakthroughs in 2D/2D metal-based and metal-free heterojunction photocatalysts, as well as their applications for H₂ evolution via water splitting, CO₂ reduction, and N₂ fixation, are discussed. Finally, a brief overview of current constraints and predicted results for 2D/2D heterojunction systems is also presented. This paper lays out a strategy for developing efficient 2D/2D heterojunction photocatalysts and sophisticated technology for solar fuel applications in order to address the energy issue.

Optimizing cardio, hepato and phospholipidosis toxicity of the Bedaquiline by chemoinformatics and molecular modelling approach

The FDA granted expedited approval for Johnson and Johnson's Bedaquiline to treat pulmonary multidrug resistant tuberculosis on 28 December 2012 which is more common in China, Russian Federation and India. Bedaquiline is the first anti-tubercular drug approved by the FDA in the last 40 years, and it has become a cynosure in the circles of synthetic chemists researching new anti-tubercular drugs. Bedaquiline's highly lipophilic nature raises major concerns like suppression of the hERG gene, hepatotoxicity, and phospholipidosis despite its potential antitubercular profile. To address these toxicity concerns, in the present work, we have employed the structural optimization of Bedaquiline using the ADMETopt web server, which optimizes lead with scaffold hopping and ADMET screening. The ADMETopt web server yielded the 476 structures through optimization of three sites in Bedaquiline. Further, we have validated the optimized structures for their activity by performing molecular docking and molecular dynamics (MD) simulations against the mycobacterial ATP synthase enzyme and density functional theory (DFT) study further provides insight into the reactivity of the compounds. After screening and analysis, compound #449 was observed to be the most promising mycobacterial ATP synthase inhibitor with minimal cardiotoxicity, hepatotoxicity and phospholipidosis.

A new approach to solve fully intuitionistic fuzzy linear programming problem with unrestricted decision variables

In many real-world problems, one may encounter uncertainty in the input data. The fuzzy set theory fits well to handle such situations. However, it is not always possible to determine with full satisfaction the membership and non-membership degrees associated with an element of the fuzzy set. The intuitionistic fuzzy sets play a key role in dealing with the hesitation factor along-with the uncertainty involved in the problem and hence, provides more flexibility in the decision-making process. In this article, we introduce a new ordering on the set of intuitionistic fuzzy numbers and propose a simple approach for solving the fully intuitionistic fuzzy linear programming problems with mixed constraints and unrestricted variables where the parameters and decision variables of the problem are represented by intuitionistic fuzzy numbers. The proposed method converts the problem into a crisp non-linear programming problem and further finds the intuitionistic fuzzy optimal solution to the problem. Some of the key significance of the proposed study are also pointed out along-with the limitations of the existing studies. The approach is illustrated step-by-step with the help of a numerical example and further, a production planning problem is also demonstrated to show the applicability of the study in practical situations. Finally, the efficiency of the proposed algorithm is analyzed with the existing studies based on various computational parameters.

Study of human knowledge and attitude toward urban birds in Faisalabad city, Pakistan

Birds are very valuable indicators of species richness and endemic patterns in a specified ecosystem, which eventually help the scientist to measure the environmental degradation. The aim of present study was to know human knowledge and attitude toward urban birds in Faisalabad city, Pakistan. The study conducted in four consecutive months: November 2019 to February 2020. Population of birds was noted from eight residential towns of Faisalabad city, data were collected through questionnaire. Faisalabad has a reasonably large population of birds and present data show that, there is a significant difference between favorite bird of residential areas and institutions. The pigeon received the most likeness in bird population among residential area residents, while the myna received the least. The most popular bird in Faisalabad institutions was the sparrow, while the least popular bird was the common myna. Bird adaptation percentage of residential areas and institutional areas of Faisalabad was the highest for parrot and sparrow respectively. People in residential areas and institutions, on the other hand, adapted least to common myna. It is concluded that people of the study area like birds and offered food and high population of birds are present in study area.

Effect of microwave plasma treatment on magnetic and photocatalytic response of manganese ferrite nanoparticles for wastewater treatment

The conventionally synthesized nano-ferrite materials do not possess bulk properties, generally required for their use in mainstream industry. To make ferrite nanoparticles clinically applicable materials, it is important to have good control over morphology and optical properties of these materials. In this study, low-pressure microwave plasma was used to tailor the structural properties and surface chemistry of manganese ferrite nanoparticles. A facile sol-gel method was used to prepare cubic spinal structures of manganese ferrite nanoparticles. These nanoparticles were exposed to oxygen plasma sustained with a microwave source for improving their magnetic and photocatalytic activities. The techniques like XRD, SEM, PL, UV-Vis DRS, transient photocurrent response and EIS were used to characterize the samples. The plasma treated nanoparticles were used to degraded methyl blue (MB) dye in the solution. The photocatalytic activity showed 85% degradation of MB after 100 min of exposure of visible light. The second part of the paper studied the magnetic properties of the nanoparticles. The saturation magnetization decreased from 0.78 emu/g to 0.68 emu/g after plasma treatment of nanoparticles.

Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, the British Association of Endocrine and Thyroid Surgeons and the British Association of Otorhinolaryngology, Head and Neck Surgery

Haematoma after thyroid surgery can lead to airway obstruction and death. We therefore developed guidelines to improve the safety of peri‐operative care of patients undergoing thyroid surgery. We conducted a systematic review to inform recommendations, with expert consensus used in the absence of high‐quality evidence, and a Delphi study was used to ratify recommendations. We highlight the importance of multidisciplinary team management and make recommendations in key areas including: monitoring; recognition; post‐thyroid surgery emergency box; management of suspected haematoma following thyroid surgery; cognitive aids; post‐haematoma evacuation care; day‐case thyroid surgery; training; consent and pre‐operative communication; postoperative communication; and institutional policies. The guidelines support a multidisciplinary approach to the management of suspected haematoma following thyroid surgery through oxygenation and evaluation; haematoma evacuation; and tracheal intubation. They have been produced with materials to support implementation. While these guidelines are specific to thyroid surgery, the principles may apply to other forms of neck surgery. These guidelines and recommendations provided are the first in this area and it is hoped they will support multidisciplinary team working, improving care and outcomes for patients having thyroid surgery.

Time, cost and carbon-efficiency: a silver lining of COVID era virtual urology clinics?

INTRODUCTION

The COVID-19 pandemic has demanded radical changes in service delivery. Our centre adopted the use of outpatient telemedicine to reduce close-contact interactions between patients and staff. We hypothesised that incidental gains may be associated with this. We evaluated financial, practical and environmental implications of substituting virtual clinics (VCs) for in-person urology outpatient appointments.

METHODS

VCs were studied over a 3-month period. Based on patient-reported 'usual mode of transport' to the hospital, travel distance, time, petrol and parking costs, and the carbon emissions avoided by virtue of remote consultations were calculated. The underlying symptom/diagnosis and the 'effectiveness' of the VC were evaluated.

RESULTS

Of 1,016 scheduled consultations, 736 (72.44%) were conducted by VCs over the study period. VCs resulted in an agreed treatment plan in 98.4% of a representative patient sample. The use of VCs was associated with an overall travel distance saving for patients of 31,038 miles (49,951km) over 3 months, with an average round-trip journey of 93.8 miles (151km) avoided for each rural-dwelling patient and an average financial saving of £25.91 (€28.70) per rural-dwelling car traveller. An estimated 1,257.8 hours of patient time were saved by avoidance of travel and clinic waiting times. Based on car-travelling patients alone, a 6.07-tonne reduction in carbon emissions was achieved with the use of VCs.

CONCLUSIONS

In appropriate clinical circumstances, VCs appear to provide efficiency across a number of domains. Future healthcare may involve offering outpatients the option of telemedicine as an alternative to physical attendance.

"Osteomyelitis of mandible"-a rare presentation of osteopetrosis

Osteopetrosis is a rare metabolic disease. Dental abnormalities may be attributed to the pathological changes in osteopetrosis. Patients with disease seem to be especially susceptible to osteomyelitis of mandible. A 9 yrs old girl presented with complaints of jaw swelling on left side with multiple discharging sinuses since last seven months. The radiograph of left mandible (oblique lateral view) showed periodontal involvement of associated molars with loss of lamina dura with small sequestrum with irregularity and erosions of the mandibular cortical margins. The patient was diagnosed as a case of osteopetrosis with superadded mandibular osteomyelitis.

Unified Approach for the Total Synthesis of Bis-THF C15 Acetogenins: A Chloroenyne from Laurencia majuscula, Laurendecumenyne B and Laurefurenynes A/B

A highly diastereoselective total synthesis of several bis-THF C15 acetogenin natural products, chloroenyne from Laurencia majuscula, laurendecumenyne B, and laurefurenynes A/B, is reported. Additionally the synthesis of an advanced intermediate reported in the earlier total synthesis of (E/Z)-elatenynes (formal synthesis) is described. The salient features in the synthesis include epoxide opening, Birch reduction, Sharpless asymmetric dihydroxylation-cycloetherification, SN2 halo­genation, and a relay cross metathesis.

Role of beneficial microbes with nitrogen and phosphorous levels on canola productivity

A research was conducted to evaluate the impact of various nitrogen and phosphorus levels along with beneficial microbes to enhance canola productivity. The research was carried out at Agronomy Research Farm, The University of Agriculture Peshawar in winter 2016-2017. The experiment was conducted in randomized complete block factorial design. The study was comprised of three factors including nitrogen (60, 120 and 180 kg ha-1), phosphorous (70, 100 and 130 kg ha-1) and beneficial microbes (with and without BM). A control treatment with no N, P and BM was also kept for comparison. Application of beneficial microbes significantly increased pods plant, seed pod, seed filling duration, 1000 seed weight, biological yield and seed yield as compared to control plots. Nitrogen applied at the rate of 180 kg ha-1 increased pods plant-1, seed pod, seed filling duration, seed weight, biological yield and seed yield. Maximum pods plant-1, seed pod, early seed filling, heavier seed weight, biological yield, seed yield, and harvest index were observed in plots treated with 130 kg.ha-1 phosphorous. As comparison, the combine treated plots have more pods plant-1, seeds pod-1, seed filling duration, heaviest seeds, biological yield, seed yield and harvest index as compared to control plots. It is concluded that application of beneficial microbes with N and P at the rate of 180 kg ha-1 and 130 kg ha-1, respectively, increased yield and its attributes for canola.

Bioactive compounds and antioxidant activity of black and green tea available in Bangladesh

People in Bangladesh are traditionally used to consume mainly black tea. However, some tea manufacturing companies are now producing green tea, though in a small scale. To create new knowledge as well as awareness about the consumption of green tea, the present study was carried out to compare the black and green tea available in Bangladesh based on their bioactive compounds and antioxidant activity. A total of eight brands of black tea and two brands of green tea were bought from the supermarkets. Total phenolics, total tannin, total flavonoids, and caffeine content were measured as bioactive compounds, and antioxidant activity was evaluated by using two different methods such as DPPH (1,1- diphenyl-2-picrylhydrazyl) radical-scavenging activity and ABTS+ radical scavenging activity of methanol extracts of black and green tea. Every bioactive compound in black and green tea was found to be significantly different (P < 0.05). The total phenolic content, on average, was measured at 242.46 mg GAE/g dry extract and 763.41 mg GAE/ g dry extract in black and green tea, respectively. Black tea contained 6.47 mg TAE/g dry extract tannin, whereas green tea had much more tannin content, 14.51 mg TAE/g dry extract, which is more than double in amount. On the other hand, the total flavonoid content was almost double in black tea (61.82 mg QE/g dry extract) compared to green tea (31.85 mg QE/g dry extract). Antioxidant activities were determined at different concentrations of tea samples. At every concentration, green tea presented higher ABTS+ and DPPH radical scavenging activity than black tea. The highest percentage of inhibition was observed at 20 ppm both in black and green tea, finding 98.50 % and 99.07 % inhibition, respectively. Overall, significantly (P < 0.05) higher amount of phenolic compounds as well as antioxidant activity were observed in green tea.

Optimal NH4 + /NO3 - ratios enhance the shade tolerance of soybean seedlings under low light conditions

In the maize-soybean intercropping system, shade is the major chronic restraint that affects normal growth of soybean. Different spatial patterns of this system affect the microclimate of soybean through shading from maize plants. However, the negative impacts of shading stress can be mitigated by providing optimal ratios of different fertilizers. Therefore, to test this hypothesis, soybean plants were grown under different light conditions (normal light or shade) to evaluate the response to varying NH4 + /NO3 - ratios. Seeds of soybean (Glycine max L. cv. Nan-99-6) were grown in nutrient solution with a total concentration of 5 mM N using different NH4 + /NO3 - ratios (T0  = 0:0, T1  = 0:100, T2  = 25:75, T3  = 50:50 and T4  = 75:25) for 40 days in a greenhouse at PPFD 320.95 μmol m-2  s-1 (low light) or 967.53 μmol m-2  s-1 (normal light). Under low light, growth and photosynthesis of soybean seedlings significantly decreased as compared to normal light conditions. However, the optimal ratios of NH4 + / NO3 - improved growth and photosynthesis of soybean seedlings under both light conditions. Our results indicated that soybean seedlings supplied with optimal NH4 + /NO3 - ratios (25:75 and 50:50) have maximum biomass yield, chlorophyll pigments, leaf gas exchange, photochemical activity and root growth as compared to low and high NH4 + /NO3 - ratios (T1 and T4 ). High ratios of NH4 + /NO3 - (T4 ) resulted in reduced plant growth due to nutrient accumulation in plant tissues; therefore, we suggest that optimal ratios of NH4 + /NO3 - (T2 and T3 ) can enhance the shade tolerance of soybean seedlings.