External Approach Research Articles

Endoscopic Dacryocystorhinostomy Following Nasolacrimal Drainage System Trauma and Medial Orbital Wall Reconstruction

Study Design Case series. Objective To describe the assessment and surgical approach to dacryocystorhinostomy (DCR) for patients with nasolacrimal duct obstruction (NLDO) in the presence of orbital wall hardware. Methods The pre-operative assessment, management and outcomes of two patients with secondary acquired NLDO following medial orbital wall fracture repair treated by nasal endoscopic DCR. Results Anatomical and functional success was achieved in both cases at 6 weeks post operatively without disruption of the orbital plate. There was persistent success at 1 and 3 years’ post-operatively. Conclusions Endoscopic DCR is a good option for the treatment of NLDO in patients with previous medial orbital wall fracture repair where the location of the plate may complicate the external approach.

Bright cyan emission from Eu-Doped borosilicate glasses by optimizing reduction of Eu3+ to Eu2+ in ambient atmosphere

Although substantial strides have been made in exploring the blue and red emissions of amorphous glass under near-ultraviolet excitation for LEDs purpose, the lack of the cyan emission heavily hinders the full spectra LED towards high-quality application. Addressing this cyan gap in white-light LED technology calls for the doping of Eu2+ as the doping center for its highly efficient luminescence. However, Eu3+ as an oxidation state of europium ions poses a critical challenge in effectively reducing to its reduction state. A popular method for reduction involves using mixed gases such as N2/H2 or CO gases in a reaction container, yet this approach brings about environmental pollution and increases production costs. In this work, we proposed a novel strategy that bright cyan emission can be achieved in Eu-doped borosilicate glasses by optimizing reduction of Eu3+ to Eu2+ in ambient atmosphere. It is observed a gradual increase in the band emission intensity associated with the reduced Eu2+, accompanied with a concurrent decrease in the sharp peak intensity linked with Eu3+ with the growing Si3N4 content. The effect of both melting temperature and synthesis time on reduction effect on the reduction of Eu3+ to Eu2+ ions were also investigated. It is revealed that either longer synthesis times or higher melting temperatures diminished the efficient reduction of Eu3+ to Eu2+ ions during the first-melting. Expanding on the Si3N4 reduction method, we employed an external bamboo charcoal approach to produce Eu-doped borosilicate glass under various synthesis times during the secondary melting. The results show that longer synthesis times attributed to the reduction effect. Finally, the optimized cyan-emitting glass sample is featured with emission wavelength of 486 nm, a transmittance of 84 %, and a quantum yield of 37.97 %. All the significant results are paving the solid way to prepare cyan-emitting glasses in the future.

On‐farm performance evaluation of small‐scale irrigation schemes in the Ethiopian Rift Valley: Internal and external performance process approach

AbstractThis study evaluated the on‐farm performance of two small‐scale irrigation schemes, Furfuro and Bedene Alemtena (hereafter referred to as Bedene), in the Ethiopian Rift Valley. Two sets of performance indicator parameters were used. The first group was internal performance indicators, which included conveyance, water application and application uniformity. The water flow velocity through canals was monitored using the floating method. The amount of irrigation water applied to the fields was measured using a cutthroat flume. The second group was external performance indicators, including agricultural performance, water use performance and physical sustainability indicators. The results indicated that Furfuro had average conveyance, application and uniformity efficiencies of 84%, 59% and 50%, respectively, while that of Bedene were 79%, 63% and 55%, respectively. The overall efficiencies for both schemes were about 49%, which is lower than the minimum permissible values. The outputs per irrigation supply and consumed water for Furfuro were 0.14 and 0.16 US$/m3, respectively, and they were 0.11 US$/m3 for Bedene. The relative irrigation and total water supply of Furfuro were 1.21 and 1.20, respectively, indicating the presence of excess water in the command area during the study season. The relative irrigation and water supply of Bedene was 0.81, which indicated that the scheme was water deficient. Irrigation water management practices need improvement in the two schemes.

Transoral endoscopic-assisted VS external approach for performing ORIF in mandibular condyle fractures: A case-series study

ObjectiveThe treatment of condylar fractures can have significant morbidity. The purpose of this study is to suggest the safest approach by comparing endoscope-assisted and open surgery. MethodsA case-series study was conducted in the Maxillo-Facial Surgery Unit of the Federico II University of Naples from January 2016 to January 2022 on 34 patients who underwent surgery for condylar fracture. Thirty patients met the inclusion criteria. They were divided into two groups according to the surgical technique used: Group A, made up of 15 patients treated by endoscope-assisted surgery; Group B made up of 15 patients treated by traditional non-endoscope-assisted surgery. ResultsThe most common complication was transient facial nerve palsy, observed in group B in 4 patients (26%) and in only 2 patients in Group A (13%). Permanent facial nerve palsy occurred in 2 patients (13%) in Group B. No permanent facial nerve palsy was observed in Group A. No plates infection occurred in Group A, 1 case (7%) was recorded in Group B. ConclusionsFrom our experience we can consider endoscope-assisted surgery a favorable option for treating condyle fractures. Patients’ selection for transoral endoscope-assisted surgery is extremely important to ensure the best surgical results with the less complications score.

Perencanaan Strategi Pengembangan Usaha Menggunakan Formulasi Matrik SWOT dan Metode QSPM

This study aims to formulate appropriate marketing strategy planning alternatives through analyzing the approach of internal factors and external factors as an effort to face competitors from Aulia Jambi Toothpick Chips. The sampling method in this study was purposive sampling, so that the total sample obtained was 30 respondents consisting of 5 from internal, namely the management of the Aulia Toothpick Chips factory employees and 25 from external, namely consumers. The analysis method used in this research is SWOT analysis (Strength, Weakness, Opportunities, and Threats) through an internal and external factor approach with the calculation of the IFE and EFE matrix table analysis and the QSPM method. The results of IFE internal factors and EFE external factors, obtained a Strength value of 2.08 and Weaknesess of 1.08 while the Opportunities value is 1.92 and Threats is 1.38. Based on the results of the calculation of the analysis quadrant diagram using the IFE and EFE approaches, it can be concluded that the x, y axes are at the Quadrant I point, so the strategy that must be applied in this condition is to support aggressive growth policies (Growth Oriented Strategy). So that the right alternative strategy for Aulia's Toothpick Chips MSME players is the S-O (Strength-Opportunities) strategy. The S-O (Strength-Opportunities) strategy, which is referred to as an aggressive growth strategy, is through the use of digital marketing for the marketing system, providing special offers and maintaining product quality.

Three approaches to the 1951 convention: The case for a dialectical approach

Abstract This article explores three different methodological approaches to the UN 1951 Convention on the Status of Refugees—and international refugee law (IRL) more broadly. These are termed the internal, external and dialectical approaches. It is argued that the dialectical approach, which combines elements of the internal and external approaches using a materialist postcolonial perspective helps make out in the light of changing conditions a more persuasive case for liberal interpretation and reform of the 1951 Convention. Put differently, the article is about the limitations and failings of mainstream IRL scholarship, which essentially pursues an internal approach to the 1951 Convention. It is equally about the need to decolonize and transform the pedagogy and research of IRL. This article concludes with some suggestions to advance refugee rights that would allow the 1951 Convention to respond more effectively to the protection needs of refugees around the world.

Sacral neuromodulation for constipation and fecal incontinence in children and adolescents – study protocol of a prospective, randomized trial on the application of invasive vs. non-invasive technique

BackgroundA therapeutic effect of sacral neuromodulation (SNM) on fecal incontinence (FI) and quality of life has been proven in adults. SNM is, however, rarely used in pediatric cases. The aim of the study is to investigate effects of SNM in pediatric constipation in a prospective parallel-group trial.MethodsA monocentric, randomized, unblinded, parallel-group trial is conducted. SNM is conducted in the invasive variant and in an innovative, external approach with adhesive electrodes (enteral neuromodulation, ENM). We include patients with constipation according to the ROME IV criteria and refractory to conventional options. Patients with functional constipation and Hirschsprung’s disease are able to participate. Participants are allocated in a 1:1 ratio to either SNM or ENM group. Clinical data and quality of life is evaluated in regular check-ups. Neuromodulation is applied continuously for 3 months (end point of the study) with follow-up-points at 6 and 12 months. Findings are analyzed statistically considering a 5% significance level (p ≤ 0.05). Outcome variables are defined as change in (1) episodes of abdominal pain, (2) episodes of FI, (3) defecation frequency, (4) stool consistency. Improvement of proprioception, influence on urinary incontinence, quality of life and safety of treatment are assessed as secondary outcome variables. We expect a relevant improvement in both study groups.DiscussionThis is the first trial, evaluating effects of neuromodulation for constipation in children and adolescents and comparing effects of the invasive and non-invasive application (SNM vs. ENM).Trial registrationThe study is registered with clinicaltrials.gov, Identifier NCT04713085 (date of registration 01/14/2021).

Orbital Subperiosteal Abscess Complicating Acute Ethmoiditis: A Case Report and Review of the Literature

Acute ethmoiditis in children is an infection of the ethmoid sinuses. The germs most often involved are Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus. The diagnosis is made when edema appears in the internal angle of the eye, often in the context of common nasopharyngitis. The Chandler classification codes the involvement of the orbit which can jeopardize the visual prognosis at advanced stages. The CT scan of the face confirms the diagnosis and helps detect ocular and endocranial complications. Treatment is essentially medical based on a combination of antibiotics. Surgery consists of drainage of the orbital abscess by external, endoscopic or combined approach.

Marketing and Corporate Social Responsibility of Trading Business in Southern Philippines

A well-planned and implemented marketing strategy and strong Corporate Social Responsibility programs could give any company a competitive advantage over its competitors. This research examined how the CTC Company in Southern Philippines survived and expanded the business through marketing strategies and social responsibility initiatives to their stakeholders. Secondary data from their website and annual reports were used by the researchers supported by interviews of the selected officers and employees of the company. Through offering quality products, providing outstanding customer service, and constantly innovating for the customer’s needs, the company grew bigger and expanded its business to other locations. The company used internal and external approaches to its CSR. In conclusion, the company was successful in its marketing strategies and able to sustain its Corporate Social Responsibility which led to the expansion of the business in Southern Philippines. Recommendations are: management can continue its product innovations not only to the leading products but also include those products which are less in demand, the corporation may provide job opportunities not only locally but also in international regions, and Corporate Social Responsibility should be strengthened not only in Davao and Cagayan de Oro Branches but also in other branches of CTC Company in Southern regions.

Exploring Attitude and Behavior Towards Shopping at Zero-Waste Store: An intra-personal and external factors approach

Many retailers have switched their business model to zero-waste retail to preserve the environment. However, many consumers still feel unfamiliar with this system and thus feel reluctant to continue shopping at zero-waste retail. This study employed the internal-external approach to comprehend consumers' intentions to shop at zero-waste stores. A total of 125 responses were collected and analyzed in SEM with Lisrel. This study found that environmental knowledge and reputation positively impact attitudes toward shopping in zero-waste stores, which in turn would also affect purchase behavior toward zero-waste stores.

External inspection approaches and involvement of stakeholders’ views in inspection following serious incidents - a qualitative mixed methods study from the perspectives of regulatory inspectors

ObjectiveThe objective was to gain knowledge about how external inspections following serious incidents are played out in a Norwegian hospital context from the perspective of the inspectors, and whether stakeholders’ views are involved in the inspection.MethodsBased on a qualitative mixed methods design, 10 government bureaucrats and inspectors situated at the National Board of Health Supervision and three County Governors in Norway, were strategically recruited, and individual semi-structured interviews were conducted. Key official government documents were selected, collected, and thematically analyzed along with the interview data.ResultsOur findings overall demonstrate two overarching themes: Theme (1) Perspectives on different external inspection approaches of responding and involving stakeholders in external inspection following serious incidents, Theme (2) Inspectors’ internal work practices versus external expectations. Documents and all participants reported a development towards new approaches in external inspection, with more policies and regulatory attention to sensible involvement of stakeholders. Involvement and interaction with patients and informal caregivers could potentially inform the case complexity and the inspector’s decision-making process. However, stakeholder involvement was sometimes complex and challenging due to e.g., difficult communication and interaction with patients and/or informal caregivers, due to resource demands and/or the inspector’s lack of experience and/or relevant competence, different perceptions of the principle of sound professional practice, quality, and safety. The inspectors considered balancing the formal objectives and expectations, with the expectations of the public and different stakeholders (i.e. hospitals, patients and/or informal caregivers) a challenging part of their job. This balance was seen as an important part of the continuous development of ensuring public trust and legitimacy in external inspection processes.Conclusions and implicationsOur study suggests that the regulatory system of external inspection and its available approaches of responding to a serious incident in the Norwegian setting is currently not designed to accommodate the complexity of needs from stakeholders at the levels of hospital organizations, patients, and informal caregivers altogether. Further studies should direct attention to how the wider system of accountability structures may support the internal work practices in the regulatory system, to better algin its formal objectives with expectations of the public.

Simple Method for Predicting the Heats of Formation of Energetic Metal–Organic Frameworks

The heats of formation (HOF) of energetic materials is crucial in determining their performance. A novel approach has been introduced to accurately predict the condensed phase HOF of energetic metal-organic frameworks (EMOFs). The experimental condensed phase HOF data of 63 EMOFs were utilized to develop and evaluate the model. This model relies on particular chemical bonds, elemental composition, and some of the specific structural parameters that can be obtained from the chemical structures of EMOFs. This model can be easily applied to EMOFs with intricate compositions and structures, without the need for complicated computer codes. Statistical parameters along with the internal and external validation approaches were employed to assess the accuracy, precision, goodness-of-fit, and goodness-of-prediction of the model. Values of the coefficients of determination in training set, as well as internal and external validation, i.e., R2, \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\ ext{Q}}_{{{\ ext{LOO}}}}^{2}$$\\end{document}, \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\ ext{Q}}_{{5{\ ext{-fold}}}}^{2}$$\\end{document}, and \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$R_{{{\ ext{External}}}}^{2}$$\\end{document} are 0.96, 0.93, 0.91, and 0.94, respectively.

The Effect of Different Methods of Nano SiO2 coating on Thermoplastic Partial Denture Clasp Materials and Their Effect on Hydrophobicity

Objectives: This in-vitro study aimed to determine the best coating technique of nano SiO2 liquid material and its effect on hydrophobicity of thermoplastic partial denture clasp resins. Materials and methods: 80 thermoplastic disc specimens (Acetal, n=40 and Polyamide, n=40) were fabricated. The specimens were randomly divided into 4 subgroups (n=10/group); brush coating, spray coating, dip coating and uncoated as control group. SEM was used to evaluate the surface topography and the spread of coating material. The subjective method, image quality assessment was used to quantify the images’ quality. The mean contact angle was identified by using Image J software. Results: Mean of opinion score of SEM showed that dip-coated specimens of the two tested materials showed the best coating spread quality among the other coating techniques. Image J software measurements revealed that the contact angle of dip-coated acetal and polyamide specimens exhibited the highest contact angle sequentially in comparison to all tested specimens. Conclusion: These results suggest that the dip coating technique has the best results in comparison with the two other coating techniques. Nano SiO2 coating of thermoplastic clasp materials has improved their contact angle which in turn has improved the hydrophobicity of these clasp materials because their external properties are better than those of control specimens. This study will provide a novel external approach for ameliorating thermoplastic partial denture clasp materials using nano SiO2 to enhance their surface properties and solve their limitations and therefore promote the use of these aesthetic clasps.

Novel method for chlorine determination in biofuel lipid feedstock by coupling a total sample introduction system (hTISIS) to an inductively coupled plasma tandem mass spectrometry (ICP-MS/MS)

BackgroundChlorine concentrations above 1 mg kg−1 in lipid feedstocks for biofuel production can generate corrosion issues in the different refining units as well as catalyst deactivation by clogging or fouling. To reach accurate analyses by inductively coupled plasma (ICP) techniques at low concentration levels, dilution in organic solvents rises as a simpler and more straightforward sample preparation methodology than conventional sample decomposition procedures (e.g., microwave-assisted acid digestion). However, matrix effects and the impact of the Cl chemical form on the signal must be overcome to obtain accurate results. ResultsIn this work, the high temperature torch integrated sample introduction system (hTISIS) operated at 350 °C is coupled to an inductively coupled plasma tandem mass spectrometry (ICP-MS/MS) for the determination of Cl in lipid biofuel feedstock samples diluted in xylene and these results are compared with those reported by a conventional sample introduction system. Under optimal conditions of the hTISIS-ICP-MS/MS configuration, matrix effects are efficiently overcome (recovery values ranged from 101 to 104%) as well as the effect of the Cl chemical form on the signal for 6 organochloride compounds. Thus, an external calibration approach can be set to carry out the quantification of this element in real samples. The method is successfully validated, obtaining a good agreement in the Cl concentration reported in a standard reference material (SRM NIST 1634c) and also by comparing the concentration results obtained by external calibration and standard addition approaches in two biofuel feedstock samples. Significance and noveltyThe hTISIS coupled to an ICP-MS/MS system is used for the first time to overcome not only matrix effects but also the impact of the Cl chemical form in biofuel feedstock samples. This novel method, with a limit of quantification (LOQ) of 7.1 μg kg−1, give access to an accurate Cl determination in all kind of lipid feedstocks for clean fuel production.

The use of Microsurgical Exploration of the External Carotid Artery for Removal of a Retained Microcatheter After Middle Meningeal Artery Embolization Using Live Fluoroscopy: A Technical Note

Fragmentation, disconnection, or entrapment of an in-use microcatheter during neuro-endovascular procedures is a known risk. Often a benign entity, retained catheters are not infrequently observed, but severe complications including thrombus, thromboembolic events, pseudoaneurysm, and limb ischemia have been described, necessitating retrieval. This technical case report demonstrates the safe use of an external carotid artery (ECA) approach for ligation and removal of a retained microcatheter after middle meningeal artery (MMA) embolization. This article also demonstrates the use of live intraoperative fluoroscopy as a surgical adjunct to ensure that the catheter is fully removed without any injury, shearing, or breakage during removal. A 66-year-old male patient presented with bilateral subdural hematomas to an outside hospital. He subsequently underwent evacuation of the hematomas followed by a right-sided MMA embolization, complicated by Onyx (Medtronic, Minneapolis, MN) entrapment of the microcatheter in the MMA. The patient was asymptomatic, but there was significant concern about continuing antiplatelet/anticoagulation therapy in the presence of the subdural hematoma. We proceeded with an open surgical approach for catheter retrieval. As the catheter was withdrawn, intraoperative fluoroscopy demonstrated complete removal without any retained fragments. The patient recovered without event and was discharged on postoperative day 1. On follow-up the patient continued to do well without any complications from the fragment that remained in the external carotid circulation. This case and accompanying video demonstrates the effective use of open ECA surgical approach to retrieve the retained microcatheter after an MMA embolization. This approach allowed for safe and effective removal of the microcatheter while significantly reducing complication risks.

The Relationship Between Destruction Sites and Clinical Findings in Diffuse Paranasal Sinus Mucoceles.

This study aimed to investigate that complicated mucoceles of paranasal sinuses and their clinical presentation, complications of relations with size, destructions areas, extension limits in affected patients. A retrospective review was performed on patients who were diagnosed and treated as paranasal sinus mucoceles at ENT department from 2002 to 2013 years. Patients' demographic data, mucoceles location, symptoms, surgical approach and complications were evaluated. The study group included 9 male and 10 female patients with a mean age of 45,0 years (range, 12-76 years). This case series include fronto-ethmoidal complex (52,6%), followed by frontal (26,3%), maxillary (15,7%) and sphenoid sinus mucoceles (5,2%). Endoscopic sinus surgery (ESS) was performed on 11 patients (57.8%); endoscopic procedures included marsupialization through an infundibulotomy, associated with an anterior ethmoidectomy and maxillary sinus antrostomy. Four patients (21%) underwent an external surgical procedure. 8 patients (42%) were treated by a combination of both endoscopic and external approaches such as trephination of the anterior wall of the frontal sinus, osteoplastic flap approach, Caldwell-Luc operation, anterior craniotomy and Lynch procedure. Complications occurred only in 2 cases (10.5%). The majority of patients with extensive paranasal sinus mucoceles exhibited ophthalmologic and intracranial symptoms. A satisfactory outcome can be achieved after surgical treatment of both endoscopic and external approaches.

Evaluation of external surgical approaches used for fenestration of the dorsal and ventral conchal bullae in horses: An ex vivo study

SummaryBackgroundEmpyema of the conchal bullae, which is a possible additional source of chronic unilateral nasal discharge, affects up to 56% of horses with paranasal sinus disease.ObjectivesThis study aimed to determine the external surgical approaches for the fenestration of the conchal bullae in horses.Study designExperimental study.MethodsSix heads of horses were used for external surgical approaches in the maxillary region, and the bilateral ventral and dorsal conchal bullae were fenestrated. Radiographic projections were performed preoperatively, and a further radiographic examination was performed after the surgical procedure using a Steinmann pin inserted through the surgical approach as a radiopaque marker. The approach to the bullae was also assessed by rhinoscopy. Dissection, macroscopic evaluation and digital photographic records of the surgical approaches were performed.ResultsA total of 92% (22/24 bullae) of the evaluated conchal bullae were fenestrated. The approach allowed the fenestration of 11/12 dorsal conchal bullae and 11/12 ventral conchal bullae. The postoperative radiographic evaluation allowed identification of the surgical approach and fenestration positioning by observing the location of the radiopaque pin within the conchal bullae. The dissection showed that the surgical approach to the dorsal conchal bulla was 3 cm dorsal to the infraorbital foramen and dorsal to the levator nasolabialis muscle, with no damage to the vascular or neural structures.Main limitationThe surgical approach to the ventral conchal bulla, when performed 1 cm rostral to the infraorbital foramen, was very close to the branches of the infraorbital nerve, which were identified and moved away from the trephination site. This was an ex vivo study and it is possible that nasal haemorrhage would affect the usefulness in clinical cases.ConclusionThe surgical approaches described in this study allow the fenestration of dorsal and ventral conchal bullae in adult horses in a simple way without the need for specific equipment.

Joint Entity and Relation Extraction Model Based on Inner and Outer Tensor Dot Product and Single-Table Filling

Joint relational triple extraction is a crucial step in constructing a knowledge graph from unstructured text. Recently, multiple methods have been proposed for extracting relationship triplets. Notably, end-to-end table-filling methods have garnered significant research interest due to their efficient extraction capabilities. However, existing approaches usually generate separate tables for each relationship, which neglects the global correlation between relationships and context, producing a large number of useless blank tables. This problem results in issues of redundant information and sample imbalance. To address these challenges, we propose a novel framework for joint entity and relation extraction based on a single-table filling method. This method incorporates all relationships as prompts within the text sequence and associates entity span information with relationship labels. This approach reduces the generation of redundant information and enhances the extraction capability for overlapping triplets. We utilize the internal and external multi-head tensor fusion approach to generate two sets of table feature vectors. These vectors are subsequently merged to capture a wider range of global information. Experimental results on the NYT and WebNLG datasets demonstrate the effectiveness of our proposed model, which maintains excellent performance, even in complex scenarios involving overlapping triplets.

Comparison of success between external and endonasal dacryocystorhinostomy in primary acquired nasolacrimal duct obstruction in South India population

Background: Dacryocystorhinostomy (DCR) has been the standard procedure for primary acquired nasolacrimal duct obstruction (PANDO) for many years. This process can be performed either using an endoscopic or external approach. Aims and Objectives: The aim is to evaluate the results and recurrence rates of external DCR (ExDCR) and endonasal DCR (EDCR) surgery in patients with PANDO in the South Indian population. Materials and Methods: Medical records were reviewed in all patients who underwent surgery for PANDO between December 2021 and August 2023 at Government Medical College Mahabubabad. Results: This study was conducted in 92 patients; 34 males (36.96%) and 58 females (63.04%) were the gender split. ExDCR was used in 52 (56.52%) of the cases, and EDCR was used in 40 (43.487%) of the cases. Operation success rates of these data revealed that 50 (54.34%) cases were recorded as successful, 24 (26.10%) of the cases were accepted as partially successful, and 18 (19.56%) of the cases were deemed unsuccessful. There was no statistically significant difference between success rates and recurrences in both groups (P>0.05). Conclusion: Endoscopic DCR produced simple, minimally invasive, and preferable results compared to ExDCR in the South Indian population. Although the success of ExDCR is higher and the recurrence is lower than endoscopic DCR, with the outcomes of this study, endoscopic DCR can be tried as the first choice to protect the patient from major surgery and anesthesia in PANDO.

A Comparison of Functional Outcome of Open Reduction Internal Fixation Versus Ilizarov External Fixation in Complex Proximal Tibial Fractures: Randomized Controlled Trial

Objective: Proximal tibia fractures can be treated with open reduction and internal fixation (ORIF), hybrid fixation, or external fixation; however, it is still unknown which method is better than the others. The purpose of the study was to compare the clinical and functional outcomes handled by Ilizarov and ORIF in order to determine the gold standard treatment choice for proximal tibia fractures. This study aimed to compare the functional outcomes of open reduction internal fixation and Ilizarov external fixation in the treatment of complicated proximal tibial fractures.
 Methodology: An RCT was carried out in the Orthopaedic Department at PIMS Islamabad. It was carried out during a 12-month period after the synopsis was approved.This study included 104 patients with Schatzker's grade IV–VI fractures who presented to the orthopaedic department at PIMS, Islamabad. Using the lottery approach, the patients were split into two treatment groups at random. Group B uses the Ilizarov External Fixation procedure, while Group A uses the Open Reduction and Internal Fixation (ORIF) technique. Every three weeks, post-operative follow-ups were conducted. Up until the fracture healed, post-operative radiographs were taken every three weeks. Every patient had a 24-week clinical follow-up. At the follow-up appointment, each patient's outcomes were documented in accordance with the operational definition. SPSS was used to enter and process all of the data.
 Using SPSS v25.0, all of the data were input and processed. The surgery time, VAS score, and length of hospital stay were compared between the two groups using an independent sample t-test. The functional outcome at six months was compared between the two groups using the Chi-square test. A significant p-value was defined as ≤0.05.
 Results: There were 31 (59.6%) men and 21 (40.4%) women in group A, and 36 (69.2%) men and 16 (30.8%) women in group B.In group A, the mean age was 44.87±14.15 years, while in group B, it was 44.25±15.68 years. In terms of functional outcome, 22 (42.3%) of the ORIF technique group had excellent outcomes, while 10 (19.2%), 16 (30.8%), and 4 (7.7%) had good, fair, and poor outcomes, respectively. In contrast, 35 (67.3%) of the Ilizarov technique group had excellent outcomes, while 10 (19.2%), 5 (9.6%), and 2 (3.8%) had good, fair, and poor outcomes, respectively. These results have a statistically significant p-value of 0.024.
 Conclusion: Compared to open reduction and internal fixation, Ilizarov external fixation is a more reliable method for fixing complicated proximal tibial fractures. For patients with complicated proximal tibial fractures, the Ilizarov external fixation approach yields superior functional outcomes than the open reduction internal fixation technique.
 KEY WORDS: Proximal Tibia Fracture, Open Reduction , Internal Fixation, Ilizarov External Fixation.