Total Closure Research Articles

Abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm: A case report and literature review

Background: Abdominal compartment syndrome (ACS) arises in approximately 7% after ruptured abdominal aortic aneurysm (RAAA) treatment. Decompressive laparotomy is a satisfactory way to treat ACS. The problem is deciding when to complete abdominal closure with appropriate alternative treatments.[1]
 Methods: This is a case report of successful ACS treatment following RAAA intervention at Ho Chi Minh University Hospital of Medicine and Pharmacy with a literature review.
 Clinical case: A 61-year-old male patient was hospitalized for abdominal pain. Computed tomography angiography demonstrated RAAA. He underwent the emergency endovascular repair of ruptured aneurysms (rEVAR). At 30 minutes post-intervention, the patient's abdomen was distended following intraabdominal hypertension measured via bladder catheter. Within ACS diagnosing, emergency decompressive laparoscopy was performed. The abdominal wall was left open and covered with a sterile nylon cover. The fascial closure was performed on the sixth postoperative day with the support of vacuum-assisted wound closure (VAC) and mesh-mediated fascial traction. On the 27th postoperative day, the wound could close completely, and the patient could be discharged successfully.
 Conclusion: A bladder pressure is required to monitor intraabdominal pressure postoperatively after decompressive laparotomy. Delayed fascial closure is appropriate with supporting VAC until total abdominal closure.

Analysis of the impacts of health service closure policy on Indonesian nursing during COVID-19 pandemic: A literature review

Background: The COVID-19 pandemic has been over yet; one of the effects of this pandemic is plenty of hospitals in Indonesia have been applying for temporary health service closure.
 Objective: This study aimed to analyse the effect of health service closure during the COVID-19 pandemic.
 Design: Simple study literature is the method for this study. 
 Data Sources: This study used two different search processes. The first search process came from online news platforms (detik.com, kompas.com, and okezone.com), which used a combination of the words “COVID-19”, “emergency room”, “hospital”, and “closed” during November 2020. The second search was from the database (CINAHL, ProQuest, ScienceDirect, PubMed, SpringerLink, and Wiley Online). 
 Review Methods: The guidelines of the second search used Preferred Reporting Items for Systematic Review and Meta-Analysis. Both searching processes applied COVID-19 and hospital closed or emergency department closed as the keywords from November 2020-January 2021. 
 Results: The first finding showed more than 300 news about health service closure, and the second showed 13 selected articles. There were 42 health service unit closures from 16 provinces in Indonesia. These closures had disadvantages effect for patients, nursing care and nursing education side.
 Conclusions: Total or partial health service closure could be happened due to increased patient capacity, delays in the treatment of the patient, many nurses getting infected by COVID-19, and nursing students cannot practice directly. Therefore, this issue needs innovative solutions to keep the nursing student placement going well by considering safety for the patient, nurses, nursing students, and trainer/ facilitator.

Effectiveness of the lateral pedicled endonasal flap for prevention of restenosis in frontal sinus drillouts.

Frontal sinus median drainage according to Draf is an established procedure for achieving maximum drainage of the frontal sinus. Despite great efforts and several modifications, restenosis of the neo-ostium is still a persistent problem. This study presents an approach by implementing local mucosal flaps to prevent restenosis and compares it with the conventional technique without using the flap. Description of endonasal, lateral pedicle mucosal flap. A Draf III procedure was performed on 156 patients between 2012 and 2021. Data for 123 of the included patients were retrospectively analyzed in terms of surgical indication, technique, postoperative aftercare and patency of the drainage pathway. The follow-up observation period was between 3 and 24 months. Treatment with the pedicle mucosal flap took place in 86 cases. 37 patients were treated as a control group without this flap. The analysis showed a significant association to the event "total closure of the drainage pathway" for surgical technique, as well as in the case of the presence of an allergy and the existence of Samter's triad. Furthermore, there was a significant association between the onset of "near total closure of the frontal sinus ostium" and Samter';s triad, CRS and revision surgery was involved. Use of an endonasal lateral pedicle flap for reconstruction of mucosal defects in frontal sinus surgery improves the long-term chances of a patent drainage pathway. Bone exposed by drilling was covered with a local mucosal flap for a faster epithelialization, healing and less scarring.

OC-074 BILAYERED RETICULAR AND LAMINAR POLYPROPYLENE MESH AS A USEFUL TEMPORARY ABDOMINAL CLOSURE FOR THE MANAGEMENT OF THE OPEN ABDOMEN

Abstract Aim To demonstrate the utility of a bilayered reticular and laminar polypropylene (PLP) mesh as a temporary abdominal closure device for the management of the open abdomen. Patients And Methods Prospective multicentric study including consecutive patients with open abdomen of any etiology. A bilayerede PLP mesh is used as temporary abdominal closure. The mesh has a 30×40 cm laminar PLP intraperitoneal layer that is fully deployed covering the viscera, and a 30x 40 cm large pore PLP layer that is trimmed to the size of the defect and sutured to the border of the fascia. Depending on the evolution time and the clinical situation of the patient, successive plicatures of the reticular PLP are performed to reduce the fascial defect. At the end, the mesh is explanted, and a complete fascial closure is attempted. Results Eighteen patients were included. Etiologies of the open abdomen were vascular (22%), trauma (28%) and sepsis (50%). There were 72% female patients, mean age of 60 years (range 19–81). Four patients died in the first 72 hours due to complications of their pathology. The other 14 patients survived, with a mean time of open abdomen of 15 days (range 1–43). In all cases a total fascial closure was achieved, with absence of adhesions between the visceral and the parietal peritoneum. No complications related with the mesh took place during the follow up Conclusion Temporary abdominal closure with a bilayered reticular and laminar polypropylene mesh is efficient and safe, with a 100% rate of fascial closure

S2853 Novel Endoscopic Technique for Treatment of Candy Cane Syndrome

Introduction: Candy cane syndrome is an underrecognized complication of Roux-en-Y gastric bypass resulting from a long blind afferent Roux limb at the gastrojejunostomy causing nausea, vomiting, reflux and pain due to food accumulation. We present a case of novel endoscopic treatment of candy cane syndrome. Case Description/Methods: 67-year-old female with vertical banded gastroplasty revised to Roux-en-Y gastric bypass and multiple open abdominal surgeries presented with worsening of persistent post prandial epigastric pain. Upper endoscopy showed Roux-en-Y anatomy. Also noted was gastro-gastric (GG) fistula (A) and an embedded over the scope clip (OTSC) in this area (B). There were no medical records of placement of the clip or patient recall of OTSC clip. A fluoroscopic upper GI series showed candy cane loop and gastro-gastric (GG) fistula (D). Her bariatric surgeon felt that her acute symptoms were likely from candy cane syndrome. Given that she had a fairly extensive surgical history she was deemed high risk for surgery, decision made to offer endoscopic therapy for candy cane syndrome. APC (1L/min, 50W) was used to coagulate the mucosal layer of the entire afferent limb (F) and then the enteric walls of the afferent limb were approximated by placing three purse string sutures using endoscopic suturing device attached to a 2-channel therapeutic upper endoscope (G). Sutures started from the end of the blind limb towards the GJ anastomosis leading to total closure of the afferent limb (Pic 1H). One month follow up upper GI series showed direct transit of most of the contrast into efferent limb with redemonstration of a much smaller though persistent candy cane limb (I and J). (Figure) Discussion: Candy cane syndrome results from creation of a long nonfunctional limb during creation of gastro-jejunostomy at time of gastric bypass. This causes intestinal dysmotility resulting in stasis, and gradual expansion of the limb over time. Upper GI series has been used traditionally to diagnose this condition though endoscopic demonstration of off-axis orientation of roux limb using a simple guide wire has also been proposed. Historically, it has been managed surgically. We present an interesting case of endoscopic reduction of candy cane loop using advanced endoscopic suturing technique.Figure 1.: (A) Roux-en-Y anatomy with afferent limb (blue), efferent limb (yellow). (B) Metallic prong seen in the lumen of gastric pouch. (C) Metallic FB identified as OTSC clip on x ray. (D) Upper GI series demonstratingrapid pooling of contrast in candy cane limb (blue) and the Roux limb (yellow). (E) fistula seen adjacent to the clip. (F) ablated afferent limb mucosa. (G) purse string suturing of the ablated afferent limb. (H) completely obliterated of afferent limb after sutures. (I) upper GI series 1 month later shows transit of most contrast from gastric pouch (red) into Roux limb (yellow) but a persistent cany cane limb (blue). (J) one month post suturing endoscopic view of closed afferent limb.

Evaluation of wound-healing efficiency of a functional Chitosan/Aloe vera hydrogel on the improvement of re-epithelialization in full thickness wound model of rat

ObjectiveChitosan-based hydrogels as wound dressings are expected to improve the efficiency of the wound-healing process. Fabrication of the composite structure of Aloe vera and biopolymeric hydrogels has been demonstrated to promote the wound-healing process through protection against a wide spectrum of microbes, and enhanced cell adhesion and differentiation. Therefore, the present study investigates to development of improved CHO/Aloe hydrogel for improving the wound-healing process in an animal model. Materials and methodsCHO hydrogel with Aloe was prepared, and its properties were evaluated in terms of viscosity, antibacterial activity, and ints In-vivo wound-healing efficiency in full-thickness wounds of rat models. Physical examination of wound-healing efficiency of CHO/Aleo hydrogel was evaluated by analyzing total wound closure, recovery percentage, and the epiderm thickness of wounds. Histological evaluation was performed using hematoxylin and eosin staining to evaluate the re-epithelialization, inflammatory response, granulation tissue formation, and fibrotic tissue formation. ResultsThe results showed a significantly higher wound-healing rate of the CHO/Aleo group compared to other groups at 3,7,14 days (p < 0.05). After 14 days of treatment, the best healing effect was observed in the CHO/Aleo gel with the highest tissue tension compared with other groups (p < 0.05). Histological findings indicated a significant difference in inflammatory response between control and treatment groups after three days of treatment (p < 0.05). Epidermal thickness was also significantly thicker in the CHO/Aleo gel group than others (p < 0.05). ConclusionThe present study an improved the effective topical drug-delivery system by CHO/Aloe hydrogel with the potential to reduce inflammation over time, allowing the body to recover more quickly and better re-epithelialization for improving the wound-healing procedures.

Agropreneurship Development in the Post COVID-19 Era; Challenges and Panacea: Views of Selected Small-Scale Poultry Farmers in Idemili North Local Government of Anambra State, Nigeria

This study x-rayed the challenges of Agropreneurship development since the outbreak of Coronavirus with views of selected small-scale poultry farmers in Idemili North Local government Area of Anambra State Nigeria. The potency of small-scale businesses in driving the socio-economic growth and development of nations particularly developing nations with emerging economy is incontrovertible. The owners of small-scale businesses are also known as entrepreneurs who are usually faced with challenges (lack of start-up and running capital, insecurity, natural disaster, paucity of business skills, etc.) which affect the business growth or total closure of the business. These challenges have been compounded by the outbreak of Coronavirus globally at the end 2019. The study employed descriptive survey design and thematic method of analysis was adopted to analyze generated data. The study found out some challenges facing the small-scale poultry farmers to include hick in prices of chick, feed and drugs, drastic drop of sales and unhealthy competition in the market from large scale farmers and lack of government support. In line with these identified hurdles, following recommendations were made; concerted efforts by government to avail financial support in terms of easy access to soft loans by small-scale farmers, organization of capacity building exercises to enhance acquisition of entrepreneurial skills by small-scale business owners and regulation of market prices to protect infant businesses.

TANTANGAN DAN PELUANG PANDEMI COVID19 PADA TAMAN SAFARI PRIGEN BESERTA PENGELOLAANNYA

The COVID-19 pandemic has become the center of attention in all countries, including Indonesia. The unprecedented pandemic has made the tourism sector sluggish. Even though the tourism sector is an important sector for the Indonesian state, such as its large contribution to Gross Domestic Product (GDP), foreign exchange, the creation of new jobs, and many more. This unprecedented phenomenon has become the main objective of the research, namely to explore the challenges and opportunities during COVID19 on tourist attractions, especially at the Taman Safari Prigen, and impacts both positive and negative, which are closely related to tourist visits, and their management, giving rise to new prepositions. This study uses a qualitative method with a phenomenological approach. The paradigm used is interpretivism. The data of this research was obtained from primary data with a semi-structured interview method, which was carried out with internal and external parties at Taman Safari Prigen. The results of this study highlight the various challenges and opportunities faced by Taman Safari Prigen during the total closure of tourist attractions and reopening due to government regulations. Other challenges and opportunities, such as economic impacts, changes in marketing, changes in visiting patterns, adaptive action steps taken for animals, human resources and tourists, and so on. There are also multiple impacts found from every management decision taken which will be reviewed in this study.

The Impact of the COVID-19 Related School Closure on the Mental Health and Well-Being of Children with SEN and Their Parents in Algeria

ABSTRACT The COVID-19 pandemic has changed our lives and affected different nations in different ways. In Algeria, education has been hit hard by the lockdown as schools embarked on a total closure to stop the spread of the virus. For students and their parents, such a closure meant limited access to the support embodied in the school. This qualitative study explored the school closure experiences of parents and their children with special educational needs (SEN). Twenty-three parents and five children with SEN were recruited in the study. Data was collected by means of semi-structured interviews, using online video calling, and was analysed using thematic analysis. Six main themes emerged from the analysis of the interviews. These were: (1) the participants’ emotional experience; (2) the participants’ social experience; (3) children’s behaviour during school closure; (4) the participants’ learning experience; (5) children’s new routine; (6) restarting all over again. The study findings revealed that both children with SEN and their parents experienced mental and social-emotional difficulties following the school closure. As such, the findings imply that the school climate and social landscape have a pivotal role in promoting and maintaining the students’ stability and well-being.

Impacts of the COVID-19 pandemic restrictions on solid waste pollution in the worldwide iconic Copacabana Beach (Rio de Janeiro, Brazil)

Total and partial restrictions to beach access during COVID-19 pandemic created an opportunity to evaluate its effect on coastal pollution. We aimed to determine the impact of access restrictions on solid waste pollution at Copacabana beach, Brazil. Solid waste amount was analyzed considering beach access restrictions: unrestricted, total closure, partial restriction, new normal. Relationships of atmospheric temperature and precipitation with access restrictions were assessed and confounding effects controlled for further analyses. Beach access restrictions significantly reduced solid waste pollution at Copacabana beach, beach closure reduced waste amount in 72 %. Partial restrictions and new normal periods have significantly reduced solid wastes amount on the beach in 60 % and 36.88 %, respectively. Qualitative data revealed that most of solid wastes were single-use plastics recently disposed at Copacabana beach, reflecting beachgoer's effects on waste left on the beach. A positive impact of COVID-19 pandemic restrictions was detected on solid waste pollution at Copacabana beach.

POS1530-HPR RHEUMATIC MUSCULOSKELETAL DISEASES (RMDs) DURING THE FIRST WAVE OF THE COVID19 PANDEMIC: PATIENTS’ POINT OF VIEW ON THE ROLE OF TELEMEDICINE

BackgroundThe COVID19 pandemic has caused health problems in people’s daily lives with a significant psychological impact. In fact, patients with RMDs have experienced diseases’ flare and also psychological problems. The lockdown and the “social quality changes” have impacted the life and the well-being of RMDs patients, influencing directly the implementation of telemedicine during daily practice.ObjectivesA descriptive observational study was designed to analyse the short-term effect of the first wave on RMDs patients on social quality changes and the usefulness of telemedicine.MethodsThe survey was carried out by administering a questionnaire consisting of 30 questions, developed ad hoc using Likert scales. Items such as family and work environment, access to healthcare facilities, healthcare provided to the patient, disease activity and the mental health status of individuals (anxiety / depressive symptoms) were investigated. Preliminary data on the first wave were collected between September and November 2021 through patient associations and social networks.Results40 RMDs patients (Rheumatoid Arthritis 57.5%, Psoriatic Arthritis 35%, Fibromyalgia and others 7.5%) prevalently women (97.5%) were included in the survey. During the pandemic, 72% of respondents reported cancellation or delays in scheduled appointments and 50% did not have alternative contacts (telephone consultations, e-mail prescriptions, telematics training) with the hospital. 40.5% of patients reported difficulty in finding DMARDs and material for the treatment of ulcers, 28.2% reported difficulties in accessing the health facilities. In particular, 34.2% reported the total closure of the hospital facilities.Moreover, our data show a worsening of health status due to an increased anxiety concerning the management of their RMDs, an increased stress within the family, a reduced access to care facilities due to their closure or travel restrictions. In 57% of patients, a worsening of health status was reported, while in 90% stress and a feeling of abandonment was developed since the beginning of the pandemic. In this context, telemedicine was considered useful by 97.5% of patients, although patients felt that an improvement was necessary with an integration with the regular follow up.ConclusionPatients with RMDs reported that the significant delays or cancellation of the outpatient visits provoked an increase of stress, worry and anxiety for their health. The majority was very concerned about the overall management of their RMDs. The worsening of symptoms in more than half of the patients was the most worrisome observation. Almost all patients agreed that Telemedicine might help the clinical evaluation of their RMDs, also providing a significant support to their psychological condition because of the direct contact with the caring physician and health professionals.

Evolution of Microporosities in Wide‐Thick Continuous Casting Slab during Heavy Reduction Process

Heavy reduction (HR) is an effective process that can significantly minimize the internal porosity and other internal defects in continuous casting steel. Herein, samples taken from different wide‐thick slab positions are examined by scanning acoustic microscopy and 3D reconstructed. The morphology and distribution of microporosities &lt;1 mm in size in the wide‐thick slab are revealed. The microporosities are mainly distributed in a stripping zone symmetric about the centerline within a 1/3‐slab thickness, and most have a considerably obvious long‐ and short‐axis tendency, which can be approximated as ellipsoids. The microporosity evolution in the wide‐thick slab during HR at the solidification end is numerically investigated with a 3D thermal–mechanical coupled model. The microporosity evolution in an aggregated distribution region during HR is little influenced by the surrounding microporosities. With increasing slab centerline‐microporosity distance, the microporosity minimization effect of HR becomes poor. When the axial ratio (long axis/short axis) is 1.43, the microporosity closure is the largest, and the porosity closure is the highest when the long axis is perpendicular to the reduction direction. When the total segment reduction is constant, the reduction mode with gradually decreasing reduction results in the highest total porosity closure and minimum reduction force.

Modeling train route decisions during track works

To better understand the choice behavior of train route schedulers and to predict their choices for optimizing the annual construction schedule, prospective data for 2020 on train route decisions are analyzed using discrete choice models and machine learning classifiers. The choice alternatives include (i) partial cancellation of the train schedule at the start, (ii) in the middle or (iii) at the end of the itinerary of the train service, (iv) detour and (v) delay/ahead of time, and are modeled using 39 train-, construction site-, and infrastructure variables. The top nine attributes account for about 80% of variable importance, including the travel time from the departure station to the construction site, total or line closure, travel time from the construction site to the terminus, length of the train and effective line capacity.The models are tested for 2021 and 2022 to verify whether they can be used to forecast choices in the following years. While Random Forest performs best in terms of prediction accuracy (2021: 60.8%; 2022: 58.6%), the improvements of about 6%-points compared to the Mixed Logit model are modest. Results indicate that a substantial amount of unobserved construction site heterogeneity is present, which Random Forest cannot capture either.

An Updated Review on Layered Closure Techniques for Total Hip Arthroplasty.

One of the main concerns with total hip arthroplasty is the development of periprosthetic joint infections (PJIs). Appropriate wound closure can contribute to the prevention of PJIs with a watertight closure effectively sealing the implant from the outside. It is important to continuously investigate which materials as well as techniques are potentially the most efficacious and cost effective for wound closure. Therefore, the purpose of this review article was to critically appraise the current total hip arthroplasty wound closure materials and techniques as reported in the literature. Specifically, we evaluated: 1) fascial approximations; 2) subdermal closures; 3) subcuticular and skin closures; 4) wound dressings; as well as 5) capsular and short external rotator repairs. A literature search was performed using the PubMed database from inception to February 2022. The query consisted of terms including "hip, arthroplasty, wound, closure, capsular closure, fascial closure, subcutaneous closure, and skin closure." References from selected texts were also reviewed for inclusion. Only manuscripts written in the English language were included for final analysis. A systematic review was performed for the five topics: 1) fascial approximations; 2) subdermal closures; 3) subcuticular and skin closures; 4) wound dressings; as well as 5) capsular and short external rotator repairs. Additionally, a meta-analysis was performed on the closing time of fascial approximations. The current literature supports performing a layered closure of the wound by approximating the fascial layers, which can help close any empty spaces. The techniques for closure at this layer seem to be equal regarding wound complications between running knotless barbed sutures versus interrupted throws; however, knotless sutures have the potential of a quicker closure time. A total of three out of four reports and the meta-analyses demonstrated that wound closure time can be reduced with barbed sutures, along with decreased number of sutures required as also shown by three out of four reports. The most superficial layers, subcuticular and skin, can be closed with either sutures, staples, or skin adhesives, all of which appear to have adequate outcomes. A report found that patients who had skin closure with barbed suture had faster time to a dry postoperative wound and lower rates of delayed discharge. For the overlying dressing, an occlusive and absorbent dressing can both protect the wound as well as collect any residual wound drainage. Two reports found increased dryness, decreased wound drainage, and decreased rates of delayed wound healing with use of 2-octyl cyanoacrylate topical adhesive with flexible self-adhesive polyester mesh dressings. If the capsule and short external rotators are taken down during the approach, repairing these can potentially help increase postoperative hip stability as well as decrease dislocation rates. The variety of materials and techniques available to close a THA wound allows surgeons to tailor closure to be patient specific. In general, the authors recommend performing layered closures from the capsule and short external rotators (if taken down during the approach), fascial layer closure with either a running knotless suture, subcutaneous closure either with the same knotless suture as the fascial layer brought more superficially, or with simple interrupted sutures to tack down any empty space, as well as finally subcuticular and skin sutures with a skin adhesive glue overtop. The skin adhesive can help provide an extra layer, particularly in active patients.

Beyond the pandemic: Implications of COVID-19 on regional economic integration in Southern Africa.

This study examined the implications of the COVID-19 pandemic on the much sought-after regional economic integration using Southern Africa as a case study. The eruption of COVID-19 stifled world economic activities and unleashed economic uncertainties. First, the disease forced countries into imposing restrictions that included total closure of businesses and borders and travel bans that resulted in reduced economic activity among countries. Second, Africa was expected to suffer economic reverse of between -2% to -5% in 2020 due to a sharp decline in output growth. This has had adverse implications on trade and financial markets across the region and scuppers the ambitions for regional economic integration. Using a desktop approach the study critiqued and analysed the literature on regional integration and the impact of the COVID-19 pandemic on prospects for enhanced regional economic integration. The findings revealed that COVID-19 plunged the prospects of regional economic integration into disarray. Owing to imposed restrictions business slumped, trade declined, poverty deepened and vulnerability of populations increased cumulatively negating the quest for regional integration. The study concludes that to manage the aftermath of COVID-19, regional economic coordination should be encouraged.

Closure of oro‐antral fistulae in conjunction with functional endoscopic sinus surgery: A systematic review and retrospective analysis

AbstractAimAn oro‐antral communication (OAC) is a recognised potential complication of maxillary tooth extraction. If it does not resolve, a pathological epithelialised tract or oro‐antral fistula (OAF) can develop. The aim of this systematic review was to determine whether OAF closure with functional endoscopic sinus surgery (FESS) provides an effective approach for total closure and relief of sinusitis.Material and MethodsThe systematic review followed the PRISMA format. An electronic database search was performed to identify publications in English between 2010 and 2020, containing human subjects with radiographic evidence of sinus pathology, relating to OAF formation following extraction, and simultaneous OAF closure with FESS. Success was measured as total closure and relief of symptoms after 3 weeks. A retrospective analysis of patients within the Cwm Taf Morgannwg University Health Board that fit the eligibility criteria over a 5‐year period was conducted and compared with the results of the review.ResultsFive papers were included in the review, covering 86 OAFs, with an overall success rate of 97.7% (84/86). Two patients required revision surgery, due to recurrent OAFs, who were both diabetic and smokers. A total of 13 patients met the case series' inclusion criteria, and 100% success was achieved. A minor complication of post‐operative nasal synechia arose in 4/99 (4.0%) patients. Evidence‐based guidance was created for local dentists encountering an acute OAC.ConclusionsOAF closure with FESS can be considered a highly effective approach, leaving patients symptom‐free. It is important that protocols are in place for dentists suspecting an OAC to expedite patient management.

Performance evaluation of coronavirus closure on air quality over central, southern and northern parts of Iraq

When the number of confirmed coronavirus disease cases rose in Iraq in the middle of February 2021, the Iraqi government performed a closure approach to constrain mobility and factory operations and enforce social distancing. In this research, the concentrations of air components (PM2.5, PM10, nitrogen dioxide (NO2) and ozone (O3)), which represent herein the degree of air quality index, were recorded, drawn and evaluated over central (Baghdad, the capital), northern (Kirkuk Province) and southern (Basra Province) Iraq before and during the closure. The experimental duration of this research was 6 months (from 1 January 2021 to 30 June 2021), which included four periods: pre-closure, first closure (total and partial), second closure (total and partial) and third closure (partial). Moreover, the impact of total closure and partial closure on the quality of the atmospheric layer over Iraq was evaluated and assessed by using Sentinel-5P satellite/Tropospheric Monitoring Instrument and Giovanni–Earthdata images. The results revealed that air pollutant concentrations dropped during the closure periods except at the end of the third closure period due to the lack of people’s commitment by breaking the closure strategy based on economic reasons. It was observed that the lockdown is one of the best solutions to defeat the coronavirus pandemic and that it significantly improved the air quality index, although it has several disadvantageous effects on the economic front of the country. Eventually, since people stay at their residences, the concentration of air pollutants becomes low and the air quality index becomes better.

Tragedy in the Time of Plague

Tragedy in the Time of Plague1 Oliver Taplin (bio) Like a salt-encrusted shipwrecked sailor who after swimming and swimming at last crawls ashore glad to have survived danger, I look back on the two years of the rough waves of Covid-19. Constant restraints and few recompenses. Far from least of the deprivations was the total closure of theatres. For me this has, though, brought a refreshed awareness of the sensualities of live theatre, the innumerable minute impacts of the physicalities of performance, the somatic responses of the audience, and our shared raptness. Of course, the livestreamed plays and recordings were far better than nothing—some were brilliant and memorable—but it was and is nonsense to claim that they were just a good as live performance, let alone that they could even supplant the experience. I have just sat through nearly four hours of Ivo van Hove's grueling sequence of episodes from six Greek tragedies, The Age of Rage.2 The blazing flames, the smells, the solidity of metal, the heft and footfalls of the vigorous choral dances choreographed by Wim Vandekeybus… These had to be experienced "in the flesh" (marvelous phrase!). And the caught breath, uneasy tension, along with the intent silence of the large audience was very much part of the actual performance. It also renewed the question: why do we subject ourselves to such things? The more narrow and academic question that first broke through my initial pandemic-induced lethargy was one which, so far as I am aware, has hardly ever been raised. When Athens suffered its terrible plague between 430 and 426 bce, did theatrical performances go on all the same? Even if it is really the case that there was little or no notion of contagion,3 were the huge gatherings not curtailed or postponed during this terrible time? And if the tragedies did continue to be played and watched, what was it that was so important about them even in time of plague? [End Page 31] First some very briefly sketched background. Most of this will be well-known to most readers of Arion, but some settings need to be in place before the core question comes into focus. During the 440s and 430s the city-state of Athens had enjoyed a golden age of increasing prosperity and power, at the same time flourishing as a cultural magnet for ideas and the creative arts, including the great "local" genres of tragedy and comedy. In 431, under the influence of their charismatic leader Pericles, they embarked on war with the great rival power of Sparta—the so-called "Peloponnesian War." Even though the Spartans were able to invade and seriously damage the surrounding countryside of Attica, there was within the safety of the walls a mood of long-term optimism. Then in early summer of 430 the totally unpredictable plague struck the crowded and war-disrupted city. It lasted for two years and then recurred in the winter of 427–6 for a further year. The symptoms were horrific—far, far worse than our coronavirus. The fever burnt so terribly that sufferers could not bear to have any clothing on them and would throw themselves into cisterns in agonies of thirst. After about a week the disease moved into the bowels and victims were fatally weakened. The death-rate was terrifyingly high: it is calculated that the plague killed about 25% of the entire population. Pericles himself succumbed in the second year. We know about this plague from the personal and authoritative account by the pioneering historian Thucydides (2.47–54). He was there and fell ill himself, but survived, observing that those who had had the plague did not contract it a second time. He gives a long and gruesome account of the sequence of symptoms. There have been many theories about what disease this was, but it may well be that it was a pathogen that no longer exists.4 There are, nonetheless, some striking analogies with our recent experiences. Thucydides relates that the disease was said to have originated far away, in Africa, and that it came to Athens through the trading port of Piraeus. There...

Sternocleidomastoid Flap Repair for Pharyngo-cutaneous Fistula Complicating Parapharyngeal Abscess: A Case Report

Pharyngo-cutaneous fistulas (PCF) are commonly seen in major hypopharyngeal and laryngeal post-operative patients. Reports of PCF as a complication of deep neck abscess is scarce. The majority of post total laryngectomy PCF closure are achieved via conservative management, only large fistulas requires surgical closure. However, there is little evidence on closure of fistulas from abscess origin shall there be a failure of conservative treatment. We present a case of a female patient with multiple comorbid who had left parapharyngeal abscess complicated with PCF who have successfully treated sternocleidomastoid pedicle flap repair.

Surgical repair of nasal septal perforations: A systematic review and meta-analysis.

A wide variety of techniques for the surgical repair of nasal septal perforations (NSPs) have been described. Surgical management of NSPs can be broadly divided into open versus endonasal approaches, with additional variables involving unilateral or bilateral flaps, use of grafts, and placement of splints. The objective of this study was to compare surgical approaches and their outcomes. PubMed, EMBASE, and CINAHL Plus databases were examined for patients undergoing NSP repair. English-language studies reporting surgical management of patients with the primary diagnosis of NSP were included. Outcome measures of interest included perforation size, surgical approach characteristics, and success rate defined as complete closure assessed by surgeon postoperatively. The quality of articles was assessed with the methodological index for nonrandomized studies (MINORS) criteria. A random-effects model was used to calculate pooled proportions for the different outcomes. The electronic database search yielded 1076 abstracts for review. A total of 64 articles met the inclusion criteria, with 1591 patients: 1127 (71%) underwent an endonasal approach and 464 (29%) an open approach. The median (range) MINORS score was 10 (5-12) out of 16 points. Overall, 91% of patients had total closure (95% confidence interval [CI], 0.89-0.93, p<0.01), with moderate heterogeneity between studies (I2 =42.03%). There was no difference in closure success between open and endonasal approaches. Use of bilateral versus unilateral flaps, interposition grafts, and intranasal splints and packing were not associated with differences in outcomes. Nasal septal perforation surgical repair success rates are comparable regardless of technique.