Visible Deformity Research Articles

Reconstruction of posterior dislocation of the sternoclavicular joint with nonabsorbable No. 5 ethibond sutures

Posterior sternoclavicular joint dislocation (PSCJD) is rare. It is usually due to contact sports or trauma and is often associated with multiple life-threatening complications. We report a case of a Kabaddi player (an Indian contact sport) who was pushed by an opponent and fell on his right shoulder. The patient complained of right shoulder pain and visible deformity over the right sternal area. After initial X-rays, the right posterior dislocation of the sternoclavicular joint was confirmed with computed tomography scan. After the attempts of closed reduction failed, open reduction and internal fixation were done with a double loop of No. 5 ethibond sutures. Excellent results can be achieved in PSCJD using open reduction and reconstruction techniques with double-stranded 5.0 ethibond nonabsorbable sutures.

Replacement of Dietary Fishmeal by Black Soldier Fly Larvae (Hermetia illucens) Meal in Practical Diets for Juvenile Tench (Tinca tinca)

The development of specific diets for the juvenile stage is a main target for culture intensification of tench (Tinca tinca). Aquafeeds still rely heavily on the use of fishmeal (FM) but concerns about economic and ecological sustainability make the use of alternative protein sources necessary. Insect meals are considered a promising substitute to replace FM. In a 90-day experiment, 6 diets with different replacement levels of FM by partially defatted black soldier fly larvae meal (BSFLM): 0%, 15%, 30%, 45%, 60% and 75%, were tested on juvenile tench. Survival rates were high (95.8–100%) without differences between treatments. Diet with 45% FM replacement allowed for best growth performance in terms of total length (TL = 66.4 mm) and weight (W = 4.19 g), without differences with 60% and 75% of replacement. A cubic relationship was evidenced between the level of FM replacement and growth. From the regression equations, the estimated optimal level of FM replacement was 47% (356 g BSFLM kg−1 diet). Externally visible deformities were always under 0.05%. The whole-body lipid content of the fish had a significantly negative linear regression with BSFLM (r2 = 0.80). The content of the essential amino acids (EAA) arginine, leucine, lysine, phenylalanine, methionine, and threonine in diets decreased with dietary BSFLM inclusion. However, it did not have a negative effect on growth performance, suggesting that EAA requirements were covered. The amount of essential amino acids in whole-body juveniles was similar independently of the diet provided. The results allow considering BSFLM as a sustainable protein source for juvenile tench feeding.

The Mini Nutritional Assessment tool's applicability for the elderly in Ethiopia: validation study.

The Mini Nutrition Assessment (MNA) is a widely used and valid tool for screening and assessment of malnutrition among the elderly population worldwide. However, MNA has not been validated among the Ethiopian elderly population and this study assessed the validity of the tool for the target population. Cross-sectional validation study design employed to validate MNA in Meki town, East Ethiopia. This study included 176 randomly selected elders living in the community, whereas amputated, bedridden, visible deformity, known liver and/or renal disorders were excluded. The original MNA questionnaires were translated to local language and administered to each participant after doing the pretest. The anthropometric, self-perception of nutritional status and serum albumin concentrations were measured. Reliability, validity, sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were calculated. Receiver-operating characteristic (ROC) curve analysis was plotted to identify the area under the curve (AUC) and optimal cut-off value for the prediction of malnutrition. A total of one hundred and seventy-six elders participated in this study. Of the total participants, 78(44.3%) were males. The mean (SD) age of the participants was 67.6 (±5.8) years and ranged from 60 to 84 years. The prevalence of malnutrition based on the MNA criteria (MNA < 17 points) was 18.2%, and 13.1% based on serum albumin concentration (<3 g/dl).The MNA had an overall Internal consistency of Cronbach's alpha 0.61. The tool also demonstrated significant criterion-related validity (0.75, p<0.001) and concurrent validity (0.51, p<0.001) with serum albumin concentration and self-perception of nutritional status respectively. Using the original cut-off point, the sensitivity, specificity, PPV and NPV of the tool were 93.5%, 44.6%, 65.4% and 86.0%, respectively. By modifying, the cut-off point to a value of <20.5, the sensitivity and specificity of the tool increases to 97.6% and 82.8% respectively. The AUC (95%CI) showed an overall accuracy of 92.7% (88.5, 96.9). The MNA tool can be used as a valid malnutrition screening tool for the Ethiopian elderly population by modifying the original cut-off point.

Provision of immobilization or ice by paramedics in Southwestern Ontario.

Pain is the most common reason for prehospital transport. As emergency wait times increase, timely pain management is essential. In children, there is abundant evidence that prehospital pharmacologic analgesia is suboptimal, but little is known about non-pharmacologic therapies. We sought to characterize documentation by paramedics of non-pharmacologic (immobilization and ice) and pharmacologic analgesia in children with musculoskeletal injuries. We reviewed all ambulance call reports for children 0-17years transported to Southwestern Ontario regional hospitals from January 1, 2017, to December 31, 2019, with a musculoskeletal injury (Ontario Ministry of Health and Long-Term Care problem codes 66 and 67). Primary and secondary outcomes were documented immobilization or ice and pharmacologic analgesia, respectively. In a multivariable analysis, we explored the relationship between immobilization or ice and the following a priori covariates: age, sex, visible deformity, crew type, pain severity, and analgesia. Of 40,692 ambulance call reports reviewed, 4445 met inclusion criteria. There were 2584/4441 (58.2%) males, with a median (IQR) age of 14 (10, 16) years. In ambulance call reports with documented pain scores, 2106/3048 (69.1%) ambulance call reports reported "moderate or severe" pain. Immobilization or ice were documented in 1605/4445 (36.1%) and 385/4445 (8.7%) of ambulance call reports. Pharmacologic analgesia was documented in 275/1983 (13.9%) and 125/991 (12.6%) of ambulance call reports for primary care paramedics and advanced care paramedics, respectively. An increased odds of documented immobilization or ice was associated with moderate or severe pain [OR: 2.4; 95% CI 1.84-3.17; p < 0.01] and visible deformity [OR: 2.5; 95% CI 1.97-3.12; p < 0.01]. Documented immobilization and ice and pharmacologic analgesia to children by paramedics is suboptimal. Our findings underscore an important need for enhanced education surrounding the benefits of non-pharmacologic options for children with musculoskeletal injuries.

Mental Health and Quality of Life Considerations: Plastic and Cosmetic Surgery During the COVID-19 Pandemic

Background: Plastic surgery incorporates procedures ranging from in-office injections to full-body reconstruction. Many of these procedures have been correlated with increasing overall mental health and quality of life. The novel coronavirus (COVID-19) effectively ended plastic surgery operations, temporarily, to prevent disease transmission and conserve personal protective equipment (PPE) for patients and forefront physicians with most need. While safety precautions and mental health have remained the primary concerns, this review aims to summarize and explore the implications of the COVID-19 pandemic on plastic and cosmetic surgery procedures and its future demand, with emphasis on patient mental health and quality of life, all while bringing potential improvements to the surgical subspecialty. Methods: A critical interpretive review involved thorough searches of Google Scholar and the National Library of Medicine’s MEDLINE/PubMed databases using the following search terms: “plastic surgery,” “COVID-19,” “aesthetic surgery,” and “coronavirus” in conjunction with “mental health,” “economic hardships,” and “post-operative complications.” Results: A total of 34 manuscripts were incorporated into this critical interpretive review. Discussion: The trend in aesthetic and reconstructive plastic surgery’s frequency of procedures was expected to continue in 2020 but was derailed by COVID-19. Patient motivations for aesthetic surgery vary from visible function-impairing deformities to perceived psychological dysphoria. During COVID-19 restrictions, mental health has declined considerably for many, especially those with body dysmorphia; however, continuing cosmetic elective procedures, following public health guidelines, can have numerous mental health benefits. Conclusions: Cosmetic plastic surgery during the COVID-19 pandemic is justified to support the mental health of patients that suffer from body dysmorphia and can abide by the safety precautions to prevent infection. Aesthetic surgery after the pandemic will continue the positive trend from previous years, but with an increased focus on the mental health of patients and an increased quality of care inspired by the pandemic.

Characterization of Developmental Neurobehavioral Toxicity in a Zebrafish MPTP-Induced Model: A Novel Mechanism Involving Anemia.

Zebrafish represent an economical alternative to rodents for developmental neurotoxicity (DNT) testing. Mechanistic understanding is the key to successfully translating zebrafish findings to humans. In the present study, we used a well-known dopaminergic (DA) neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) as a model chemical to uncover the molecular pathways for observed DNT effects. To enhance the specificity of potential molecular targets, we restricted our exposure to a concentration that is nonteratogenic yet exhibits high DNT effects and an exposure window sensitive to MPTP. Our DNT assessment based on a battery of motor and social behavioral tests revealed an effective concentration of 1 μM and a sensitive window of 48-96 h postfertilization (hpf) for MPTP-induced hypoactivity. It is worth noting that this hypoactivity persisted into later larval development until 28 dpf. We observed increased cell apoptosis, oxidative stress, and decreased ATP levels in larvae immediately after exposure at 96 hpf. Significant reductions of DA neurons were found in the retina at 72, 96, and 120 hpf. No visible deformity was found in motoneurons at 72, 96, and 120 hpf. Transcriptome analysis uncovered a novel pathway manifested by significant upregulation of genes enriched with erythropoiesis. Sensitive window exposure of MPTP and other DA neurotoxins rotenone and paraquat exhibited a concentration-dependent effect on transcriptional changes of embryonic hemoglobins and anemia. Given that anemia is a significant risk factor for Parkinson's disease and MPTP is known to cause parkinsonism in humans, we concluded that anemia resulting from dysregulation of primitive erythropoiesis during embryonic development might serve as a common mechanism underlying DA neurotoxin-induced DNT effects between zebrafish and humans.

Development of a new critical size defect model in the paranasal sinus and first approach for defect reconstruction—An in vivo maxillary bone defect study in sheep

Fractures of the paranasal sinuses often require surgical intervention. Persisting bone defects lead to permanent visible deformities of the facial contours. Bone substitutes for reconstruction of defects with simultaneous induction of new bone formation are not commercially available for the paranasal sinus. New materials are urgently needed and have to be tested in their future area of application. For this purpose critical size defect models for the paranasal sinus have to be developed. A ≥2.4 cm large bilateral circular defect was created in the anterior wall of the maxillary sinus in six sheep via an extraoral approach. The defect was filled with two types of an osteoconductive titanium scaffold (empty scaffold vs. scaffold filled with a calcium phosphate bone cement paste) or covered with a titanium mesh either. Sheep were euthanized after four months. All animals performed well, no postoperative complications occured. Meshes and scaffolds were safely covered with soft tissue at the end of the study. The initial defect size of ≥2.4 cm only shrunk minimally during the investigation period confirming a critical size defect. No ingrowth of bone into any of the scaffolds was observed. The anterior wall of the maxillary sinus is a region with low complication rate for performing critical size defect experiments in sheep. We recommend this region for experiments with future scaffold materials whose intended use is not only limited to the paranasal sinus, as the defect is challenging even for bone graft substitutes with proven osteoconductivity.Graphical abstract

Pure Obturator Dislocation of the Hip, a Rare Variety of Regular Dislocations, and Long-Term Clinical Outcomes

Introduction: Traumatic knee dislocation is considered an orthopedic emergency. Knee dislocations are relatively infrequent injuries. This injury frequently occurs from high-energy impact trauma. Neurovascular injuries can result in debilitating consequences if the diagnosis and treatment are delayed. Associated complications include degenerative arthritis, permanent neurovascular injury, and amputation. The poorest prognosis is seen in patients with knee dislocation longer than 6-8 hours before reduction. History: The 25-year-old male patient presented with a history of a road traffic accident to the emergency department. The patient presented with swelling, pain, and deformity of the left knee and leg. Examination: On examination, the patient had tense swelling and tenderness of the left knee joint and leg. Visible deformity of the left knee joint is seen. The posterior tibial artery and dorsalispedis artery were not palpable. Active ankle and toe movements were absent. Investigations: Plain radiograph was taken at the emergency department of the left knee and leg. X-rays showed anterior dislocation of the knee joint. Treatment: After valid written informed consent, the dislocated left knee joint was reduced under sedation in the operation theatre and immobilized in the above knee plaster slab. Reduction of the knee joint was done within 4 hours of injury. Then the distal pulses were re-assessed. The posterior tibial and dorsalispedis artery was absent. Hence, MR Angiography of the left lower limb was done. It showed popliteal artery transection. So, the artery was explored and end-to-end vascular anastomosis was done. A knee-spanning external fixator was applied to the left lower limb. Fasciotomy was done for the tense leg compartments. After a week, the fasciotomy wounds were infected for which extensive debridement of the wounds was done and antibiotic beads were placed. Knee was mobilized with a gradual range of motion exercises and non-weight bearing mobilization with a foot drop splint. Gradually full weight-bearing ambulation was allowed. Conclusion: Knee dislocation is rare, albeit a serious and potentially limb-threatening condition. The prognosis of knee dislocations is variable and is heavily dependent on the time interval between trauma and initiation of management. Immediate, timely, and proper management can salvage the limb, and amputation is not the only solution. Keywords: Dislocation, Posterior tibial artery, Fasciotomy

Infrahyoid myofascial flap transfer for the prevention of concave deformity and gustatory sweating after parotidectomy

ObjectiveConcave deformities and gustatory sweating are the most common complications that cause substantial patient dissatisfaction after parotidectomy. Various surgical methods to prevent these complications have been described. However, effective techniques have not been established, especially in patients with medium- to large-sized parotidectomy defects. We evaluated the utility of infrahyoid myofascial flap reconstruction of parotidectomy defects for the prevention of these complications. MethodsWe conducted a retrospective case series study in patients with a benign or malignant parotid tumor measuring over 4 cm who underwent immediate pedicle infrahyoid myofascial flap reconstruction after total or subtotal parotidectomy or total resection of either the superficial or deep parotid gland at our hospital. Subjective analyses of facial symmetry, postoperative concave deformities of the anterior neck, gustatory sweating, voice disorders, odynophagia, neck scarring in the parotid and anterior neck areas, sensory disorders, pain, and neck stiffness were performed using patient interview data. Objective evaluations of facial symmetry were made by the first or second author. Both analyses were performed after a follow-up of more than six months. Additionally, patient demographic data, clinicopathological factors, parotidectomy and skin incision types, flap survival, and postoperative complications were evaluated. ResultsWe included eight patients (male, n=5; mean age, 69.3 years [range, 37–93 years]). Procedures included total or subtotal parotidectomy (n=4), superficial lobe parotidectomy (n=2), and deep lobe parotidectomy with partial superficial lobe parotidectomy (n=2). Infrahyoid myofascial flaps reached the cranial tip of the parotid defect without tension, and their volume sufficiently filled the parotidectomy defect in all patients. There were no local signs of insufficient blood flow within the transferred flaps.Objective and subjective assessments were made after a mean duration of 1.2 years (range, 0.6-1.8). Postoperatively, no patient subjectively reported facial asymmetry. Objectively, facial symmetry was “good” in four patients and “fair” in four patients. No distinctly visible concave deformity in the parotid or anterior neck area occurred in any patient. Gustatory sweating occurred in one patient; this individual had the largest parotidectomy defect. Only one patient experienced donor site morbidity (mild anterior neck stiffness) related to infrahyoid myofascial flap elevation. ConclusionAlthough complete prevention of gustatory sweating was unsuccessful, infrahyoid myofascial flap reconstruction of medium- to large-sized parotidectomy defects led to postoperative facial symmetry with minimal donor site morbidity.

28 Assessment of Pain and Provision of Non-Pharmacologic Analgesia to Children by Prehospital Providers in Southwestern Ontario: A Cross-Sectional Study

Abstract Primary Subject area Emergency Medicine - Paediatric Background There is abundant evidence that provision of pharmacologic analgesia by prehospital providers to children is suboptimal. Most paediatric calls are performed by primary care paramedics (PCPs) who are unable to administer pharmacologic analgesia to children but can administer non-pharmacologic therapies. Objectives Our objective was to describe the provision of non-pharmacologic analgesia to children by prehospital providers. Design/Methods We reviewed all ambulance call reports (ACRs) of children 0-17 years with acutely painful conditions (headache, abdominal pain, injury, head/ears/eyes/nose/throat pain, and back pain) who were transported to a paediatric tertiary referral centre serving a catchment of &amp;gt; 1 million from 2017-2019. Data collection was recorded by two blinded assessors using a study-specific Excel™ sheet. The primary outcome was the proportion of children offered non-pharmacologic analgesia. We performed a stepwise logistic regression on the primary outcome using covariates defined a priori: age, sex, visible deformity, type of crew, complaint, pain score, call time, and prior analgesia. Results All 11,084 ACRs from January 1, 2017 to December 31, 2019 were reviewed. The sample included 5887/11084 (53.1%) males, ranging from 1 month to 17 years, with a mean (SD) age of 10.5 (5.6) years. Calls involved mainly PCPs [8576/11084 (77.4%)]. Non-trauma-related musculoskeletal injuries were most common, comprising 2743/11,084 (24.7%) of calls. Pain scores were documented in 6947/11084 (62.7%) of calls. The verbal numeric rating scale (0-10) was used in 5022/6947 (72.3%) of calls, with a mean (SD) score of 5.2 (3.2). Non-pharmacologic analgesia was provided in 2926/11084 (26.4%) of calls, most commonly splint (1115/2926, 38.1%) and ice (931/2926, 31.8%). Pharmacologic analgesia was provided in 458/11084 (4.1%) of calls. In the multivariate model, mild (OR: 3.2; 95% CI 2.3-4.4; p &amp;lt; 0 .001) and moderate pain (OR: 1.7; 95% CI 1.3-2.2) (versus no pain) were significant predictors of non-pharmacologic analgesia, whereas visible deformity (OR: 0.5; 95% CI 0.3-0.6; p &amp;lt; 0 .001) was a significant negative predictor. Conclusion The provision of non-pharmacologic analgesia to children in Southwestern Ontario by prehospital providers is suboptimal, despite moderate to severe pain. There is a clear need for education surrounding approaches to non-pharmacologic analgesia in children among prehospital providers.

Assessment of morphological differences of the proximal tibia in healthy knees: analysis of the 3-dimensional mathematical model.

High tibial osteotomy and many orthopedic surgical procedures around the knee joint requires precise preoperative planning. In-depth knowledge of the tibial plateau morphology is necessary to limit intraoperative complications like lateral hinge fracture. No studies were exploring the differences in proximal tibia surface geometry, in regards to gender and laterality, using a mathematical model. The aim of our study was to assess morphological differences in healthy knees using a three-dimensional mathematical model. Eighty-seven computed tomography examinations collected from 52 patients were selected for the study. The inclusion criteria were: age between 20 and 40 years, knee joint without visible deformities, no history of significant trauma to index knee, no history of systemic and chronic disorders. The average age of the included patients was 32.5±8.9 years old. For the calculation and comparisons, 45 right knee joints (18 females and 27 males) and 42 left knee joints (17 females and 25 males) were used. The male tibial plateau was much larger than the female one, for the right (P=0.001) and left knees (P=0.001). Male knees showed much bigger variability in two-dimensional tibial plateau dimensions especially for the left knees (P=0.001), and there was also a marked difference in variability between sides in males. Three-dimensional variability was significant for medial condyles for both genders. Male knees had a statistically bigger (P=0.04) tibial plateau surface area for all measured condyles. The proximal tibial plateau showed in the designed mathematical models high variability in the two-dimensional and three-dimensional analysis. The males' knees presented great variability between sides and condyles. This finding must be considered during preoperative planning.

Patterns of leprosy at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, and review of current clinical practice

Background. The World Health Organization announced a strategy to eliminate childhood leprosy infections, visible deformities and discriminatory legislation against leprosy patients by 2020. However, challenges in achieving a leprosy-free world and preventing neurological sequelae still exist. HIV infection is a challenge in South Africa (SA). HIV-leprosy co-infection may result in an increase in the frequency of leprosy reactions without affecting the spectrum of leprosy. From 1921 to 1997, the prevalence of leprosy remained <1 patient per 10 000 population. Current SA literature has very scanty information regarding leprosy infections. Objectives. To describe the trend of new leprosy patients at Chris Hani Baragwanath Academic Hospital, Johannesburg, SA, from 1999 to 2015, including demographics, clinical spectrum and treatment outcomes. Methods. A retrospective review of patients’ clinical records was undertaken. Data on demographics, clinical spectrum including the leprosy classification, reactions, neurological involvement, association with HIV infection and treatment outcomes were extracted. Data analysis was performed using descriptive and inferential statistics and a time series analysis. Results. An upward trend from 1999 to 2001 was followed by a decline in the number of new patients. Eighty patients were registered over a period of 17 years, with a male-to-female ratio of 3:1. Thirty-six patients were immigrants, and 5 were children aged <15 years. Multibacillary leprosy was the most common type ( n =71 patients). Thirty-six patients had the lepromatous leprosy subtype, 22 were borderline lepromatous, 13 were borderline tuberculoid, 6 were borderline borderline, and 3 had tuberculoid leprosy. Thirty-one patients presented with reactions, type 1 in 9 patients and type 2 in 21 patients, with both types in 1 patient. Grade 2 neurological deformities were diagnosed in 37 patients, of whom 2 were children. Eight patients were found to have HIV-leprosy co-infection. Of 52 patients who completed treatment, 26 were cured and 26 were lost to follow-up. Twenty-one patients defaulted from treatment, while 3 patients relapsed. Conclusions. This study highlights the current status of leprosy in a low-endemic centre with declining numbers of new patients. Multibacillary forms with grade 2 disabilities (G2Ds) are common. The constant emergence of leprosy in our population highlights shortfalls in our control campaigns. Furthermore, a high rate of G2Ds necessitates scrutiny of education directed at early patient detection and follow-up strategies.

Static Suspension of the Paralyzed Face Utilizing the Midfacial Corridor: Anatomic Evaluation and Surgical Technique.

Fascia lata and tendon grafts are frequently utilized to support the paralyzed midface and to extend muscular reach in McLaughin style, orthodromic temporalis transfers. The grafts are frequently placed in a deep subcutaneous positioning that can lead to the development of a, bowstring deformity in the cheek. This paper describes insertion of tendon grafts into the midfacial corridor collectively formed by the buccal, submasseteric and superficial temporal spaces. Over a seven-year period, all patients that underwent insertion of facia lata and tendon grafts in the midfacial corridor were included. Demographic information, perioperative variables and clinical outcomes were collected and analyzed. A total of 22 patients were included with a mean age of 64.3 years (33-86). There were multiple etiologies for the facial weakness including acoustic neuroma (9.1%), Bell's palsy (13.6%), facial nerve schwannoma (9.1%), temporal bone fracture (4.6%) and malignancy (22.7%). Midfacial corridor grafts were utilized in combination with nerve transfers (V-VII and XII-VII) in nine patients, McLaughin style temporalis transfers in 12 and as a standalone procedure in one individual. During the study period, no patients exhibited a tethering, or concave deformity in the midface. Additionally, no impingement, difficulties with mastication, parotitis or hematoma were encountered. One patient developed a postoperative infection, that was successfully managed. Placement of tendon or fascia grafts for static support or tunneling of an orthodromic temporalis transfer through the midfacial corridor can be performed rapidly while providing midfacial support and avoiding the creation of visible cutaneous deformities.

Delay in diagnosis as a prognostic factor for disability in patients with leprosy in Paraguay. Case and control study

Leprosy, a chronic infectious disease, is one of the major causes of preventable disability. Early treatment prevents neurological damage and disability. To identify prognostic factors of disability in individuals with multibacillary and paucibacillary leprosy who completed a drug treatment between 2011 and 2017 in Paraguay. A case-control study was carried out on 34 patients, of them 9 were cases and 25 controls. Cases were those patients with Grade 1, presented lack of sensation in lower or upper limbs, and those of Grade 2 lagophthalmos, rigidity, visible deformity ulcerations, passive claw, active claw. Controls had no disabilities. Mean age of the patients was 53 ± 15.2 years, 55.9% were male, and 58.9% had primary education or no formal education. Multibacillary leprosy was found in 58.8% of patients; and 64.7% were diagnosed after consulting with two or more physicians. Diagnosis delay of more than one year was significantly (p = 0.047) greater in the cases than in the controls (77.8% vs 12%; OR: 7.44; 95% CI: 1.02-67.86). In this study, a diagnosis delay of more than one year is a prognostic factor for disability.

Effect of Educational Program on Health Consequences of Patients with Leprosy

Context: Leprosy remains a leading cause of peripheral neuropathy and disability globally despite the extensive efforts to reduce the disease burden. It is associated with social stigma, and the patients sometimes suffer social discrimination because it often leads to visible physical deformities.&#x0D; Aim: The present study aimed to evaluate the effect of educational program on the health consequences of patients with leprosy.&#x0D; Methods: The study was conducted at outpatient clinics in Dermatology Hospital affiliated to the Ministry of Health and population. A quasi-experimental (pre/post-test) design was used on a purposive sample of 72 leprosy patients. Four tools were used to collect the data for this study: A structured interviewing questionnaire, a patients' reported practices checklist, an attitude assessment scale for patients with leprosy, and health consequences assessment questionnaire for patients with leprosy. &#x0D; Results: The current study reveals a significant improvement in the patients’ knowledge, reported practice, and attitude toward leprosy. A significant improvement in health consequences (problems and needs) after education compared with the preintervention level. An association between the total knowledge, practice, and attitude after health education was significant (p&lt;0.001). An association between the mean and standard deviation of knowledge, practice, and attitude before and after the health education program was significant (p&lt;0.001).&#x0D; Conclusion: Educational program had a remarkable effect on improving patients' knowledge, practice level, patient attitude, and health consequences (problems and needs) of leprosy. The study recommended applying educational programs for patients with leprosy in different health care settings focusing on prevention from disabilities.

Lateral Wall Implant as an Adjunct to Lateral Wall Orbital Decompression in Severe Thyroid Eye Disease.

To describe the use of a lateral wall implant as an adjunct in lateral orbital wall decompression in severe thyroid eye disease. This study is a retrospective review of 6 patients who underwent prior orbital decompression but had persistent proptosis. These patients underwent lateral wall decompression with adjunct lateral wall implant placement with a manually vaulted 0.6-mm polyethylene-coated titanium mesh implant. Data collection included: visual acuity, intraocular pressure, exophthalmometry, ocular motility, eyelid position, and complication rates. Eight orbits in 6 patients underwent maximal lateral wall decompression and reconstruction using the polyethylene-coated titanium implant. Four males and 2 females were included with ages ranging from 25 to 73 years. Visual acuity improved an average of 2.4 lines (range 0-5 lines). Intraocular pressure improved an average of 7.5 mm Hg (2-13 mm Hg). There was reduction of proptosis by 3.4 mm on average (1-7 mm). Upper eyelid retraction improved on average by 1.8 mm (0-5 mm). Horizontal eye movements improved by 11% on average (-3.1% to +25%). Excellent cosmesis was achieved with no visible temple deformity, trismus, conjunctival scarring, orbital hemorrhage, or vision loss. The amount of volume created in lateral wall decompression is limited by the amount of native bone present and the temporalis muscle. In severe or recalcitrant cases, the authors propose the placement of a lateral wall implant as an adjunct to laterally displace the temporalis muscle and create additional volume. This technique accomplishes further reduction of proptosis in patients who have undergone prior orbital decompression.

Juvenile tench ( Tinca tinca L.) response to practical diets with different replacement levels of fish meal by pea protein concentrate supplemented with methionine

The effects of methionine supplementation in diets with different replacement levels of fish meal (FM) by pea protein concentrate (PPC) on survival, growth performance and body composition of juvenile tench (0.39 g of initial weight) were studied in a 90-day experiment. Six practical diets (50% crude protein) differing in replacement level of FM by PPC were tested: 0% (control diet), 35%,45%, 60%, 75% or 85%, corresponding to 0, 285, 366, 487, 608 and 685.4 g PPC kg−1 diet respectively. To provide the same amount as in control diet, methionine was included from the 45% substitution level. Survival rates were high, between 93.7% and 100%, without differences among treatments. Juveniles fed 75% and 85% of replacement diets showed lower (p < 0.05) weight and specific growth rate, which cannot be attributed to methionine deficiency. In all treatments, percentages of fish with externally visible deformities were low (under 0.1%). The increase in PPC diet content resulted in a significant reduction of lipid content in whole-body juvenile. Minimum methionine requirements for juvenile tench could be estimated in 10 g kg−1 diet and supplementation over this amount would be not necessary. Juvenile tench exhibited a high tolerance to PPC dietary content, up to 487 g kg−1, without affecting growth performance, which make possible to consider this vegetal source of protein as a suitable substitute to FM.

Extracorporeal acidic predigestion of commercial dry diets can reduce the incidence of body deformities in the stomachless fish crucian carp (Carassius carassius L.)

Abstract The aim of the present study was to test the hypothesis that predigesting commercial dry diets for fish with hydrochloric acid (HCl) can contribute to the reduction of the incidence of body deformities in a stomachless cyprinid species intensively reared under controlled conditions. Two different dry diets (Carpco Crumble by Coppens International and Aller Futura by Aller Aqua), their respective variants modified with HCl, and frozen larval chironomids (control diet) were fed as sole food sources to juvenile Carassius carassius in a recirculating aquaculture system at 25°C for 60 days. At the end of the experiment, visible body deformities occurred exclusively in the groups fed dry diets. The shares of deformities were significantly lower in fish groups fed the modified diets (6.1–13.2%) as compared to those fed the original ones (74.0–87.0%). Fish in the latter groups had significantly the highest condition factor values, which indicated a possible phosphorus deficiency. As evidenced by our results, predigesting commercial dry diets with HCl can be a useful method to mitigate the problem of body deformities occurring in intensively fed cyprinid species.

Factors Influencing Leprosy Incidence: A Comprehensive Analysis of Observations in Wenshan of China, Nepal, and Other Global Epidemic Areas.

Leprosy remains endemic in some regions and is a global health concern. However, the possible causes and risk factors of the disease remain unclear. Data in Wenshan, China were collected from the Wenshan Institute of Dermatology (1986–2015); data in Nepal were obtained from the Leprosy Control Division, Department of Health Services, Nepal (2011 to 2015); and data from Indonesia, India, and Brazil were collected from WHO records. We assessed the epidemiological trends of leprosy in Wenshan and compared the features of possible causes and risk factors with those of other countries. We then performed a descriptive and statistical analysis to make our study more purposeful and definitive. A total of 3,376 cases were detected in Wenshan from 1986 to 2015. The overall prevalence rate (PR) of leprosy presented a decreasing trend with a peak (4.9/10,000 population) in 1986. The detection of new leprosy cases was higher in males than in females. Visible deformity increased every year since 2005 with a disability of 34.8% in 2015 among new cases. In Nepal, 2,461 leprosy patients received multi-drug therapy (MDT) in 2015 which corresponded to the PR of 0.89/10,000 population. Geographic latitude and socio-economic situations appeared to be the main causes of leprosy, and the healthcare condition was an important factor associated with leprosy incidence. The introduction of MDT effectively reduced leprosy prevalence worldwide. Wenshan (China), Nepal, and other countries share similarities in various aspects with respect to socio-cultural features, geographical distribution, environmental factors, and economic situation, which may contribute to leprosy being endemic in these areas.

The use of statistical modelling to identify important parameters for the shape of the torso following surgery for adolescent idiopathic scoliosis.

The surgical strategy in adolescent idiopathic scoliosis (AIS) aims to recreate the symmetry of the torso. This requires the minimisation of both the size of the scoliosis and the angulation between the sides of the torso, along with the recreation of a normal thoracic kyphosis. This study uses predictive modelling to identify the significance of the value of the pre-operative parameters, and the change in the magnitude of the parameters as a result of an operation on the shape of the torso using the 'most prominent points'; two areas of maximum prominence on either side of the spine with x, y and z coordinates. The pre-operative values, and the change in magnitude between the pre and post-operative values, for scoliosis, kyphosis and skin angulation from a group of Lenke 1 convex to the right AIS were analysed with measures collected using Integrated Spine Imaging System 2 surface topography and compared with those without visible spinal deformity. The models best explained the z coordinate and least well explained the x coordinate, although there was a contribution to all of the models that remained unexplained. The parameters that affected the position of the coordinates in the model differed between the models. This confirms that surgically altering the shape of the spine and torso whilst correcting an AIS does not lead to a symmetrical torso. There are as yet, undefined factors which contribute to the shape of the torso and which if identified and corrected surgically would lead to greater symmetry post-operatively.