Total or subtotal replacement of tarsal plate by novel silicone plate for upper eyelid reconstruction in malignant tumors

Purpose

: To evaluate the cost, safety, surgical outcome, and efficacy of modified Cutler-Beard eyelid reconstruction utilizing a novel silicone plate as a tarsal plate replacement in the repair of 60% to 100% eyelid defects following the excision of large malignant tumors.

Methods

: A prospective, noncomparative, interventional study of 30 eyes was done over 3 years. Fourteen patients were female, and 16 patients were male. In all the cases, a silicone plate, the synthetic, artificial tarsal plate, was utilized for a total or subtotal replacement of the tarsal plate. The created defect was measured in mm (length and width) and later expressed in percentage. Pre- and postoperative action of levator palpebrae superioris (LPS) was measured. Pre- and postoperative measurements of the margin-to-margin reflex distance (MRD1) were noted.

Results

: Preoperative LPS action was 1.23 ± 1.35 mm, whereas postoperative LPS actions at the end of 1 week and 18 months were 11. 8 ± 0.88 mm and 13.53 ± 0. 73 mm, respectively. Preoperative MRD1 was - 3.0 ± 1.144 mm, whereas postoperative MRD1 values at the end of 1 week and 18 months were 2.18 ± 0.27 mm and 4.16 mm ± 0.35, respectively. The mean created defect after the removal of the tumor was 87.3% ±11.10. The mean length of the silicone plate implanted in this study was 27.53 ± 2.48 mm. The follow-up period for the study participants was 18 months.

Conclusion

: The synthetic novel silicone plate was successful as a tarsal plate replacement. A second surgical site for ear cartilage harvesting is avoided. Cadaver transfer of Achilles tendon carries the risk of transmission of communicable diseases, for example, hepatitis B and HIV. Silicone is an inert, nonreacting, and tissue-tested material, thus eliminating the possibility of graft rejection. This material is readily available and cost-effective. The novel silicone plate is considered to be the most promising alternative material as a tarsal replacement in the future generation.

Impact of conventional retting of jute (Corchorus spp.) on the environmental quality of water: a case study

Production of quality jute fibre primarily depends on the retting process of jute. However, the quality of retting water is of great concern because of the scarcity of available water bodies for retting. A study conducted on physico-chemical and microbiological changes in retting water (pre- and post-retting) from four intensively jute-growing districts namely Nadia, North 24 Parganas, Hooghly and South Dinajpur of West Bengal, India, during jute retting. The post-retting water samples recorded lower pH (6.22 to 7.08) and higher EC (electrical conductivity) (0.509 to 0.850 ds/m) compared with pre-retting water samples (pH 6.63 to 7.44; EC 0.197 to 0.330 ds/m) collected from all the four districts under study. The biological oxygen demand (BOD) and chemical oxygen demand (COD) increased several folds in the post-retting water samples indicating very high microbial growth and activities and depleted oxygen level compared with pre-retting water. The Ca + Mg (calcium + magnesium) content in pre-retting water was high (24.15 to 36.60 ppm) which raised further (61.30 to 103.67 ppm) in post-retting water, while the bicarbonate content also increased and ranged between 2.72 and 6.81 me/l in post-retting water compared with its status in pre-retting water (1.30 to 3.15 me/l). The post-retting water was found to be a rich source of nutrients like nitrogen (N), phosphorus (P), iron (Fe), manganese (Mn), zinc (Zn) and copper (Cu) which increased substantially because of jute retting as compared with their status in pre-retting water. The population of pectinolytic, xylanolytic, cellulolytic and ligninolytic bacterial cfu (colony forming unit) increased by 1.5 times in post-retting water as compared with pre-retting water, because these specific bacterial population were involved in the degradation of pectin, xylan, cellulose and lignin during retting of jute. Thus, post-retting water can be judiciously used as a potent source of primary, secondary and micronutrients for succeeding crops besides having higher BOD and COD as a result of higher microbial growth related to jute retting.

Long-term effects of fertilizer and manure application on soil quality and sustainability of jute-rice-wheat production system in Indo-Gangetic plain

A long-term fertilizer experiment was initiated in 1971 in sandy loam soil (Eutrochrept) of Barrackpore, West Bengal to study the effects of applying organic and inorganic sources of nutrients on yield of jute-rice-wheat system and soil health. The unfertilized soil supported yields of 0.8 t ha-1 of jute fibre, 1.5 t ha-1 of rice grain and 0.7 t ha-1 of wheat grain (average yield of 42 years). Application of 150% recommended NPK through chemical fertilizers produced maximum yields of jute (2.1 t ha-1), rice (3.8 t ha-1) and wheat (2.8 t ha-1). The yields obtained with 150% NPK fertilizers were 5%, 2.7% and 12% higher than that with 100% NPK fertilizers +FYM. Combined application of 100% NPK fertilizers and FYM, however, increased soil organic carbon, available nitrogen, phosphorus and potassium from 5.60 to 8.90 g kg-1, 270 to 316 kg ha-1, 40.7 to 120 kg ha-1 and 139 to 236 kg ha-1 respectively. Maximum DTPA-extractable micronutrients in soil were also observed with 100%NPK fertilizers+FYM. Applying FYM together with NPK fertilizers increased microbial biomass from 221 to 435 mg kg-1 and microbial quotient from 3.95 to 4.89 with concomitant increase in dehydrogenase, phosphatase and fluorescein-diacetate-hydrolyzing activities in the soil. The acid phosphatase activity (139 to 275 μg PNPg-1 h-1) was much lower than alkaline phosphatase activity  (479 to 616 μg PNPg-1 h-1). The enzymes assayed showed significant correlation with microbial-C and organic C. Beneficial effects of integrated nutrient management (NPK+FYM) on soil health were reflected on the yields of all the crops.

Localized Castleman’s Disease in Retroperitoneum Mimicking Broad Ligament Leiomyoma – a Diagnostic Challenge

Primary retroperitoneal tumours pose a diagnostic dilemma and therapeutic challenges because of their location and late detection. Localized Castleman Disease (CD) in retroperitoneal location is a rare occurrence, with incidence of only 4% cases occurring in diverse locations like retroperitoneum. A rare case of unicentric localized Castleman Disease localized in broad ligament is hereby reported which was clinically & radiologically suspected as broad ligament leiomyoma but finally diagnosed as Castleman’s Disease, hyaline vascular type in a young female posing a diagnostic challenge both for the pathologist and clinician. Definite diagnosis is essential as complete surgical excision in case of unicentric Castleman’s Disease has good prognosis after resection.   

Spectrum of histopathological lesions in the fallopian tubes

Background: Fallopian tubes are common surgical specimen in the pathology laboratory; still there is a lack of data to describe the frequency of various histological fi ndings. The aim and objectives of this study was to describe the various histopathological fi ndings of fallopian tubes. Materials and Methods: Two thousand fi ve hundred and seventy fi ve cases where fallopian tubes were removed either separately or along with other female genital tract organs were studied retrospectively and their histopathological fi ndings documented. Results: Ectopic pregnancy comprised maximum number of cases closely followed by salpingitis. Primary neoplastic lesions were rare as compared to secondary malignancies. Serial sections of fallopian tube and sections from representative areas are essential for a pathologist so that the diagnosis of these pathological entities is not missed. Conclusion: Though the fallopian tubes remain unremarkable in majority of the surgical pathological specimens, it must be subjected for histopathological examination to demonstrate the pathological lesions. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 356-360 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7858

Fibrous dysplasia: rapid malignant transformation into osteogenic sarcoma - A rare occurance

Malignant transformation of fibrous dysplasia is rare, occurring in less than 1% of cases with a mean lag period of 13.5 years. We report a case of Osteogenic Sarcoma with chondroid differentiation in a pre-existing Fibrous Dysplasia occurring within one year of surgical resection and without any history of exposure to radiation. To the best of our knowledge and extensive search of literature, malignant transformation of Fibrous Dysplasia in such a short period of time, and without history of radiation exposure has never been reported from India.Journal of Pathology of Nepal (2012) Vol. 2, 335-337DOI: http://dx.doi.org/10.3126/jpn.v2i4.6891

Comparative dosimetry of GammaMed Plus high-dose rate Ir brachytherapy source

The comparative dosimetry of GammaMed (GM) Plus high-dose rate brachytherapy source was performed by an experiment using 0.1-cc thimble ionization chamber and simulation-based study using EGSnrc code. In-water dose measurements were performed with 0.1-cc chamber to derive the radial dose function (r = 0.8 to 20.0 cm) and anisotropy function (r = 5.0 cm with polar angle from 10° to 170°). The nonuniformity correction factor for 0.1-cc chamber was applied for in-water measurements at shorter distances from the source. The EGSnrc code was used to derive the dose rate constant (Λ), radial dose function g(L)(r) and anisotropy function F(r, θ) of GM Plus source. The dosimetric data derived using EGSnrc code in our study were in very good agreement relative to published data for GM Plus source. The radial dose function up to 12 cm derived from measured dose using 0.1-cc chamber was in agreement within ±3% of data derived by the simulation study.

Algorithms and heuristics for efficient medical information display in PDA

Accessing medical information in mobile devices such as PDAs and mobile phones is becoming widespread. Since these devices do not have the same rendering capabilities as of desktop computers, it is necessary for medical information to be fragmented for proper presentation on these types of devices. In this paper, we propose an architecture for displaying medical information in PDA. In the proposed system, a server extracts the information, categorizes the information in order of its relevance for diagnosis, and dynamically generates a hierarchical view of the relevant information based on certain medical domain knowledge. Displaying image and graphics data in PDA poses several challenges. The proposed system supports an image visualization tool, which interactively displays an image or a portion of an image in user's PDA. This visualization tools increases the resource utilization of PDA by offloading a part of the computation to the server. A suitable caching scheme is incorporated for optimum utilization of communication channel bandwidth.

The use of PHC clinic-based women's groups for financial empowerment in a rural area

The article is based on a four-year project during which Primary Health Care (PHC) nurses worked with women's groups in their areas. The aim of the study was to explore the involvement of PHC nurses in economic empowerment, both in terms of health promotion and in terms of the PHC approach. In particular the objectives were to establish whether nurses could lead economic empowerment groups, whether such groups could establish adequate external links and become financially viable. Eleven groups were used as case studies, and a cross-case analysis was done in terms of the three objectives. It was found that between the women and the nurses, adequate leadership existed for the groups to function well. Very limited external linkages were established, notwithstanding efforts in this regard. Nine out of 11 groups contributed to financial welfare of their members after 18 months, but a range of problems with regard to financial viability are identified.

Study of scattered radiation for in-air calibration by a multiple-distance method using ionization chambers and an HDR 192Ir brachytherapy source

The aim of this study is to estimate the room-scatter correction when measuring air kerma rate of an HDR 192Ir brachytherapy source by in-air calibration. The variation in scattered radiation due to the specially designed jig and from the room walls was also studied. Two therapy ion chambers of volume 0.1 cm3 and 0.6 cm3 were used in the present study. Air kerma was measured by placing the source at several distances between 10 cm and 20 cm from the chamber. The scatter radiation was determined by superimposing the theoretically derived model curve of known scatter (based on the inverse square law) over the plot of measured air kerma strength values. The scatter radiation was estimated in terms of percentage of the primary radiation at 10 cm measurement distance. The scatter estimated by the 0.6 cm3 chamber at two positions was 0.33% and 0.59%, respectively. Similarly the scatter estimated at two other positions by the 0.1 cm3 chamber was 0.58% and 1.11%. This variation in scatter with position as well as with the chamber was due to the varying scatter contribution from components of the measurement set-up. The scatter radiation becomes constant at a distance greater than 100 cm from the walls of the room. We conclude that a fixed chamber with changing source positions should be used in multiple-distance measurement of air kerma rate when using a measurement jig.

Economic evaluations of community-based care: lessons from twelve studies in Ontario

A series of 12 studies (five historic cohort and seven randomized trials) examined clients in community settings in Southern Ontario suffering from a variety of chronic physical and mental health conditions. These studies are appraised using a framework for evaluating possible outcomes of economic evaluation. In the 12 studies, sample composition and size varied. Each study was designed to quantify the well-being outcomes and expenditures associated with different community-based approaches to care provided in the context of a system of national health insurance. As a collective, these studies represent increasing methodological rigour. Multiple-perspective client well-being outcome measures were used. In two studies, caregiver burden also was analysed. A common approach to quantification and evaluation of expenditures for service consumption was used in all 12 studies. The nature of community-based health services (health vs. disease care orientation) was found to have direct and measurable impact on total expenditures for health service utilization and client well-being outcomes. In most cases, a recurring pattern of equal or better client outcomes, yet lower expenditures for use of community based health services, was associated with well-integrated health oriented services. Integrated services aimed at factors which determine health are superior when compared to individual, fragmented, disease oriented, and focused approaches to care. The main lessons from the 12 studies are that it is as or more effective and as or less expensive to offer complete, proactive, community health services to persons living with chronic circumstance than to provide focused, on-demand, piecemeal services. Complete services would have a psychosocial and mental health focus included with the physical care approach. Furthermore, people with coexisting risk factors (age, living arrangements, mental distress and problem-solving ability) are the ones who most benefit at lower expense from health oriented, proactive interventions.

Empowerment through self-directed learning

In the 1970s, McMaster University, Hamilton, introduced self-directed learning (SDL) to its undergraduate nursing program. This innovation was prompted by a fundamental belief in the importance of nurse empowerment and the link between empowerment and SDL. The empowerment of nurses, it was believed, was critical to the improved health and welfare of patients. In the 1990s, faculty and alumni have perceived another benefit to SDL: the ability of McMaster graduates to persevere and excel in the face of health care system change.

Cultural sensitivity training among foreign medical graduates

OBJECTIVES

To examine the effectiveness of culture sensitivity training for foreign-trained medical graduates licensed to practice in Ontario, Canada.

DESIGN

A study of pretest-post-test design was conducted to determine the effect of cultural sensitivity training on newly immigrated physicians licensed in Canada. Twenty-four physicians, those who had passed the medical licensing exam in 1996 and had not yet started their residency program, were given 15 hours of cultural sensitivity training and were considered the experimental group. This group was compared with a control group of 24 physicians who had passed the licensing exam and were in the process of completing residency.

SETTING

University of Toronto.

SUBJECTS

Foreign-trained medical graduates.

RESULTS

Both groups completed the Cross-Cultural Adaptability Inventory both before and after the training of the experimental group. Statistical significance in three subscales of the Open-Mindedness/Flexibility, Emotional Resilience and Perceptual Acuity dimensions were demonstrated in the experimental group as compared with the control group.

CONCLUSIONS

In order for Canada to mould professional and effective physicians great care must be taken in the design and process of cultural sensitivity programmes to enhance both knowledge and skills. Follow-up should be undertaken to compare their effectiveness with the control group.

Management of family and workplace stress experienced by women of colour from various cultural backgrounds

Minority women identify finances and maintaining cultural values as their most commonly experienced stressors at home and in the work-place. A before and after study of ethnic minority women in focus group sessions led by a trained ethnic minority facilitator examined how social and workplace supports, or lack thereof, impact on the individuals' ability to manage daily life. Creative, effective solutions to stressors were identified by the participants. Outcomes were evaluated in terms of the impact of changes on the participants' coping styles in family and work life. Results indicate that a large percentage of women in this study felt discriminated against based on their culture/race, however, this perceived discrimination decreased after the focus groups. The predominant stress management techniques were prayer and music. Family support was the most influential factor in decreasing stress. The family is a major source of support for the working women, acting as a buffer to workplace pressures.

AIDS awareness among women: the benefit of culturally sensitive educational programs

AIDS affects everyone, regardless of race, age, or religion; hence, information must be accessible to everyone. This descriptive study identified the need to generate culturally sensitive educational programs and evaluated their effect. Culturally sensitive AIDS educational training was offered to culturally diverse women. Training was conducted by women of the same ethnicity as the women in the group. The facilitators were specially trained on the role of a facilitator and the participatory method of learning. To assess any change in attitude, knowledge, and beliefs regarding AIDS, the questionnaire was administered before and after the training programs. Educational training had a positive effect (p < .05) on participants' attitude and knowledge regarding AIDS; they felt comfortable discussing their concerns in their own language, and with their friends from the same community, and they viewed the resources used as culturally sensitive.

Pakistan's community health workers

Pakistan's health characteristics are worse than those of other Asian countries at similar stages of development. Its mortality rate for children under five is 139 per 1,000, and its maternal mortality is 60 per 10,000. Malnutrition in women and children is widespread; 50 per cent of children under five are stunted. Pakistan's population growth rate of 3.1 per cent per year is among the highest in Asia. The high population growth rate and poor health status of many people call for extensive health care services, but, unfortunately, health services do not reach most of the people of Pakistan. Partly because the training of doctors and nurses is lengthy and expensive, there is an acute shortage of health care providers, especially women. Although female health professionals are preferred for caring for women, cultural constraints inhibit women from seeking education. Such is the multifaceted dilemma in the provision of primary health care in Pakistan.

Self-directed learning in the context of a nursing curriculum: development of a learning plan

The rapid pace at which biological health breakthroughs and advancements in technology occur is creating unique challenges to health care programmes. The curricula of all health care programmes will need to be set in learning environments where students will be able to develop learning skills that are transportable across situations, over a whole lifetime. This article attempts to focus on self-directed learning (SDL) concepts and the development of a learning contract/plan, including the roles of both the student and faculty in self-learning approaches and contractual development.

The prevalence of multicultural groups receiving in-home service from three community agencies in southern Ontario: implications for cultural sensitivity training

This survey assessed the ethnocultural proportion of clients (largely seniors) receiving services from three home care health agencies in Southern Ontario. Providers from the three agencies were asked to recall clients served in the previous two weeks and to describe them in terms of race, language, sex, age and disability status. White, English-speaking clients comprised 88.3% of the sample (N = 931). The remaining 11.7% of clients were white, non-English-speaking (7.8%), visible minority (2.8%), francophone (0.77%), indigenous (0.22%) and Hispanic (0.11%). Sixty-three percent of clients were women and 34% men. The majority (66.6%) of clients were over 65 years. The 11.7% of clients who were identified as multicultural in three home care agencies are an under-representation of the multicultural mix of population in the Southern Ontario region, which is 24%. Some recommendations have been offered for a system for ethnocultural data collection for the region and provision of cultural sensitivity training programs to enhance staff knowledge and skills.

Examination of student learning about dimensions of health and illness using Stewart's conceptual framework for primary health care

In view of the increasing emphasis on community-based primary health care, nursing education programs need to identify creative learning strategies to prepare nurses capable of promoting, maintaining and restoring health in diverse populations. The purpose of this descriptive study was to identify the learning outcomes acknowledged by junior baccalaureate nursing students in non-traditional community settings. Data were gathered through semi-structured interviews with the students, through journals kept daily by the students, and from the faculty tutor's anecdotal notes. Analysis of data illustrated concepts from Stewart's conceptual framework for primary health care. Students gained an appreciation of the influence of the social-cultural-political and physical environments on health. They also came to understand the significance of collaborative modes of interaction with recipients of nursing care. Thus, non-traditional community experiences demonstrated effectiveness in enhancing students' understanding of the multiple dimensions of health as well as the necessity for mutuality in nurse-person interactions. Providing varied learning environments in undergraduate nursing programs will produce practitioners who are more responsive to present and future primary health care issues.

An in vitro model for measuring tryptase release from nasal mucosa in response to allergen challenge

A simple in vitro nasal mucosal culture model has been developed to measure release of the mast cell specific enzyme tryptase in response to allergen challenge. Patients who were undergoing inferior turbinectomy were skin-tested for commonly inhaled allergens. The mucosa from the inferior turbinates was kept viable using Minimal Essential Medium. Tryptase release into the medium was measured using the Pharmacia Riact Assay. There was a significant increase in tryptase release in response to allergen challenge from the mucosa harvested from skin-test positive patients. Mucosa from skin-test negative patients failed to demonstrate an increase in tryptase release. This could prove to be a useful research model for the study of nasal type I hypersensitivity and drugs that affect it.

Enhancing students' perspectives of health through non-traditional community experiences

The shift in emphasis to community-based health care necessitates that opportunities be provided for nursing students to acquire an understanding of the complex nature of health. A qualitative study was used to demonstrate the benefits accrued by junior baccalaureate nursing students in non-traditional community settings. Key themes that emerged from data analysis included definitions of health and illness as context specific, and environmental factors influencing health. The study demonstrated that learning experiences with diverse communities can broaden students' perspectives and understanding of health behaviours. Students gained an appreciation of the sociocultural variation in meanings of health and illness as well as of the social and political dimensions of health.

Sonourethrography in the evaluation of anterior urethral strictures: correlation with radiographic urethrography

A total of 30 patients with suspected urethral strictures underwent sonographic and roentgenographic urethrograms. Two patients showed a normal anterior urethra in the sonourethrogram; 29 strictures were diagnosed in the remaining 28 patients, 1 patient showing strictures at two different sites. Sonourethrography was an accurate predictor of stricture length, retrograde urethrography underestimating the stricture length in most of the cases. Periurethral structures, including the urethral wall, corpus spongiosum, corpora cavernosa, bulb, and external urinary sphincter, were seen clearly with sonourethrography. Periurethral fibrosis was seen in 16 patients and graded as mild (n = 5), moderate (n = 2) or severe (n = 9), depending on the depth of involvement of the corpus spongiosum. Sonourethrography was unsatisfactory in the evaluation of membranous strictures, failing to visualize the proximal limit of the stricture.

Experiential learning: an approach to transcultural education for nursing

Delivery of culturally appropriate health care in our pluralistic society demands that practitioners develop special attitudes, knowledge, and skills. Experimental learning is a powerful methodology for addressing the affective, as well as the cognitive, domain of learning. The exploration of personal values is an essential first step in developing cultural awareness in order to move learners beyond ethnocentrism through awareness, understanding, acceptance, and appreciation of other cultures if learners are to truly adopt a multicultural approach to their professional practice. The nursing curriculum at McMaster University School of Nursing is based on the principles of adult education and self-directed learning. A series of guided experiences have been undertaken with a variety of health sciences learners, both students and faculty members, to foster an increased appreciation of (their) own values preliminary to embarking on knowledge and skill acquisition for transcultural health care.

Low dose amiodarone in refractory tachyarrhythmias

Fifty patients with drug resistant tachyarrhythmias were treated with amiodarone for 6-22 months; 16 for recurrent ventricular tachycardia (VT), 2 for VT followed by ventricular fibrillation (VF), 14 for complex ventricular ectopics, and 18 for supraventricular tachyarrhythmias (SVT). Amiodarone was administered in a dose much lower than that used in western trials. The actual incidence of successful amiodarone therapy was 81.2% at 22 months for patients with VT. Among the patients with SVT, 88.6% patients were successfully treated for 22 months (range 3-22 months). Amiodarone toxicity appeared in 22 of 50 patients (44%) treated for more than 12 weeks. Withdrawal of therapy was required in 4 patients. Despite the lower dose, clinical efficacy and onset of action were comparable to the western experience.

Neuro-endocrine tumours of the head and neck

We report two types of neuroendocrine carcinoma of the head and neck, small cell carcinoma of the ethmoid and large cell carcinoma of the larynx, demonstrating a differential response to radiotherapy.