The Effectiveness of Mostafa Maged Technique in Closure of the Episiotomy during Vaginal Delivery

Background

This study is done to assess the effectiveness of Mostafa Maged technique in suturing the episiotomy.

Methods

At the time of delivery, this technique will be applied to all women with episiotomy or perineal or vaginal tears. The technique employs absorbable vicryl threads with 75 mm round needles. Mostafa Maged technique includes the continuous suturing of the vaginal epithelium and the muscle layer. Evaluation of the perineal region within the next twenty-four hours prior to discharge searching for (edema-hematoma-septic wound - continence - ecchymosis - dyspareunia).

Results

The current study included 50 patients. All patients had an episiotomy during delivery; 25 patients' episiotomies were sutured using Mostafa Maged technique, while the remaining patients' episiotomies were by regular traditional technique. Mostafa Maged technique has demonstrated efficacy in achieving adequate hemostasis and avoiding dead space formation during an episiotomy. It was found that 100 % of patients with Mostafa Maged technique have no dead space, and 95.8% of Mostafa Maged patients do not have vulval edema. The technique of Mostafa Maged has also proven effectiveness in achieving postoperative hemostasis. Unlike patients with regular maneuvers, 83.3% do not have dead space, and 83.3 % do not have vulval edema.

Conclusions

Mostafa Maged technique is a simple technique and easy to apply when suturing episiotomy. Mostafa Maged technique is significantly superior to conventional maneuvers in preventing bleeding at the episiotomy site and preventing formation of dead space so achieving good hemostasis; therefore, it is highly recommended. I recommend more studies on efficacy of Mostafa Maged maneuver on large sample of patients.

Localization of stomatal lineage proteins reveals contrasting planar polarity patterns in Arabidopsis cotyledons

Many plant cells exhibit polarity, revealed by asymmetric localization of specific proteins within each cell.^1,2,3,4,5,6 Polarity is typically coordinated between cells across a tissue, raising the question of how coordination is achieved. One hypothesis is that mechanical stresses provide cues.⁷ This idea gains support from experiments in which cotyledons were mechanically stretched transversely to their midline.⁸ These previously published results showed that without applied tension, the stomatal lineage cell polarity marker, BREVIS RADIX-LIKE 2 (BRXL2), exhibited no significant excess in the transverse orientation. By contrast, 7 h after stretching, BRXL2 polarity distribution exhibited transverse excess, aligned with the stretch direction. These stretching experiments involved statistical comparisons between snapshots of stretched and unstretched cotyledons, with different specimens being imaged in each case.⁸ Here, we image the same cotyledon before and after stretching and find no evidence for reorientation of polarity. Instead, statistical analysis shows that cotyledons contain a pre-existing transverse excess in BRXL2 polarity orientation that is not significantly modified by applied tension. The transverse excess reflects BRLX2 being preferentially localized toward the medial side of the cell, nearer to the cotyledon midline, creating a weak medial bias. A second polarity marker, BREAKING OF ASYMMETRY IN THE STOMATAL LINEAGE (BASL), also exhibits weak medial bias in stomatal lineages, whereas ectopic expression of BASL in non-stomatal cells exhibits strong proximal bias, as previously observed in rosette leaves. This proximal bias is also unperturbed by applied tension. Our findings therefore show that cotyledons contain two near-orthogonal coordinated biases in planar polarity: mediolateral and proximodistal.

2021 ISB World Athletics Award for Biomechanics: The Subtalar Joint Maintains "Spring-Like" Function While Running in Footwear That Perturbs Foot Pronation

Humans have the remarkable ability to run over variable terrains. During locomotion, however, humans are unstable in the mediolateral direction and this instability must be controlled actively-a goal that could be achieved in more ways than one. Walking research indicates that the subtalar joint absorbs energy in early stance and returns it in late stance, an attribute that is credited to the tibialis posterior muscle-tendon unit. The purpose of this study was to determine how humans (n = 11) adapt to mediolateral perturbations induced by custom-made 3D-printed "footwear" that either enhanced or reduced pronation of the subtalar joint (modeled as motion in 3 planes) while running (3 m/s). In all conditions, the subtalar joint absorbed energy (ie, negative mechanical work) in early stance followed by an immediate return of energy (ie, positive mechanical work) in late stance, demonstrating a "spring-like" behavior. These effects increased and decreased in footwear conditions that enhanced or reduced pronation (P ≤ .05), respectively. Of the recorded muscles, the tibialis posterior (P ≤ .05) appeared to actively change its activation in concert with the changes in joint energetics. We suggest that the "spring-like" behavior of the subtalar joint may be an inherent function that enables the lower limb to respond to mediolateral instabilities during running.

Current Concepts in Acetabular Positioning in Total Hip Arthroplasty

Being one of the most successful surgeries in the history of medicine, the indications for total hip arthroplasty have widened and are increasingly being offered to younger and fitter patients. This has also led to high expectations for longevity and outcomes. Acetabular cup position has a significant impact on the results of hip arthroplasty as it affects dislocation, abductor muscle strength, gait, limb lengths, impingement, noise generation, range of motion (ROM), wear, loosening, and cup failure. The variables in cup position are depth, height, and angular position (anteversion and inclination). The implications of change in depth of center of rotation (COR) are medialized versus anatomical positioning. As opposed to traditional medialization with beneficial effects on joint reaction force, the advantages of an anatomical position are increasingly recognized. The maintained acetabular offset offers advantages in terms of ROM, impingement, cortical rim press fit, and maintaining medial bone stock. The height of COR influences muscle activity and limb lengths and available bone stock for cup support. On the other hand, ideal angular position remains a matter of much debate and reliably achieving a target angular position remains elusive. This is not helped by variations in the way we describe angular position, with operative, radiologic, or anatomic definitions being used variably to describe anteversion and inclination. Furthermore, pelvic tilt plays a major role in functional positions of the acetabulum. In addition, commonly used techniques of positioning often do not inform us of the real orientation of the pelvis on operating table, with possibility of significant adduction, flexion, and external rotation of the pelvis being possibilities. This review article brings together the evidence on cup positioning and aims to provide a systematic and pragmatic approach in achieving the best position in individual cases.

Treatment outcome with guiding flange prosthesis in hemimandibulectomy patients: Case series of three patients

There are various indications that may necessitate partial or complete resection of the mandible, from trauma to congenital deformities. However, the most prevalent indication that requires surgical resection of the mandible along with the involved adjacent oral structures is the presence of a locally aggressive neoplastic growth. The resultant continuity defect leads to an alteration in the range and direction of mandibular movement, impedes clear articulation of syllables and cosmetic disfigurement. The role of a prosthodontist is paramount in bringing about the restoration of the esthetic and functional dysfunction. This article discusses a series of hemimandibulectomy cases wherein mandibular deviation was successfully corrected using guide-flange prosthesis.

Instrumenting the balance error scoring system for use with patients reporting persistent balance problems after mild traumatic brain injury

OBJECTIVE

To determine whether alterations to the Balance Error Scoring System (BESS), such as modified conditions and/or instrumentation, would improve the ability to correctly classify traumatic brain injury (TBI) status in patients with mild TBI with persistent self-reported balance complaints.

DESIGN

Cross-sectional study.

SETTING

Outpatient clinic.

PARTICIPANTS

Subjects (n=13; age, 16.3±2y) with a recent history of concussion (mild TBI group) and demographically matched control subjects (n=13; age, 16.7±2y; control group).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Outcome measures included the BESS, modified BESS, instrumented BESS, and instrumented modified BESS. All subjects were tested on the noninstrumented BESS and modified BESS and were scored by visual observation of instability in 6 and 3 stance conditions, respectively. Instrumentation of these 2 tests used 1 inertial sensor with an accelerometer and gyroscope to quantify bidirectional body sway.

RESULTS

Scores from the BESS and the modified BESS tests were similar between groups. However, results from the instrumented measures using the inertial sensor were significantly different between groups. The instrumented modified BESS had superior diagnostic classification and the largest area under the curve when compared with the other balance measures.

CONCLUSIONS

A concussion may disrupt the sensory processing required for optimal postural control, which was measured by sway during quiet stance. These results suggest that the use of portable inertial sensors may be useful in the move toward more objective and sensitive measures of balance control postconcussion, but more work is needed to increase sensitivity.

Estimating postural control with the balance rehabilitation unit: measurement consistency, accuracy, validity, and comparison with dynamic posturography

OBJECTIVE

To examine the psychometric properties (test-retest reliability, concurrent validity, construct validity) of the Balance Rehabilitation Unit (BRU) during testing of sensory integration processes in healthy adults and individuals with vestibular disorders.

DESIGN

Experimental cross-sectional design.

SETTING

Clinic.

PARTICIPANTS

Participants (N=90) included 30 subjects with vestibular disorders (age range, 18-85y), 30 young healthy adults (age range, 18-50y), and 30 older healthy adults (age range, 60-85y).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants were tested twice with the BRU and once with the SMART EquiTest Sensory Organization Test (SOT). The center of pressure (COP) in the anteroposterior direction (COPap) and the COP in the mediolateral direction (COPml) were recorded. The COPap and COPml time series were used to estimate the area and velocity of the COP.

RESULTS

The intraclass correlation coefficient of the COP area and velocity measures for the BRU for all subjects was at least .76 in all sensory organization conditions (P<.001). Significant correlations were found between the BRU and the SOT, ranging from .64 to .81 for COP area and from .44 to .76 for COP velocity. The older control group had significantly greater COP area and velocity compared with younger controls for the BRU and the SOT. The COP (area, velocity) was significantly higher for the younger individuals in the vestibular group than the younger controls.

CONCLUSIONS

The reliability and validity of COP measurements obtained during testing of the sensory integration processes were demonstrated using the BRU. Future work should examine the responsiveness of these measures when individuals with balance disorders participate in rehabilitation.

Deep brain stimulation of the mediodorsal thalamic nucleus yields increases in the expression of zif-268 but not c-fos in the frontal cortex

This study explores the regions activated by deep brain stimulation of the mediodorsal thalamic nucleus through examination of immediate early genes as markers of neuronal activation. Stimulation was delivered unilaterally with constant current 100 μs duration pulses at a frequency of 130 Hz delivered at an amplitude of 200 μA for 3h. Brains were removed, sectioned and radio-labelled for the IEGs zif-268 and c-fos. In anaesthetised rats, deep brain stimulation of mediodorsal thalamic nucleus produced robust increases in the expression of zif-268 but not c-fos localised to regions that are reciprocally connected with the mediodorsal thalamic nucleus, including the prelimbic and orbitofrontal cortices, and the premotor cortex indicating an increase in synaptic activity in these regions. These findings map those brain regions that are persistently, rather than transiently, activated by high frequency electrical stimulation of the mediodorsal thalamic nucleus by a putatively antidromic mechanism which may be relevant to neuropsychiatric disorders such as schizophrenia in which thalamocortical systems are disrupted and in which DBS protocols are being considered.