ABSTRACT
Emerging from the shadow of the COVID-19 pandemic, it is time to ground ourselves and retrospectively assess the recent achievements of SEGH over the past years. This editorial serves as a comprehensive report on the progress made in comparison to the aspirations and goals set by the society's board in 2019 (Watts et al., Environ Geochem Health 42:343-347, 2019) (Fig. 1) and reflects on the state of the SEGH community as it reached its 50th anniversary at the close of 2021 (Watts et al. Environ Geochem Health 45:1165-1171, 2023). The focus lies on how the SEGH community navigated through the extraordinary challenges posed by the COVID-19 pandemic since early 2020, and to what extent the 2023 targets have been met.
Subject(s)
COVID-19 , COVID-19/epidemiology , Humans , Environmental Health , Societies, Scientific , Retrospective Studies , SARS-CoV-2ABSTRACT
Fins are widely used in many industrial applications, including heat exchangers. They benefit from a relatively economical design cost, are lightweight, and are quite miniature. Thus, this study investigates the influence of a wavy fin structure subjected to convective effects with internal heat generation. The thermal distribution, considered a steady condition in one dimension, is described by a unique implementation of a physics-informed neural network (PINN) as part of machine-learning intelligent strategies for analyzing heat transfer in a convective wavy fin. This novel research explores the use of PINNs to examine the effect of the nonlinearity of temperature equation and boundary conditions by altering the hyperparameters of the architecture. The non-linear ordinary differential equation (ODE) involved with heat transfer is reduced into a dimensionless form utilizing the non-dimensional variables to simplify the problem. Furthermore, Runge-Kutta Fehlberg's fourth-fifth order (RKF-45) approach is implemented to evaluate the simplified equations numerically. To predict the wavy fin's heat transfer properties, an advanced neural network model is created without using a traditional data-driven approach, the ability to solve ODEs explicitly by incorporating a mean squared error-based loss function. The obtained results divulge that an increase in the thermal conductivity variable upsurges the thermal distribution. In contrast, a decrease in temperature profile is caused due to the augmentation in the convective-conductive variable values.
ABSTRACT
The National Health Laboratory Service (NHLS) collects all public health laboratory test results in South Africa, providing a cohort from which to identify groups, by age, sex, HIV, and viral suppression status, that would benefit from increased tuberculosis (TB) testing. Using NHLS data (2012-2016), we assessed levels and trends over time in TB diagnostic tests performed (count and per capita) and TB test positivity. Estimates were stratified by HIV status, viral suppression, age, sex, and province. We used logistic regression to estimate the odds of testing positive for TB by viral suppression status. Nineteen million TB diagnostic tests were conducted during period 2012-2016. Testing per capita was lower among PLHIV with viral suppression than those with unsuppressed HIV (0.08 vs 0.32) but lowest among people without HIV (0.03). Test positivity was highest among young adults (aged 15-35 years), males of all age groups, and people with unsuppressed HIV. Test positivity was higher for males without laboratory evidence of HIV than those with HIV viral suppression, despite similar individual odds of TB. Our results are an important national baseline characterizing who received TB testing in South Africa. People without evidence of HIV, young adults, and males would benefit from increased TB screening given their lower testing rates and higher test positivity. These high-test positivity groups can be used to guide future expansions of TB screening.
Subject(s)
HIV Infections , Tuberculosis , Male , Young Adult , Humans , HIV Infections/diagnosis , HIV Infections/epidemiology , South Africa/epidemiology , Tuberculosis/diagnosis , Tuberculosis/epidemiology , Mass Screening , Logistic ModelsABSTRACT
In this research, we present an analytical analysis of HIV-1 infection of CD4 + T cells with a conformable derivative model (CDM) in biology. An improved Υ'/Υ-expansion method is used to investigate this model analytically to construct a new exact traveling wave solution, namely, exponential function, trigonometric function, and the hyperbolic function, which can be further studied for more (FNEE) fractional nonlinear evolution equations in biology. Also, we provide some graphs in 2D plots that demonstrate how accurate the results will be produced using analytical approaches.
ABSTRACT
AIM: This cross-sectional survey aimed to identify aerobic bacteria, antimicrobial resistance, and multi-drug resistance profiles of bacteria isolated from different wound infections among a group of Egyptian patients. RESULTS: Of 120 positive samples, 170 isolates were identified. Polymicrobial infections were determined in 55% of samples. The dominant Gram-positive isolated strains were Staphylococcus aureus, especially from wound infections because of accidents (71.8%). Piperacillin, methicillin, ampicillin/sulbactam, and amoxicillin/clavulanic acid were all highly resistant to S. aureus and Coagulase-negative Staphylococci. The prevalence of methicillin-resistant S. aureus in wound infections was 89.9%. S. aureus showed superior sensitivity to vancomycin (85.3%) and linezolid (81.3%). The highest prevalence of Gram-negative isolates was for Pseudomonas aeruginosa (40%), which was highly sensitive to ciprofloxacin (79.2%) and highly resistant to levofloxacin (83.3%). Several isolates revealed a multi-drug resistance profile (52.4%). The overall MDR rate of Gram-positive and Gram-negative isolates were 50% and 54.9%, respectively. CONCLUSION: The prevalence of MRSA isolated from various wound infections and MDR is a warning issue in Upper Egypt. It should implement a health education strategy and hygiene measures to prevent the spread of wound infection-causing organisms in the community.
Subject(s)
Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections , Wound Infection , Humans , Cross-Sectional Studies , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Staphylococcus aureus , Egypt/epidemiology , Prevalence , Bacteria , Staphylococcal Infections/epidemiology , Wound Infection/drug therapy , Wound Infection/microbiology , Microbial Sensitivity TestsABSTRACT
Human migration facilitates the spread of infectious disease. However, little is known about the contribution of migration to the spread of tuberculosis in South Africa. We analyzed longitudinal data on all tuberculosis test results recorded by South Africa's National Health Laboratory Service (NHLS), January 2011-July 2017, alongside municipality-level migration flows estimated from the 2016 South African Community Survey. We first assessed migration patterns in people with laboratory-diagnosed tuberculosis and analyzed demographic predictors. We then quantified the impact of cross-municipality migration on tuberculosis incidence in municipality-level regression models. The NHLS database included 921,888 patients with multiple clinic visits with TB tests. Of these, 147,513 (16%) had tests in different municipalities. The median (IQR) distance travelled was 304 (163 to 536) km. Migration was most common at ages 20-39 years and rates were similar for men and women. In municipality-level regression models, each 1% increase in migration-adjusted tuberculosis prevalence was associated with a 0.47% (95% CI: 0.03% to 0.90%) increase in the incidence of drug-susceptible tuberculosis two years later, even after controlling for baseline prevalence. Similar results were found for rifampicin-resistant tuberculosis. Accounting for migration improved our ability to predict future incidence of tuberculosis.
Subject(s)
HIV Infections , Tuberculosis, Multidrug-Resistant , Tuberculosis , Male , Humans , Female , Young Adult , Adult , South Africa/epidemiology , Cities , Tuberculosis/epidemiology , Tuberculosis, Multidrug-Resistant/epidemiology , Surveys and Questionnaires , HIV Infections/epidemiologyABSTRACT
Food safety risks are becoming a public health problem with important socioeconomic consequences for human wellbeing, especially for pregnant women and infants. In this article, we describe findings from microbiological, toxicological, and nutritional quality assessments of foods from 5 localities in Burkina Faso, with the aim to provide baseline data on the quality of food and the risks to mothers and children. Samples for assessment included food sold in markets, stores, and restaurants (eg, cereals, oilseeds, vegetables, edible oils, powdered milk, dried fish, packaged water, ready-to-eat meals). The research team selected the samples using the random route method and analyzed them at the National Public Health Laboratory in Ouagadougou between January and December 2020. A total of 443 food samples were collected, of which 101 were analyzed for microbial contamination, 360 were analyzed for the presence of toxins, and 59 were analyzed for their nutritional value. The microbiological quality of 11.88% of the food samples was unsatisfactory, and 41.50% were contaminated with aflatoxins. At least 1 pesticide residue and cyfluthrin were detected in 58.10% of samples. The most detected contaminant (cyfluthrin) was found in 79.10% of the analyzed samples. A peroxide index higher than the normal value (10 mEq/kg) was found in 3.38% of the oil samples and 76.27% of the oil samples had a vitamin A content lower than the recommended limit of 11 mg/kg. This study is the first in Burkina Faso that provides baseline data on the quality of food and potential health risks to mothers and children in Burkina Faso. Considering the level of contaminants reported in this article, it is imperative to enhance routine monitoring of foods in the country.
Subject(s)
Food , Restaurants , Animals , Burkina Faso , Child , Female , Humans , Infant , PregnancyABSTRACT
Incorporation of novel-prepared metal-organic complexes as crosslinking accelerators for multifunctional epoxy was on top of interest by coating formulators. The present work investigated the loading of mixed ligand metal complexes (Zr(IV) and Cu(II)) of metformin (MF) and 2.2'bipyridine (Bipy) against the free ligands as crosslinking modifiers via some epoxy coating formulations to assess their superb performances on the C-steel surface. Zr(IV) and Cu(II) demonstrated the minor energy gap (∆E) values at 0.190 au compared to free MF and Bipy according to the calculated energy values, and this behavior reflected their enhanced properties via epoxy coating applications. EIS measurements using high saline formation water as a corrosive medium were performed and offered that PA-DGEBA/MC-Cu coated film showed the superior resistance values (Rct = 940 and Rc = 930 kΩ cm2). The accelerated corrosion salt spray experiment clarified that PA-DGEBA/MC-Cu coating achieved the least corrosion rate at 0.00049 mm/y and exhibited the highest protection efficiency of 99.84%. SEM/EDX combination survey affirmed the protective performance of the checked coatings. AFM microanalysis confirmed that surface-treated Cu(II) coating displayed the smoothest film surface with complete curing. Mechanical durability properties were evaluated and the obtained results illustrated that pull-off adhesion for PA-DGEBA/MC-Cu coated film fulfilled the highest adhesion strength at 6.3 MPa, the best bend character at 77, and the maximum impact resistance at 59.7 J. UV immovability trial was performed at 10 irradiance and 80 h duration. PA-DGEBA/MC-Cu coated film displayed the highest resistance to UV irradiance with blistering (#8 size and few frequencies) in addition to offering a minor gloss variation and matt properties.
Subject(s)
Coordination Complexes , Steel , Corrosion , Dental Materials , Epoxy Resins , Surface PropertiesABSTRACT
Estuaries are complex systems involving numerous biogeochemical gradients and processes that influence the behavior of trace metals. Lead (Pb), cadmium (Cd), and copper (Cu) speciation and partitioning were studied in the Gironde Estuary (SW France), using a multi-method approach in which data from innovative sensors and laboratory-based techniques were combined. For the first time in this system, the so-called dynamic fractions of the target metals (dissolved forms that are potentially bioavailable) were recorded on-board through voltammetry using unique antifouling gel-integrated microelectrode arrays (GIME) incorporated in a submersible sensing probe (TracMetal). Trace metals in the operationally defined dissolved <0.2 µm and <0.02 µm fractions, as well as complexed with suspended particles (collected after centrifugation) were quantified through sampling/laboratory-based techniques. High spatial resolution trace metal concentrations were monitored along the salinity gradient (S = 0.10 to S = 34.0) together with master bio-physicochemical parameters providing robust cruise-specific information on how well-known abiotic and biotic processes control the Gironde estuarine trace element partitioning, (i.e. conservative behavior, addition/removal). Combining conventional methods with GIME measurements showed: (i) the dominance of Cd dynamic species in the intra-estuarine total dissolved fraction (up to 90%), (ii) the importance of small colloids as trace metal carrier phases, desorbing and complexing dynamic fractions of Pb and Cu, and (iii) the potential influence of photo-redox processes remobilizing Pb under their dynamic forms (up to 80%). Data also suggest trace metal release/sorption by phytoplankton with an increase of dissolved Cu concentrations in the riverine branch, as well as Cu and Cd particulate concentrations showing higher levels towards productive coastal waters. This complete approach allowed to monitor key estuarine biogeochemical processes and highlighted the valuable use of the TracMetal to record subtle variations of potentially bioavailable dissolved metal fractions.
Subject(s)
Metals, Heavy , Trace Elements , Water Pollutants, Chemical , Environmental Monitoring , Estuaries , Metals/analysis , Metals, Heavy/analysis , Trace Elements/analysis , Water Pollutants, Chemical/analysisABSTRACT
KEY CLINICAL MESSAGE: Right atrial thrombus is a rare medical emergency that should be suspected in all cases of pulmonary embolism, and rapid action should be taken to ensure a timely, proper management.
ABSTRACT
In opposite to most countries, avian influenza virus H5N1 became endemic in Egypt. Since, its first emerge in 2006 in Egypt, the virus could infect different species of birds and animals and even human. Beside the great economic losses to the local poultry industry in Egypt, the virus infected 166 confirmed human cases, 59 cases ended fatally. In the present study, the persistence of the avian influenza in the Egyptian environment was studied. For this purpose, serum samples were collected from human, cattle, buffaloes, sheep, goat, horses, donkeys, swine, sewage rats, stray dogs and stray cats. The sera were collected from Cairo and the surrounding governorates to be examined for the presence of anti-H5N1 antibodies by Haemagglutination Inhibition Test (HI) and ELISA test. Clear differences in the seroprevalence were noticed among different species and also between the results obtained by both techniques indicating the difference in test accuracy. The present data indicate wide spread of the H5N1 virus in the Egyptian environment.
Subject(s)
Antibodies, Viral/blood , Influenza A Virus, H5N1 Subtype/immunology , Influenza, Human/epidemiology , Influenza, Human/immunology , Orthomyxoviridae Infections/epidemiology , Orthomyxoviridae Infections/veterinary , Animals , Biomarkers/blood , Buffaloes , Cats , Cattle , Dogs , Egypt/epidemiology , Enzyme-Linked Immunosorbent Assay , Equidae , Goats , Hemagglutination Inhibition Tests , Horses , Humans , Influenza in Birds/blood , Influenza in Birds/epidemiology , Influenza in Birds/immunology , Influenza, Human/blood , Orthomyxoviridae Infections/blood , Orthomyxoviridae Infections/immunology , Poultry , Rats , Seroepidemiologic Studies , Sheep , Species Specificity , SwineABSTRACT
INTRODUCTION: The lung is the organ most frequently involved by metastatic calcification. This condition is probably under-diagnosed, the patients usually being asymptomatic. This article summarizes the current knowledge concerning pulmonary metastatic calcification. BACKGROUND: The pathogenesis of pulmonary metastatic calcification is not well known, but it involves phosphate-calcium balance, renal function and pH. The most frequently encountered aetiologies are hyperparathyroidism, neoplastic bony lesions, and renal failure. The definitive diagnosis is achieved by histology, radiological examinations being insensitive. The clinical manifestations are various and can include a pulmonary restrictive syndrome, diffusion abnormalities, hypoxaemia and respiratory failure. The latter can be severe and influence the prognosis adversely: 19 cases of fatal pulmonary metastatic calcification have been reported. The treatment is aetiological and symptomatic. VIEWPOINT: The prognostic factors for a poor outcome of this potentially lethal condition remain to be determined. The management of asymptomatic patients is also uncertain. CONCLUSIONS: Pulmonary metastatic calcification is a rare condition of complex pathogenesis. The clinical manifestations are varied, ranging from asymptomatic to severe, even fatal.
Subject(s)
Calcinosis/etiology , Lung Diseases/etiology , Lung/pathology , Calcinosis/diagnostic imaging , Calcinosis/pathology , Humans , Lung/diagnostic imaging , Lung Diseases/diagnostic imaging , Lung Diseases/pathology , Tomography, X-Ray ComputedABSTRACT
Eosinophilic fasciitis is a rare connective tissue disease, described by Shulman in 1974. This syndrome is characterized by a symmetrical swelling of the skin associated with eosinophilia. A progressive induration of the skin replaces the swelling. Arms and legs are the most affected sites. The face and hands are usually not involved and the patients don't complain of Raynaud phenomenon. No circulating autoantibodies are found. Diagnosis is made with history, MRI and histology. MRI detects fascial thickening and contrast enhancement of this fascia. A full thickness skin to muscle biopsy is necessary to confirm the diagnosis. It shows an inflammation and thickening of the fascia with lymphocytes and plasmocytes. High doses of corticosteroids are reported to be effective in more than 70% of the cases. Immunosuppressive drugs are sometimes necessary to induce clinical remission.
Subject(s)
Synovitis/diagnosis , Synovitis/drug therapy , Eosinophilia , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Prognosis , Synovitis/etiologyABSTRACT
In the French island of Mayotte in the Indian Ocean, the health and food situation remains contrasted. For a very long time dry beriberi women in postpartum had been suspected and treated. But in 2004 the first infantile epidemic of beriberi was scientifically authenticated and a program of thiaminic supplementation for the pregnant women and infants was set up. In this context, we describe an epidemic of 11 cases of shoshin beriberi among adults between January 2008 and Februar 2009. Over 11 cases of shoshin beriberi, 5 cases were confirmed biologically and 6 were probable. The sex ratio M/W was 0.37. The median age was 34 years. The clinic picture was typical: severe acute dyspnea, an agitation/drowsiness, right cardiac failure: polynevritis of the lower limbs was noted in 9 cases over 11. Biologically it was characterized by a lactic acidosis (average pH: 7.08, lactates: 12.08 mmol/l). The evolution was favorable in the 8 cases which could benefit from early thiaminic refill. The outbreak of an epidemic of shoshin beriberi among adults mainly in groups not having benefited from supplementation shows the effectiveness of the program but also its limits. We compare our series with others: the period from April to June when the food is less diversified, is confirmed as a higher risk period. The programs of nutritional education must be increased and a B1 vitamin supplementation for broader people during the rain season might be discussed.
Subject(s)
Beriberi/epidemiology , Adult , Aged , Cohort Studies , Comoros/epidemiology , Disease Outbreaks , Female , Geography/statistics & numerical data , Humans , Indian Ocean/epidemiology , Male , Middle Aged , Pregnancy , Retrospective Studies , Time Factors , Young AdultABSTRACT
BACKGROUND: Recent data provided evidence on the implication of the adipocytokines adiponectin, visfatin, and resistin in inflammation, immune response, and tissue destruction and revealed several links between them and arthritis. AIM OF THE STUDY: The purpose of this study was to assess the levels of adiponectin, visfatin, and resistin in serum and synovial fluid of patients with rheumatoid arthritis (RA) and their relationship with disease activity. SUBJECTS AND METHODS: A total of 70 female patients with RA and 30 age- and sex-matched healthy controls were enrolled. The clinical activity of RA patients was assessed according to the 28 joint count Disease Activity Score and patients were classified into two groups: 39 patients with active disease (group A) and 31 patients in remission (group B). Synovial fluid was obtained by arthrocentesis of the affected knee joints from 39 patients with active disease. Serum adiponectin, visfatin, and resistin concentrations were measured in RA patients and controls, while a specific enzyme-linked immunosorbent assay was used to measure the synovial concentrations of adiponectin, visfatin, and resistin in the group of patients with active RA. RESULTS: Serum levels of adiponectin and visfatin were significantly higher in all RA patients and patients with active disease compared to the control group and patients in remission. No significant difference was observed in the resistin level between patients and controls. Serum and synovial adiponectin and visfatin were positively correlated with DAS28-ESR in RA patients with active disease. CONCLUSION: Our data demonstrated that adiponectin and visfatin are related to disease activity in RA patients and might be involved in the progression of RA. The English full-text version of this article is available at SpringerLink (under "Supplemental").
Subject(s)
Adiponectin/blood , Arthritis, Rheumatoid/blood , Arthritis, Rheumatoid/diagnosis , Nicotinamide Phosphoribosyltransferase/blood , Resistin/blood , Synovial Fluid/metabolism , Adult , Female , Humans , Male , Middle Aged , Reference Values , Statistics as TopicABSTRACT
Melanoma is actually one of the most common malignancies to be diagnosed during pregnancy. Nevertheless, the role of the pregnancy hormones on the melanoma course is not yet completely clear. We present the case of melanoma in a pregnant woman, with a particularly fulminant postpartum development. This raised the question of a possible protection by the pregnancy hormones against melanoma.
Subject(s)
Melanoma , Pregnancy Complications, Neoplastic , Skin Neoplasms , Adult , Fatal Outcome , Female , Humans , Melanoma/diagnosis , Melanoma/secondary , Pregnancy , Pregnancy Complications, Neoplastic/diagnosis , Skin Neoplasms/diagnosisABSTRACT
The effect of Helicobacter pylori infection on systemic disorders is not well understood. This study was to evaluate the effect of H. pylori eradication on blood count, differential leucocytic count and RBCs indices. In this study, a total of 115 H. pylori positive patients underwent eradication triple therapy for one week, with cured 100 patients. Complete blood count, RBCs indices and differential leucocytic count were analyzed before 2 & 12 weeks after eradication for the cured patients. The results showed that two weeks after H. pylori eradication, platelets count significantly increased but total leucocytic counts and neutrophils were significantly reduced. After three months, RBCs count, Hb concentration, MCV and MCHC were significantly increased, but lymphocytic counts was significantly reduced.
Subject(s)
Clarithromycin/adverse effects , Helicobacter Infections/drug therapy , Helicobacter pylori , Hematologic Diseases/chemically induced , Metronidazole/adverse effects , Omeprazole/adverse effects , Adult , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/therapeutic use , Clarithromycin/administration & dosage , Clarithromycin/therapeutic use , Enzyme Inhibitors/administration & dosage , Enzyme Inhibitors/adverse effects , Enzyme Inhibitors/therapeutic use , Female , Helicobacter Infections/microbiology , Humans , Male , Metronidazole/administration & dosage , Metronidazole/therapeutic use , Omeprazole/administration & dosage , Omeprazole/therapeutic useABSTRACT
UNLABELLED: Many procedures have been proposed for the management of sacrococcygeal pilonidal sinus disease. The aim of this work is to evaluate the superiorly based flap (used before for reconstruction of pressure sore) for reconstruction after excision of sacrococcygeal pilonidal sinus. PATIENTS AND METHODS: Between January 2004 and February 2007, 25 male patients of ages between 14 and 29 years(median age: 23 years), who had recurrent pilonidal sinus, underwent surgical treatment by the Limberg flap technique. The mean duration of symptoms was 5.2 + or - 4.5 years (range 3-6 years). Rhombic-shaped excision of the sinus-bearing skin and subcutaneous tissue up to the presacral fascia guided by electrocautery was performed, followed by reconstruction of the defect by perforator-based Limberg flap (based on the superior gluteal and sacral perforators). RESULTS: Primary healing occurred in 22 patients. Two patients (8%) had seroma with negative bacterial cultures, which healed completely with bedside drainage and conservative treatment. Another patient (4%) had superficial wound infection that were treated by appropriate antimicrobial therapy. Complete healing of all cases occurred without recurrence during the follow-up period. The mean operative time was 40min (ranging between 30 and 45min according to the size of the lesion). There was no ischaemia or necrosis of the flaps, and all flaps remained viable. The mean length of hospital stay was 2 days, ranging between 1 and 6 days. CONCLUSION: The use of superiorly based Limberg flap in reconstruction after excision of sacrococcygeal pilonidal sinus is reliable, easily performed, associated with complete cure and low postoperative complications.
Subject(s)
Pilonidal Sinus/surgery , Plastic Surgery Procedures/methods , Surgical Flaps/blood supply , Adolescent , Adult , Humans , Male , Postoperative Complications , Recurrence , Sacrococcygeal Region/surgery , Wound Healing , Young AdultABSTRACT
AIM OF THE WORK: To evaluate the feasibility of using the bipedicled flap in the reconstruction of an exposed tibia. PATIENTS AND METHODS: Twenty-three patients underwent reconstruction of the exposed tibia using the fasciocutaneous bipedicled flap from the medial of the leg (in 12 patients), from the lateral aspect (in 9 patients) and from both the medial and the lateral (in 2 patients). In all cases, the donor site of the flap was covered by split-thickness skin graft. RESULTS: In 23 patients, 25 fasciocutaneous bipedicled flaps were used, a single flap in 21 patients, and double flaps in two patients. Twenty-three flaps were completely viable and healed totally. One of the remaining flaps (which were used to cover an exposed tibia after excision of a chronic leg ulcer) was complicated by partial necrosis due to superficial necrosis of its lateral edge which healed conservatively. The last flap was severely infected resulting in necrosis which required debridement and reconstruction using a free forearm flap. CONCLUSION: The bipedicled flap has advantages of dual blood supply, achievement of sensitivity in the damaged area and acceptable aesthetic appearance.