Exploring the efficacy of a novel prebiotic-like growth promoter on broiler chicken production performance.

This study attempts to isolate a candidate growth promoter from the ovine paunch waste and scrutinize its effects on the production performance of broiler chickens as compared to mannan-oligosaccharide (MOS), a prebiotic, and lincomycin, an antibiotic growth promoter (AB). The paunch waste collected from slaughtered sheep was processed to remove particulate matter. The clarified liquid was then added to an excess of ethanol (1:9 ratio), and the resultant precipitate {(novel growth-promoting paunch extract (NGPE)} was collected, dried, and stored. In vitro increase in cell density for probiotic bacteria viz. Lactobacillus rhamnosus and Enterococcus faecalis (Log10 CFU/ml) were significantly higher (P < 0.01) in NGPE supplemented media (2.78 ± 0.11 and 2.77 ± 0.10) as compared to that on MOS (1.28 ± 0.05 and 2.49 ± 0.09) and glucose (1.09 ± 0.04 and 1.12 ± 0.04) supplemented media. In the in-vivo trial of six weeks duration with broiler chickens (Cobb-400), NGPE supplementation resulted in significantly higher growth in weeks IV (P < 0.05) and VI (P < 0.01) of age in comparison to MOS and AGP supplemented groups, a lower (P < 0.01) cumulative feed conversion ratio in comparison to MOS supplemented groups, and a higher (P < 0.01) cumulative protein efficiency ratio compared to MOS and AGP supplementation. NGPE supplementation also lowered lipid peroxidation (P < 0.01), increased reduced glutathione activity (P < 0.01) in chicken erythrocytes, and boosted the lactic acid bacteria count in the cecal contents (P < 0.01). This is the first report of the isolation of a paunch waste extract that increased the in vitro growth of probiotic bacteria and improved the production performance of broiler chickens.

Occupational Stress- Addressing Woes of the Nurses in a Burn Unit.

Occupational stress can leave the nurses drained while caring for patients in the burn unit. This existential-phenomenological study aimed to explore burn unit nurses' lived experiences of occupational stressors and organizational support. Twenty-two nurses working in the burn unit were interviewed. Data were analyzed utilizing Colaizzi's 7-step method. Three themes were generated: stressful work environment; feelings of helplessness; need for organizational support. Nurses reported that organizational support should be available for dealing with the work-related stressors in the burn unit.

Endoscopic evaluation of velopharyngeal function in cleft lip palate patients - A correlation with speech analysis.

BACKGROUND: Speech abnormalities due to velopharyngeal insufficiency (VPI) significantly affect communication skills, self-esteem, and scholastic performance. It leads to a poor social, emotional, educational, and behavioral development and a poor quality of life overall in cleft lip palate (CLP) patients. Its early diagnosis and severity assessment using video-nasoendoscopy and speech assessment can significantly contribute to management. The present study evaluated VPI in CLP patients using both tools. METHODS: A total of 48 patients with repaired cleft palate were subjected to speech and video-nasoendoscopic assessment. Speech assessment measured severity of hypernasality, speech intelligibility, and voice quality. Video-nasoendoscopy evaluated velopharyngeal port closure to grade the severity of VPI. The speech assessment and video-nasoendoscopy findings were analyzed and correlated. RESULTS: There was a moderately strong statistically significant negative correlation between the grade of VPI and hypernasality (r = -0.542, p = 0.000). There was a stronger statistically significant negative correlation of grade of velopharyngeal port insufficiency with speech intelligibility (r = -0.634, p = 0.000). About 72% of the patients had abnormal voice quality. CONCLUSION: This study is the first attempt at diagnosing and grading VPI on a quantitative scoring based on a ratio scale for the motion of soft palate and pharyngeal walls. The strong correlation between endoscopic grading and speech analysis findings warrants further evaluation of nasoendoscopic grading of VPI in more studies.

Advancing Sowing Time and Conservation Tillage - The Climate-Resilient Approach to Enhance the Productivity and Profitability of Wheat.

Field experiments consisting of two sowing time (early and timely), two tillage options (conventional tillage and conservation tillage) and ten genotypes were conducted with the aim to maximize the wheat productivity and profitability. The early sowing (second fortnight of October) produced 16.0% higher grain yield compared to timely sowing (mid-November) in northern Indian Plains. However, no significant yield differences were observed between conventional tillage (CT) and conservation tillage (CST) practices. Among genotypes, the better yielders were PBW 723, BISA 927 and HD 2967. The interaction of sowing time and genotype had a significant (p < 0.05) effect on wheat yield. However, the interaction of genotype and tillage did not produce any significant response on wheat yield. The experiments conducted at farmer's fields also demonstrated similar performance of wheat under CT and CST systems but CST offered the savings of more than Rs. 3500 (US $ 47) along with 125 kg ha- 1 lesser CO2 emissions over CT due to reduction in fuel consumption associated with tillage and seed bed operations. At farmers field also, early sown wheat yielded 5.5% higher over wheat sown in November. The results of present studies show that early sowing of high yielding wheat genotypes under CST practice enhanced the productivity and profitability of wheat under rice-wheat cropping system along with lesser noxious impact on the environment. Amidst climate vagary and its menace on the agriculture, the adoption of climate-resilient management practices such as advancing the sowing time and conservation tillage can improve the productivity of long duration wheat cultivars in sub-tropical humid conditions besides lesser deleterious consequences on the environment.

Division of Fasciocutaneous Pedicled Flaps-Is It Time to Change Practice?: A Prospective Randomized Controlled Trial.

INTRODUCTION: The study was carried out to evaluate the safety of early division of the pedicled flaps and to identify the optimum day of division. METHODS: This prospective, parallel arm, open-label, noninferiority, randomized controlled trial was carried out from January 2019 to July 2020. All patients (age, ≥5 years) undergoing reconstructive procedures using pedicled flaps were randomized in 1:1 ratio to receive either early division or conventional division protocol. In the early-division group, the flap perfusion, if satisfactory on day 8 by clinical and thermographic methods, a clamp was applied on the pedicle. The clamp was gradually tightened to produce controlled delay, and perfusion assessment was repeated after complete tightening. If satisfactory, the flaps were divided. Primary endpoints were flap at 24 hours after division, day of division, and day of complete inset of the flap. Secondary end points included perfusion of the flap on day 8, morbidity parameters (wound infection/suture dehiscence, need for secondary surgery and donor site morbidity), quality of life, and function scores. RESULTS: Thirty-five patients were included in each group. The 2 groups were similar in terms of various demographic, clinicopathological variables, defect and flap characteristics. The flap survival rate was similar (P = 0.31) between the early (34/35) and standard (35/35) division groups. The early-division group had a significantly early mean day of flap division (mean difference of 12.74 days; P < 0.00001) and complete flap inset (mean difference of 12.09 days; P < 0.00001). All flaps had satisfactory perfusion on day 8. The wound infection rate was 1.33 times significantly higher in the conventional group (P = 0.033). There was a higher incidence of donor site morbidity (9% vs 0%) in the conventional group when compared with the early division group. The quality of life and function scores at 3 weeks (mean difference 2.37; P < 0.001) and 6 weeks (mean difference 3.76; P < 0.001) and adjacent joint stiffness were significantly higher in the early division group when compared with conventional group. CONCLUSIONS: The pedicled flaps can be divided significantly early at an average duration of 10 to 11 days after flap inset with increased patient satisfaction rate and with a reduced postoperative morbidity. The authors have included a diversity of pedicled flaps used in different anatomic locations. By using stratified block randomization, we could ensure that the distribution was similar between the 2 groups, thus minimizing the heterogeneity in the analysis. This could also potentially indicate the usefulness of the controlled delay technique, irrespective of the anatomic location and type of the flap.

Histological Analysis of the Effect of Nanofat Grafting in Scar Rejuvenation.

Introduction: The morphology and tissue response to macro- and micro-fat grafting have been widely studied in both clinical and experimental settings; the histological effects of the nanofat graft, however, remain largely unexplored. Aims: This study was carried out to evaluate the histological changes leading to scar rejuvenation in a fine scar following nanofat grafting. Materials and Methods: This was an experimental study carried out on guinea-pig fine-line scar models. Nanofat prepared from abdominal fat of the animal was injected into scar on right legs (NFG) at 1 month whereas left acted as controls (CG). Punch biopsies from all scars were analyzed at 2, 4, and 6 months by Hematoxylin&Eosin, Masson's trichrome, and Picrosirius red stains to evaluate dermal/epidermal regeneration, collagen fiber orientation, pattern of distribution, and amount of mature and immature collagen. Results: Nine animals were included in the final analysis of the study. On histological analysis, the amount of inflammatory infiltrate, collagen fiber orientation, pattern and total histological score at 2, 4, and 6 months were similar between the groups. There was an increased trend for earlier appearance of organized and mature forms of collagen in the NFG group. The distribution of collagen was similar at 2 months; however, there was a significant increase in collagen distribution in NFG at 4 months (NFG: 46.11±11.6, CG: 31.16±9.9; P = 0.010) and at 6 months (NFG: 63.48± 6.6, CG: 49.9 ±8.8; P = 0.002). Conclusion: Nanofat grafting is associated with an accelerated and increased production of mature collagen with proper alignment in fine-line scars.

The Impact of "COVID-19" and "Webinar Pandemic" on Plastic Surgery Practice in Teaching Institutes and Resident Training-A Multicentric Perspective.

Introduction The study was carried out to quantify the changes induced by the pandemic in plastic surgery practice and training and to study the impact of the webinars on plastic surgery education from a residents' perspective. Methods In this multicentric study, the number and type of surgeries, cause of injuries, and their regional variation during the coronavirus disease 2019 (COVID-19) period (February-September 2020) were compared with pre-COVID-19 time. An online survey on the impact of webinars was conducted for plastic surgery trainees across the country. Results There was a significant reduction in total number of surgeries ( p = 0.003). The procedures for hand ( p = 0.156), faciomaxillary injuries ( p = 0.25), and replantations ( p = 0.46) were comparable; there was a significant reduction in combined orthopedic-plastic-surgical procedures ( p = 0.009) during the pandemic. There was a significant reduction in road accidents ( p = 0.007) and suicidal injuries ( p = 0.002) and increase in assault ( p = 0.03) and domestic accidents ( p = 0.01) during the COVID-19 period. A usefulness score of >8 was given for the webinars by 68.7% residents. There was no significant difference in perception of utility when correlated with the academic program at their institutes ( p = 0.109); 92% opined webinars should continue in post-COVID times. Conclusion There was a drastic reduction in number of elective and emergency procedures during the COVID-19 time, negatively affecting resident training program. Majority of residents felt that webinars could prove a useful adjunct to training in formal training program in post-COVID-19 scenario.

An Innovative Skin Simulation Model to Augment Competency-based Training in Facial Plastic Surgery.

Introduction Competency-based medical education (CBME) approach in the medical curriculum has been introduced globally with the goal of providing flexibility, accountability, and learner-centeredness among medical learners. Traditional surgical skill training in most places has relied on "see one, do one, teach one model," while simulation model-based training has been shown to improve competencies in surgical trainees. We wanted to assess the usefulness of a hydrophilic barrier adhesive foam wound dressing as a novel skin simulation model for learning biomechanics and practice of cutaneous flaps among plastic surgical resident trainees at our institute. Materials and Methods An absorbent, soft polyurethane foam pad located centrally upon a larger polyurethane membrane, coated with a hydrocolloid adhesive, forming an island dressing, was used as a simulation model for this study. It was obtained from the hospital store either after or nearing their expiry dates of clinical use. Plastic surgery residents in different years of training were invited to participate in a simulation workshop, using this novel model, and give their feedback. Results Seventeen residents in different plastic surgery training levels participated in the workshop and gave their feedback on the skin flap simulation model. The simulation model received extremely high (100%) scores on two parameters, namely, utility for flap and suture practice and high scores (88%-94%) for texture, ability to mark, and improving confidence among trainees. Conclusions Adhesive bilayer polyurethane foam can be used as a novel cutaneous skin flap simulation model for understanding the biomechanics of skin flaps and cutaneous flap practice.

Effect of single dose intravenous tranexamic acid on blood loss in tangential excision of burn wounds - A double blind randomised controlled trial.

INTRODUCTION: This study was carried out to evaluate role of intravenous tranexamic acid (TXA) in reducing blood loss during tangential excision of burns. METHODS: This was a single center, prospective double-blinded parallel arm superiority randomized placebo-controlled trial. Patients (15-55 years) with deep dermal thermal burns <30% undergoing tangential excision were randomly assigned (1:1) to TXA and placebo groups. Patients in TXA and placebo groups received injection TXA 15 mg/kg and 10 ml saline respectively, 10 min preoperatively. Primary outcome was volume of blood loss per square centimeter area of burn excised. Secondary outcomes were total volume of blood loss, postoperative hemoglobin, intraoperative fluid requirement, blood transfusion, graft take and length of hospitalization (LOH). RESULTS: Thirty patients were included. Both groups were comparable in terms of Body Mass Index (BMI) preoperative hemoglobin, area of burn excised, duration of surgery and the intraoperative temperature. The average blood loss per square centimeter burn area excised was found to be significantly lower in TXA when compared to placebo group (mean difference: 0.28 ± 0.025 ml/cm2; p = 0.000). The total volume of blood loss was lower in TXA group (258.7 ± 124.10 ml vs 388.1 ± 173.9 ml; p = 0.07). None of the patients required transfusion. The requirement of intra-operative fluids was similar between the two groups (crystalloids: p = 0.236; colloids: p = 0.238). Postoperative hemoglobin, length of hospitalization and graft-take were comparable between the two groups. CONCLUSION: TXA reduced blood loss per unit burn area of tangential excision in <30%TBSA burn, however, we found no significant effect on postoperative Hb and transfusion.

Atypical fibroxanthoma of hand.

Atypical fibroxanthoma (AFX) is a rare cutaneous ulcerative lesion with a good prognosis. Diagnosis is difficult and is usually made by exclusion from pleomorphic dermal sarcoma and squamous cell carcinoma. Definitive treatment varies from Mohs micrographic surgery to wide local excision. We present a case of 76-year-old woman with AFX over the dorsum of her left hand. The tumour was excised and the resulting defect was reconstructed with a local second dorsal metacarpal artery perforator flap.

Clinical Outcomes of Surgical Management of Primary Brachial Plexus Tumors.

Introduction This study evaluates the clinical presentation, tumor characteristics, and clinical outcomes of surgically treated benign and malignant brachial plexus tumors (BPTs). Methods A prospective study of patients with BPTs from June 2015 to August 2020 was conducted. All patients underwent surgical resection with microneurolysis and intraoperative electrical stimulation to preserve the functioning nerve fascicles. Results Fourteen patients with 15 BPTs underwent surgical resection. Mean age was 37.8 ± 12.3 years; with male to female ratio 4:10. The clinical presentations were swelling (100%), pain (84.6%), and paresthesia (76.9%). The lesions involved roots (5/15), trunk (5/15), division (1/15), and cords (4/15). Thirteen patients had benign pathology (8 schwannomas, 3 neurofibromas, 2 lipomas) and two had malignant neurofibrosarcoma. Gross total resection was achieved in all cases except a dumbbell tumor. The mean follow-up period was 24 ± 5 months. Postoperatively, all patients reported improvement in pain and paresthesia with no new sensory deficit. All patients had developed initial motor weakness (Grades 2-4); however, full power (Grade 5) was recovered by 3 to 5 months. Conclusion Total resection can be achieved by appropriate microneural dissection and electrophysiologic monitoring and is potentially curative with preserving function.

Use of Islanded Supratrochlear Artery Component Paramedian Forehead Flap and Cranial Bone Graft for Composite Nasal Defect Reconstruction.

ABSTRACT: The authors present a case series of patients with composite loss of nasal skin cover and lining following road accidents. The nasal skeletal framework in all these cases was also severely communited. The reconstruction of all the these was achieved in 1 operation. The authors have utilized islanded supratrochlear artery based paramedian forehead skin and pericranial flap for reconstruction of both skin and lining defects. The nasal skeletal framework was restored with the help of cantilevered split cranial bone graft. In all but 1 patient, the reconstruction was done in the emergency setting at the time of initial admission itself. One patient had infected wound that necessitated an initial debridement and split skin grafting. In this case, the definitive reconstruction was done after a gap of 3 months.A long-term follow-up of these patients is presented.

Craniosynostosis in an Indian Scenario: A Long-term Follow-up.

Craniofacial surgery as a subspecialty has finally taken off in India. Young plastic surgeons in the early 1990s became fascinated by its enormous scope. The author was also among the lucky ones to be trained in this field with Dr. Ian Jackson at the Craniofacial Center at Southfield, Michigan, from 1993-1994. This facility for craniofacial surgery was established in the North Indian tertiary care hospital at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, in 1995. METHODS: We have reviewed the outcomes of management of craniosynostosis patients and evaluated changes in these outcomes as the experience was gained. The study is a retrospective chart review of the 169 patients operated on for various craniosyntoses in the hospital, for the last 25 years from January 1995 to July 2019. RESULTS: The whole spectrum of craniosynostoses patients have been operated on and followed up for up to 20 years. All the patients underwent open surgery involving fronto-orbital advancement and remodelling of the deformed calvarium. It was noted that all the syndromic patients required more than one operation, whereas the non-syndromic patients had a stable result after a single surgery. Craniofacial surgery has now truly arrived in India. Our experience with management of craniosynostosis at PGIMER, Chandigarh, has shown an acceptable morbidity and mortality which is at par with the global standards.

Prospective Analysis and Comparison of Periareolar Excision (Delivery) Technique and Pull-Through Technique for the Treatment of Gynecomastia.

BACKGROUND: Gynecomastia is one of the most common disorders affecting adolescent and adult males. It is a benign disorder but has severe psychological manifestations like low self-confidence, depression, anxiety and social phobia in patients suffering from gynecomastia. Different surgical techniques have been described utilizing a variety of incisions, excisions, lipectomy and liposuction methods. Very frequently, these methods are combined for the gynecomastia treatment with variable reported results. However, there is a lack of studies comparing these techniques. The present study was planned to compare cases of gynecomastia treated by liposuction with periareolar excision (delivery technique) and liposuction with a pull-through technique. METHOD: A prospective randomized control study was conducted at a tertiary care hospital on 20 patients with gynecomastia. The patients were assigned to either liposuction with periareolar excision (delivery technique) or liposuction with pull-through technique. Anthropometric analysis and breast evaluation questionnaire (BEQ) scores were analyzed and compared before and after the surgery. RESULTS: The majority of the study subjects were between 21 and 30 years of age. Low self-confidence was the main reason for surgery in most of the cases. Twelve patients had gynecomastia grade IIa and eight had grade IIb. Both groups had similar responses to BEQ scores before and after the surgery with no statistically significant difference. A statistically insignificant difference was observed between the groups on comparison of anthropometric analysis preoperatively and postoperatively. The mean lipoaspirate volume was 280 ml for the pull-through technique and 367 ml for the periareolar excision technique. No complications were observed in cases operated on by the pull-through technique, while two cases (10%) operated on by the periareolar excision had hematomas. CONCLUSION: Both techniques provide excellent cosmetic results with low risk of complications in both small and moderate breast enlargement with skin excess. The pull-through technique combines the benefits of direct excision of glandular tissues along with the minimally invasive nature of liposuction. Thus, performing the procedure via a single incision without the use of drains is a safer alternative to traditional liposuction with the periareolar excision technique. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Assessment of Clinical and Histological Changes in the Skin Paddle of Pectoralis Major Myocutaneous Flap in Intraoral Reconstruction: A Prospective Cohort Study.

PURPOSE: This study was carried out to characterize the clinical and histological changes in the cutaneous portion of the transferred pedicled pectoralis major myocutaneous flaps used in intraoral reconstruction in patients with head and neck malignancy. METHODS: This was a prospective cohort study carried out from July 2016 to 2018. All patients underwent ablative surgery for oropharyngeal cancers and primary reconstruction with pedicled pedicled pectoralis major myocutaneous flaps. The intraoral flaps were examined for color, texture, presence of hair, chronic inflammatory changes, and ulceration. At 12 months, incisional biopsies were taken from the skin paddle of the intraoral flap and contralateral normal buccal mucosa, and flap histology was compared with that of the contralateral buccal mucosa. RESULTS: Twenty patients were included in the final analysis (M/F, 4:1; mean ± SD age, 51.38 ± 6.76 years). Fourteen flaps resembled oral mucosa, 3 had a mixed appearance of both skin and mucosa, and 3 had appearance of normal skin at 1 year follow-up. The epidermis and stratum corneum were retained in all the flap biopsies; however, severe attenuation was noted in 7 patients (had mucosal appearance) but was significantly different from oral mucosa(P = 0.0003). Cutaneous appendages were found in all the flap epithelia. Thirteen flaps showed grossly attenuation, of which 11 patients had a gross appearance resembling oral mucosa and 2 had a mixed appearance. The biopsies showed varied degree of chronic changes like desquamation in around 35% (7 patients), hyperkeratosis in 35% (7 patients), and chronic candidiasis in 30% (6 patients). CONCLUSIONS: Although the intraorally transferred flaps demonstrate a morphological appearance similar to oral mucosa, there is a histological preservation of skin elements and architecture.

High-pressure chemical injection injury to the hand: usually underestimated injury with major consequences.

The damages caused by high-pressure injuries are often underestimated. Such incidents are characterised by a small punctiform entry wound and the normal colour of skin. The internal damage caused by these injuries can be severely devastating in nature. These injuries required emergent surgical debridement and irrigation. Postoperatively intensive physiotherapy is required for the successful return of hand function. The final functional outcome depends on the initial latency to treatment, nature of injected material, location and volume of injection and postoperative physiotherapy.

Comparison of efficacy of silver-nanoparticle gel, nano-silver-foam and collagen dressings in treatment of partial thickness burn wounds.

INTRODUCTION: This study was carried out to compare the efficacy of silver nanoparticle gel (SG), nanosilver foam (SF) and collagen (C) dressings in partial thickness burn wounds. METHODS: This was a single-center, prospective cohort study carried out over a period of 1 year on patients with 15-40% partial thickness thermal burns ≤48 h. Each patient received all three dressings (silver-nanoparticle gel, nanosilver foam, collagen) simultaneously at 3 randomly selected areas which were comparable in terms of burn depth and surface area. Efficacy of the dressings was assessed in terms of healing rates, time taken and ease of application, pain at dressing change, cost, wound-swab culture and scar quality (at 3 months). RESULTS: A total of 20 patients were included. In SF group, number of patients with 60%-80% re-epithelialization on day10 (SG: 10/20; C: 10/20; SF: 16/20; p = 0.042) and complete healing on day14 (SF: 11/20, C: 6/20, SG: 4/20; p = 0.032) was significantly higher. The time for dressing change was similar at admission (p = 0.918) and day 10 (p = 0.163), although majority of the patients in SF group needed less than 10 min. The time taken (<10 min) was significantly lower in SF group by 14th day (SF: 18/20 C: 6/20 SG: 6/20; p < 0.001). The ease of application rated by clinicians as "extremely easy" was significantly better in SF group (SG: 78%, C: 80%, SF: 95%; p = 0.011). There was a significantly faster decrease in pain scores in SF group by 5th day (VAS score SF: 6, C: 8; SG: 8; p = 0.038), however, pain scores were comparable at 2 weeks. The scar quality (p = 0.82), cost (p = 0.09) and infection rates (SG: 7/20; C: 4/20; SF: 3/20; p = 0.05) were comparable. The need for skin-graft cover was lower in SF group (SG: 5/20; C: 3/20; SF: 1/20). CONCLUSION: Nanosilver-foam dressings were found to be more efficacious for re-epithelialization, healing, ease of application, tolerance when compared to silver nanoparticle gel and collagen dressings in partial-thickness burns. All were found to be safe.