An Overview of Rhinoplasty Practices: European Academy of Facial Plastic Surgery, Collaborative Cross-Sectional Study.

This collaborative European Academy of Plastic Surgery (EAFPS) study aimed to provide an overview of rhinoplasty practices, informing clinician and patient decision making. It is a multicenter cross-sectional study, reported as per Strengthening the Reporting of Observational Studies in Epidemiology guidelines. All EAFPS members were contacted via email, inviting them to participate. Members expressing an interest to participate were asked to anonymously complete a questionnaire, related to rhinoplasties that they performed as first/supervising surgeon over a period from January 1, 2019 to January 1, 2022. A descriptive analysis was performed. One hundred and fifteen surgeons submitted data on 41,259 rhinoplasties from 33 countries. Eighty percent of rhinoplasties were primary, and 20% were secondary. Thirty five percent of primary rhinoplasties were closed and 65% were open. Thirty one percent of primary rhinoplasties were for cosmetic indications, 11% functional and 58% were for both. Of the 8147 secondary rhinoplasties, 44% were closed and 56% were open. Thirty percent were for cosmetic indications, 11% functional, and 59% for both cosmetic and functional. Ninety-one percent of rhinoplasties were performed by ENT surgeons, 3% by plastic surgeons, 5% by maxillofacial surgeons, and 1% were dual (maxillofacial and ENT) trained. One-thousand seven-hundred thirty primary rhinoplasties underwent revision surgery (5%) and 102 secondary rhinoplasties underwent revision surgery (1%). The most commonly reported indications for revision surgery were dorsal asymmetry, nasal blockage, and dissatisfaction with nasal tip. Three percent of rhinoplasties underwent preoperative psychological assessment. To the authors knowledge, this is the largest published rhinoplasty dataset. This study provides an overview of rhinoplasty practices that can be used for benchmarking and to guide clinician and patient decision making. Psychological assessment of prerhinoplasty appears insufficient with higher levels recommended to minimize unsuccessful outcomes. This study showcases the power of collaborative research and may serve as a catalyst for future collaborative facial plastic surgery research.

Photosynthetic pigments and quantum yield of West Indian cherry under salt stress and NPK combinations.

West Indian cherry cultivation has proved to be an important economic activity in northeastern Brazil. However, irrigation with brackish waters limits cultivation, requiring new strategies to minimize the effect of salt stress. In this context, the present study aimed to evaluate the effect of nitrogen (N), phosphorus (P), and potassium (K) combinations on the photosynthetic pigments and quantum yield of West Indian cherry cultivated under salt stress, in the second year of production. The assay was conducted in a protected environment by adopting an experimental design in randomized blocks, with treatments distributed in a 2×10 factorial arrangement referring to two electrical conductivity levels of irrigation water - ECw (0.6 and 4.0 dS m-1) and 10 NPK fertilization combinations - FC (80-100-100; 100-100-100; 120-100-100; 140-100-100; 100-80-100; 100-120-100; 100-140-100; 100-100-80; 100-100-120, and 100-100-140% of the recommendation, in the second year of production), with three replications, each consisting of one plant. Irrigation with the electrical conductivity of 4.0 dS m-1 negatively affected the synthesis of photosynthetic pigments and the photochemical efficiency of the West Indian cherry cv. Flor Branca. The NPK combinations did not attenuate the effects of salt stress on the analyzed variables. However, the combinations referring to 120-100-100%, 140-100-100%, and 100-120-100% of NPK recommendation improved the quantum yield of photosystem II by reducing the initial fluorescence and increasing the maximum fluorescence of the West Indian cherry cv. Flor Branca.

Morphophysiology and production of bell pepper grown under salt stress and salicylic acid foliar application.

Considering the relevance of bell pepper and the limitations imposed by the deleterious effects of salt stress, especially in semi-arid regions, it is extremely important to establish strategies that can facilitate the use of saline water in vegetable production. In this scenario, this study aimed to evaluate the effect of the frequency of foliar application of salicylic acid on the morphophysiology and production of the bell pepper cv. "All Big" irrigated with saline water. The study was conducted at a greenhouse in Campina Grande - PB. The treatments were distributed in a completely randomized design and set up in a 4 × 4 factorial arrangement with three replications, corresponding to four application frequencies of salicylic acid (F1- No application of salicylic acid, F2 - Weekly application, F3- fortnightly application, and F4- monthly application) and four levels of electrical conductivity of irrigation water - ECw (0.8, 1.6, 2.4 and 3.2 dS m-1). The fortnightly application of salicylic acid at a concentration of 1.0 mM mitigated the effects of salt stress on the morphophysiology and production components of bell pepper cv. All Big cultivated with ECw of up to 2.4 dS m-1, which reinforces the hypothesis that salicylic acid can act as a signaling molecule and reduce the effects of saline stress in bell pepper, enabling the use of brackish water in agricultural activity, mainly in semi-arid regions of northeastern Brazil, which have a shortage of fresh water.

Hydrogen peroxide in attenuation of salt stress effects on physiological indicators and growth of soursop.

To mitigate the deleterious effects of salt stress, substances capable of acting as mitigators and/or inducers of tolerance to stress have been used, enabling the use of saline waters and contributing to the development of irrigated agriculture. In this context, the aim of the present study was to evaluate the effect of foliar spraying with hydrogen peroxide as an attenuator of salt stress effects on soursop morphophysiology. The experiment was conducted under greenhouse conditions in Campina Grande - PB, Brazil, using a randomized block design, in a 4 × 4 factorial arrangement, whose treatments resulted from the combination of four levels of electrical conductivity of irrigation water - ECw (0.8 - control, 1.6, 2.4, and 3.2 dS m-1) and four concentrations of hydrogen peroxide - H2O2 (0, 10, 20, and 30 µM), with three replicates. Foliar application of hydrogen peroxide at a concentration of 10 µM increased growth, chlorophyll synthesis, and relative water content in the leaves and consequently reduced the foliar water saturation deficit of soursop irrigated with ECw up to 1.6 dS m-1. The concentration of hydrogen peroxide of 30 µM intensified the salt stress on the electrolyte leakage in the leaf blade and the photosynthetic pigments of soursop, 270 days after transplanting.

Sampling methods for assessing social wasps species diversity in a eucalyptus plantation.

Social wasps were collected in a eucalyptus (Eucalyptus urograndis, a genetically enhanced eucalyptus) plantation in Juiz de Fora, state of Minas Gerais, southwestern of Brazil, by using a variety of sampling methods, including active capture and baited traps set at two microhabitats. Six new records of social wasps for this region were obtained during the study: Brachygastra lecheguana Latreille, Polybia ignobilis Haliday, Polybia occidentalis Olivier, Polybia platycephala (Richards), Protonectarina sylveirae Saussure, and Protopolybia exigua Saussure (Hymenoptera: Vespidae). The active capture method sampled the greatest number of species. Baited traps installed in the canopy sampled agreater number of individuals of social wasps than those set on the trunks of eucalyptus trees. Fruit based baits captured a greater number of social wasp species than those baited with a protein derivative. Once no method was able to sample all species, we concluded that the efficiency of a survey can be maximized by using traps with a variety of different baits, in combination with active capture methods.

A classical model of educational cooperation in Human Anatomy: the Table Leaders.

This project has been developed for many years in the Human Anatomy courses.Its good outcomes have been confirmed by years of evidence of excellent resultsobtained through the learning of Human Anatomy. This method of teaching andlearning as one allows students who are taking Human Anatomy classes to receivepractical training in small groups and transmit it to their colleagues in the practicaltraining established in the Medical degree. Table Leaders feel rewarded as theylearn to speak in public, regularly transmitting the knowledge obtained, and byhaving to be up to date with their studies. These are all aspects that help, not onlythe Table Leaders process of learning, but also that of their colleagues, who seeclosely and carefully anatomical details that help them understand the subject.This method of supporting practical training is always under the supervision ofthe teacher who develops the practical classes. These Leaders used to pass thetest without additional problems. Thus the note was significantly increased versusthe class colleagues.

Sub-alar batten grafts as treatment for nasal valve incompetence; description of technique and functional evaluation.

OBJECTIVE: To describe and evaluate the functional results of a surgical technique for treating nasal valve incompetence, in which a cartilage graft called a sub-alar batten graft is placed along the undersurface of the lateral crus of the lower lateral cartilage. METHODS: The functional outcomes of 27 patients who had sub-alar batten grafts placed on 39 sides were evaluated by means of clinical examination and subjective self-assessment. RESULTS: Of a total of 39 sides operated upon, 10 (26%) were rated as optimal, 15 (39%) as improved, 13 (33%) as equal and 1 (2%) as worse. Overall on 25 sides (65%) the post-operative situation was considered to be better than pre-operatively. In all cases in which there was a wish for cosmetic improvement, besides the functional indication, this was obtained, and in no case did the grafts give cause to cosmetic grievances or other complications. CONCLUSION: Placement of sub-alar battens had a positive effect on nasal valve function in roughly two thirds of cases in this series. Although in our opinion this result was slightly disappointing from a purely functional point of view, they can improve the cosmetic result and continue to be considered in cases in which avoidance of surface irregularities is a primary concern or as a preventative measure in rhinoplasty patients at risk for post-operative valve collapse.

Feed efficiency indexes and their relationships with carcass, non-carcass and meat quality traits in Nellore steers.

Five hundred and seventy-five Nellore steers were evaluated for residual feed intake and residual feed intake and gain and their relationships between carcass, non-carcass and meat quality traits. RFI was measured by the difference between observed and predicted dry matter intake and RIG was obtained by the sum of -1*RFI and residual gain. Efficient and inefficient animals were classified adopting ±0.5 standard deviations from RFI and RIG mean. A mixed model was used including RFI or RIG and contemporary group as fixed effects, initial age as covariate and sire and experimental period as random effects, testing the significance of the regression slope for each evaluated trait. RIG was positively related to longissimus muscle area. Efficient-RFI animals had lower liver and internal fat proportions compared to inefficient-RFI animals. Efficient-RFI and efficient-RIG animals had 11.8% and 11.2% lower extracted intramuscular fat, compared to inefficient-RFI and inefficient-RIG animals, respectively. Efficient-RFI animals had tougher meat compared to inefficient-RFI animals.

Immunotherapy for allergic rhinitis--a United Kingdom survey and short review.

Allergic rhinitis (AR) is a common condition which is treated using different modalities, including immunotherapy. The aim of this study was to survey the current management strategies among ENT consultants in the UK in treating AR, and their views on immunotherapy. The study design was a postal questionnaire survey and the setting a university teaching hospital. Participants were consultant members of the British Association of Otolaryngologists - Head and Neck Surgeons (BAO-HNS). The main outcome measures were common treatment modalities adopted by the survey group to treat AR, and the number of consultants practising immunotherapy. The majority (81.1 per cent) of the consultants surveyed practise medical therapy with or without surgery. Immunotherapy is advised by 26 per cent of ENT consultants, but only 6.6 per cent currently administer immunotherapy.

The influence of the Internet on decision making in acoustic neuroma.

OBJECTIVE: To determine the access to and the use of the Internet by acoustic neuroma patients as a medical information source, and the influence of the Internet on decision-making, as well as the patients' views on the quality of particular sites. MATERIALS AND METHODS: A retrospective 27-item questionnaire was sent to 138 consecutive acoustic neuroma patients diagnosed between 1997 and 2002. The study included patients treated by conservative, radiotherapeutic and surgical modalities. MAIN OUTCOME MEASURES: Patient demographics, the extent of Internet use as well as quality and quantity of available information. RESULTS: There were 86.95 per cent questionnaires available for analysis. Twenty-four per cent accessed the Internet to obtain information about acoustic neuromas. Ninety-seven per cent of patients said that the information provided in the clinic matched with the information obtained from the websites, 49 per cent said that the information obtained from the Internet did not influence decision making regarding acceptance of treatment of their tumour. Some patients said the Internet information was depressing, devastating, and they would never look up the Internet again for medical information. CONCLUSION: A significant proportion of our patients accessed the Internet for information. Caution should be exercised when advising patients regarding websites as the information on the Internet is often not controlled or checked for accuracy. Acoustic neuroma specialists and ENT surgeons in general should familiarize themselves with related websites so that patients can then be directed to high-quality sites.

Synthesis, characterization, and biological screening of a copper flurbiprofen complex with anti-inflammatory effects.

The flurbiprofen complex of copper(II) was prepared and characterized by IR, UV-VIS and EPR Spectroscopy, magnetic susceptibility, and thermogravimetric analysis. The compound was tested for in vivo anti-inflammatory and analgesic activities in rats. The inhibitory effect on carrageenin-induced paws inflammation and analgesic effect of copper flurbiprofen complex were similar to those of free flurbiprofen. However, the copper complex produced less gastric irritation than the parent drug.

Water-soluble rhodium(II) carboxylate adducts: cytotoxicity of the new compounds.

Rhodium(II) carboxylate (acetate, propionate, and butyrate) adducts with isonicotinic acid (Hisonic) were prepared for study. Elemental analyses and electronic spectroscopy show that the adducts contain two isonicotinic acid ligands coordinated in the axial position at the pyridinic nitrogen. The in vitro (K562 human leukemic cell line) assay and LD10 in mice results, in addition to tests of solubility, suggest that, in the presence of blood lipids or cellular membrane, the adducts dissociate into the parent compounds and the rhodium(II) carboxylate enters the cell to carry out its biological effects.

Atypical gastric presentation of strongyloidiasis in HIV-infected patient--case report.

Strongyloides stercoralis is an intestinal helminth of systemic distribution, which, once in its host, has the ability to perpetuate itself through an autoinfection cycle, leading to chronic infection. In healthy hosts, the parasite usually does not cause any symptoms, or only mild symptoms that are limited mainly to the small intestine. However, in immunocompromised hosts, uncontrolled multiplication with massive infection may occur, causing hyperinfection syndrome or disseminated strongyloidiasis, which are both associated with high morbidity and mortality. There are few reports of gastric involvement, particularly presenting as ulcer in the stomach. We report a case of gastric ulcer caused by S. stercoralis in HIV-infected patient.

Simple snoring: current practice.

Snoring is a significant problem with both social and medical manifestations. This article addresses the current management of the simple snorer from initial out-patient assessment to definitive treatment.

Osseo-integration in Paget's disease: the bone-anchored hearing aid in the rehabilitation of Pagetic deafness.

The first report of a patient with gross Paget's disease and progressive hearing loss who successfully underwent hearing rehabilitation with an osseo-integrated hearing aid is presented. The otological manifestations of Paget's disease and the principles of osseo-integration are discussed. The use of a bone-anchored hearing aid (BAHA) in selected patients with Paget's disease can provide useful amplification and hearing rehabilitation.

Pleomorphic adenoma involving the stylomastoid foramen.

A rare case of an intratemporal pleomorphic adenoma is presented and the management of such a tumour is discussed. Some anatomical aspects of the facial nerve, pertinent to the pathophysiology of facial paralysis are outlined. This case demonstrates that tumour extension into the temporal bone can be resected successfully at initial surgery with excellent facial nerve functional outcome. We advocate exploration of the fallopian canal to be carried out at primary surgery and be performed by a surgeon familiar with the surgical anatomy of the intratemporal segment of the facial nerve. This approach will reduce the risk of facial nerve injury and palsy both at surgery and subsequently.

Unusual cause of subglottic stenosis in an adult.

Subglottic foreign bodies presenting, as chronic subglottic stenosis is extremely rare in adults. A high index of suspicion and a careful history is of paramount importance in the diagnosis of a subglottic foreign body. Laser should not be used to excise granulation tissue to expose the foreign body because of the danger and potential of a fire particularly when the nature of the foreign body is not known. Rigid bronchoscopes are more beneficial than flexible ones in the removal of foreign bodies especially in long-standing cases.

Medium-term outcome of palatal surgery for snoring using the Somnus unit.

The aim of this study was to retrospectively survey patients who had undergone radiofrequency ablation of the soft palate for snoring complaints. Fifty-nine patients who had undergone radiofrequency ablation were sent an anonymous questionnaire to assess snoring (using visual analogue scales), pain and satisfaction with the procedure. Sixty-one per cent of the group returned the questionnaire. The mean time since operation was 17.5 months. Taking an improvement in snoring of 50 per cent or greater as a successful operation, snoring improvement occurred in 22 per cent. Post-operative pain was minimal with a median pain score of zero. Information was requested on whether the patient would undergo this procedure again, 50 per cent responded that they would and 44 per cent would advise a friend in the same situation to have this procedure. Radiofrequency ablation of the soft palate, as in other forms of surgery for snoring, seems to have a relapse rate over the long-term.

[Report of a case of latrodectism occurring in Manaus, Amazonas, Brazil]. / Relato de um caso de latrodectismo ocorrido em Manaus, Amazonas, Brasil.

In July 2, 1995 arrived at the Instituto de Medicina Tropical do Amazonas as eleven-year-old male with complaining of spider bite on his right retroauricular region, presenting typical findings of latrodectism. The accident was reported as having occurred in the suburbs of Manaus. The patient was given neostigmine preceded by atropine, calcium gluconate, cimetidine, diazepan and hydrocortisone. Within three days the patient showed improvement, and was aware, orientated and with significant palpebral oedema reduction. Muscle spasms are still present, as well as fever, shivering, and intense sweating. In spite of a daily progressive improvement, at the fifth day appeared a spotted papular erythema. The patient was discharged without symptoms after the 13th day. This is the first such reported case which took place in Amazonian region, it might have been happened a consequence of the urban sprawl which has characterized the growth of the city of Manaus, in the last twenty years. It is not possible at this point to evaluate the epidemiological resound of the event, but in any case, it seems plausible to recommend that black widow antivenom become available.

[Study of in vitro antimicrobial resistance of positive coprocultures to Shigella sp]. / Estudo da resistência antimicrobiana in vitro das coproculturas positivas para Shigella sp.

BACKGROUND: The gastroenteritis caused by Shigella sp (shigellosis) represents an important cause of morbimortality, especially in children under two years old. It is well known that the proper antimicrobial therapy can improve clinical state and diminish the disease dissemination. Increasing levels of resistance to drugs commonly used in the treatment of shigellosis have been described, and its sensibility has not been recently evaluated in our setting. OBJECTIVE: To evaluate the Shigella antimicrobial resistance in our setting. METHODS: A retrospective study was conducted using 106 coprocultures of patients, hospitalized or not, who have been assisted at HCPA and at HPV, during the period of 1994 to 1996, with the sensibility test done through the Kirby-Bauer technique of diffusion discs. RESULTS: Out of the 106 coprocultures studied, 35 (33%) came from HPV and 71 (67%), from HCPA. Considering the species, 58.8% were S. flexneri, 39.6%, S. sonnei, 0.9%, S. disenteriae and 0.9%, S. boydii. The resistance levels to usually indicated antibiotics were: ampicillin -57.5%, trimethropim-sulfamethoxazol -75.5%, and nalidixic acid -7.5%. CONCLUSIONS: These results show significant (p<0.001) in vitro antimicrobial resistance to ampicillin and trimethoprim-sulfamethoxazol and low resistance to nalidixic acid among Shigella sp. Thus, nalidixic acid may be an option to treat infections caused by resistant organisms.