Otoplasty: The Belfast Experience. A 10-Year Review of 2333 Ear Outcomes.

BACKGROUND: "Prominent ear" remains one of the most common referrals to pediatric plastic surgery. The perceived deformity has been corrected using a multitude of techniques for over a century, and significant variation in practice still exists. Recent studies suggesting that cartilage-scoring techniques are associated with more major complications than suture techniques may have led to an adverse international perception of the technique. Thus, waning use of anterior scoring prominent ear correction appears to be occurring. For appropriate cases, the authors have used anterior scoring for over 20 years, with high patient satisfaction and low complication rates. They present a review of all cases and outcomes from 2005 to 2015. The authors believe this is the largest case series of anterior scoring otoplasty published to date. METHODS: All pediatric cases undergoing prominent ear correction from 2005 to 2015 were included in this retrospective case note analysis and follow-up study. Patient demographics, operative details including early and late complications, and postoperative results were analyzed. METHODS: Over a 10-year period, 1199 otoplasties were performed (1134 bilateral, 65 unilateral), for a total of 2333 ear corrections. A total of 1575 ears were corrected using the anterior scoring technique. The remaining cases underwent correction by means of suture only, cartilage reduction, or combination techniques. There was a significantly lower all-cause reoperation rate for anterior scoring compared to suture-only techniques ( P = 0.0039; significant at P < 0.025). There were no reported cases of cartilage necrosis. CONCLUSIONS: This study demonstrates that in appropriately selected patients, anterior scoring otoplasty is a low-morbidity procedure. In the authors' institution, when compared to suture techniques, it was associated with a lower rate of complications and reoperation rate than suture-only techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The Hepatoprotective and Anti-Nephrotoxic Potential of Methanolic Extract of a Polyherbal Preparation in CCl4-Induced Liver Injury Model of Wistar Rats.

The liver and kidneys are the vital organs of the body and perform important life-sustaining functions in the body. Synthetic drugs used in the treatment of liver and kidney diseases are sometimes inadequate and can lead to serious side effects. Medicinal herbs and plants were used to combat diseases for a long time and combination therapy is preferred over single plant therapy. In the current study, the Asparagus racemosus, Mucuna pruriens, Anacyclus pyrethrum, and Tribulus terrestris polyherbal preparation (PHP) was selected to evaluate its hepatoprotective, antioxidant, and anti-nephrotoxic potential. The methanolic extract of PHP was prepared following standard protocols. Fifty-six albino rats were divided into 7 groups (n = 8). The negative control (NC) having the healthy rats and the remaining 6 groups were induced liver toxicity by intraperitoneally injecting 0.5 mL/kg of 50% CCl4 in olive oil. Group 2 was positive control and group 3 and 4 received silymarin standard drug at the dose of 100 and 200 mg/kg body weight. Groups 5, 6, and 7 (PHP-1, PHP-2, PHP-3) were the liver-damaged rats receiving the PHP at a dose of 50, 100, and 150 mg/kg body weight. Blood samples were collected at 21 of the trial, to evaluate oxidative stress, hepatoprotective and anti-nephrotoxic potential. Results of liver function tests revealed significant (P < .05) hepatoprotective activities of PHP after intoxication with CCl4 of albino rats as compared to standard groups. Moreover, results of renal functions also showed that PHP has a significant (P < .05) restoring the capacity of blood urea, creatinine, and uric acid in intoxicated rats as compared with the control group. The PHP also reduced the oxidative stress in the treatment groups by increasing the total antioxidant capacity and reducing the total oxidative status. It can be concluded that selected medicinal plants have a potential role in the management of liver and kidney disorders. So, by running the clinical trial on a large scale and by isolating the phytochemical constituents responsible for hepatoprotective and nephroprotective activities, locally prepared drugs could be developed to manage liver and renal disorders.

Phytochemical Screening, Antioxidant, and Inhibition Activity of Picrorhiza kurroa Against α-Amylase and α-Glucosidase.

Picrorhiza kurroa (P.K) usually familiar as kutki is a well-known plant in the Ayurvedic system of medicine due to its reported activities including antidiabetic, antibacterial, antioxidant, antitumor, anti-inflammatory, and hepatoprotective. The current research was intended to evaluate the antioxidant, inhibition activity of the ethanolic, methanolic, and aqueous extracts of P.K roots against α-amylase and α-glucosidase in vitro, after the phytochemical analysis. For this purpose, P.K roots were extracted with ethanol (EthPk), methanol (MthPk), and distilled water (AqPk) and phytochemical study of the extracts were performed to recognize the total phenolic content (TPC) and total flavonoids content (TFC). Antioxidant capability of the extracts was assessed by FRAP, ABTS, and DPPH assay. α-amylase inhibitory and α-glucosidase inhibitory activities were also determined. Software SPSS-23 was used to statistically analyze with One Way ANOVA and results were stated as mean standard deviation. Result of the study showed that MthPk contained the maximum concentration of TPC and TFC than EthPk and AqEh. Antioxidants in terms of DPPH (lowest IC50 = .894 ± .57), FRAP (612.54 ± 11.73) and ABTS (406.42 ± 4.02) assay was also maximum in MthPk. MthPk was also showed maximum inhibition activity against α-amylase and α-glucosidase with lowest IC50 (.39 ± .41; .61 ± .24), respectively. The extracts α-amylase and α-glucosidase inhibitory activities order was as MthPk > EthPk> AqPk. Results clearly specified that the methanolic extract of Picrorhiza kurroa have the maximum antioxidant, α-amylase, and α-glucosidase inhibitory activities. A positive correlation of TPC, TFC with antioxidant, and α-amylase and α-glucosidase inhibition activities of the P.K roots were also shown. The plant has capability to diminish the oxidative stress and can be used to treat diabetes by inhibiting α-amylase and α-glucosidase actions.

Lightning injuries in Northern Ireland.

INTRODUCTION: Lightning injuries are uncommon in Northern Ireland (NI) with scarce reports detailing incidence and local experience. We present a case study of 3 patients involved in a single lightning strike with a review of the incidence of similar injuries in the province. METHODS: Data from TORRO's National Lightning Incidents Database between 1987 and 2016 (30 years) were searched to identify victims of lightning injuries in NI. Information on 3 patients with lightning injuries that were managed in our regional burns and plastic surgery service was collected and examined. A supplementary search in hospital records was conducted over the last 20 years to identify additional data. RESULTS: Prior to our study, 6 victims of lightning injuries were identified of whom 5 survived and 1 died. Our 3 patients comprised of 2 children and 1 accompanying adult. All survived but the adult suffered cardiac arrest and required a prolonged period of cardiopulmonary resuscitation. CONCLUSION: While lightning injuries are rare in NI, this is the first report of more than one person affected by a single lightning incident in the province. In our limited experience, immediate public response and prolonged cardiopulmonary resuscitation efforts facilitated by automated defibrillators result in a favourable outcome.

Antimicrobial susceptibility of acinetobacter clinical isolates and emerging antibiogram trends for nosocomial infection management

Abstract: Introduction: The drug resistant Acinetobacter strains are important causes of nosocomial infections that are difficult to control and treat. This study aimed to determine the antimicrobial susceptibility patterns of Acinetobacter strains isolated from different clinical specimens obtained from patients belonging to different age groups. METHODS: In total, 716 non-duplicate Acinetobacter isolates were collected from the infected patients admitted to tertiary-care hospitals at Lahore, Pakistan, over a period of 28 months. The Acinetobacter isolates were identified using API 20E, and antimicrobial susceptibility testing was performed and interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: The isolation rate of Acinetobacter was high from the respiratory specimens, followed by wound samples. Antibiotic susceptibility analyses of the isolates revealed that the resistance to cefotaxime and ceftazidime was the most common, in 710 (99.2%) specimens each, followed by the resistance to gentamicin in 670 (93.6%) isolates, and to imipenem in 651 (90.9%) isolates. However, almost all isolates were susceptible to tigecycline, colistin, and polymyxin B. CONCLUSIONS: The present study showed the alarming trends of resistance of Acinetobacter strains isolated from clinical specimens to the various classes of antimicrobials. The improvement of microbiological techniques for earlier and more accurate identification of bacteria is necessary for the selection of appropriate treatments.

Protection of DNA during oxidative stress and cytotoxic potential of Artemisia absinthium.

Medicinal plants are rich in secondary metabolites (alkoloids, glycosides, coumarins, flavonides, steroids, etc.) and considered to be more effective and a safer alternative source to manage a variety of diseases related to liver, heart and kidney disordered. This study determines in vitro antioxidant and in vivo toxicological profile including hemolytic, brine shrimp lethality and mutagenicity of aerial parts of Artemisia absinthium. DNA protection assay was performed on pUC19 plasmid vector using H(2)O(2) as oxidative agent. Total phenolic and flavonoid content were determined using colorimetric methods. Toxicity of the plant was evaluated by brine shrimp lethality, hemolytic and mutagenic activity. DNA protection assay of the plant showed concentration dependent protective effect and at concentration 10µL/mL revealed complete protective effect against H(2)O(2) induced DNA damage. Highest phenolic and flavonoid content was found to be 167.3 (mg GAE 100g DW(-1)) and 14 (mg CE 100g DW(-1)) respectively. Results showed that A. absinthium is potent against standard toxicological procedures, that indicates the presence of bioactive components in the plant and possess antioxidant activity that protects DNA against H(2)O(2) induced oxidative damage. Thus the results showed/support that A. absinthium provides significant health benefits.

Subungual Congenital Nevus with Recurrent Nevus Phenomenon.

Melanonychia is uncommon. We report the first case of histopathologic recurrence of a completely excised subungual congenital nevus that presented as congenital melanonychia.

Lymph node flap based on the right transverse cervical artery as a donor site for lymph node transfer.

Lymph node transfer is a novel technique in lymphedema surgery. In this study, we present our experience in harvesting lymph nodes flap based on the right transverse cervical artery. In a period of 7 months, we harvested 11 cervical lymph node flaps based on the right transverse cervical artery (TCA). The reliable anatomy of the TCA and the low complication rate of the donor site make this lymph node flap ideal for transfer in the treatment of lymphedema. Knowledge of the regional anatomy and the anatomic variations of the TCA are mandatory for safe dissection of this flap. We also present the preliminary results of our first 2 cases in which we performed cervical lymph node transfer for secondary lower extremity lymphedema.

Successful treatment of thread-lifting complication from APTOS sutures using a simple MACS lift and fat grafting.

UNLABELLED: Facial soft tissue lifting with subdermal sutures has a significant attraction for physician and patient alike. The case report describes a 48 year old woman who presented with pain and discomfort over the left cheek after a thread-lift procedure with anti-ptosis (APTOS) sutures performed 13 months previously. The clinical examination showed extrusion of the APTOS thread (Aptos, Moscow, Russia) accompanied by slight soft tissue tightness and tenderness along its course to the temporal area, indicating complete removal of the thread. A simple minimal access cranial suspension lift was performed with the patient under local anesthesia to remove the subdermal sutures together with autologous fat grafting to enhance the aesthetic result. At the 1 year follow-up visit, no complications were reported, and the patient was entirely satisfied with the final result. LEVEL OF EVIDENCE V: 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 .

Outbreak of epidemic methicillin-resistant Staphylococcus aureus in a regional burns unit: management and implications.

Colonization of burn patients with methicillin-resistant Staphylococcus aureus (MRSA) is not uncommon, however an outbreak that necessitates closure of a burns unit is relatively rare. The objective of this study was to present the experience of a regional adult burns unit where an outbreak of epidemic MRSA-15 (EMRSA-15) took place. During the studied period, 176 patients were admitted to the unit, 52 with burns, 48 for elective plastic surgery procedures while the remainder belonged to other specialties. Patients admitted under burns and plastic surgery were investigated together with 46 staff members to control the outbreak. MRSA was isolated in 18 patients out of which 12 had EMRSA-15. Among the staff members, MRSA was isolated in nine of which five had EMRSA-15. The burns unit was closed to all admissions to terminate this outbreak. The MRSA positive staff members were sent on "special leave" and underwent treatment with nasal mupirocin and triclosan body wash. All staff members were able to return to work after one week's treatment. The burns unit underwent re-furbishment and decontamination while it was closed. In conclusion, the study shows that an outbreak of EMRSA was controlled successfully, however, it highlights the implications of such an event for a regional burn service with regard to staff, patients and guidelines for management.