ABSTRACT
BACKGROUND: Most of the symptoms of coronavirus disease 2019 (COVID-19) are covered by large repertory rubrics and hence many remedies have been proposed as "genus epidemicus". The aim of this study was to combine the information from various data collections to prepare a COVID-19 Bayesian mini-repertory/an algorithm-based application (app) and test it. METHODS: In July 2021, 1,161 COVID-19 cases from 100 practitioners globally were combined. These data were used to calculate "condition-confined" likelihood ratios (LRs) for 59 symptoms of COVID-19. Out of these, 35 symptoms of the 11 medicines that had at least 20 cases each were considered. The information was entered in a spreadsheet (algorithm) to calculate combined LRs of specific combinations of symptoms. The algorithm contained the medicines Arsenicum album, Belladonna, Bryonia alba, Camphora, Gelsemium sempervirens, Hepar sulphuris, Mercurius solubilis, Nux vomica, Phosphorus, Pulsatilla and Rhus toxicodendron. To test concordance, the doctors were then invited to re-enter the symptoms of their cases into this algorithm. RESULTS: The algorithm was re-tested on 358 cases, and concordance was seen in 288 cases. On analysis of the data, bias was noticed in the Merc group, which was therefore excluded from the algorithm. The remaining 10 medicines, representing 81.8% of all cases, were included in the preparation of the next version of the homeopathic mini-repertory and app. CONCLUSION: The Bayesian mini-repertory and app is based on qualitative clinical experiences of various doctors in COVID-19 and gives indications for specific medicines for common COVID-19 symptoms. It is freely available [English: https://hpra.co.uk/; Spanish: https://hpra.co.uk/es ] for further testing and utilization by the profession.
Subject(s)
COVID-19 , Homeopathy , Strychnos nux-vomica , Humans , Bayes Theorem , AlgorithmsABSTRACT
Sensory cortex exhibits receptive field plasticity throughout life in response to changes in sensory experience and offers the experimental possibility of aligning functional changes in receptive field properties with underpinning structural changes in synapses. We looked at the effects on structural plasticity of two different patterns of whisker deprivation in male and female mice: chessboard deprivation, which causes functional plasticity; and all deprived, which does not. Using 2-photon microscopy and chronic imaging through a cranial window over the barrel cortex, we found that layer 2/3 neurones exhibit robust structural plasticity, but only in response to whisker deprivation patterns that cause functional plasticity. Chessboard pattern deprivation caused dual-component plasticity in layer 2/3 by (1) increasing production of new spines that subsequently persisted for weeks and (2) enlarging spine head sizes in the preexisting stable spine population. Structural plasticity occurred on basal dendrites, but not apical dendrites. Both components of plasticity were absent in αCaMKII-T286A mutants that lack LTP and experience-dependent potentiation in barrel cortex, implying that αCaMKII autophosphorylation is not only important for stabilization and enlargement of spines, but also for new spine production. These studies therefore reveal the relationship between spared whisker potentiation in layer 2/3 neurones and the form and mechanisms of structural plasticity processes that underlie them.SIGNIFICANCE STATEMENT This study provides a missing link in a chain of reasoning that connects LTP to experience-dependent functional plasticity in vivo We found that increases in dendritic spine formation and spine enlargement (both of which are characteristic of LTP) only occurred in barrel cortex during sensory deprivation that produced potentiation of sensory responses. Furthermore, the dendritic spine plasticity did not occur during sensory deprivation in mice lacking LTP and experience-dependent potentiation (αCaMKII autophosphorylation mutants). We also found that the dual-component dendritic spine plasticity only occurred on basal dendrites and not on apical dendrites, thereby resolving a paradox in the literature suggesting that layer 2/3 neurones lack structural plasticity in response to sensory deprivation.
Subject(s)
Calcium-Calmodulin-Dependent Protein Kinase Type 2/physiology , Dendritic Spines/physiology , Neuronal Plasticity/physiology , Neurons/enzymology , Sensory Deprivation/physiology , Somatosensory Cortex/physiopathology , Animals , Calcium-Calmodulin-Dependent Protein Kinase Type 2/deficiency , Calcium-Calmodulin-Dependent Protein Kinase Type 2/genetics , Cell Size , Dendritic Spines/ultrastructure , Female , Male , Mice , Mice, Inbred C57BL , Neurons/ultrastructure , Phosphorylation , Protein Processing, Post-Translational , Skin Window Technique , Somatosensory Cortex/cytology , Somatosensory Disorders/physiopathology , Vibrissae/injuries , Vibrissae/innervationABSTRACT
In this work we have comprehensively studied the up-conversion (UC) properties of BaMgF4:Yb3+,Tb3+ phosphor for the first time. BaMgF4:Yb3+,Tb3+ phosphors were prepared by a simple and low cost precipitation method. To determine the influence of dopant concentration on luminescence properties, the corresponding UC luminescence spectra of BaMgF4:Yb3+,Tb3+ phosphors were studied under NIR excitation. Emission spectra under NIR excitation reveal the vital role of Tb3+ concentration in spectral tuning from the blue to green region. The UC decay curves were also studied to explore the possible energy transfer (ET) mechanisms between Yb3+ and Tb3+. The results reported here are expected to provide an approach for better understanding ET mechanisms in many Yb3+/Tb3+ codoped UC phosphors. This study will be helpful in applications where precisely defined optical transitions is an essential criterion.
ABSTRACT
INTRODUCTION: Microvascular anastomosis is a crucial procedure in replantation surgeries. Venous insufficiency is one of the most consistent cause of failure or re-exploration in these surgeries necessitating the use of venous grafts. MATERIALS AND METHODS: We discuss our study of 9 such replantation surgeries executed in calendar year 2013-2014, including a double finger replantation done in the same patient having total amputation of 4 fingers of the same (right) hand, in which an arterial segment was used as a microvascular interposition graft for venous anastomosis. Out of these 9 surgeries, 3 were re-exploration procedures for venous compromise and 6 were successful primary replantations. RESULTS: In all, 8 replants were successful and one failed due to arterial compromise. DISCUSSION: In our experience and extensive review of the previously available literature, we would like to portray the advantages of arterial segments as microvascular grafts in replant surgeries. Specifically, in a crush amputation injury for which the use of a vascular interposition graft is being contemplated. If any other digit is also amputated and is unsuitable for replantation, it can act as a potential donor site to harvest the arterial segment. However, when dealing with single finger amputation, the surgeon must be confident about the single digital arterial anastomosis, before harvesting the second digital artery as a microvascular graft. CONCLUSION: In our study, we found the use of arterial grafts in microvascular anastomosis of veins advantageous, as arterial segments have better ability to resist spasm due to environmental changes, better pressure tolerance as compared to venous segments, and provide an appropriate calibre match and ease of harvest in the same operative field.
ABSTRACT
The subiculum is a structure that forms a bridge between the hippocampus and the entorhinal cortex (EC), and plays a major role in the memory consolidation process. Here, we demonstrate spike-timing-dependent plasticity (STDP) at the proximal excitatory inputs on the subicular pyramidal neurons of juvenile rat. Causal (positive) pairing of a single EPSP with a single back-propagating action potential (bAP) after a time interval of 10 ms (+10 ms) failed to induce plasticity. However, increasing the number of bAPs in a burst to three, at two different frequencies of 50 Hz (bAP burst) and 150 Hz, induced long-term depression (LTD) after a time interval of +10 ms in both the regular-firing (RF), and the weak burst firing (WBF) neurons. The LTD amplitude decreased with increasing time interval between the EPSP and the bAP burst. Reversing the order of the pairing of the EPSP and the bAP burst induced LTP at a time interval of -10 ms. This finding is in contrast with reports at other synapses, wherein pre- before postsynaptic (causal) pairing induced LTP and vice versa. Our results reaffirm the earlier observations that the relative timing of the pre- and postsynaptic activities can lead to multiple types of plasticity profiles. The induction of timing-dependent LTD (t-LTD) was dependent on postsynaptic calcium change via NMDA receptors in the WBF neurons, while it was independent of postsynaptic calcium change, but required active L-type calcium channels in the RF neurons. Thus the mechanism of synaptic plasticity may vary within a hippocampal subfield depending on the postsynaptic neuron involved. This study also reports a novel mechanism of LTD induction, where L-type calcium channels are involved in a presynaptically induced synaptic plasticity. The findings may have strong implications in the memory consolidation process owing to the central role of the subiculum and LTD in this process.
Subject(s)
Excitatory Postsynaptic Potentials , Hippocampus/physiology , Long-Term Synaptic Depression , Pyramidal Cells/physiology , Animals , Calcium/metabolism , Calcium Channels, L-Type/metabolism , Hippocampus/cytology , Hippocampus/growth & development , Pyramidal Cells/metabolism , Rats , Rats, Wistar , Receptors, N-Methyl-D-Aspartate/metabolismABSTRACT
Translational bioinformatics (TBI) has transformed healthcare by providing personalized medicine and tailored treatment options by integrating genomic data and clinical information. In recent years, TBI has bridged the gap between genome and clinical data because of significant advances in informatics like quantum computing and utilizing state-of-the-art technologies. This chapter discusses the power of translational bioinformatics in improving human health, from uncovering disease-causing genes and variations to establishing new therapeutic techniques. We discuss key application areas of bioinformatics in clinical genomics, such as data sources and methods used in translational bioinformatics, the impact of translational bioinformatics on human health, and how machine learning and artificial intelligence are being used to mine vast amounts of data for drug development and precision medicine. We also look at the problems, constraints, and ethical concerns connected with exploiting genomic data and the future of translational bioinformatics and its potential impact on medicine and human health. Ultimately, this chapter emphasizes the great potential of translational bioinformatics to alter healthcare and enhance patient outcomes.
Subject(s)
Artificial Intelligence , Computing Methodologies , Humans , Quantum Theory , Computational Biology , GenomicsABSTRACT
Viral vector engineering is critical to the advancement of several sectors of biotechnology, gene therapy, and vaccine development. These vectors were produced from viruses, were employed to deliver therapeutic genes or to alter biological processes. The potential for viral vectors to improve the precision, safety, and efficiency of therapeutic interventions has boosted their demand. The dynamic interplay between technological advancements and computational tools in establishing the landscape of viral vector engineering and vector optimization for therapeutic reasons is discussed in this chapter. It also emphasizes the importance of in silico techniques in maximizing vector potential for therapeutics and many phases of viral vector engineering, from genomic analysis to computer modelling and advancements to improve precise gene delivery. High-throughput screening propels the expedited process of vector selection, and computational techniques to analyze complex omics data to further enhance vector capabilities have been discussed. As in silico models reveal insights into off-target effects and integration sites, vector safety (biodistribution and toxicity) remains a crucial part and bridges the gap between preclinical and clinical investigations. Despite the limitations, this chapter depicts a future in which technology and computing merge to catapult viral vector therapy into an era of boundless possibilities.
Subject(s)
Genetic Therapy , Genomics , Tissue Distribution , Computer Simulation , High-Throughput Screening AssaysABSTRACT
The present study examines the bioactive potential of sheep plasma protein hydrolysates (SPPH) produced by in-vitro gastrointestinal digestion as antioxidants, antimicrobials, anti-obesity agents, and inhibitors of lipid oxidation in sausage to address the oxidative stability and shelf-life issues of mutton. The antioxidant and antimicrobial activities, indicate a positive relationship between the degree of hydrolysis and digestion duration. The study finds that SPPH has a potent inhibitory effect on pancreatic lipase and cholesterol esterase. It has higher oil holding capacity than sheep plasma protein, observed at one hour of hydrolysis time. SPPH exhibit an improved behavior in foaming properties along alkaline pH and digestion time while display lower emulsifying activity and stability with hydrolysis advancement. The SPPH act as a natural preservative in developing functional mutton sausage by inhibiting lipid-oxidation. This study showed that the recovery of SPPH can be a cost-effective and sustainable strategy for generating available ingredients for enhanced shelf-life of meat products.
Subject(s)
Meat Products , Protein Hydrolysates , Animals , Sheep , Protein Hydrolysates/chemistry , Antioxidants/chemistry , Hydrolysis , LipidsABSTRACT
The present study examined the corrosion and tribological behavior of novel Ti-5Cu-xNb alloy synthesized via powder metallurgy as a new biomedical material in a simulated bodily fluid (SBF) solution. The electrochemical impedance spectroscopy (EIS) study reveals the formation of two protective layers on the surface of alloys during the test. The alloys spontaneously produce a passivating oxide coating on their surfaces, and the breakdown potential (1.14-1.17 V) and re-passivation current density (2.07-3.04 µAcm-2) were observed during the potentiodynamic polarization test. The highest corrosion resistance was observed for the alloy Ti-5Cu-10Nb (icorr = 21.44 nA-cm-2). The SEM and XPS analysis of the corroded surface showed the formation of oxide on the surfaces of the alloys. The samples were tested at 10 N, 15 N, and 20 N loads against the zirconia counterpart to investigate the effect of loading on friction and wear. The lowest coefficient of friction was obtained for Ti-5Cu-5Nb (0.25-0.41) at 20 N loading, while the maximum for Ti-5Cu-10Nb at 15 N load falls in the range of (0.71-0.25). Additionally, they present the wear rate in the range of (5.3 × 10-8-1.45 × 10-6 mm3/mm), in accordance with the change in microstructure and mechanical properties. However, the wear rate increases with the addition of niobium and reaches the maximum for Ti-5Cu-15Nb at 20 N loading condition, but it is relatively deficient compared to commonly used implant material. Therefore, it is suggested that this ß-type Ti-5Cu-xNb alloy is a promising candidate, more suitable than the commercially used Ti and Ti-6Al-4V for dental applications.
Subject(s)
Body Fluids , Dental Implants , Corrosion , Alloys/chemistry , Titanium/chemistry , Oxides , Surface Properties , Materials TestingABSTRACT
Background: Pyogenic liver abscess (LA) is a significant contributor to morbidity and mortality in developing countries like India. The risk factors predisposing to the LA specifically in children are not known. Studies done in the past largely remain inconclusive and have identified only probable causes. The cause of LA in children with no coexisting illness remains unknown. Methodology: This prospective observational study was conducted at a tertiary teaching hospital located in New Delhi, India. All children between 2 months and 12 years of age with sonographically confirmed LA presenting to the hospital were included and managed with appropriate intravenous antibiotics and relevant investigations. Results: A total of 52 children were included. The mean age was 6 years and 4 months, and the male: female ratio was 1.4:1. Around 50% of the patients were malnourished. Fever, abdominal pain and loss of appetite were the most common symptoms. Nine patients (17%) were managed conservatively, 13 (25%) needed percutaneous needle aspiration and 30 (57.69%) required drainage using a pigtail catheter. Poor socioeconomic status and anaemia were found to be the most commonly associated risk factors. Selective immunoglobulin A (IgA) deficiency was the most common primary immunodeficiency disorder followed by T-cell defect. On multivariate analysis, it was seen that in those with clinical icterus, gamma-glutamyl transferases >350 IU/m, and those with impending rupture, the time to defervescence was significantly different (P = 0.05). Conclusion: Poor socioeconomic status causing malnutrition emerged as a significant risk factor for LA in children. Selective IgA deficiency was the most common immunodeficiency seen in a few children. Adopting a conservative approach like aspiration and percutaneous drainage led to lower mortality and good recovery rates.
Subject(s)
Liver Abscess, Pyogenic , Humans , Male , Child , Female , Liver Abscess, Pyogenic/therapy , Liver Abscess, Pyogenic/drug therapy , Drainage , Anti-Bacterial Agents/therapeutic use , Risk Factors , Prospective StudiesABSTRACT
Whey protein-derived carbon nanodots (WCND) were synthesized using the microwave irradiation method, and its amine-rich surface functionality was crosslinked with covalently bound Iodine functionalized 2,5-dimethoxy-2,5-dihydrofuran (DHFI) to produce WCND-DHFI. The physicochemical characterization of both WCND and WCND-DHFI was performed and compared to comprehend the consequence of iodination on the characteristics of WCND. The suitability of CND in biological environments was evaluated through in vitro cytocompatibility and Chorioallantoic Membrane (CAM) assay, as well as a hemocompatibility study. WCND-DHFI has shown enhanced cell viability against WCND. Further, the antibacterial properties of both CNDs were studied against both gram-positive and gram-negative bacterial strains, representing an enhancement in antibacterial activity after DHFI crosslinking. WCND-DHFI has depicted a stable and prominent bacteriostatic activity for up to 6 h for both strains of bacteria. WCND-DHFI has denoted a 99.996% and 99.999% loss of bacterial viability for gram-positive and negative strains, respectively. Novel surface functionalization portrays an improvement in antibacterial activity. Transmission and scanning electron microscopy represent the cell wall rupturing by the WCND-DHFI, resulting in bacterial death. The ROS-mediated bacteriostatic mechanism of WCND-DHFI has been explored through assessing lipid peroxidation and protein oxidation assay. Moreover, the oxidative damage of DNA also has been explored. WCND-DHFI is performing as a promising cytocompatible and hemocompatible material for antibacterial applications.
Subject(s)
Iodine , Whey Proteins/pharmacology , Carbon/chemistry , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/chemistry , BacteriaABSTRACT
Titanium-based biomedical alloys are susceptible as they are used as a substitute for human bone. In this study, titanium alloy, Ti-5Cu-x%Nb (x= 0, 5, 10, 15) (%wt) was developed by powder metallurgy route. The effect of alloying niobium with Ti-5Cu alloy and its effect on the microstructure, mechanical strength, corrosion resistance, and antibacterial properties have been evaluated. The results show that the sintered alloy has bothα-Ti and Ti2Cu phases. With increasing niobium content in the alloy,ß-Ti was also detected. Additionally, it was found that the micro-hardness and compressive strength of the studied alloy was better than commercially pure titanium (cpTi), while the Young's modulus was lower than cpTi. These properties are highly favorable for using this alloy to replicate the human cortical bone. The alloy was also tested for anticorrosive property in Ringer's solution. The antibacterial activity was also examined forStaphylococcus aureusandEscherichia colibacteria. The alloy showed promising anticorrosive and antibacterial ability.
Subject(s)
Alloys , Niobium , Alloys/chemistry , Anti-Bacterial Agents/chemistry , Corrosion , Humans , Niobium/chemistry , Titanium/chemistryABSTRACT
Cortical layer 5 contains two major types of projection neuron known as IB (intrinsic bursting) cells that project sub-cortically and RS (regular spiking) cells that project between cortical areas. This study describes the plasticity properties of RS and IB cells in the mouse visual cortex during the critical period for ocular dominance plasticity. We find that RS neurons exhibit synaptic depression in response to both dark exposure (DE) and monocular deprivation (MD), and their homeostatic recovery from depression is dependent on TNF-α. In contrast, IB cells demonstrate opposite responses to DE and MD, potentiating to DE and depressing to MD. IB cells' potentiation depends on CaMKII-autophosphorylation and not TNF-α. IB cells show mature synaptic properties at the start of the critical period while RS cells mature during the critical period. Together with observations in somatosensory cortex, these results suggest that differences in RS and IB plasticity mechanisms are a general cortical property.
Subject(s)
Neuronal Plasticity , Visual Cortex , Animals , Dominance, Ocular , Mice , Neuronal Plasticity/physiology , Neurons/physiology , Somatosensory Cortex/physiology , Visual Cortex/physiologyABSTRACT
In recent times, carbon dots (CDs) are emerging for numerous interdisciplinary applications by modulating their inherent chemical functionality during or post-synthesis modification. The current study reports the hydrothermal synthesis of polyvinylpyrrolidone K-30 (PVP) passivated clove bud-derived carbon dots (PPCCDs) for multifaceted applications. The adopted technique is facile and environmentally friendly for the production of CDs with in situ PVP passivation. Physicochemical characterization of CDs is performed using various spectroscopic and microscopic techniques. The study reveals the formation of nitrogen-doped spherical PPCCDs with an average hydrodynamic size of â¼ 4.9 nm. It is also evident that there is modulation in optical properties and quantum efficiency as a result of PVP passivation. The study further demonstrates their suitability in biological environments as observed by pH stability, photostability, and cytocompatibility results. PPCCDs have shown significant antioxidant activity against DPPH (EC50: 57 µg/mL), suppression of superoxide anion radical (EC50: 53 µg/mL), and an efficient catalytic activity towards degradation of Rhodamine-B (Rh-B) dye. UV-Visible spectroscopy unveil the reaction mechanism during antioxidant and catalytic activities of CDs that are validated by Electron paramagnetic resonance (EPR) spectroscopy with an indication of effective electron or proton donating abilities. Its bioimaging potential is evidenced through cellular fluorescence imaging with 3T3 and L929 cell lines.
Subject(s)
Quantum Dots , Syzygium , Carbon/chemistry , Antioxidants/pharmacology , Quantum Dots/chemistry , Povidone , Nitrogen/chemistry , Catalysis , Fluorescent Dyes/chemistryABSTRACT
Eu/Yb co-doped NaYF4 phosphors have been synthesized by the combustion method. The Eu doping was fixed and the effect of Yb doping concentration on the structural, morphological and luminescence properties has been investigated. X-ray diffraction analysis revealed that the phosphors consisted of mixed α- and ß-phases, but the ß-phase was dominant. All elements of the host and dopants, as well as adventitious C, were detected using X-ray photoelectron spectroscopy. The surface morphology showed a microrod-like structure with sharp hexagonal edges. Energy dispersive X-ray spectroscopy spectra proved the formation of the desired materials. The photoluminescence spectra illustrated the optical emission properties of Eu3+ in the red region when excited at 394â¯nm, while, under the same excitation, Yb3+ ions gave emission at 980â¯nm. The up-conversion (UC) emission of Eu/Yb co-doped NaYF4 produced a white color at the higher concentration of Yb excited by a 980â¯nm laser, which was made possible by green emission of Er contamination (from Yb source) and blue emission of Eu2+ ions. The lifetime of the Eu3+ UC luminescence at 615â¯nm was also affected by the Yb doping concentration. The temperature sensitivity associated with the Er3+ peaks at 520 and 542â¯nm was assessed as a function of temperature and the maximum of 0.0040â¯K-1 occurred at 463â¯K.
ABSTRACT
Management of vascular malformations is multimodal with documented role of surgical resection in specific facets of this condition. Surgical resection of these lesions is technically challenging owing to diffuse and relatively ill-defined extent with involvement of multiple tissue planes limitation of access and excessive intra-operative bleeding. An observational study was conducted in 24 cases taken up for surgical resection of vascular malformations. The cases were divided into two groups based on the hemostasis technique used: Group A: Harmonic shears (n = 12) (Ethicon Inc. Somerville, New Jersey, United States). Group B: Electrosurgery (monopolar/bipolar) with standard knot tying (n = 12). We conclude that use of harmonic scalpel in surgical resection causes less parallel tissue damage, secures haemostasis promptly, does not impede vision and aids surgical dissection thereby significantly reducing the operative time and improving the surgical outcome, typically in large vascular malformations of head and neck region.
ABSTRACT
Actinomycosis is a chronic suppurative granulomatous infection most commonly involving the cervicofacial region. Clinical diagnosis is usually difficult, and fine-needle aspiration cytology or imaging studies are usually unhelpful in diagnosing actinomycosis. Definitive diagnosis is based on the histopathological examination of a tissue biopsy. The authors report a case of a 32-year-old healthy man who underwent multiple surgeries over a period of 7 years to correct a posttraumatic scar on his forehead with unusual behavior. Final diagnosis was made by tissue biopsy. Scar was excised and penicillin was administered for 1 month postoperatively; after a 12-month follow-up, the wound was fully healed with minimal scarring and no recurrence.
Subject(s)
Actinomycosis, Cervicofacial/pathology , Anti-Bacterial Agents/administration & dosage , Cicatrix/pathology , Forehead/pathology , Penicillin G/administration & dosage , Wound Healing/drug effects , Actinomycosis, Cervicofacial/drug therapy , Administration, Oral , Adult , Biopsy, Fine-Needle , Cicatrix/microbiology , Humans , Male , Recurrence , Treatment OutcomeABSTRACT
BACKGROUND: The excellent freedom of movement and range of this flap when based on a the nasolabial perforator flap have not been sufficiently explored. In this study, along with demonstrating the other key advantages of this flap over its traditional counterpart, we will endeavour to fill these lacunae in the available literature. MATERIALS AND METHODS: From February 2009 to February 2012, twenty patients with nasal defects were repaired with a nasolabial perforator flap in the Department of Plastic and Cosmetic Surgery at Sir Ganga Ram Hospital, New Delhi. Of these, two patients (10%) underwent the procedure bilaterally. Thus, a total of 22 nasolabial perforator flap procedures were carried out. Prospectively, collected clinical records and data of each patient were retrospectively retrieved and reviewed to study the nasal defect and surgery done. RESULTS: All the twenty (100%) patients had good functional and aesthetic outcome. All patients who had nasal stenosis preoperatively had very good improvement in the patency of the nasal passages, breathing and nasal blockage with complete recovery of symptoms. The patients were entirely satisfied with the functional recovery. CONCLUSIONS: The reliability and versatility of the nasolabial perforator flap exceed its recognised application in reconstruction of nasal defects and it must form a part of every plastic surgeon's armamentarium.
ABSTRACT
Cleft palate fistula is defined as a breakdown in the primary surgical repair of the palate resulting in oronasal communication, which can create symptomatic regurgitation for fluids/solids and affect speech, manifested by airflow escape during phonation. With the reported postoperative occurrence rate of 33-37% postfistula repair, it remains a challenging problem. The primary aim of this study was to describe our experience in the management of 7 consecutive cases of recalcitrant palatal fistula, all secondary to primary cleft palate repair. Pure cancellous bone graft was harvested in a standard fashion in sufficient quantity based on size of fistula from the iliac crest and was morselized and was kept mixed with the patient's blood. After flap turnover for nasal closure, the graft was packed over the raw surface on the oral aspect and was secured by placing an oxidized regenerated cellulose sheet fixed to the surrounding mucosa. As per the Papineau technique, no oral closure was performed. Six-month follow-up showed complete epithelization of the oral raw surface in 6 of the 7 patients. In the diverse spectra of cleft surgeries, management of recalcitrant cleft palate fistula remains a surgical challenge. Repurposing Papineau's concept of open cancellous bone grafting in cleft palate fistula is a novel attempt with a sound scientific basis. In our experience, this technique has proved to be very effective in managing recalcitrant palatal fistulae.