Surgical Procedures, Complications, and Durations in Patients with Noma Disease: A Cross-sectional Study.

Background: Noma is a devastating disease that causes severe destruction of facial tissue, necessitating comprehensive surgical intervention for functional restoration and improved quality of life. This cross-sectional study aimed to identify common surgical procedures used for noma defect reconstruction in Ethiopia, analyze their durations, and assess associated complications. Methods: The study retrospectively analyzed noma patient records from Facing Africa's database, covering electronic medical data from 2007 to 2019, and utilized SPSS version 2020 for analysis. Results: Facing Africa treated 235 noma cases (2007-2019) with 438 procedures. The most commonly used surgical technique was reconstructive surgery, which encompassed two or more other surgical methods and was used in 177 cases. This was followed by the submental flap in 47 cases and ankylosis release in 35 cases. The study also found complications in 11 cases, including flap necrosis, abscesses, and ankylosis-related mouth restriction. Additionally, the analysis of 102 noma cases revealed significant variations in the duration of surgical procedures, ranging from 10 to 48 hours for specific cases, with the majority (63.7%) requiring 2 to 5 hours. The mean duration of noma surgery was calculated to be 4.08 hours. Conclusions: Comprehending common surgical techniques, complications, and durations benefits surgical planning, resource allocation, and patient care. Thus, the results of this study are a useful contribution to the development of effective noma treatment. However, further research and continuous efforts are needed to refine surgical practices, address potential complications, and enhance patient care in the battle against this devastating disease.

The symptomatic Pulfrich phenomenon can be successfully managed with a coloured lens in front of the good eye--a long-term follow-up study.

PURPOSE: Many visual symptoms originating from a spontaneous Pulfrich phenomenon can be alleviated by the provision of a tinted lens worn in front of the least affected eye. Here, we report on the long-term outcome of four patients who have been provided with a uniocular tinted spectacle or contact lens. METHODS: The case notes of four cases were reviewed. The review period was at least 5 years in all four cases. RESULTS: In all cases, visual symptoms and perceptual difficulties occurring from the spontaneous Pulfrich effect were completely eliminated over a period of many years. In one case, the relief has been sustained over a 20-year period. CONCLUSIONS: A uniocular tinted lens, or contact lens, provides immediate and lasting relief from the visual difficulties caused by the visual delay underlying the spontaneous Pulfrich effect.

Anaerobic dechlorination and redox activities after full-scale Electrical Resistance Heating (ERH) of a TCE-contaminated aquifer.

The effects of Electrical Resistance Heating (ERH) on dechlorination of TCE and redox conditions were investigated in this study. Aquifer and groundwater samples were collected prior to and after ERH treatment, where sediments were heated to approximately 100 degrees C. Sediment samples were collected from three locations and examined in microcosms for 250 to 400 days of incubation. Redox activities, in terms of consumed electron acceptors, were low in unamended microcosms with field-heated sediments, although they increased upon lactate-amendment. TCE was not dechlorinated or stalled at cDCE with field-heated sediments, which was similar or lower compared to the degree of dechlorination in unheated microcosms. However, in microcosms which were bioaugmented with a mixed anaerobic dechlorinating culture (KB-1) and lactate, dechlorination past cDCE to ethene was observed in field-heated sediments. Dechlorination and redox activities in microcosms with field-heated sediments were furthermore compared with controlled laboratory-heated microcosms, which were heated to 100 degrees C for 10 days and then slowly cooled to 10 degrees C. In laboratory-heated microcosms, TCE was not dechlorinated and redox activities remained low in unamended and lactate-amended sediments, although organic carbon was released to the aqueous phase. In contrast, in field-heated sediments, high aqueous concentrations of organic carbon were not observed in unamended microcosms, and TCE was dechlorinated to cDCE upon lactate amendment. This suggests that dechlorinating microorganisms survived the ERH or that groundwater flow through field-heated sediments carried microorganisms into the treated area and transported dissolved organic carbon downstream.

Redox processes and release of organic matter after thermal treatment of a TCE-contaminated aquifer.

Redox conditions in heated and unheated microcosm experiments were studied to evaluate the effect of thermal remediation treatment on biogeochemical processes in subsurface environments. The results were compared to field-scale observations from thermal treatments of contaminated sites. Trichloroethene-contaminated aquifer material and groundwater from Ft. Lewis, WA were incubated for 200 days at ambient temperature (i.e., 10 degrees C) or heated to 100 degrees C for 10 days and cooled slowly over a period of 150 days to mimic a thermal treatment. Increases of up to 14 mM dissolved organic carbon were observed in the aqueous phase after heating. Redox conditions did generally not change during heating in the laboratory experiment, and only minor changes occurred as an effect of heat treatment in the field. The conditions were slightly manganese/iron-reducing in two sediments and possibly sulfate-reducing in the third sediment based on production of up to 0.20 mM dissolved iron and 0.15 mM dissolved manganese and consumption of 0.08 mM sulfate. The calculated energy gain of less than -20 kJ/mol H2 for iron and sulfate reduction as well as methane production indicated that these processes were thermodynamically favorable. Sulfate reduction and methane production occurred in the unheated microcosms upon lactate amendment. Little or no reduction of the redox level was identified in heated lactate-amended microcosms, possibly because of limited microbial activity. Because the redox conditions, pH, and alkalinity remained within normal aquifer levels upon heating, bioaugmentation may be feasible for stimulating anaerobic dechlorination in heated samples or in future field applications.

Accommodation as a function of age and the linearity of the response dynamics.

The changes with age in the accommodation responses to dynamic stimuli can reveal useful information on the factors underlying presbyopia development. Analysis of the monocular accommodation responses of 19 normal observers (ages 18-49 years) to stimuli whose vergence varied sinusoidally with time at different temporal frequencies (peak-to-peak stimulus 1.33-2.38 D, at 0.05-1.00 Hz) showed that at all ages both the gain and phase of the response were essentially linear functions of the temporal frequency. Extrapolation of least-squares, regression line fits to the gain data for each subject gave the gain at zero frequency, G0, and the cut-off frequency, fc, at which the gain fell to zero. G0 reduced with age but fc remained essentially constant at about 1.7 Hz, up to at least the age of about 40. The magnitude of the response to step stimuli covering the same stimulus range was well correlated with the value of G0. The linear changes in phase lag with temporal frequency corresponded to simple time delays td. The time lag varied from close to zero for the youngest subjects to about 0.5 s for the subjects in their late forties. There was substantial variation between the responses of subjects of similar age: those subjects with high values of G0 also tended to have low values of td, both effects probably being due to the superior ability of some individuals to predict the sinusoidal changes in the accommodation stimulus. Comparison of theoretical step responses, derived by applying linear theory to the parameters obtained from the results for the sinusoidal stimuli, with the actual responses to unpredictable steps for the same subjects supports the view that prediction effects and other possible factors make linear theory inapplicable to this type of data. The results are discussed in the context of current ideas on the development of presbyopia: it is suggested that the constancy of fc with age is the result of the ciliary body maintaining its efficiency, whereas the fall in G0 and increase in td result from increases in lens rigidity.

Accommodation dynamics as a function of age.

Experiments are described in which the dynamic accommodation response to a stimulus whose vergence was varying sinusoidally with time between 1.33 and 2.38 D was measured as a function of frequency for 19 subjects, with ages distributed between 18 and 49 years. Response to abrupt stimulus change between the same levels was also measured. The results showed that at any age, for the sinusoidal stimuli, gain fell with frequency and phase lag increased: at fixed frequency, gain fell with age and phase lag increased. Neither reaction nor response times for step stimuli changed with age. Analysis of the sinusoidal data suggests the possible existence of a cut-off frequency of about 2 Hz, which varies little with age and above which the system cannot respond. The phase data is compatible with the existence of a frequency-independent time delay, which increases with age from about 0.17 s at 20 years to 0.48 s at 40 years. The results are discussed in terms of current knowledge of the factors contributing to the development of presbyopia.

Age changes in the interactions between the accommodation and vergence systems.

Experiments are described in which static and dynamic accommodation (Ar), accommodative convergence (AC), vergence (C) and convergence accommodation (CA) responses to small stimuli were measured dynamically in 13 subjects with ages in the range 16 to 48 years. Analysis showed that the amplitudes of both blur and disparity-driven accommodation declined significantly with age, whereas the two types of vergence response did not. As a result, the AC/Ar ratio rose significantly with age, whereas the CA/C ratio fell. No significant change with age was found in response latencies and durations.

Influence of chronic alcohol abuse and ensuing forced abstinence on static subjective accommodation function in humans.

PURPOSE: Acute alcohol ingestion can change accommodation, but the long term effects of sustained alcohol consumption on accommodative function have not been studied in detail. This study was thus undertaken on individuals with a history of alcohol abuse. METHODS: Thirty-seven male individuals aged 25-56 years (average 40 years) from an alcohol rehabilitation centre in Inverness, Scotland, were assessed on admission and after a week of forced abstinence. The results were compared to a paired age-matched set of control male subjects. The static amplitude of accommodation was measured by an RAF rule, and the pupil size measured with a pupil gauge. RESULTS: On admission, the group mean measured amplitude of accommodation was 4.7 +/- 2.2 D (mean +/- SD). These values for the alcoholics were lower than age-matched controls (of 5.9 +/- 2.9 D). The slope of the age-dependent decline in RAF rule accommodation measures was significantly smaller for the alcoholics compared to controls (at 0.215 +/- 0.027 D/year versus 0.332 +/- 0.015 D/year, respectively; p < 0.001), with the younger alcoholics showing a greater impairment. Following abstinence, there was no measurable change in accommodation measured, indicating the lower amplitude in the alcoholics was not attributable to circulatory alcohol levels. The resting pupil diameter in the alcoholics was 4.37 +/- 0.63 mm compared to the controls of 3.97 +/- 0.75 mm, with a higher incidence of small pupils (< or = 3 mm) in the controls. CONCLUSIONS: The results indicate that chronic alcohol use can adversely affect subjective static accommodation, especially in younger alcoholics, as well as cause slight mydriasis.

Changes in the static accommodation response with age.

A transverse study of the monocular, steady-state accommodation response/stimulus curves for 49 normal subjects with ages between 17 and 49 years shows that the slope of the curve reduces only slowly with age up to about 40 years and then declines rapidly as complete presbyopia is approached. Such behaviour appears to result from the accommodation system changing its characteristics with age to make optimal use of the available objective amplitude of accommodation and the depth-of-focus of the eye.

Dynamics of the accommodation response to abrupt changes in target vergence as a function of age.

The dynamic accommodation responses to small, abrupt changes in an accommodation stimulus were studied in two experiments. In the first, responses of 19 subjects with ages distributed between 18 and 49 years were measured for step stimuli of +/- 1.05 D. In the second, responses to small step stimuli (+/- 0.75, +/- 1.75 D) were recorded for a group of six 'young' (mean age 22, range 16-26 years) and six 'old' (mean age 42, range 36-48 years) subjects. In both experiments, the low target vergences always lay within the accommodation range of all subjects. Whether the data were analysed in terms of simple reaction and response times, or in terms of the frequency response, no marked systematic changes with age were found in the dynamics of the response in either of the experiments. It is concluded that, for small stimuli within the amplitude of accommodation, the response dynamics over the adult age range studied remain remarkably constant, even though the amplitude progressively reduces with age as complete presbyopia is approached.

The measurement of pupil cycling time.

PURPOSE: To assess the influence of pupil size on pupil cycling time (PCT), a measure which may be elongated in cases of neurological disease. METHOD: Clinically, pupil "cycling" is produced by focusing a slit-lamp beam on the pupil margin. A rhythmic contraction and dilation of the pupil is produced, as changes in pupil size alternately prevent and allow the light beam to reach the retina. In this study, however, the light beam was controlled electronically so that cycling could be produced around different pupil sizes. Measurements of the variation of PCT with pupil size were taken from 22 young normal subjects. RESULTS: PCT was seen to depend upon pupil size, increasing monotonically but non-linearly as size increased. The wave-form of pupil cycling is typically sawtooth, contraction being much faster than dilation. There was considerable variation amongst subjects in the range of pupil sizes where pupil cycling could be elicited. CONCLUSIONS: The results point to the need for a standardised procedure for the measurement of cycling time, because differences in clinical conditions will themselves influence pupil size, as will other external variables such as ambient light level. The results also bring into question neurological explanations for increased PCT in those diseases where pupil size is affected, because normal subjects have PCTs well beyond the accepted limits of normality when their pupils are enlarged.

Reduced accommodative function in dyskinetic cerebral palsy: a novel management strategy.

A 9-year-old boy with dyskinetic cerebral palsy secondary to neonatal encephalopathy is described. He presented with blurring of near vision which had begun to impact on his school work. Objective assessment of accommodation showed that very little was present, although convergence was almost normal. The near-vision symptoms were completely removed and reading dramatically improved with the provision of varifocal spectacles. Varifocal lenses provide an optimal correction for far, intermediate (i.e. for computer screens), and near distances (i.e. for reading). Managing this type of patient with varifocal spectacles has not been previously reported. It is clearly very important to prescribe an optimal spectacle correction to provide clear vision to optimize learning.

On the linearity of accommodation dynamics.

Available experimental data on the gain and phase lags in the closed-loop accommodation responses to stimuli whose dioptric vergence changes sinusoidally with time are examined. It is shown that both phase lags and gain change almost linearly with the temporal frequency of the stimulus. This implies that the phase lags correspond to a frequency-independent time delay and that, if the system is linear, the impulse response should take a symmetrical (sin x/x)(2) form, with a corresponding standard form of step response. Comparison of this derived step response with the quasi-exponential results found experimentally underlines the limitations of attempting to generalize dynamic accommodation performance from responses obtained with predictable sinusoidally-changing stimuli and the application of a linear model. Consideration of the frequency response which would lead to an exponential step response supports the argument that, although the gain results obtained with sinusoidal stimuli are reasonably representative of those applying with other forms of stimulus, the predictable nature of sinusoidally-changing stimuli makes the derived phase lags inapplicable to non-predictable step or other stimuli. Other limitations in linear models of the response are discussed.

Repeated measures of horizontal heterophoria.

PURPOSE: To assess repeatability, horizontal heterophoria measurements were taken from 31 subjects on five occasions, each between 1 and 4 weeks apart. METHOD: Distance heterophoria was measured using a Maddox Rod, and near heterophoria was measured using a Maddox Wing. In addition, near measurements were repeated with a +3.00 D lens in front of each eye to place the targets at optical infinity. In each case, the standard deviation of the five values was taken as a metric of the test variability. RESULTS: On average, the variability of the Maddox Rod was half of the Maddox Wing, both with and without the lenses. CONCLUSION: This consistency suggests that the difference reflects the test conditions rather than optical differences in the target position.

Accommodation responses and ageing.

PURPOSE: To study the impact of age on accommodation dynamics. METHODS: Monocular accommodation responses were measured continuously using a modified Canon Auto Ref R1 infrared optometer. The stimulus was a single letter oscillating sinusoidally between 2.38 and 1.33 D providing a stimulus amplitude of 0.52 D, about a mean level of 1.86 D. Response characteristics were used to quantify gain and phase. Step responses were also recorded between these stimulus vergence levels for calibration purposes and to measure reaction and response times. Nineteen visually normal subjects 18 to 49 years of age participated, and 11 frequencies were used in the range 0.05 to 1.0 Hz. A key feature of the experimental design was to use a stimulus vergence range that lay within the amplitude of accommodation of all the observers. RESULTS: Accommodation gain reduced and phase lag increased with age, particularly at the higher frequencies used. No strongly significant change with age was found for reaction and response times or accommodation velocity, and results were similar for both far-to-near and near-to-far responses. Response amplitude for the step change in target vergence declined with age, and substantial differences were found between the measured and predicted (from reaction time) phase lags at 1.0 Hz as a function of age. Young observers showed a phase lag that was shorter than predicted, whereas older observers' measured phase lags were considerably larger than predicted. CONCLUSIONS: Results show that for a target oscillating sinusoidally in a predictable manner at a modest amplitude, the main ageing effects occur in phase lag, which is appreciably longer than predicted from reaction times in the older observers. The effects of ageing on gain were not as marked. Although responses to small step changes do reduce with age, there is no evidence of increased response times with ageing. In general, accommodation function in the middle-aged eye is quite robust despite a dwindling amplitude of accommodation. These results provide evidence of accommodative vigor in youth and a slowing of accommodation with ageing.