Development of nutritious probiotic sportsman drink.

Whey plays an important role in the sports nutrition because of high quality proteins and essential amino acid profile. Nine formulations of sportsman drinks were made using Cheddar, Mozzarella and Paneer whey with normal as well as additional fermentation. The developed sportsman drinks were evaluated for physico-chemical analyses, amino acid profile, viscosity and total plate count along with sensory response during two month storage. Drink having Cheddar whey (T4) with additional fermentation was better in terms of quality and nutrition. Furthermore, amino acid profile considered it a complete and balanced source of essential and non-essential amino acids. Amongst essential amino acids, highest values was recorded for branched chain amino acids like leucine (73.16±3.09) followed by lysine (61.56±0.61) and valine (44.13±1.86)mg/g protein. The dietary significance of sportsman drink can be enhanced through additional fermentation using Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophillus.

Avian influenza at animal-human interface: One-health challenge in live poultry retail stalls of Chakwal, Pakistan.

BACKGROUND: Live poultry retail stalls (LPRSs) are believed to be the source of human infection with avian influenza viruses (AIVs); however, little is known about epidemiology of these viruses in LPRSs of Pakistan. OBJECTIVES: The current study was conducted to estimate the virological and serological prevalence of AIVs in humans and poultry and associated risk factors among seropositive butchers. METHODS: A field survey of LPRSs of Chakwal District was conducted between December 2015 and March 2016. In total, 322 samples (sera = 161 and throat swab = 161) from butchers and 130 pooled oropharyngeal swabs and 100 sera from birds were collected. Baseline sera (n = 100) from general population were also tested. Data were collected by structured questionnaires. Sera were tested by hemagglutination inhibition (HI) test further confirmed by micro-neutralization test (MN). Swabs were processed by real-time RT-PCR. Logistic regression analyses were conducted to identify risk factors. RESULTS: In butchers, 15.5% sera were positive for antibodies against H9 virus using a cutoff of ≥40 in HI titer; 6% sera from general population were positive for H9. Seroprevalence in poultry was 89%, and only 2.30% swabs were positive for H9. Presence of another LPRS nearby and the number of cages in the stall were risk factors (OR > 1) for H9 seroprevalence in butchers. CONCLUSIONS: This study provides evidence of co-circulation of H9 virus in poultry and exposure of butchers in the LPRSs, which poses a continued threat to public health. We suggest regular surveillance of AIVs in occupationally exposed butchers and birds in LPRSs.

Results Of Immediate Facial Nerve Reconstruction In Patients Undergoing Parotid Tumour Resection.

BACKGROUND: Facial nerve is usually sacrificed in total parotidectomy. The objective of this study is to present results of immediate reconstruction of facial nerve in total parotidectomy cases where facial nerve is sacrificed. METHODS: This is a prospective study done in patients who had total parotidectomy including facial nerve and immediate reconstruction was done with inter-positional nerve grafts (sural n=12 and greater auricular n=10) from December 2017 till February 2018 by single surgeon (MR). Wounds were closed primarily (n=15), local flap (n=2) and free flap (n=5). Clinical evaluation was done at four months minimum follow up (those operated in January to February 2018) and eight months maximum follow up (those operated in December 2017), for facial nerve functional recovery using House and Brackmann grading system by single author (MR). RESULTS: Total of 22 (male n=7, female n=15) patients included in study from December 2017 till February 2018. Sural nerve grafts were used in 54% (n=12) and greater auricular nerve grafts in 45% (n=10) patients for reconstruction of facial nerve. On clinical evaluation using House and Brackmann grading system, showed grade V (n=4), grade IV (n=7), grade III (n=8) and grade II (n=3) repairs. CONCLUSIONS: Although primary end to end facial nerve repair is ideal but in situation where a significant segment of nerve is lost or where the repair is under tension, inter-positional nerve grafting is a simple and reliable reconstructive technique with good outcomes.

Comparison Of Microvascular Free Tissue Transfer In Adult And Paediatric Patients.

BACKGROUND: Free tissue transfer is a routine practice in adults with good success rates. Further advances in techniques and microsurgical skills have proved that free tissue transfer in paediatric population is feasible, reliable and safe. METHODS: This study is conducted to compare anastomosis duration, total general anaesthesia duration, hospital stay and outcomes of flaps (survival, partial loss, complete loss, complications) in paediatric group (age <15 years) and adult group (15-70 years age). All patients with large soft tissue defects, congenital defects, traumatic defects and post tumour extirpation were included in this study from December 1st 2017 to May 30th 2018. These patients underwent different microsurgical procedures, the reconstructive armamentarium included use of Latissimus dorsi flap, Anterolateral thigh flap, Fibula flap, Radial forearm flap, functioning Gracillis muscle, iliac crest flap, deep inferior epigastric artery perforator flap and Rectus abdominis muscle flap. Post-traumatic defects were the commonest indication of free tissue transfer in Paediatric population while post tumour extirpation defects were commonest defects encountered in adult population.. RESULTS: On average the total anaesthesia duration is slightly shorter in paediatric group than in adult patients while anastomosis duration is slightly shorter in adults then in paediatric patients. The overall complication rate is comparable in both groups and all the flaps survived well. CONCLUSIONS: Microsurgical free tissue transfer can be confidently attempted in children and their results are comparable with those of adult group.

Can The Anterolateral Thigh Flap Replace The Rectus Abdominis Free Flap In The Reconstruction Of Complex Maxillary Defects?

BACKGROUND: Maxilla is perhaps the most essential and visible part of the mid-face. It is a threedimensional structure and when reconstructing maxillectomy defects the principles of aesthetics as well as the best functional outcomes are taken into account. The aim of this study is to compare the Anterolateral Thigh Flap (ALTF) to the standard option like the Rectus Abdominis Free Flap (RAMFF) for the reconstruction of complex maxillary defects. METHODS: This descriptive case series was conducted at the Department of Plastic and Reconstructive Surgery, Shifa International Hospital Islamabad, Pakistan from 2009 to 2016. Patients of all age groups with complex maxillectomy defects, (Type III and IV according to Cordeiro classification) resulting from tumour resection, trauma, osteoradionecrosis or infection, underwent reconstruction with the free anterolateral thigh flap and the rectus abdominis free flap. RESULTS: Over a period of 8 years, 49 Rectus Abdominis free flaps and 32 Anterolateral thigh free flaps were performed for reconstruction of Type III and IV maxillectomy defects. The follow up was weekly for 1 month and then 3 monthly for the 1st year, 6 monthly for 2nd year and then yearly. All the patients had an uneventful immediate recovery. CONCLUSIONS: ALTF has advantages over the RAMFF in terms of the donor site morbidity, operative time and postoperative recovery in the reconstruction of complex maxillectomy defects.

Use Of Steroids In Rhinoplasty With Lateral Osteotomies For Reducing Post Operative Oedema.

BACKGROUND: TPostoperative periorbital oedema is a commonly encountered side effect of rhinoplasties in which lateral osteotomies have been incorporated. It dissatisfies the surgeon as well as the patient. Osteotomies are done at the end of all soft tissue manipulation to reduce the development of oedema. The aim of this study was to determine the efficacy of intravenous dexamethasone in reducing oedema in patients who undergo rhinoplasty with lateral osteotomies. METHODS: A Prospective randomized controlled trial was done at department of plastic and reconstructive surgery, Shifa International Hospital Islamabad. Sixty patients age between 16-55 requiring open rhinoplasty were taken for this study and divided in two groups. One group received dexamethasone 8mg intravenously preoperatively and second dose 4 hours postoperatively. The second group did not receive anything. Both groups were assessed on first post-operative day and 7th day for periorbital oedema. RESULTS: The overall decrease in oedema in patients who received steroid was by 50% while in control group was 33.3%. By the 7th day control group 13.3% patients had grade III oedema as compared to 3.33% in steroid group. Chi test was applied and p-value of 0.0289 was obtained which was found to be statistically very significant. CONCLUSIONS: Dexamethasone used in minimal dosage showed significant advantage in reducing periorbital oedema after rhinoplasty with no evidence of any side effects secondary to steroid administration.

Congenital alveolar synechiae with cleft palate.

Congential maxillomandibular fusion or jaw adhesions is a rare entity. It is often associated with other congenital anomalies like cleft palate and is characterized by restricted mouth opening. This unusual presentation of congenital alveolar synechiae is highlighted in a 15 days old baby boy. Under inhalational anaesthesia his fibrocartilagenous adhesions were excised and endotracheal tube was then placed. Good recovery without any residual scars or adhesions and a 25 mm mouth opening was achieved.

Schwannoma of the brachial plexus; report of two cases involving the C7 root.

Brachial plexus schwannomas are rare tumors. They are benign nerve sheath tumors and only about 5% of Schwannoma arise from the brachial plexus. They pose a great challenge to surgeons due to their rare occurrence and complex anatomical location. We present two cases who presented with a supraclavicular swelling, that were proven to be schwannoma on histopathology.

Extensive uterovaginal prolapse during labor.

Uterovaginal prolapse complicating pregnancy is an extremely rare event. Obstetricians should be familiar with the condition as early recognition and close follow up is essential in order to avoid possible fetomaternal risks. We report a case of 35-year-old lady who presented to the emergency with complaints of labor pains, absent fetal movements and huge uterine cervical prolapse in active phase of labor. She was conservatively treated with bedrest, blood transfusions and irrigation of prolapsed cervix. A dead female fetus was delivered vaginally. Ring pessary was placed postnatally. We believe that an extensive uterovaginal prolapse needs close surveillance and can be managed conservatively.