Role of Ommaya Reservoir in Pediatric Hydrocephalus: Experience in Bangladesh Medical College Hospital from 2019-2021.

The goal of this study was to analyze the efficacy of the Ommaya reservoir within all the different types of hydrocephalus in pediatric patients. At the same time, it's safe for repeated aspirations or long-term retention of the reservoir in the body. This retrospective, cross-sectional study was performed from January 2019 to December 2021, 33 consecutive cases of reservoir implantation were taken into the study irrespective of the etiology of hydrocephalus in the Neurosurgery Department of Bangladesh Medical College Hospital, Dhaka, Bangladesh. These were mostly placed along with endoscopic third ventriculostomy and some were placed as an intermediary procedure to combat shunt complications in emaciated infants. Cerebrospinal fluid (CSF) aspiration was done in case of failed endoscopic third ventriculostomy and the frequency of aspiration depended upon the production of cerebrospinal fluid. Acetazolamide was routinely administered in each patient to reduce the frequency of aspiration. Most of the patients required ventriculo-peritoneal (VP) shunt while they had sufficient body weight and few required no surgery. The average age at presentation was 76.88 days. All the neonates and infants had less weight in terms of their age. 42.4% of babies needed aspiration 2 times per week. Among all cases, 9.1% developed reservoir complications. Complications were not related to the number and volume of aspiration or duration of the reservoir in the body. Two (2) patients died after one year of reservoir implantation due to unknown etiology. Out of the 31 survivors, 3 patients did not need any further aspiration and 19 patients needed a ventriculo-peritoneal shunt, but the reservoir was kept in situ for a future emergency. The rest of them is waiting for a definitive shunt procedure. Other findings include low socioeconomic group was more prone to low birth weight and they carried the burden of congenital hydrocephalus and meningomyelocele. Most affected babies had their prenatal period in arsenic-affected areas in Bangladesh. Overall folic acid supplementation was started after the formation of the neural tube irrespective of socioeconomic status. Ommaya reservoir placement along with endoscopic third ventriculostomy plays a vital role in delaying shunt in endoscopic third ventriculostomy failure. It is a 'time buying' procedure until the baby has sufficient weight for successful shunt surgery. It has been found very effective intermediary intervention for managing shunt infection and it also helps revive a channel in shunt obstruction.

A three-dimensional printed myringotomy, tympanostomy and ventilation tube placement simulator.

OBJECTIVE: Tympanostomy is one of the most commonly performed surgical procedures in otolaryngology, and its complexity is challenging for trainee surgeons. Investing in medical education is a cornerstone of good patient safety practices. For trainees, use of simulators before operating on actual patients helps mitigate risks. This study aimed to develop a three-dimensional printed model simulator for myringotomy, tympanostomy and ventilation tube placement. METHODS: An articulated model with a detachable portion, base and plastic bag to simulate the external auditory canal, middle ear and tympanic membrane, respectively, was modelled and printed. RESULTS: The final simulator was made from acrylonitrile butadiene styrene polymer and measured 4 × 4 × 12 cm. It was designed to mimic the angulation of patient anatomy in the myringotomy position and simulate the texture and colour of the tissues of interest. The cost was low, and testing with an operating microscope and endoscope yielded satisfactory results. The advent of three-dimensional printing technology has made surgical simulation more accessible and less expensive, providing several advantages for medical education. CONCLUSION: The proposed model fulfilled expectations as a safe, inexpensive, reproducible, user-friendly and accessible surgical education tool that can be improved and reassessed for further research.

Valor nutritivo do capim-xaraés em três intensidades luminosas / Nutritive value of xaraés palisade grass in three light intensities

Este trabalho teve como objetivo avaliar o valor nutritivo e a força de cisalhamento da cultivar de Urochloa brizantha (syn Brachiaria brizantha) cv Xaraés submetida a três intensidades luminosas e quatro cortes. O experimento foi conduzido na FMVZ - Unesp de Botucatu, com delineamento experimental em blocos ao acaso, sendo os tratamentos: luminosidade natural, redução de 30% e 60% de luz, com quatro cortes e três repetições. As análises realizadas foram: composição bromatológica, digestibilidade e a força de cisalhamento. Não houve diferença na digestibilidade entre os tratamentos em nenhum dos cortes, mas a qualidade forrageira foi influenciada pelos níveis de intensidade de luz, tendo o tratamento com 60% de redução de luminosidade apresentado maiores concentrações de proteína bruta e cinzas, menores teores de fibra em detergente neutro, hemicelulose, celulose e força de cisalhamento. Em relação aos cortes estudados, o primeiro teve o menor intervalo de corte e produziu forragem com qualidade superior em comparação ao último, pois obteve menor teor de fibra em detergente ácido, lignina, hemicelulose, celulose e consequente menor força de cisalhamento. Portanto, a redução de 60% de luminosidade é benéfica à qualidade e à força de cisalhamento da cultivar Xaraés.(AU)

This study aimed to evaluate the nutritive value and shear strength of the Xaraés grass (Urochloa brizantha) under the three intensities of light and four cuts. The experiment was conducted at FMVZ - UNESP, Botucatu, with a randomized block design, with the following treatments: natural luminosity, 30% and 60% light reduction, with four cuts and three replications. The analyzes were bromatological composition, digestibility, and shearing strength. There was no difference in digestibility between the treatments in any of the cuts, forage quality was influenced by the light intensity levels, and the treatment with 60% of light reduction produced higher concentrations of crude protein and ash, lower levels of neutral detergent fiber, hemicellulose, cellulose and shear strength. According to the studied cuts, the first one had the lowest cut interval and produced superior forage compared with the last one, as it obtained lower fiber content in acid detergent, lignin, hemicellulose, cellulose and consequent lower shear force. Therefore, the reduction of 60% of luminosity is beneficial to the quality and shear force of the Xaraés palisade grass.(AU)