Trends of surgical-care delivery during the COVID-19 pandemic: A multi-centre study in India (IndSurg Collaboration).

Context: The COVID-19 pandemic and subsequent lockdowns adversely affected global healthcare services to varying extents. To accommodate its added burden, emergency services were affected along-with elective surgeries. Aims: To quantify and analyze the trends of essential surgeries and bellwether procedures during the waxing and waning of the pandemic, across various hospitals in India. Settings and Design: Multi-centric retrospective study. Methods and Material: A research consortium led by World Health Organization (WHO) Collaboration Center (WHOCC) for Research in Surgical Care Delivery in Low-and Middle-Income countries, India, conducted this study with 5 centers. All surgeries performed during April 2020 (Wave I), November 2020 (Recovery I), and April 2021 (Wave II) were compared with those performed in April 2019 (pre-pandemic period). Statistical Analysis Used: Microsoft Excel 2019 and SPSS Version 20. Results: The total number of surgeries reduced by 77% during Wave I, which improved to a 52% reduction in Recovery I compared to the pre-pandemic period. However, surgeries were reduced again during Wave II to 68%, but the reduction was less compared to Wave I. Emergency and essential surgeries were affected along with the elective ones but to a lesser extent. Conclusions: The present study has quantified the effects of the pandemic on surgical-care delivery across a timeline and documented a reduction in overall surgical volumes during the peaks of the pandemic (Wave I and II) with minimal improvement as the surge of COVID-19 cases declined (Recovery II). The surgical volumes improved during the second wave compared to the first one which may be attributable to better preparedness. Cesarean sections were affected the least.

Comparative evaluation of 2.0 mm locking plate system vs 2.0 mm non-locking plate system for mandibular angle fracture fixation: a prospective randomized study.

OBJECTIVE: This prospective randomized study evaluated the efficacy of a 2.0 mm locking plate/screw system compared with a 2.0-mm nonlocking plate/screw system in fixation of 60 isolated non-comminuted mandibular angle fractures. PATIENTS AND METHODS: Sixty patients were randomly assigned to receive a 2.0 mm locking plate (group A, n = 30) or 2.0 mm non-locking plate (group B, n = 30). All patients were followed up to 6 months postoperatively and evaluated for complications, occlusal stability and overall results of fixation. RESULTS: Five complications occurred in the locking group and fourteen in the non-locking group with complication rates equalling 17% and 47% respectively. When comparing the overall results according to plates used, the χ² test showed a statistically significant difference between the locking and non-locking plates (p < 0.01). Fewer patients required IMF in group A. CONCLUSIONS: Mandibular angle fractures treated with 2.0 mm locking plates show greater stability and were associated with fewer complications than with 2.0 mm non-locking plates.

Seminal LDH-C4 isoenzyme and sperm mitochondrial activity: a study in male partners of infertile couples.

Lactate dehydrogenase isoenzyme patterns were obtained in the seman of 93 male partners of infertile couples and 28 proven fertile subjects as a control group. Sperm mitochondrial activity index (SMAI) alongwith the conventional seminal parameters was studied for all the subjects excepting the azoospermic and vasectomised males. Only LDH-C4, a germ cell specific isoenzyme activity varied with the variation in sperm density. LDH-C4 activity varied significantly (p<0.001) within and between different groups. Lactate dehydrogenase-C4 activity was absent in 17 azoospermic samples, confirming its germinal epithelial origin, as well as in 8 samples of vasectomised males. In one azoospermic sample, there were many immature germ cells along with surprisingly high LDH-C4 activity suggesting more activity of germinal epithelium associated with high LDH-C4 activity. LDH-C4 activity was reduced significantly in oligozoospermic samples in proportion to sperm density, thus confirming strong correlation (p<0.001) between LDH-C4 and sperm density. There was statistically significant correlation between LDH-C4 and percentage sperm motility as well as between LDH-C4 and Sperm Mitochondrial Activity Index (SMAI) (probability varying from p<0.05 to p<0.01 in different groups), but no such correlation was found between LDH-C4 and sperm morphology. The data confirms LDH-C4 as a germinal epithelial marker. Its relationship with percentage sperm motility is suggestive of definite role of LDH-C4 in evaluation of the spermatozoal quality, similarly its relationship with Sperm Mitochondrial Activity Index (SMAI score) suggest the role of LDH-C4 in metabolism of the spermatocytes and sperms, though further studies are required for clear and detailed understanding of its metabolic role in semen.

Titanium osteosynthesis hardware in maxillofacial trauma surgery: to remove or remain? A retrospective study.

INTRODUCTION: A 5-year retrospective study evaluated the incidence and causes for removal of titanium miniplates. MATERIAL AND METHODS: The surgical records of 156 patients treated with rigid internal fixation after maxillofacial traumas were reviewed. Study variables included age, sex, site of fracture, site and number of plates, time of plate removal and reasons for plate removal. RESULTS: Of 384 plates used for fixation, 35 plates (9 %) in 21 patients (13.5 %) were removed due to hardware related complications. Statistical significance (p < 0.01) was observed in mandibular body and parasymphysis fractures with regards to both fracture site location and plate removal rates. Most plates were removed within the first year after placement (p < 0.01). The highest number of fractures were observed in the 20-30 years group (p < 0.01) while most cases of removal were in the 30-40 years group (p < 0.01). Secondary reconstruction/growth facilitation (11/156, 7 %) (p < 0.01) was the main cause of plate removal while infection/wound dehiscence (9/156, 6 %) (p < 0.01) was the main cause for complication related plate removal. A significantly greater number of plates placed via intraoral incisions (p < 0.01) needed removal. CONCLUSIONS: The low incidence of complication related plate removal (7 %) in the mid and upper face in this study suggests that routine removal of asymptomatic titanium miniplates after maxillofacial trauma at these sites may not be beneficial. The high rate of mandibular site complications (19 %) in this study suggests that routine removal of titanium hardware from mandibular sites may be indicated.

The retromandibular transparotid approach to mandibular subcondylar fractures.

The aim of this study was to evaluate the safety, utility and morbidity associated with the treatment of mandibular subcondylar fractures using the retromandibular transparotid approach and to evaluate the stability of a single 2mm miniplate fixation system for such fractures. Forty-two cases with 48 mandibular subcondylar fractures were analysed prospectively for 12 months and evaluated for functional results, scar, postoperative complications and stability of fixation. There were three cases of suboptimal occlusal status, two cases of haematoma that were drained and resolved, eight patients with facial nerve weakness which resolved in a few weeks, and three cases of salivary fistulae that resolved after treatment. All cases showed stable osteosyntheses. Maximal postoperative interincisal distance was 32-61 mm (mean 44 mm). Four patients had deflection on opening, while clicking on opening or chewing was observed in five patients. The postoperative scars were well accepted by all patients. The results of this study suggest that a retromandibular approach will facilitate accurate reduction and fixation of subcondylar fragments with a good cosmetic result and minimal complications. A single 2 mm miniplate fixation provides stable results.

Clinical audit: can we improve further?

Clinical audit is an important tool for comparing one's practice against existing standards. The authors have analysed the Junior Doctor's understanding of audit by performing a survey and questionnaire from 146 trainees, SpRs and SHOs from nine hospitals. The study showed that 107 (72.8%) performed audit and among those who performed audit, 52 (48.6%) experienced difficulty in obtaining data. This study highlights the importance of support needed to encourage the junior doctors to participate in audit programmes.