The Use of a Unilateral Curved Spreader Graft in the Management of Crooked Nose Deformity.

AIM OF WORK: The aim of this study is to present a new technique of using spreader grafts in the correction of crooked nose deformity with C-shaped deviation of the middle third of the nose. PATIENTS AND METHODS: This is a prospective case series study conducted on 18 patients with crooked nose deformity with C-shaped deviation of the middle third of the nose. All of the patients were managed by open septorhinoplasty. During surgery, a curved spreader graft was harvested from the nasal septum and placed on the convex side of the C-shaped deviation of the dorsal part of the nasal septum. Objective measurements of the angles of external nasal deviation (END) and the internal nasal valve (INV) angles were performed before and 6 months after the surgery. Subjective assessment of aesthetic satisfaction by the visual analog scale and nasal function by the nasal obstruction symptom evaluation scale was also performed before and 6 months after surgery. RESULTS: Eighteen patients were enrolled in the study and completed the minimum follow-up period of 6 months. The mean follow-up period was 17.3 months. Objectively, there was highly significant ( P < 0.00001) improvement of the END angle and INV angle. Subjectively, there was also highly significant ( P < 0.00001) improvement of both the nasal obstruction symptom evaluation score and the visual analog scale score for aesthetic satisfaction. CONCLUSIONS: The insertion of a curved unilateral spreader graft over the convexity of the deviated nasal dorsum can correct the END, improve the collapsed INV on both sides, and consequently achieve satisfactory aesthetic and functional outcomes.

Improving the productive performance of growing lambs using prebiotic and probiotic as growth promoters.

The feed additives (prebiotics and probiotics) are used to stabilize the healthy gut microbiome by supporting beneficial microorganisms, thereby improving the animal growth rate. Thirty growing lambs, with around 20.50 ± 0.65 kg live weight were placed into five equal groups (6 animals each). The concentrate feed mixture (CFM) + roughage was given to the control groups. The treatments (T) of T1, T2, and T3 treatments were fed the control ration with three levels of prebiotic supplementation: 0.50, 1.00, and 1.50 g/kg CFM of mannan oligosaccharids + beta glucan, respectively. The T4 received the control ration and was supplemented with 1.0 g/kg CFM probiotic (3.0 × 108 CFU/g, Bacillus amyloliquefaciens). The roughage was provided ad libitum, and the animals were supplemented with CFM at 2.00% of the body weight. A digestibility trial was conducted at the end of the 150-day feeding trial. The results demonstrated that increasing the prebiotic to 0.15% enhanced average daily gain and feed efficiency (P < 0.05) when compared to the control group. Although daily gain and feed efficiency in probiotic-fed animals were higher (P < 0.05) than in the control group, they were lower in prebiotic-fed lambs. The blood parameters were within normal range. The animals that received 0.10% prebiotic had the highest economic feed efficiency when compared to the other groups. Prebiotic treatment improved nutrient digestibility and nutritive values; however, the results for control and probiotic treatment were practically identical. Additionally, further research is needed to investigate the effects of prebiotics, probiotics and synbiotics as feed additives on productive and reproductive performance in ruminants.

The role of high-resolution Computer Tomography in prediction of the round window membrane visibility and the feasibility of the round window electrode insertion.

OBJECTIVE: The aim of this work is to assess the role of pre-operative high-resolution computerized tomography (HRCT) in prediction of the round window membrane (RWM) visibility and the feasibility of round window electrode insertion. MATERIALS AND METHODS: Retrospective study on a series of 97 cases of cochlear implant (CI) who were implanted in tertiary referral centers. We reviewed HRCT of all cases, and we implicated two radiological measurements on HRCT which are membrano-facial angle (MFA) and length of the bony overhang of the round window niche (RWN). We reviewed the intra-operative surgical video recordings of all cases for detection of the type of RWM visibility, according to The St Thomas' Hospital classification. RESULTS: The MFA was 21.9 ± 14.5. The length of the bony overhang of the RWN was 2.4 ± 0.33 mm. About 37% of the studied patients needed cochleostomy. The best cut-off of MFA in the prediction of the RW (type 2B and 3) was ≥ 15.1o with sensitivity 100%, and specificity 82%. CONCLUSION: HRCT offers highly reliable and reproducible measurements for the prediction of RWM visibility and, therefore, prediction of the utility of the RW approach for electrode insertion. Membrano-facial angle (MFA) is a new measurement that can be used for this purpose.

Reconstruction of the outer attic wall by cortical bone and bone cement.

OBJECTIVE: To asses using cortical bone and bone pate with and without glass ionomer bone cement (GIBC) for reconstructing the outer attic wall (OAW) defect during cholesteatoma surgery without mastoid cavity obliteration. METHOD: This is a prospective case series of 25 patients who underwent primary surgery for cholesteatoma with presence of OAW defect that was reconstructed by cortical bone graft and bone pate, further fixation of the cortical bone graft in place was done by GIBC in 18 patients. RESULTS: There was significant improvement of persistent otorrhea and hearing loss after surgery (P < 0.001). Recurrence of cholesteatoma was found in 2 patients (8%), residual TM perforation was found in one patient (4%). CONCLUSION: Reconstruction of OAW by cortical bone and bone pate is an effective surgical option to decrease the incidence of recurrence in cholesteatoma surgery. Glass ionomer bone cement can be added safely to fix the cortical bone graft in the OAW defect.

Topical platelet rich plasma versus hyaluronic acid during fat graft myringoplasty.

OBJECTIVES: To evaluate the effect of adding platelet rich plasma (PRP) or Hyaluronic acid (HA) to fat graft myringoplasty (FGM) for medium sized central tympanic membrane (TM) perforations. METHODS: This is a retrospective study conducted on 69 patients with medium sized central TM perforations. In 21 patients, PRP was used with the FGM; and in 23 patients, HA was used with the FGM; while in 25 patients, pure FGM was performed without adding an enhancing material. RESULTS: Successful TM perforation repair was achieved in 18 ears (85.7) with using PRP with FGM and in 20 ears (87%) with using HA with FGM and in 15 ears (60%) with pure FGM. CONCLUSION: FGM with adding PRP or HA is more successful in closure of TM perforation than pure FGM in case of medium sized central TM perforation.

Death from methamphetamine intoxication in a body stuffer.

A 28-year-old man was admitted dead to the emergency department of the regional hospital. All resuscitation attempts were unsuccessful in this case. Attending officers stated that he was suspected of possessing drugs at the time of arrest and had taken them quickly to cover up. Upon arrival at the hospital, signs of violence were noted all over his body. During the autopsy, two large blue plastic packages were found in the antrum of the stomach. The first was 6.3 × 2.2 cm and had two tight knots, while the second was 7.6 x 1.7 cm and had a single knot. Both packages were irregularly shaped and contained tablet debris that was clearly leaking, as a large amount of gastric juice was present in both packages. A confirmatory forensic toxicology analysis revealed toxic concentrations of methamphetamine in the blood of the dissected case. The patient died of acute methamphetamine intoxication associated with a severe stress condition resulting from violent resistance during arrest.

Nylon fiber waste as a prominent adsorbent for Congo red dye removal.

In this research nylon fibers wastes (NF) were fabricated into porous sheet using a phase inversion technique to be utilized as an adsorbent materials for Congo red dye (CR). The fabricated sheet denoted as NS was characterized using FTIR and XRD. The surface studies of the adsorbent materials using SEM and BET analysis reveals a highly pores structure with an average pore volume 0.61 cc/g and BET surface area of 767 m2/g. The adsorption studies of fabricated NS were employed into CR at different parameters as pH, effect of time and dye concentration. The adsorption isotherm and kinetic studies were more fit to Langmuir and pseudo second order models. The maximum adsorption capacity qmax reached 188 mg/g with removal percentage of 95 for CR concentration of 400 mg/L at pH 6 and 0.025 g NS dose for 10 ml CR solution. The regeneration study reveals a prominent adsorption behavior of NS with removal % of 88.6 for CR (300 mg/L) after four adsorption desorption cycles. Effect of incorporation of NaonFil Clay to NS was studied using Response Surface Methodology (RSM) modeling and reveals that 98.4% removal of CR could be achieved by using 19.35% wt. of fiber with 8.2 g/L dose and zero clay, thus at a predetermined parameters studies of NanoFil clay embedded into NS, there are no significant effect for %R for CR.

Endoscopic-Assisted Cochlear Implantation in Far Advanced Otosclerosis.

OBJECTIVES: To evaluate the effectiveness of cochlear implantation (CI) in case of far advanced otosclerosis and to evaluate the value of using intraoperative otoendoscopy to facilitate the identification of the round window membrane and the scala tympani without the need to remove the posterior canal wall or to perform a subtotal petrosectomy. STUDY DESIGN: Retrospective case-series study. SETTING: Tertiary academic CI center. PATIENTS AND METHODS: This study was conducted on patients with far advanced otosclerosis who underwent endoscopic-assisted CI between January 2010 and June 2020 at the same CI center. The minimum follow-up period was 2 years after surgery. RESULTS: Fourteen patients were included in the study. Ten patients had undergone a previous stapedotomy. Electrode insertion in the scala tympani was successfully accomplished in all cases included in the study. There was a statistically significant improvement in pure-tone average and speech discrimination scores in all cases of the study group (p < 0.0001). There were no statistically significant differences in postoperative pure-tone average or speech discrimination scores between cases with and without cochlear ossification or between cases with and without a previous stapedotomy (p > 0.05). CONCLUSION: Endoscopic-assisted CI is an effective option for hearing restoration in patients with far advanced otosclerosis. Otoendoscopy can facilitate visualization and access to the scala tympani without the need to remove the posterior canal wall or to perform a subtotal petrosectomy.

External Auditory Canal: Computed Tomography Analysis and Classification.

Introduction Computed tomography (CT) details of the external auditory canal (EAC) are not fully covered in the literature, so building up base for the CT evaluation and description is important. Preoperative details of the EAC are mandatory before any approach or procedure involving the canal. Objective To determine the different dimensions, measurements, and grading of the EAC by CT scan that were not previously published. Methods The CT scans of 100 temporal bones (200 sides) were included. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes for all subjects. Results At the EAC entry, the mean vertical length (height) was 7.75 ± 1 mm, and its mean horizontal length (width) was 6.1 ± 0.8. At the bony cartilaginous junction of the EAC, the mean vertical length was 7.88 ± 1 mm, and its mean horizontal length was 6.22 ± 0.9. At the EAC isthmus, the mean vertical length was 6.8 ± 0.97 mm, and its mean horizontal length was 5.2 ± 0.76. At the medial end of the EAC, the mean vertical length was 7.1 ± 0.9 mm, and its mean horizontal length was 5.4 ± 0.85. There were no reported significant differences between right and left sides in all dimensions. Males showed significantly longer vertical and horizontal dimensions of the EAC entry, vertical dimension of the isthmus, and vertical dimension of the medial end of the EAC than females. Conclusion This study improves otologists and radiologists' awareness of EAC variations in the ear field and can be of help to residents in training.

Robust SMC-PSS and AVR design: A grid connected solar concentrated OTEC system application.

This work analyzes the stability and performance of an offshore solar-concentrated ocean thermal energy conversion system (SC-OTEC) tied to an onshore AC grid. The OTEC is a system where electricity is generated using small temperature differences between the warm surface and deep cold ocean water. Existing control methods for SC-OTEC systems lack coordination, hindering dynamic stability and effective damping for the synchronous generator (SG). These methods struggle to quickly adapt to sudden disturbances and lack the capability to adequately reject or compensate for such disturbances due to complex control constraints and computational demands. To this regard, a control strategy combining sliding mode control (SMC) and a power system stabilizer (PSS) to improve the SC-OTEC dynamic stability and damping features for the SG. Moreover, an auxiliary secondary automatic voltage regulator is assembled with a non-linear exciter system to provide damping features. The proposed PID-PSS and secondary AVR controller gains are adaptively tuned using a modified whale optimization algorithm with the balloon effect modulation. The studied SC-OTEC is tested through MATLAB/Simulink under a severe 3ϕ short-circuit fault, solar radiation variations, and a change in surface seawater temperature as well as changes in local loads. The final findings approved that the proposed control strategy preserves a strong performance and can mimic effectively the proposed SC-OTEC damping compared to the conventional system.

Advanced load frequency control of microgrid using a bat algorithm supported by a balloon effect identifier in the presence of photovoltaic power source.

Due to the unpredictability of the majority of green energy sources (GESs), particularly in microgrids (µGs), frequency deviations are unavoidable. These factors include solar irradiance, wind disturbances, and parametric uncertainty, all of which have a substantial impact on the system's frequency. An adaptive load frequency control (LFC) method for power systems is suggested in this paper to mitigate the aforementioned issues. For engineering challenges, soft computing methods like the bat algorithm (BA), where it proves its effectiveness in different applications, consistently produce positive outcomes, so it is used to address the LFC issue. For online gain tuning, an integral controller using an artificial BA is utilized, and this control method is supported by a modification known as the balloon effect (BE) identifier. Stability and robustness of analysis of the suggested BA+BE scheme is investigated. The system with the proposed adaptive frequency controller is evaluated in the case of step/random load demand. In addition, high penetrations of photovoltaic (PV) sources are considered. The standard integral controller and Jaya+BE, two more optimization techniques, have been compared with the suggested BA+BE strategy. According to the results of the MATLAB simulation, the suggested technique (BA+BE) has a significant advantage over other techniques in terms of maintaining frequency stability in the presence of step/random disturbances and PV source. The suggested method successfully keeps the frequency steady over I and Jaya+BE by 61.5% and 31.25%, respectively. In order to validate the MATLAB simulation results, real-time simulation tests are given utilizing a PC and a QUARC pid_e data acquisition card.

Risk factors for diphtheria in Sana'a, Yemen, 2019: a matched case-control study.

Objective: To identify risk factors for diphtheria related to sociodemographic, immunization and household status, and source of infection in Sana'a. Methods: A retrospective matched case-control study (1:2 ratio) was conducted. Cases were defined as patients who met the World Health Organization's definition of confirmed diphtheria living in Sana'a between January and November 2019. Controls were defined as subjects without a history of diphtheria infection, living in the same neighbourhood, and matched with cases by age and sex. Crude odds ratios, adjusted odds ratio (aOR) and 95% confidence intervals (CI) were calculated to evaluate associations between risk factors and diphtheria. Results: In total, 76 confirmed cases and 152 controls were enrolled in this study. Multi-variate analysis found significant associations between diphtheria infection and sharing a bedroom with at least two people (aOR 2.8, 95% CI 1.2-6.6), non-vaccination (aOR 2.6, 95% CI 1.2-6.0) and contact with a diphtheria case (aOR 10.6, 95% CI 2.6-43.6). Conclusions: This study found that vaccination, not sharing a bedroom with at least two people, and isolation of diphtheria cases to prevent contact with non-infected individuals were the most important measures for protection of the community from diphtheria. Raising community awareness about vaccination, transmission and preventive measures is recommended.

Drain-Less Submandibular Gland Excision With Preserved Facial Artery.

OBJECTIVES: To describe our experience in excision of the submandibular gland (SMG) without drain insertion and with preservation of the facial artery as a day case surgery as well as evaluation of the surgical outcomes of this procedure. METHODS: Prospective case series study of 42 cases of chronic calcular submandibular sialadenitis that underwent SMG excision by the same surgical team during the period from 2017 to 2021. The initial surgical plan in all cases was to excise the SMG with preservation of the facial artery and without drain insertion. RESULTS: SMG excision without drain insertion was successfully achieved in 28 patients who were discharged on the same day. In the remaining 14 patients, the surgical dissection was difficult and a suction drain was inserted at the end of the surgery; consequently, they were discharged on the next day. In all cases, facial vessels were preserved, and complete gland excision was achieved. Among the 28 patients who had no drain insertion, 1 patient had a postoperative seroma and no patient had wound related complications. Among the 14 patients who had drain insertion, 2 patients had postoperative seroma and 3 patients had wound related complications in the form of obvious scar formation. There were no other significant complications in all patients. CONCLUSIONS: Submandibular gland (SMG) excision with facial artery preservation and without drain insertion as a day case surgery could be safely done in cases of chronic calcular inflammation provided that meticulous surgical dissection and complete hemostasis were achieved.

Thoracic surgery in Egypt.

General thoracic surgery operations in Egypt are performed mainly by cardiothoracic surgeons and less oftenly by dedicated thoracic surgeons and general surgeons. This is mainly due to the relatively small number of thoracic surgeons in relation to population as only 210 cardiothoracic surgery specialists and 458 consultants are registered with the Egyptian Medical Syndicate (EMS) in a country with a population of more than 100 million people. Thoracic surgeons in Egypt are faced with a number of burdens, including the need to propagate the service to advanced technology infront of the obstacle of limited resources. Other burdens include higher incidence of TB, trauma and foreign body inhalation related to cultural backgrounds. More centres now are major video-assisted thoracic surgery (VATS) providing centres and others are specialized in more complex surgeries like complicated airway procedures and radical surgery for mesothelioma. As part of the international community, the COVID-19 pandemic has put more burdens on the thoracic surgery service as most centres have reduced their elective surgery workload to less than half of usual. Interestingly, the pandemic has allowed a self-referral screening programme with widespread Computed Tomography (CT) chest being performed among the population allowing thoracic surgeons to operate more on early stage lung cancer. The academic challenges for thoracic surgeons are even more with need for developing national databases. Nevertheless, thoracic surgeons in Egypt are optimistic regarding the future. The rising interest among the younger population will push training programs to meet the interests of enthusiastic junior surgeons. While the ancient history of thoracic surgery in Egypt seems to be extraordinary, the future perspectives promise to be more rewarding.

Field Epidemiology Training Program Response to COVID-19 During a Conflict: Experience From Yemen.

COVID-19 pandemic has underscored the need for a well-trained public health workforce to save lives through timely outbreaks detection and response. In Yemen, a country that is entering its seventh year of a protracted war, the ongoing conflict severely limited the country's capacity to implement effective preparedness and response measures to outbreaks including COVID-19. There are growing concerns that the virus may be circulating within communities undetected and unmitigated especially as underreporting continues in some areas of the country due to a lack of testing facilities, delays in seeking treatment, stigma, difficulty accessing treatment centers, the perceived risks of seeking care or for political issues. The Yemen Field Epidemiology Training Program (FETP) was launched in 2011 to address the shortage of a skilled public health workforce, with the objective of strengthening capacity in field epidemiology. Thus, events of public health importance can be detected and investigated in a timely and effective manner. During the COVID-19 pandemic, the Yemen FETP's response has been instrumental through participating in country-level coordination, planning, monitoring, and developing guidelines/standard operating procedures and strengthening surveillance capacities, outbreak investigations, contact tracing, case management, infection prevention, and control, risk communication, and research. As the third wave is circulating with a steeper upward curve than the previous ones with possible new variants, the country will not be able to deal with a surge of cases as secondary care is extremely crippled. Since COVID-19 prevention and control are the only option available to reduce its grave impact on morbidity and mortality, health partners should support the Yemen FETP to strengthen the health system's response to future epidemics. One important lesson learned from the COVID-19 pandemic, especially in the Yemen context and applicable to developing and war-torn countries, is that access to outside experts becomes limited, therefore, it is crucial to invest in building national expertise to provide timely, cost-effective, and sustainable services that are culturally appropriate. It is also essential to build such expertise at the governorate and district levels, as they are normally the first respondents, and to provide them with the necessary tools for immediate response in order to overcome the disastrous delays.

ENT manifestation in COVID-19 patients.

OBJECTIVE: to detect, analyze and discuss the different ear nose throat (ENT) manifestations those were reported in COVID19 positive patients in the reviewed and published literatures. METHODS: We performed a search in the PubMed databases, Web of Science, LILACS, MEDLINE, SciELO, and Cochrane Library using the keywords; COVID-19, Novel coronavirus, corona, 2019-nCoV, SARS-CoV-2, ENT, ear, nose, throat, otorhinolaryngology, ORL, pharynx, ORL, smell, larynx, different ENT related symptoms. We reviewed published and peer reviewed studies that reported the ENT manifestations in COVID-19 laboratory-confirmed positive patients. RESULTS: within the included 1773 COVID-19 laboratory-confirmed positive patients, the most common ENT manifestations of COVID-19 were sore throat (11.3%) and headache (10.7%). While the other reported ENT manifestations were pharyngeal erythema (5.3%), nasal congestion (4.1%), runny nose or rhinorrhea (2.1%), upper respiratory tract infection (URTI) (1.9%), and tonsil enlargement (1.3%). CONCLUSION: ENT manifestations for COVID-19 are not common as fever and cough. But, a universal questionnaire using well-defined COVID-19 manifestations is needed to make the COVID-19 data precisely defined, complete and homogenous.

Massive Hemoptysis and Recurrent Infective Endocarditis in Intravenous Drug user: A Case Report.

Intravenous drug use (IDU) poses a high risk of serious complications such as infective endocarditis (IE), which carries high morbidity and mortality rates. Mycotic pulmonary artery aneurysms (MPAA) are rarely associated with right-sided IE, especially in the setting of IDU. It is a potentially fatal complication as it can lead to severe hemorrhage if the aneurysm ruptures. We report the case of a young male with a history of current IDU and tricuspid valve replacement post complicated IE 2 years ago. The patient initially presented with massive hemoptysis and fever. Chest computed tomography (CT) showed a lobulated lesion in the right lower lobe with clear continuation to the pulmonary vessels. We aim to draw attention to the magnitude of complications of active IDU, including massive hemoptysis due to MPAA which should be promptly identified and emergently managed with embolization or surgery, followed by counseling and rehabilitation to minimize the risk of recurrence and save these patients.

Myocardial perfusion imaging by single-photon emission tomography (MPI SPECT) versus Instantaneous wave-free ratio (IFR) for assessment of functional significance of intermediate coronary artery lesions.

BACKGROUND: The aim of our work was to compare the myocardial perfusion imaging by single-photon emission tomography (MPI-SPECT) as a non-invasive, relatively non-expensive test versus the instantaneous wave-free ratio (IFR) for the evaluation of functional significance of the borderline coronary artery lesions in the view of results of fractional flow reserve (FFR) which is considered the gold standard reference test. RESULTS: Our study was conducted in the Cardiology Department. It included 50 patients with borderline coronary artery lesions; they underwent physiological evaluation by stress/rest myocardial perfusion imaging using followed by an invasive physiological assessment by Instantaneous wave-free ratio (IFR) and Fractional flow reserve (FFR). Finally, the results of both SPECT MPI and IFR were compared to FFR as a gold standard reference. There was a strong (kappa = 0.754) significant (P value < 0.001) agreement between the MPI results and FFR results and the overall agreement was 88%. The sensitivity of the MPI was 81.8%, the specificity was 92.9%, the positive predictive value was 90%, the negative predictive value was 86.7%, the positive likelihood ratio was 11.45, and the negative likelihood ratio was 0.20. There was a strong (kappa = 0.918) significant (P value < 0.001) agreement between the IFR results and FFR results and the overall agreement was 96%. The sensitivity of the IFR was 90.9%, the specificity was 100%, the positive predictive value was 100 %, the negative predictive value was 93.3%, and the negative likelihood ratio was 0.09. CONCLUSIONS: The instantaneous wave-free ratio (IFR) may be a valid alternative to fractional flow reserve to assess the functional significance of intermediate coronary lesions. The myocardial perfusion imaging may be an alternative, non-invasive, relatively non-expensive test for the evaluation of the physiological significance of intermediate coronary lesions.

Traumatic Dural Venous Sinuses Injury.

The traumatic dural venous sinus injury is one of the most dangerous complications of TBI, either due to fatal intracranial compressing venous bleeding, or disturbing the intracranial pressure which could be caused by injury to the SSS On the other hand, post traumatic dural sinus thrombosis is considered a rare complication which may lead to hemorrhagic infarction with its serious consequences including epilepsy, neurological deficits, or death. Therefore, knowledge of the appropriate treatment of this kind of head injury is essential.