TYMPANOPLASTY TYPE-1: DIFFERENT APPROACHES AND THEIR SURGICAL OUTCOMES

Objective: To calculate the surgical outcomes of different approaches of tympanoplasty type 1 in terms of air bone gap closure, wound healing, and postoperative pain. Study Design: Prospective cross-sectional study. Place and Duration of Study: Department of ENT, Head and Neck Surgery, Medical Teaching Institute (MTI), Lady Reading Hospital (LRH), Peshawar, Pakistan from Jun 2018 to May 2020. Methodology: Size of sample was 75 patients divided into three groups. Consent was obtained from all the patients included in study. After proper evaluation and relevant investigation pre- and post-operative PTA was performed. Tympanoplasty type-1 was performed by the same surgeon by the three approaches following established otological surgical protocol. Collected data was entered in SPSS-25 for analysis. Results: All 75 patients were divided into three equal groups. Male were 55 (73.3%), females were 20 (26.7%). Male: female ratio was 2.7:1. Majority of patients presented in 2nd and 3rd decades of life 31 (41.33%) and 28 (37.33%) respectively. Preoperative mean ± SD, ABG in groups A, B and C were 37.60 ± 11.28 dB, 37 ± 9.68 dB and 31.80 ± 12.40 dB, respectively. No significant difference was found amongst the three groups regarding pre-operative and post-operative ABG (p=0.85 and p=0.4), respectively. Mean ± SD, wound healing time in Groups A, B and C were 1.00 ± 0.00, 1.80 ± 0.40 and 1.76 ± 0.43 respectively with p=0.0001 and similarly postoperative pain with p=0.001. The wound healing time and post-operative was statistically better (p<0.05) in group A (Transmeatal approach) than other groups........

Does Probiotic Consumption Enhance Wound Healing? A Systematic Review

The use of probiotics is one of the emerging lines of treatment for wound healing. This systematic review aimed to summarize currently available evidence on the effect of oral or enteral probiotic therapy on skin or oral mucosal wound healing in humans. To verify the developments in this field and the level of available scientific evidence, we applied a broad search strategy with no restrictions on wound type, target population, probiotic strain, or intervention protocol used. This review included seven studies involving 348 individuals. Four studies reported positive outcomes for healing improvement after probiotic therapy, and none of the studies reported adverse effects or a marked increase in wound healing time. The positive or neutral results observed do not generate strong evidence regarding the effectiveness of probiotics for wound healing. However, they suggest a promising field for future clinical research where the probiotic strains used, type of wounds, and target population are controlled for.

Risk factors for corneal epithelial wound healing: Can sex play a role?

Purpose To determine if sex is associated with corneal epithelial wound healing time in patients with persistent corneal epithelial defects (PCEDs). Methods Retrospective case series on patients with PCED from November 2014 to January 2019. Records of 127 patients with diagnosis of PCED were reviewed. Patients with an epithelial defect that lasted more than two weeks in the absence of an active corneal infection were included. Main outcome was corneal epithelial wound healing time. Results 55 patients (29 males) with a mean age of 65.3 ± 16.5 years were included. No difference was found between female and male patients in terms of risk factors, age, treatment strategies or intervals between visits (median of 15 days in females and 12 days in males; p = 0.24). Median duration of the PCED was 51 days (IQR 32-130), with a median number of 5 clinical visits (IQR 4-8). Female patients had significantly longer healing times (p = 0.004) and a corresponding increase in the number of clinical visits (median of 7 visits vs. 5 clinical visits in males, p = 0.012). Conclusion Results from this study suggest female patients with PCED might have a longer corneal epithelial wound healing duration and may therefore require earlier intervention.

Assessment of frailty in elderly patients attending a multidisciplinary wound care centre: a cohort study

Background The incidence of frailty and non-healing wounds increases with patients’ age. Knowledge of the relationship between frailty and wound healing progress is greatly lacking. Methods The aim of this study is to characterize the degree of frailty in elderly patients attending a multidisciplinary wound care centres (MWCC). Additionally, we seek to assess the impact of frailty on the wound healing rate and wound healing time. An open cohort study was conducted on 51 consecutive patients aged > 70 years treated for wounds at an MWCC of an intermediate care hospital. The frailty score was determined according to the Frail-VIG index. Data were collected through patient questionnaires at the beginning of the study, and at 6 months or upon wound healing. Wounds were followed up every 2 weeks. To analyse the relationship between two variables was used the Chi-square test and Student’s or the ANOVA model. The t-test for paired data was used to analyse the evolution of the frailty index during follow-up. Results A total of 51 consecutive patients were included (aged 81.1 ± 6.1 years). Frailty prevalence was 74.5% according to the Frail-VIG index (47.1% mildly frail, 19.6% moderately frail, and 7.8% severely frail). Wounds healed in 69.6% of cases at 6 months. The frailty index (FI) was higher in patients with non-healing wounds in comparison with patients with healing wounds (IF 0.31 ± 0.15 vs IF 0.24 ± 0.11, p = 0.043). A strong correlation between FI and wound healing results was observed in patients with non-venous ulcers (FI 0.37 ± 0.13 vs FI 0.27 ± 0.10, p = 0.015). However, no correlation was observed in patients with venous ulcers (FI 0.17 ± 0.09 vs FI 0.19 ± 0.09, p = 0.637). Wound healing rate is statically significantly higher in non-frail patients (8.9% wound reduction/day, P25-P75 3.34–18.3%/day;AQ6 p = 0.044) in comparison with frail patients (3.26% wound reduction/day, P25-P75 0.8–8.8%/day). Conclusion Frailty is prevalent in elderly patients treated at an MWCC. Frailty degree is correlated with wound healing results and wound healing time.

The Therapeutic Effects of Oral Intake of Hydrogen Rich Water on Cutaneous Wound Healing in Dogs

This study explored the effects of drinking Hydrogen-rich water (HRW) on skin wound healing in dogs. Eight circular wounds were analyzed in each dog. The experimental group was treated with HRW thrice daily, while the control group was provided with distilled water (DW). The wound tissues of dogs were examined histopathologically. The fibroblasts, inflammatory cell infiltration, the average number of new blood vessels, and the level of malondialdehyde (MDA) and superoxide dismutase (SOD) activity in the skin homogenate of the wound was measured using the corresponding kits. The expressions of Nrf-2, HO-1, NQO-1, VEGF, and PDGF were measured using the real-time fluorescence quantitative method. We observed that HRW wounds showed an increased rate of wound healing, and a faster average healing time compared with DW. Histopathology showed that in the HRW group, the average thickness of the epidermis was significantly lower than the DW group. The average number of blood vessels in the HRW group was higher than the DW group. The MDA levels were higher in the DW group than in the HRW group, but the SOD levels were higher in the HRW group than in the DW group. The results of qRT-PCR showed that the expression of each gene was significantly different between the two groups. HRW treatment promoted skin wound healing in dogs, accelerated wound epithelization, reduced inflammatory reaction, stimulated the expression of cytokines related to wound healing, and shortened wound healing time.

Sinus pilonidalis fisztuloszkópos kezelése gyermekekben

Összefoglaló. Bevezetés: A sinus pilonidalis nehezen kezelhető, sok szövődménnyel és recidívával járó betegség. A legtöbb műtéti eljárás többnapos kórházi kezelést, munkából vagy iskolából való hiányzást követel. Célkitűzés: Munkánk célja, hogy a PEPSiT- (pediatric endoscopic pilonidal sinus treatment) műtétek eredményességét vizsgálja. Módszer: Intézetünkben 2019–2020-ban PEPSiT-műtéten átesett, 18 év alatti betegeket válogattunk be a vizsgálatba. Kizártuk a cisztoszkóppal operált és kontrollra nem jelentkező betegeket. A szövődmények, recidívák számát, a kórházi tartózkodás hosszát, a sebgyógyulás és a hétköznapi aktivitáshoz való visszatérés idejét vizsgáltuk. Eredmények: Betegeink többsége fiú (24 fiú, 4 lány), átlagéletkoruk 15,6 év volt. 28 betegen 31 PEPSiT-beavatkozást végeztünk (3 re-PEPSiT), 6 recidíva, 1 sebgennyedés alakult ki. A betegek egy része egynapos ellátás keretében, míg a többség egy éjszaka bentfekvés után tért haza (1,74 nap ápolási idő). A hétköznapi aktivitáshoz 1,37 nap után tértek vissza, a gyógyulási idő 5,9 hét volt átlagosan. Megbeszélés: A PEPSiT-beavatkozás minimálisan invazív lehetőség, igen rövid kórházi tartózkodással. A betegek hamar térnek vissza a szokott aktivitásukhoz, a korábbi sipolyon kívül újabb műtéti seb nem alakul ki. A recidívaarány hasonló az egyéb technikákéhoz. Következtetés: A PEPSiT-beavatkozás jól alkalmazható, a recidívaarány csökkentése fontos. Orv Hetil. 2021; 162(43): 1740–1743. Summary. Introduction: The treatment of pilonidal disease is often challenging, due to frequent recurrences and adverse events. Most operative treatments require a lengthy hospital stay, and absence from school or work. Objective: We aimed towards assessing the effectivity of PEPSiT (pediatric endoscopic pilonidal sinus treatment). Method: In this study, we included patients subjected to PEPSiT from 2019 to 2020 between ages 0–18 years. Patients operated via cystoscope and patients who did not attend follow-up examinations were excluded. Adverse events, recurrences, length of hospital stay, wound healing time and return to everyday activity were assessed. Results: The majority of our patients were male (24 male, 4 female), the mean age was 15.6 years. 31 PEPSiT operations were recorded on 28 patients (3 were redo surgeries). 6 recurrences and 1 wound suppuration were documented. Some patients were treated within the confines of one-day surgery, while most of them stayed one night (mean length of stay was 1.74 days). Return to everyday activity was an average 1.37 days, and mean wound healing time was 5.9 weeks. Discussion: PEPSiT is a minimally invasive operative approach with a very short hospital stay. Patients return to everyday activity faster. New operative scarring does not happen apart from the preexisting fistula opening. Recurrence rate is similar to that of other treatment techniques. Conclusion: PEPSiT technique is applicable, however, reduction of the recurrence rate is important. Orv Hetil. 2021; 162(43): 1740–1743.

Preventative Value of Predictive Health Interventions on PICC-Related Thrombosis in Patients with Severe Burns

Background Burn mainly refers to the damage caused by high temperature to the skin and mucous membrane tissue. Seriously, it causes damage to the subcutaneous tissue or subcutaneous mucous membrane, which is easy to induce infection and poses a threat to the life safety of patients.For patients with deep burns, surgical removal of damaged skin and mucosal tissue, Postoperative,immediate coverage of surgical wounds,avoid infection due to body fluid and energy loss with related tissue necrosis.The clinical treatment period for critical burn patients is longer and high incidence of postoperative complications.The corresponding nursing intervention while undergoing treatment can help to eliminate the impact of the bad psychological state on the patients, improve the treatment compliance, and reduce the occurrence of complications. Objective Evaluation of the value of predictive health intervention in preventing thrombosis associated with Peripherally Inserted Central Catheter (PICC) via peripheral vein in critically ill burn patients Methods Select 90 patients with severe burn treated by PICC infusion from January 2019- February 2021, Group by reference to intervention methods, with 45 using conventional health intervention (control group) and another 45 using predictive health interventions (observation group). The incidence of pulmonary and wound infection, the incidence of adverse events associated with PICC catheterization and wound healing time were recorded in the two groups. The degree of pain was evaluated by visual simulation (VAS) score, and the differences of platelet, D- dimer (D-D) and hemodynamics were detected in the two groups Results The incidence of pulmonary infection, PICC associated thrombus and total adverse events in the observation group was lower, and higher rate of functional recovery,but less wound healing time with control group,which had statistical significance (P<0.05) .Incidence of wound infection, incidence of catheter blockage, incidence of unplanned extubation,the difference was not statistically significant (P>0.05) .Comparison before intervention/The pain score decreased at 7 ck 14d> 21d (P<0.05), and the observation group was lower than the control group (P<0.05) .Intervention of the 7d, 14d two sets all platelet elevation (P< 0.05) ,but D-D concentration decreases (P< 0.05) .Intervention of the 7d> 14d two sets was increased of the intrathoracic blood volume index (ITBVI) (P<0.05) , but extravascular lung water index (EVLWI) and mean arterial pressure (MAP) the difference was not statistically significant (P>0.05). Conclusions Predictive health intervention can reduce the pain degree of critically burned patients, reduce the incidence of adverse events such as infection and PICC-related thrombosis, and promote wound recovery.

Clinical efficacy of arthroscopic reconstruction of the anterior talofibular ligament with preservation of the stump

Background The purpose of this study was to investigate the clinical efficacy of anatomic reconstruction of the anterior talofbular ligament with preservation of the stump. Methods This retrospective study included 42 patients who underwent an endoscopic lateral ligament reconstruction between from June 2015 to June 2019.Fourteen consecutive patients (10 [71.4%] males and 4 [28.6%] female, mean age 27.79 ± 4.56[range 26 to 36] years) with preserved anterior tibiofibular ligament stump were enrolled in this study.On the other side ,there were 18 patients with unpreserved tibiofibular ligament stumps (unpreserved stump group), 12 males and 6 females, aged 20–36 years, mean (28.56 ± 5.67) years.The functional evaluation was carried out according to the Ankle-Hindfoot Score by the American Orthopaedic Foot and Ankle Society.The Tegner system was used to evaluate range of motion after the index procedure. Ankle proprioception was assessed using the visual analogue scale (VAS) to assess the degree of subjective pain symptoms. Operative time, fever time and wound healing time were also recorded. Results There were no statistically significant differences in postoperative outcomes such as postoperative fever time and wound healing time between the two groups (P > 0.05). The operative time was slightly longer in the stump-preserving group than in the non-stump-preserving group (94.14 ± 11.59 vs. 82.94 ± 15.61 P < 0.05). There were no statistically significant differences in preoperative AOFAS ankle-hindfoot scores, Tegner motor level scores, and VAS scores between patients in the retained-stump group and the non-reserved-stump group (P > 0.05). At 1 year after surgery, the AOFAS ankle-hindfoot scores and Tegner motor level scores improved and the VAS pain scores decreased in both the presurgical and non-presurgical groups. The AOFAS ankle-hindfoot scores and Tegner motion level scores 1 year after surgery were higher in the group with preserved stump than in the group without preserved stump (P < 0.05). Conclusion Arthroscopic reconstruction of the anterior talofibular ligament with and without preservation of the stump can achieve good clinical outcomes. Although arthroscopic anterior talofibular ligament reconstruction with preserved stump prolonged the operative time compared with surgery without preserved stump, it could better improve the subjective ankle function and motion status of patients and improve the prognosis.