Complications of the nasal dorsum reconstruction using autologous or alloplastic grafts: evidence from systematic review and meta-analysis / Complicações da reconstrução do dorso nasal com enxerto autólogo ou aloplástico: evidências de uma revisão sistemática e metanálise

Abstract Introduction Augmentation rhinoplasty depends mainly on intact stable bony and cartilaginous parts. Many trials have used different materials as a graft to perform the operation and support the nose. Debate exists whether alloplastic or autogenic grafts are more appropriate. Common available alloplastic grafts include silicone, medpor, and gore-tex. Autogenic grafts are usually derived from costal cartilages. Warping, infection, and hypertrophic scars are the main complications of the procedure. Yet no subgroup analysis has been performed to investigate the effect of different risk factors. Objective To investigate the effect of different types of grafts and the association of the income level of the country on surgery complications. Methods A comprehensive literature search of articles was conducted in PubMed, Cochrane Library, Web of Science, and SCOPUS databases through October 2019. We included articles that used autologous or alloplastic grafts in nasal dorsum reconstruction surgery. We performed subgroup analysis according to the type of graft used, region, and income level of the country. A meta-regression analysis model was carried out from the period of 1999-2018, to study the incidence of these complications over time. Results The overall complication rate was 7.1%, which was higher in the alloplastic group (7.8%) than the autogenic group (6.9%). The most common complications were secondary surgery for re-correction (4.1%), infection (2.1%), warping (1.6%), and hypertrophic scars (1.6%). All outcomes were homogeneous (I2 < 50%). Conclusion Patients with autogenic grafts are less liable to develop complications than their peers reconstructed with alloplastic grafts. Moreover, Asian patients are less susceptible to overall rhinoplasty complications. Attention should be noted for low-income countries in which surgical complications are more prone to occur.

Resumo Introdução A feitura de uma rinoplastia de aumento depende principalmente das partes ósseas e cartilaginosas intactas. Muitos estudos usaram enxertos de diferentes materiais para a feitura da cirurgia e como apoio da estrutura nasal. Ainda existem controvérsias em estudos prévios sobre quais tipos de enxertos, se materiais aloplásticos ou autogênicos, seriam os mais adequados. Os enxertos aloplásticos comuns incluem silicone, medpor e gore-tex. Os enxertos autogênicos são geralmente derivados de cartilagens costais. Deformações, infecção e cicatrizes hipertróficas são as principais complicações do procedimento. No entanto, nenhuma análise de subgrupo foi feita para investigar o efeito de diferentes fatores de risco. Objetivo Investigar o efeito de diferentes tipos de enxertos e o nível de renda do país nas complicações cirúrgicas Método Uma pesquisa abrangente de artigos na literatura foi feita nas bases de dados PubMed, Cochrane Library, Web of Science e SCOPUS até outubro de 2019. Foram incluídos artigos que usaram enxertos autólogos ou aloplásticos em cirurgias de reconstrução do dorso nasal. Foi feita uma análise de subgrupos de acordo com o tipo de enxerto usado, região e nível de renda do país. Um modelo de análise de metarregressão foi feito de 1999 a 2018, para estudar a incidência dessas complicações ao longo do tempo. Resultados A taxa global de complicações foi de 7,1%, a qual foi maior no grupo aloplástico (7,8%) do que no grupo autogênico (6,9%). As complicações mais comuns foram cirurgia secundária para recorreção (4,1%), infecção (2,1%), deformidade (1,6%) e cicatrizes hipertróficas (1,6%). Todos os resultados foram homogêneos (I2 < 50%). Conclusão Os pacientes com enxertos autogênicos são menos propensos a desenvolver complicações, em comparação com seus pares com enxertos aloplásticos. Além disso, pacientes asiáticos são menos suscetíveis a complicações gerais da rinoplastia. Merece atenção o fato de que em países de baixa renda as complicações cirúrgicas são mais propensas a ocorrer.

A conventional multiplex PCR for the detection of four common soil-transmitted nematodes in human feces: development and validation.

Soil-transmitted helminth (STH) infections, mainly caused by Ascaris lumbricoides, Trichuris trichiura, and hookworms, are among the most common intestinal parasites that infect humans. The infections are widely distributed throughout tropical and subtropical countries, including Malaysia, particularly in underprivileged communities. Microscopic and culture techniques have been used as a gold standard for diagnostic techniques. However, these methods yield low sensitivity and specificity, laborious and time-consuming. Therefore, simple, rapid, and accurate alternative methods are needed for the simultaneous detection of STH infections. Although advanced technologies such as real-time multiplex PCR have been established, the use of this technique as a routine diagnostic is limited due to the high cost of the instrument. Therefore, a single-round multiplex conventional PCR assay for rapid detection of four STH species in the fecal sample was developed in this study. To perform the single-round multiplex PCR, each pair of species-specific primers was selected from target genes, including Ancylostoma duodenale (Internal Transcribed Spacer 2; accession No. AJ001594; 156 base pair), Necator americanus (ITS 2; accession No. AJ001599; 225 base pair), Ascaris lumbricoides (Internal Transcribed Spacer 1; accession No. AJ000895; 334 base pair) and Trichuris triciura (partial ITS 1, 5.8s rRNA and partial ITS 2; accession No. AM992981; 518 base pair). The results showed that the newly designed primers could detect the DNA of STH at low concentrations (0.001 ng/ µl) with no cross-amplification with other species. This assay enables the differentiation of single infections as well as mixed infections. It could be used as an alternative and is a convenient method for the detection of STHs, especially for the differentiation of N. americanus and A. duodenale.

Comparison Between Using Monocryl Suture and Polypropylene Suture in Closure of Alar Base Excision in Rhinoplasty.

BACKGROUND: Rhinoplasty is one of the most common procedures that act as a challenge for consistent outstanding results. Alar base reduction is a technique of rhinoplasty that is prescribed in many conditions. Wound closure requires using of sutures and there are several types of sutures for this purpose; however, good scar results are necessary for patients'satisfaction. AIM: To evaluate alar base resection scar results after surgical resection using different types of suturing material. METHODS: This is a retrospective cohort study that was conducted at King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia. The study was performed by reviewing patient's records and performing post-operative photography for patient who underwent alar base resection. The patients were divided into 2 groups, the first group of patients had the alar base wound closed with interrupted Polypropylene 6/0 and the other group wound was closed with monocryl 6/0 sutures. Visual analog scale was used to investigate basal views. RESULTS: The study included 80 patients divided into 2 groups, each group included 40 patients, in the first group (Polypropylene group) there were 25% males and 75% females, whereas in the second group (monocryl) there were 15% and 85% males and females, respectively. There were 85% and 82.5% unnoticeable scar reported by the first and second group, respectively; however there was no significant difference between the 2 groups (P = .75). CONCLUSION: Both Polypropylene and monocryl sutures result in the same result for closing alar base wound post surgically.

HISTORIQUE: La rhinoplastie est l'une des principales interventions chirurgicales oú il est difficile de toujours obtenir des résultats remarquables. La réduction de la base des ailes du nez est une technique prescrite pour de nombreuses affections. Plusieurs types de sutures peuvent être utilisées pour fermer les plaies, mais de belles cicatrices s'imposent pour satisfaire les patients. OBJECTIFS: Les chercheurs ont évalué les résultats des cicatrices de la base des ailes du nez après des résections chirurgicales au moyen de divers matériaux de suture. MÉTHODOLOGIE: Étude de cohorte rétrospective réalisée à l'hôpital universitaire du roi Abdulaziz de Riyad, en Arabie saoudite. Les chercheurs ont examiné les dossiers des patients et photographié ceux qui avaient subi une résection de la base des ailes du nez. Les patients ont été divisés en deux groupes de 20 patients: dans le premier, les plaies de la base des ailes du nez ont été fermées par des sutures de polypropylène 6/0 et dans le deuxième, par des sutures de monocryl 6/0. Les chercheurs ont utilisé une échelle analogique visuelle pour évaluer les vues de la base des ailes du nez. RÉSULTATS: L'étude se composait de 80 patients divisés en deux groupes de 40 patients. Le premier groupe (polypropylène) était composé à 25% d'hommes et à 75% de femmes, d'un âge moyen total de 32 ans, et le deuxième (monocryl), à 15 % d'hommes et à 85% de femmes. Les cicatrices n'étaient pas visibles chez 85% et 82,5% des membres du premier et du deuxième groupe, respectivement, mais la différence n'était pas significative (P = 0,75). CONCLUSION: Les sutures de polypropylène et de monocryl donnent le même résultat clinique pour fermer les plaies de la base des ailes du nez.

Complications of the nasal dorsum reconstruction using autologous or alloplastic grafts: evidence from systematic review and meta-analysis.

INTRODUCTION: Augmentation rhinoplasty depends mainly on intact stable bony and cartilaginous parts. Many trials have used different materials as a graft to perform the operation and support the nose. Debate exists whether alloplastic or autogenic grafts are more appropriate. Common available alloplastic grafts include silicone, medpor, and gore-tex. Autogenic grafts are usually derived from costal cartilages. Warping, infection, and hypertrophic scars are the main complications of the procedure. Yet no subgroup analysis has been performed to investigate the effect of different risk factors. OBJECTIVE: To investigate the effect of different types of grafts and the association of the income level of the country on surgery complications. METHODS: A comprehensive literature search of articles was conducted in PubMed, Cochrane Library, Web of Science, and SCOPUS databases through October 2019. We included articles that used autologous or alloplastic grafts in nasal dorsum reconstruction surgery. We performed subgroup analysis according to the type of graft used, region, and income level of the country. A meta-regression analysis model was carried out from the period of 1999-2018, to study the incidence of these complications over time. RESULTS: The overall complication rate was 7.1%, which was higher in the alloplastic group (7.8%) than the autogenic group (6.9%). The most common complications were secondary surgery for re-correction (4.1%), infection (2.1%), warping (1.6%), and hypertrophic scars (1.6%). All outcomes were homogeneous (I2 < 50%). CONCLUSION: Patients with autogenic grafts are less liable to develop complications than their peers reconstructed with alloplastic grafts. Moreover, Asian patients are less susceptible to overall rhinoplasty complications. Attention should be noted for low-income countries in which surgical complications are more prone to occur.

A conventional multiplex PCR for the detection of four common soil-transmitted nematodes in human feces: development and validation

@#Soil-transmitted helminth (STH) infections, mainly caused by Ascaris lumbricoides, Trichuris trichiura, and hookworms, are among the most common intestinal parasites that infect humans. The infections are widely distributed throughout tropical and subtropical countries, including Malaysia, particularly in underprivileged communities. Microscopic and culture techniques have been used as a gold standard for diagnostic techniques. However, these methods yield low sensitivity and specificity, laborious and time-consuming. Therefore, simple, rapid, and accurate alternative methods are needed for the simultaneous detection of STH infections. Although advanced technologies such as real-time multiplex PCR have been established, the use of this technique as a routine diagnostic is limited due to the high cost of the instrument. Therefore, a single-round multiplex conventional PCR assay for rapid detection of four STH species in the fecal sample was developed in this study. To perform the single-round multiplex PCR, each pair of species-specific primers was selected from target genes, including Ancylostoma duodenale (Internal Transcribed Spacer 2; accession No. AJ001594; 156 base pair), Necator americanus (ITS 2; accession No. AJ001599; 225 base pair), Ascaris lumbricoides (Internal Transcribed Spacer 1; accession No. AJ000895; 334 base pair) and Trichuris triciura (partial ITS 1, 5.8s rRNA and partial ITS 2; accession No. AM992981; 518 base pair). The results showed that the newly designed primers could detect the DNA of STH at low concentrations (0.001 ng/μl) with no cross-amplification with other species. This assay enables the differentiation of single infections as well as mixed infections. It could be used as an alternative and is a convenient method for the detection of STHs, especially for the differentiation of N. americanus and A. duodenale.

Cranial osteopathic treatment and stress-related effects on autonomic nervous system measured by salivary markers: A pilot study.

BACKGROUND: Variations in the concentration of salivary alpha amylase (sAA) may indicate a change in the autonomic nervous system functionality. In osteopathic medicine it has long been stated that the osteopathic manipulative treatment (OMT) can modulate the autonomic nervous system. Studies carried out on the compression of the fourth ventricle (CV4) have shown a positive effect in reducing the sympathetic tone. The goal of this pilot study is measuring the physiological response of the sAA levels after CV4 technique. METHODS: 90 subjects were randomly assigned to a sham, a control or a CV4 group. Randomization accounted for sex and score in the STAI-2 (form Y) questionnaire. Each subject completed the STAI-1 (form Y) questionnaire to evaluate the anxiety of the moment. sAA activity and saliva flow rate were measured. Saliva was collected before, immediately after and 30 min after treatment. RESULTS: Within group analysis revealed that sAA activity increased significantly immediately after the technique application only in the CV4 group (p = 0,05). Between groups analysis show a significant difference of the sAA activity in the CV4 group respect the control group (p < 0,05), but no significant difference between CV4 and sham group (p > 0,05). The effect in the CV4 group after the intervention is highly variable and appeared to be related to the level of stress measured with the STAI-Y1 questionnaire (p = 0,002). CONCLUSIONS: This study shows a positive effect of the CV4 procedure on sAA activity even if not significantly different from the sham procedure, probably due to the confounding effect of stress variability between groups.

The Axial Frontonasal Flap for Nasal Tip Defect: A Single Centre Experience.

Objectives Skin defects of the nose can be a surgical challenge for facial plastic surgeons. Often, invasive surgery of the nose is accompanied by aesthetic issues for the patient. Hence, following invasive surgery of the nose, a reconstructive procedure should be performed to correct the morphological and aesthetic issues. This can help to restore the aesthetic features of the nose. Of the several reconstructive procedures available for nasal tip defects, the axial frontonasal flap is regarded as a good option for nasal tip reconstruction. Herein, we describe our experience with the axial frontonasal flap for the reconstruction of nasal tip defect in 15 patients. We also would specify the indications for the use of this flap and describe in detail the surgical technique. Materials and Methods This was a retrospective study of 15 patients who underwent reconstruction of nasal tip defect with an axial frontonasal flap between 2012 and 2015. In all the patients, the defects were located on the nasal tip. The measurement of the nasal tip defect in all the cases was ≥ 1.4 cm in their shortest diameter. The patients were followed up to 12 months after surgery. Results The axial frontonasal flaps for all the patients survived completely without any complications. In all patients, the follow-up surgical result was rated as good or excellent by the patients and surgeons. Conclusions Based on the results of our review of cases, we highly recommend the axial frontonasal flap as an option for the reconstruction of nasal tip defects measuring ≥ 1.4 cm in diameter.

Effect of Media on Facial Plastic Surgery in Saudi Arabia.

Objectives To evaluate the effect of social media, TV shows, plastic surgeons' self-advertisement, and before-and-after cosmetic surgery photos of patients who actually visited the clinic to seek a consultation or intervention. Methods This is a cross-sectional study; institutional review board approval was granted in 2018. This study was conducted among patients attending cosmetic clinics at King Abdulaziz University Hospital in Riyadh, Saudi Arabia. The questionnaire is composed of socio-demographic data and about the reason for the trending of plastic surgeries. Results Three hundred and ninety-nine patients participated in the study. Of all participants, 60.4% agreed on the impact of the surgeon's self-advertisement in the trending of plastic surgeries; 53.4% said yes to cosmetic television programs having an effect on the trend of plastic surgeries; 65.7% of the participants answered yes to before-and-after pictures of social media having an effect on the trend of cosmetic procedures; and 54.1% of the participants answered yes to wanting to look better in selfies as a reason for the rise of cosmetic surgery. Conclusion The results of this study have shown that the majority of patients visiting plastic surgery clinics were positively affected, but not exclusively, by media coverage of cosmetic surgery results.

Human hydatidosis in Tehran, Iran: a retrospective epidemiological study of surgical cases between 1999 and 2009 at two university medical centers.

This study was conducted to evaluate retrospectively 203 patients diagnosed with hydatid cyst disease and treated surgically at two university medical centers between 1999 and 2009 in Tehran, the capital of Iran. Cystic echinococcosis (CE) affected more females 117 (57.6%) than males 86 (42.4%). A remarkable gender difference skewed towards females was observed, and the male/female ratio among CE cases ≤20 and ≥61 years old was 1.18 and 0.52, respectively. The age of the patients ranged from 8 to 82 years, and the age group 21-40 years (42.8%) was the most affected. A significantly higher number of hydatid cysts were recorded in the liver than in other sites (P<0.001), and more females had higher hepatic cysts (48.8%) than males (35.0%). The ratio of hepatic hydatidosis to pulmonary hydatidosis was about 11. There was a relative direct relationship between the ratio of liver to lung cases and age, and this ratio was significantly (P<0.01) higher in individuals >40 years of age (liver/lung ratio ≥43) than in those <40 years of age (liver/lung ratio 2.8-7.6). Unusual cyst locations in kidneys, brain and pelvic area, followed by spleen and spine was also observed. Single organ involvement was found in 95% of the patients, and was more common in females (55.2%) than in males (39.9%). Housewives had the highest rate of infection (53.5%) followed by labourers with 14.8%, which showed a significant difference (P<0.001). Similarly, urban dwellers was also over-represented among the cases (87% urban vs. 13% rural; P<0.001). In 69.5% of cases there was only one cyst, 16.3% had two cysts, 4.7% with three cysts, and 9.5% had four cysts or more. The results showed that further studies are needed to determine the prevalence, economic impact and risk factors of the disease in the area.

Human hydatidosis in Tehran, Iran: A retrospective epidemiological study of surgical cases between 1999 and 2009 at two university medical centers

This study was conducted to evaluate retrospectively 203 patients diagnosed with hydatid cyst disease and treated surgically at two university medical centers between 1999 and 2009 in Tehran, the capital of Iran. Cystic echinococcosis (CE) affected more females 117 (57.6%) than males 86 (42.4%). A remarkable gender difference skewed towards females was observed, and the male/female ratio among CE cases 61 years old was 1.18 and 0.52, respectively. The age of the patients ranged from 8 to 82 years, and the age group 21– 40 years (42.8%) was the most affected. A significantly higher number of hydatid cysts were recorded in the liver than in other sites (P40 years of age (liver/lung ratio >43) than in those <40 years of age (liver/lung ratio 2.8–7.6). Unusual cyst locations in kidneys, brain and pelvic area, followed by spleen and spine was also observed. Single organ involvement was found in 95% of the patients, and was more common in females (55.2%) than in males (39.9%). Housewives had the highest rate of infection (53.5%) followed by labourers with 14.8%, which showed a significant difference (P<0.001). Similarly, urban dwellers was also over-represented among the cases (87% urban vs. 13% rural; P<0.001). In 69.5% of cases there was only one cyst, 16.3% had two cysts, 4.7% with three cysts, and 9.5% had four cysts or more. The results showed that further studies are needed to determine the prevalence, economic impact and risk factors of the disease in the area.