A Retrospective Observational Study of Facial Dog Bite Injuries and Its Management in a Tertiary Care Center.

Background : Facial dog bite injuries result in significant emotional, psychological, and physical trauma to the victims involved and should be considered a significant health issue. The purpose of this study is to share our experience in the management and to add to the existing medical literature regarding the epidemiological patterns of facial dog bite injuries. Materials and Methods : This is a single-center retrospective observational study conducted at Dr. RML Hospital, New Delhi, from January 2021 to January 2022. A total of 105 patients were included. The wounds were managed according to the recommendations made by the national rabies control program and surgical intervention was performed in the form of primary suturing or flap cover. Results : Children of age group 0 to 10 years are most commonly affected. Pet dogs are the cause in 61% of cases and 57.1% of bites were provoked. Midface is most commonly affected and modified Lackmann's class 3A and 3B are the most common wounds. Conclusion : In view of raising incidence of dog bites with pet dogs, the general public needs to be educated regarding the practices to prevent these injuries. Postexposure prophylaxis should be given to all affected individuals irrespective of the vaccination status of the dog. Immediate surgical intervention gives better results.

Role of Preoperative Skin Stretching in Single-Stage Wound Closure.

Background Mechanical skin stretching (SS) is now becoming one of the commonly sought after procedures for wound healing. This study was aimed to assess the efficacy of preoperative SS for the closure of large wounds and to evaluate various postoperative outcome parameters. Methodology An observational study was conducted from December 2017 to May 2019 where a sample size of 30 patients was included with inclusion criteria being wounds of ≥5 cm width that require surgical management, presence of sufficient healthy skin edge of the wound/scar (at least one) for the stretching procedure, and age between 18 and 70 years. SS devices used were the top closure tension relief system. Postoperatively, various parameters were recorded to evaluate outcomes and complications. Results Majority of wounds that is 16 (53.3%) were <50 cm 2 , 9 (30%) were between 50 and 75 cm 2 , and 5 (16.7%) were >75 cm 2 . The mean duration of stretch was 2.3 ± 0.82 weeks. For 30 wounds treated with staged cycles of wound closure, there was a significant difference between every two visit points, i.e., 10%. The mean patient-reported patient and observer scar assessment scale score was 3.5 ± 0.93. Twenty-five cases (83.3%) had uneventful postoperative recovery. Twenty-seven patients (90%) reported an improved aesthetic outcome. Fourteen patients (46.7%) reported some improvement in function. Conclusion The study concluded that the SS devices are the simple and effective method for the primary closure of large and challenging wounds and skin defects.

Surface Modified Activated Carbons: Sustainable Bio-Based Materials for Environmental Remediation.

Global warming and water/air contamination caused by human activities are major challenges in environmental pollution and climate change. The improper discharge of a large amount of agro-forest byproduct is accelerating these issues mainly in developing countries. The burning of agricultural byproducts causes global warming, whereas their improper waste management causes water/air pollution. The conversion of these waste materials into effective smart materials can be considered as a promising strategy in waste management and environmental remediation. Over the past decades, activated carbons (ACs) have been prepared from various agricultural wastes and extensively used as adsorbents. The adsorption capacity of ACs is linked to a well-developed porous structure, large specific surface area, and rich surface functional moieties. Activated carbon needs to increase their adsorption capacity, especially for specific adsorbates, making them suitable for specific applications, and this is possible by surface modifications of their surface chemistry. The modifications of surface chemistry involve the introduction of surface functional groups which can be carried out by various methods such as acid treatment, alkaline treatment, impregnation, ozone treatment, plasma treatment, and so on. Depending on the treatment methods, surface modification mainly affects surface chemistry. In this review, we summarized several modification methods for agricultural-waste-based ACs. In addition, the applications of AC for the adsorption of various pollutants are highlighted.

Postauricular Tubed Flap in the Reconstruction of Auricular Margin Defects: Revisited.

Background Reconstruction of the auricular margin defects is challenging due to the ear's intricate architecture. Tubed flap raised from the postauricular area is a simple and reliable option for reconstructing marginal defects. Methods Eight patients with various auricular margin defects were reconstructed, using a postauricular tubed flap in a staged manner. Parameters like flap survival, reliability, complications, and cosmesis were assessed. Results Out of eight patients, one patient had marginal necrosis, which was managed with debridement and lengthening of the flap. All the flaps settled well with a good aesthetic outcome. Conclusion Postauricular tubed flap is a reliable and efficient method for reconstructing auricular margin defects.

Decoration of Zinc Oxide Nanorods into the Surface of Activated Carbon Obtained from Agricultural Waste for Effective Removal of Methylene Blue Dye.

Zinc oxide (ZnO) nanorods incorporated activated carbon (AC) composite photocatalyst was synthesized using a hydrothermal process. The AC was prepared from lapsi (Choerospondias axillaris) seed stone, an agricultural waste product, found in Nepal by the chemical activation method. An aqueous suspension of AC with ZnO precursor was subjected to the hydrothermal treatment at 140 °C for 2 h to decorate ZnO rods into the surface of AC. As-obtained ZnO nanorods decorated activated carbon (ZnO/AC) photocatalyst was characterized by various techniques, such as scanning electron microscopy (SEM), X-ray diffraction (XRD), and photoluminescence (PL) spectroscopy. Results showed that highly crystalline hexagonal ZnO nanorods were effectively grown on the surface of porous AC. The photocatalytic property of the as-prepared ZnO/AC composite was studied by degrading methylene blue (MB) dye under UV-light irradiation. The ZnO/AC composite showed better photocatalytic property than that of the pristine ZnO nanorods. The enhanced photocatalytic performance in the case of the ZnO/AC composite is attributed to the combined effects of ZnO nanorods and AC.

Textiles wastewater treatment technology: A review.

The following is a review of published literature on textile wastewater in 2019. Presented are the sections described for the review: concise introduction on the textiles wastewater, followed by a review of present textile treatment technologies organized by physicochemical, biological, and combined processes. Lastly, a discussion of the future topics is presented. PRACTITIONER POINTS: The discharge of textile dye wastewater represents a serious environmental problem and public health concern. Effluents from textile manufacturing, dyeing, and finishing processes contain high-concentration recalcitrant chemicals that are resistant to biodegradation. The textile wastewater needs environmental-friendly and cost-effective combined treatment process.

Fate of environmental pollutants: A review.

A review of the literature published in 2019 on topics associated with the fate of environmental pollutants is presented. Environmental pollutants covered include pharmaceuticals, antibiotic-resistant bacteria and genes, pesticides and veterinary medicines, personal care products and emerging pollutants, PFAS, microplastics, nanomaterials, heavy metals and radionuclides, nutrients, pathogens and indicator organisms, and oil and hydrocarbons. For each pollutant, the occurrence in the environment and/or their fate in engineered as well as natural systems in matrices including water, soil, wastewater, stormwater, runoff, and/or manure is presented based on the published literature. The review includes current developments in understanding pollutants in natural and engineered systems, and relevant physico-chemical processes, as well as biological processes.

Monitoring, sampling, and automated analysis.

A review of the literature published in 2018 on topics related to monitoring, sampling, and automated analysis is presented. The review includes current developments in monitoring, sampling, and analysis of water, wastewater, and groundwater. This review includes the following sections: brief introduction; sample preparation and extraction techniques; real-time, high-frequency, and/or in situ monitoring (microbiological, inorganic, organic, metals, and others); passive monitoring; and the biosensors. In the end, the authors have discussed future of the topic. PRACTITIONER POINTS: Advances in monitoring, sampling and automated analysis of water and wastewater are summarized. Real-time, high-frequency, and in-situ monitoring and analysis of pollutants are summarized. Topics include sample preparation and extraction and passive monitoring, and biosensors for pollutants.

Experience with various reconstructive techniques for meningomyelocele defect closure in India.

BACKGROUND: The estimated incidence of spina bifida is 1-2 cases per 1000 population. In earlier literature, the global prevalence of meningomyelocele (MMC) is reported as 0.8-1.0 per 1000 live births. This retrospective study analyses the outcome of various surgical procedures performed for the closure of MMC defects. METHOD: A total of 22 patients with MMC defects who underwent repair at our institute from July 2016 to August 2018 were included in the study. A retrospective review of all the cases operated was completed to analyse patient demography including defect size, defect location, surgical procedures, complications and the final outcome. RESULTS: Out of 22 cases, wherein the neurosurgery department sought help from the plastic surgery department, 11 defects were closed using the Limberg flap technique, 4 defects were closed with either primary closure or the double flap rotation flaps, one defect was closed using the triple rotation flap and 2 defects were closed using the local transposition flap cover technique. Complications were noted in only three cases. One patient had a local wound infection, while in two other cases, wound dehiscence was observed. All 3 cases were managed conservatively. On average, it takes approximately 70 days in India to close such defects. CONCLUSION: MMC defects can be effectively managed with local flap options such as Limberg flap, local transposition flap or rotation flaps. Various reasons for the delay in closure were reported in patients late to our centre, when the first point of contact was with other departments.

Textiles Wastewater Treatment.

A review of the literature published in 2017 on topics related to textiles wastewater treatment is presented. This review includes the following sections: brief introduction of textiles wastewater treatment, review of current treatment technologies categorized into physicochemical, biological, and combined processes. In the end, the authors have discussed future of the topic.

High-Flow Vascular Malformation of Ear: A Case Report.

Vascular anomalies are categorized into vascular tumours or vascular malformations on the basis of clinical features and histopathology. The literature regarding high flow arteriovenous malformations of the auricle is rare. A case of a patient clinically diagnosed with an arteriovenous malformation of the external ear and was managed with preoperative embolization, surgical excision and reconstruction of ear with split thickness skin graft, is presented. The pathogenesis, clinical presentation, diagnostic work up, radiological intervention and management options regarding arteriovenous malformations are discussed. Total cure is an illusion and rarely achieved in high flow high grade vascular malformation with nearly 98% recurrence reported in 5 years. Patient followed for next 3 months with no evidence of recurrence.

Intraoperative partial pressure of oxygen measurement to predict flap survival.

INTRODUCTION: Flap monitoring using partial pressure of oxygen (pO2) is a proven modality. Instruments needed are expensive and are not readily available to a clinician. Here, pO2 of flap has been determined using readily available and cheap methods, and a cut-off value is calculated which helps in predicting flap outcome. METHODS AND RESULTS: Total 235 points on 84 skin flaps were studied. Capillary blood was collected from flap and fingertip using 1-ml syringes after at least 30 min of flap inset, and pO2 analysed using blood gas analyser. Fall/change of pO2 (difference of mean of pO2 [diff-pO2]) was also calculated by subtracting the flap pO2 from the finger pO2. Flap was monitored clinically in post-operative period and divided into two groups depending on its survival with Group 1 - dead points and Group 2 - alive points. pO2 and diff-pO2 amongst both the groups were compared and found to be statistically different (P = 0.0001). Cut-off value calculated for pO2 was found to be <86.3 mmHg with a sensitivity of 100% and specificity of 89.05%. The difference of >68.503 mmHg of flap pO2 compared from finger pO2 was calculated as a cut-off with sensitivity of 94.12 and specificity of 79.60%. CONCLUSIONS: Flap areas having intra-operative pO2 value <86.3 mmHG have higher chances (60.71%) of getting necrosis later. Similarly, if diff-pO2 compared to fingertip is >68.5 mmHg, chances of those points getting necrosed in post-operative period are high.

An algorithmic approach to posttraumatic nail deformities based on anatomical classification.

BACKGROUND AND AIMS: Most of the clinical series on posttraumatic nail deformities (PTNDs) address an individual deformity and its correction. The aim of the study was to classify PTND on the basis of its anatomical defect, devise the reconstructive modality and propose an algorithmic approach to PTND. We have also analysed our results of surgical correction and compared the data with the published literature. METHOD: A 5-year retrospective study of 45 patients with PTND was conducted. The deformities were classified into three groups: intact nail bed, partially amputated nail bed and completely amputated nail bed on the basis of the remnant nail bed. RESULTS: PTNDs with intact nail bed were present in 78%, with partially amputated nail bed in 16% and with completely amputated nail bed in 7% of the patients. Deformities in intact nail bed group were nonadherence (33%), ridged nail (31%), split nail (9%) and nail horn (4%). All patients with partially amputated nail bed presented with hooked nail deformity. A satisfactory result was seen in 87% of nonadherence, 71% of ridged nail, 50% of split nail and 57% of hooked nail. None of the patients with nail horn and absent nail showed a satisfactory result. CONCLUSION: PTND with intact nail bed are consistently benefitted when the option is only split-thickness sterile matrix (STSM) grafting. Appreciable correction of hooked nail deformity can be achieved by the reconstruction of lost components. In our opinion, there is no role of split-thickness germinal matrix (STGM) and STSM graft transfer in total nail reconstruction. LEVEL OF EVIDENCE: III.

Spatial multiobjective optimization of agricultural conservation practices using a SWAT model and an evolutionary algorithm.

Finding the cost-efficient (i.e., lowest-cost) ways of targeting conservation practice investments for the achievement of specific water quality goals across the landscape is of primary importance in watershed management. Traditional economics methods of finding the lowest-cost solution in the watershed context (e.g.,(5,12,20)) assume that off-site impacts can be accurately described as a proportion of on-site pollution generated. Such approaches are unlikely to be representative of the actual pollution process in a watershed, where the impacts of polluting sources are often determined by complex biophysical processes. The use of modern physically-based, spatially distributed hydrologic simulation models allows for a greater degree of realism in terms of process representation but requires a development of a simulation-optimization framework where the model becomes an integral part of optimization. Evolutionary algorithms appear to be a particularly useful optimization tool, able to deal with the combinatorial nature of a watershed simulation-optimization problem and allowing the use of the full water quality model. Evolutionary algorithms treat a particular spatial allocation of conservation practices in a watershed as a candidate solution and utilize sets (populations) of candidate solutions iteratively applying stochastic operators of selection, recombination, and mutation to find improvements with respect to the optimization objectives. The optimization objectives in this case are to minimize nonpoint-source pollution in the watershed, simultaneously minimizing the cost of conservation practices. A recent and expanding set of research is attempting to use similar methods and integrates water quality models with broadly defined evolutionary optimization methods(3,4,9,10,13-15,17-19,22,23,25). In this application, we demonstrate a program which follows Rabotyagov et al.'s approach and integrates a modern and commonly used SWAT water quality model(7) with a multiobjective evolutionary algorithm SPEA2(26), and user-specified set of conservation practices and their costs to search for the complete tradeoff frontiers between costs of conservation practices and user-specified water quality objectives. The frontiers quantify the tradeoffs faced by the watershed managers by presenting the full range of costs associated with various water quality improvement goals. The program allows for a selection of watershed configurations achieving specified water quality improvement goals and a production of maps of optimized placement of conservation practices.

Potential water quality changes due to corn expansion in the Upper Mississippi River Basin.

While biofuels may yield renewable fuel benefits, there could be downsides in terms of water quality and other environmental stressors, particularly if corn is relied upon exclusively as the feedstock. The consequences of increased corn production will depend importantly on where (and how) the additional corn is grown, which, in turn, depends on the characteristics of land and its associated profitability. Previous work has relied on rules of thumb for allocating land to increased acreage based on historical land use or other heuristics. Here, we advance our understanding of these phenomena by describing a modeling system that links an economics-driven land use model with a watershed-based water quality model for the Upper Mississippi River Basin (UMRB). This modeling system is used to assess the water quality changes due to increased corn acreage, which is associated with higher relative corn prices. We focus on six scenarios based on six realistic pairs of corn and soybean prices which correspond to a scale of decreasing soybean to corn price ratio. These price-driven land use changes provide estimates of the water quality effects that current biofuel policies may have in the UMRB. Our analysis can help evaluate the costs and environmental consequences associated with implementation strategies for the biofuel mandates of the new energy bill. The amounts of total N and P delivered to the outlet of the UMRB (located at Grafton, Illinois, USA) rise as corn production becomes more intensive in the region. Our results indicate that a 14.4% in corn acreage in the watershed due to corn intensification in the most economically profitable locations would result in a 5.4% increase in total nitrogen loads and in a 4.1% increase in total phosphorus loads at Grafton. Our most aggressive scenario, driven by high but not out of reach crop prices, results in about a 57% increase in corn acreage with a corresponding 18.5% increase in N and 12% increase in P. These are somewhat conservative increases in nutrients, compared to those of previous studies, likely due to our focus on cultivated cropland which is already heavily fertilized.

Dormant primary cutaneous actinomycosis: Acute exacerbation after 16 years.

Actinomycosis of head and neck are secondary to a nidus in the oral cavity and the aero-digestive tract. Primary actinomycosis without such predisposition is mostly due to trauma. We are presenting a case of this rare variant involving the forehead. The patient had a swelling over the forehead after a windscreen injury, which was asymptomatic for 17 years. However, 1 year ago, there was a repeat blunt trauma on the same site, but there was no breach of skin. Following this, the swelling became tender and started increasing in size. There was no response to a course of antibiotic and the patient had no concomitant history of any systemic illness. The swelling was excised and the biopsy revealed actinomycosis. This presentation of primary actinomycosis after such a long dormancy has never been reported before. This is yet another unusual presentation of actinomycosis, which is notoriously misdiagnosed owing to its rarity and numerous differential diagnoses.

Risk analysis of seasonal stream water quality management.

Seasonal discharge programs, which take advantage of temporal variation of stream assimilative capacity, are cost effective. However, these seasonal discharge control programs should not increase the risk of water quality violations. A method is presented to estimate the allowable pollutant loads under both seasonal and non-seasonal discharge control programs for a single discharger that maintains the same level of risk of water quality violation. An enhanced in-stream water quality model QUAL2E-UNCAS was applied to a 39-km river reach of the Des Moines River below Des Moines Sewage Treatment Plant (DMSTP) in Iowa. The model was calibrated for dissolved oxygen (DO), biological oxygen demand (BOD), and ammonia as nitrogen with standard errors of 10, 17, and 23% by comparing with the observed water quality data. Monte-Carlo simulation technique was then implemented for seasonal and non-seasonal discharge program to assess the water quality violation risk and the allowable pollutant load. The results indicated that the four-seasonal program offers about 136% increase in BOD loading and 61% increase in ammonia loading when compared with the non-seasonal program without any increase in the violation probabilities, whereas the two-seasonal program only offers 13% decrease in BOD loading and 56% increase in ammonia loading. It is found that the multi-discharge program was beneficial for both water quality indicators, and thus provides a way of reducing the overall cost of waste treatment.

Least-cost control of agricultural nutrient contributions to the Gulf of Mexico hypoxic zone.

In 2008, the hypoxic zone in the Gulf of Mexico, measuring 20 720 km2, was one of the two largest reported since measurement of the zone began in 1985. The extent of the hypoxic zone is related to nitrogen and phosphorous loadings originating on agricultural fields in the upper Midwest. This study combines the tools of evolutionary computation with a water quality model and cost data to develop a trade-off frontier for the Upper Mississippi River Basin specifying the least cost of achieving nutrient reductions and the location of the agricultural conservation practices needed. The frontier allows policymakers and stakeholders to explicitly see the trade-offs between cost and nutrient reductions. For example, the cost of reducing annual nitrate-N loadings by 30% is estimated to be US$1.4 billion/year, with a concomitant 36% reduction in P and the cost of reducing annual P loadings by 30% is estimated to be US$370 million/year, with a concomitant 9% reduction in nitrate-N.

Port retrieval for salvage of tissue expansion in case of lost or malfunctioning port.

Tissue expansion though a promising modality of reconstructive surgery is fraught with many complications. In addition to expander-related complications, subcutaneous port-related mishaps during tissue expansion, though infrequent, can result in procedure failures. We are reporting two patients with port-related complications. In one patient, there was failure to localise the port and the other had a leaking port. Both the expanders were salvaged by retrieving the ports. In the former, as the port was competent, it was simply exteriorised. But in the later case, the connecting tube was retrieved and the incompetent port was replaced with a Luer lock external port. Both the cases were successfully salvaged without any further complications. Expansions were completed and requisite reconstructive end points were achieved.