Is Gelfoam Necessary for Middle Ear Surgery: A Comparative Study of the Results of Tympanoplasty With and Without Gelfoam in the Middle Ear.

Absorbable gelatin sponge (Gelfoam) has been used for many years in middle ear surgeries. It not only provides support to the graft and ossicular reconstruction materials but also helps in haemostasis and aeration of the middle ear. Although gelfoam is generally well tolerated but fibrosis and granulations in the mesotympanum have been attributed to its usage in some studies. This study was conducted to compare the results of middle ear surgeries with and without gel foam in terms of both objective and subjective improvements of symptoms. To study the outcome of tympanoplasty with and without gel foam in the middle war by measuring following attributes (for measuring outcomes) at an intervals of 6 weeks, 12 weeks and 6 months after surgery. (a) Graft take up rate as evaluated by otoscopy. (b) Pre and post-operative hearing levels as measured on Pure Tone Audiogram. (c) Subjective improvement in symptoms of ear discharge, heaviness in ears, hearing loss and tinnitus. Study design-prospective clinical study. patients undergoing tympanoplasty type 1 between August 2018 to July 2019 were included in the study. Group A (n = 36) consisted of patients who underwent tympanoplasty with gel foam in the middle ear and Group B (n = 36) consisted of patients who underwent tympanoplasty without any gel foam inside the middle ear. The uptake of graft after tympanoplasty was almost similar in the patients using gelfoam (89%) and those without gelfoam (84%) at the end of 6 months. The improvement in the subjective symptoms of ear discharge and hearing loss at 6 weeks following the surgery was better in patients without gelfoam whereas, at the end of 6 months the improvement in these symptoms was similar in both the groups. The improvement in hearing 6 months following tympanoplasty as assessed by pure tone audiometry and was found to be the same in both the groups. Tympanoplasty can be performed safely without using any gelfoam in the ear. This not only makes patients comfortable early but also avoids any gelfoam induced fibrosis or granulations in the middle ear.

The Effectiveness of the Bilobed Pectoralis Major Myocutaneous Flap at a Tertiary Care Hospital: A Retrospective Analytical Study.

BACKGROUND: Cosmetic defects after the major orofacial disease corrections may have an effect on the overall well-being of the patient. Head-and-neck cosmetic surgeries after a major episode of oral cancer impact the functional ability of the individual in several ways. In general, two types of flap are used in reconstructive surgery: microvascular free flaps and regional pedicle flaps. In socioeconomically poor countries like India, bilobed pectoralis major myocutaneous (PMMC) flap has been seen as a mainstay in facial reconstructive surgeries. MATERIALS AND METHODS: The present study was conducted on 100 individuals with oral neoplasm who underwent resective surgery had a soft-tissue defect. All the complications that arose after reconstructive surgery were noted. Simple proportions were recorded. RESULTS: Majority of the individuals had the buccal mucosa as the common site of oral neoplasm, and the tumor nodes and metastases staging was I + II. One individual sustained total flap necrosis. Wound infection and dehiscence were the most common complications. CONCLUSIONS: PMMC is best proven for flap reconstruction in oral neoplasm cases. It is established to be effective with good acceptability and very few complications. Due to these reasons, in spite of the known advances in facial reconstructive surgeries, this technique is widely followed in developing countries.

A Qualitative Study of the Impact of COVID 19, on Health Care Providers for Cancer Patients: An Original Research.

INTRODUCTION: In the challenging times of the COVID-19, the care of individuals with the debilitating diseases such as cancers has been an additional burden to the medical team. We aim to find out about the obstacles for the clinical care of the patients in the COVID, the questions frequently asked by cancer patients, and the medical care and support teams' general experience in taking care of cancer patients during the times of the pandemic. MATERIALS AND METHODS: We conducted a Qualtrics survey that was developed by Cancer and Aging Research Group among 275 health care providers to cancer patients during. There were twenty questions in the survey. Of these 20, three open-ended questions were included that inquired about the barriers to the clinical care of cancer patients during COVID-19; the questions asked to the health care team by cancer patients or the attendants; health care teams general experience in the situations of the COVID-19. Two different reviewers performed the quality analysis for the open-ended questions after they were assigned a code. SPSS ver-23 was used for the descriptive statistics. RESULTS: Medical services organizational difficulties and addressing necessities and support were generally reported. Hindrances to the medical health teams included the included administrative difficulties, access of the patient to the support and basic resources, uncertainties for patients' psychological and physical well-being, and teleconsultation challenges. The most common concern of the patients was the safety and the need for the treatment. Medical health care teams were seen to worry for the mental and the physical health of cancer patient. There was also reported concern for the medical team's own safety, obstruction in multi-level establishments; also the health team was seen feeling positive leadership and communications. CONCLUSION: The medical health provider teams felt a need for thorough support at the organizational level for cancer patients. Medical teams were expected to comprehend the short-term and long-term impact of the COVID-19 on cancer patients. It was accepted that there has been an increased workload and mental stress among the providers. Appreciating the experiences of the medical teams during the pandemic may help in the future guidance in the care of cancer patients.

Impact of atrazine concentration on bioavailability and apparent isotope fractionation in Gram-negative Rhizobium sp. CX-Z.

Compound-specific stable isotope analysis of micropollutants has become an established method for the qualitative and quantitative assessment of biodegradation in the field. However, many of environmental factors may have an influence on the observed isotope fractionation. Herein, we investigate the impact of substrate concentration on the observed enrichment factor derived from Rayleigh plot of batch laboratory experiments conducted to measure the atrazine carbon isotope fractionation of Rhizobium sp. CX-Z subjected to the different initial concentration level of atrazine. The Rayleigh plot (changes in bulk concentration vs. isotopic composition) derived from batch experiments shown divergence from the linear relation towards the end of degradation, confirming bioavailability of atrazine changed along with the decay of substrate concentration, consequently, influenced the isotope fractionation and lowered the observed enrichment factor. When microbial degradation is coupled to a mass transfer step limiting the bioavailability of substrate, the observed enrichment factor displays a dependence on initial atrazine concentration. Observed enrichment factors (ε) (absolute value) derived from the low concentration (i.e. 9.5 µM) are below 3.5‰ to the value of -5.4‰ determined at high bioavailability (membrane-free cells). The observed enrichment factor depended significantly on the atrazine concentration, indicating the concentration level and the bioavailability of a substrate in realistic environments should be considered during the assessment of microbial degradation or in situ bioremediation based on compound-specific stable isotope analysis (CSIA) method.

Isotope fractionation in atrazine degradation reveals rate-limiting, energy-dependent transport across the cell membrane of gram-negative rhizobium sp. CX-Z.

In the biological mass transfer of organic contaminants like atrazine, the cellular membrane limits bioavailability of pesticides. We aimed to illustrate the roles of cellular membrane physiology and substrate uptake (e.g., passive diffusion and energy-dependent transport) on the limitations of bioavailability in atrazine biodegradation by Gram-negative strain Rhizobium sp. CX-Z. Compound-specific stable isotope analysis revealed energy-dependent transport across cellular membrane led to bioavailability limitations in atrazine biotransformation. Carbon isotope fractionation (ε(C) = -1.8 ±â€¯0.3‰) was observed and significantly smaller in atrazine biodegradation by Rhizobium sp. CX-Z than that expected in acid hydrolysis (ε(C) = -4.8 ±â€¯0.4‰) and hydrolysis by the pure enzyme TrzN (ε(C) = -5.0 ±â€¯0.2‰). However, isotope fractionation was restored in membrane-free cells of Rhizobium sp. CX-Z (ε(C) = -5.4 ±â€¯0.2‰) where no cellular membrane limits substrate uptake. When respiratory chain was inhibited by rotenone, the pseudo-first order kinetic rate constants (0.08 ±â€¯0.03 h-1, 0.09 ±â€¯0.03 h-1) was observed to be statistically less than in the control group (0.23 ±â€¯0.02 h-1, 0.33 ±â€¯0.02 h-1), demonstrating that energy-dependent transport dominated atrazine transfer across the cellular membrane. Therefore, our results revealed energy-dependent transport across cellular membrane existing in Gram-negative strain Rhizobium sp. CX-Z determines bioavailability of atrazine in biotransformation process even at high concentration.