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To determine the incidence of nasolacrimal duct injury after functional endoscopic sinus surgery radiologically, using computed tomography.
Fifty patients of either sex who underwent functional endoscopic sinus surgery were evaluated for nasolacrimal duct injury by computed tomography. Computed tomography was conducted pre-operatively, and post-operatively at the end of four weeks, and nasolacrimal duct injury was analysed.
The prevalence of nasolacrimal duct injury dehiscence was 1.16 per cent, with a similar incidence of 1.16 per cent for nasolacrimal duct injury post-operatively. However, no cases of symptomatic nasolacrimal duct injury were recorded.
Computed tomography scan is an effective, non-invasive method to evaluate nasolacrimal duct injury following functional endoscopic sinus surgery, in accordance with evidence-based medicine.
The ENT run through pilot was introduced in 2018 to improve early recruitment to the specialty. This study aimed to understand what makes a successful interview applicant and the experience of the run through trainees during the specialty trainee one and specialty trainee two years.
A questionnaire survey was sent to all ENT run through trainees.
Twenty-three trainees responded. Of the successful candidates, 74 per cent held additional degrees prior to application. The median core surgical interview rank was 27 (range: 3–174). Trainees felt that being on the run through pilot had increased ENT trainer engagement.
The ENT run through posts are highly competitive, and holding an additional degree may improve applicant success. The pilot programme has been successful by increasing trainer engagement at this critical stage of training. These results will enable development of the pilot programme and provide valuable information for those applying to an ENT run through post.
This study investigated the impact of the Webinar on deep human learning of CHD.
Materials and methods:
This cross-sectional survey design study used an open and closed-ended questionnaire to assess the impact of the Webinar on deep learning of topical areas within the management of the post-operative tetralogy of Fallot patients. This was a quantitative research methodology using descriptive statistical analyses with a sequential explanatory design.
One thousand-three-hundred and seventy-four participants from 100 countries on 6 continents joined the Webinar, 557 (40%) of whom completed the questionnaire. Over 70% of participants reported that they “agreed” or “strongly agreed” that the Webinar format promoted deep learning for each of the topics compared to other standard learning methods (textbook and journal learning). Two-thirds expressed a preference for attending a Webinar rather than an international conference. Over 80% of participants highlighted significant barriers to attending conferences including cost (79%), distance to travel (49%), time commitment (51%), and family commitments (35%). Strengths of the Webinar included expertise, concise high-quality presentations often discussing contentious issues, and the platform quality. The main weakness was a limited time for questions. Just over 53% expressed a concern for the carbon footprint involved in attending conferences and preferred to attend a Webinar.
E-learning Webinars represent a disruptive innovation, which promotes deep learning, greater multidisciplinary participation, and greater attendee satisfaction with fewer barriers to participation. Although Webinars will never fully replace conferences, a hybrid approach may reduce the need for conferencing, reduce carbon footprint. and promote a “sustainable academia”.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
Crenidens macracanthus was originally described in 1874 based on a single specimen collected from Chennai (Madras), south-east coast of India. In 1875, the species was synonymized with C. indicus without citing any valid reason. Since then, no taxonomic studies have been attempted for the genus Crenidens, except in 2013 the species was resurrected from synonymy and redescribed as a valid species based on the holotype and non-type specimen. In view of the fact that C. macracanthus is a poorly known species, it is redescribed based on examination of 30 additional specimens of 105.8–162.2 mm SL, collected from Puri, Odisha, north-east coast of India (Bay of Bengal) from 2017–2019, using morphological and molecular examinations. Our study provides a detailed morphological description, first colour photographs and phylogenetic analysis using COI barcodes of the species. The study has expanded the range in several morpho-meristic characters in comparison with the type and non-type specimens described earlier. The species in fresh condition can be easily distinguished from its two congeners (C. crenidens and C. indicus) by the yellowish tip of the lower caudal-fin lobe. Our study has also extended the distribution range of C. indicus (previously known only from the north-eastern Arabian Sea) to the eastern Indian Ocean, based on examination of a preserved specimen collected from Tuticorin, Tamil Nadu.
To determine the radiological prevalence of frontal cells according to the International Frontal Sinus Anatomy Classification in patients undergoing computed tomography of the paranasal sinuses for clinical symptoms of chronic rhinosinusitis, and to examine the association between cell classification and frontal sinusitis development.
A total of 180 (left and right) sides of 90 patients were analysed. The prevalence of each International Frontal Sinus Anatomy Classification cell was assessed. Logistic regression analysis was used to compare the distribution of various cells in patients with and without frontal sinusitis.
The agger nasi cell was the most commonly occurring cell, seen in 95.5 per cent of patients. The prevalence rates for supra agger cells, supra agger frontal cells, supra bullar frontal cells, supra bullar cells, supra-orbital ethmoid cells and frontal septal cells were 33.3 per cent, 22.2 per cent, 21.1 per cent, 36.1 per cent, 39.4 per cent and 21.1 per cent, respectively. There was no significant difference in the occurrence of any of the cell types in patients with frontal sinusitis compared to those without (p > 0.05).
The presence of any of the International Frontal Sinus Anatomy Classification cells was not significantly associated with frontal sinusitis.
We report an approach to expand the effective number of pixels available to small, two-dimensional electron detectors. To do so, we acquire subsections of a diffraction pattern that are then accurately stitched together in post-processing. Using an electron microscopy pixel array detector (EMPAD) that has only 128 × 128 pixels, we show that the field of view can be expanded while achieving high reciprocal-space sampling. Further, we highlight the need to properly account for the detector position (rotation) and the non-orthonormal diffraction shift axes to achieve an accurate reconstruction. Applying the method, we provide examples of spot and convergent beam diffraction patterns acquired with a pixelated detector.
ENT surgeons are likely to be at high risk of coronavirus disease 2019 exposure.
A national registry of UK ENT surgeons with suspected or confirmed coronavirus disease 2019 was created with the support of ENT UK. Voluntary entry was made by either the affected individual or a colleague, using a web-based platform.
A four-month data collection period is reported, comprising 73 individuals. Coronavirus disease 2019 was test-confirmed in 35 respondents (47.9 per cent). There was a need for hospitalisation in two cases (2.7 per cent) and tragically one individual died. Symptom onset peaked in March. The majority suspected their exposure to have been in the workplace, with a significant proportion attributing their disease to a lack of personal protective equipment at a time before formal guidance had been introduced.
The registry suggests that a significant number of ENT clinicians in the UK have contracted coronavirus disease 2019, and supports the need for tailored personal protective equipment guidance and service planning.
The practice of psychiatry throws multitude of ethical challenges and dilemmas for a clinician in making decisions. Historically, doctors follow the well-established principles of medical ethics – namely justice, autonomy, beneficience and non-maleficience in medical practice. Along with these, clinical practice in psychiatry in England and Wales is governed by the principles outlined in the Mental Health Act 1983.
Whilst general ethical guidances are available as principles mentioned above, there are no clear directives in a complex clinical presentation when the various principles are in conflict themselves. Example, it is difficult to assess whether autonomy takes precedence over beneficience or vice versa when they are in conflict. In such cases, clinicians are left to exercise their own judgment.
We undertook a literature search to look for instances of published cases about hierarchy in different principles of medical ethics in the context of complex clinical presentations in psychiatry that pose conflict in the aforementioned principles. The results are outlined. We illustrate this in relation to a complex clinical presentation we came across in our practice that deals with detention, capacity and consent. The case exemplifies conflict is different ethical principles.
Psychiatric practice is complex without set rule. No clear consensus exists in the application of ethical principles specifically when they appear to be conflict. It is imperative there is a debate to agree on a hierarchy of ethical principles such that practitioners bias and prejudices are not brought in to practice in times of ethical conflicts.
The objective of this study was to investigate protective potential of 17β estradiol (E2) treatment on the activity of monoamine oxidase, calcium homeostasis, membrane polarization, genomic DNA degradation, 4- hydroxynonenal and protein oxidation levels occurring in brains of female rats of 3 months (young), 12 months (adult) and 24 months (old) age groups, and to see whether these changes are restored to normal levels after exogenous administration of estradiol.
The aged rats (12 and 24 months old) (n= 8 for each group) were given subcutaneous injection of 17b-estradiol (0.1 μg/g body weight) daily for one month. After 30 days of hormone treatment, experimental animals of all the groups were sacrificed and brains were isolated for further study.
The results obtained in the present work revealed that normal aging was associated with significant increases in the activity of monoamine oxidase, calcium homeostasis, genomic DNA degradation, 4- hydroxynonenal and protein oxidation levels in the brains of aging female rats, and a decrease in membrane polarization. Our data showed that exogenous administration of E2 brought these changes to near normalcy in aging female rats.
It can therefore be concluded that E2's beneficial effects seemed to arise from its, antioxidant and antilipidperoxidative effects, implying a therapeutic potential drug for age related changes. Based on our studies and others, we conclude that E2 have therapeutic potential for adjunctive therapy along with dopamine replacement in Parkinson's disease.
To examine the gene expression in rat’s brain, treated by non-ionizing electromagnetic radiation from 900MHz-GSM mobile phone.
As studies supported electromagnetic radiation may cause membrane leakage due to loss of calcium. Membrane leakage of lysosomes release. Damage to DNA is a fundamental mechanism for developing tumors and cancer when DNA damage exceeds the rate of DNA repair. DNA damage in brain cells can affect neurological functions.
We investigated whether an exposure of GSM-900 MHz irradiation from the Mobile Phone (3hours/day up to 28 days) could lead to the modulation of gene expression pattern in the rat brain. All rats were habitualised for one week prior to start the experiment in well designed circular mobile phone exposure (CCPE) cage. In the cage, mobile phone was placed in the center and rats were allowed to move around the device within 10 cm. radius. After 28 days, mRNA from the brain of control, sham and GSM-900 MHz exposed rats were isolated and subjected to qRT-PCR array analysis. Gene expression was measured and expressed in fold change. The qRT-PCR was performed by using Sybr green chemistry on ABI 7900HT platform.
There was no significant change in expressions of genes involved in DNA damage and repair pathways such as chromatin assembly (CHAF1A), DNA damage checkpoints (Chk1), DNA synthesis (POLD1), post-transcriptional processes (RBM4), translation synthesis (POLI) and stress signaling (Hsp90) as compared with controls.
Mobile phone’s acute exposure does not support for genes expression involved in DNA damage and repair pathways.
In the UK, blood investigations ordered by the Mental Health Trust are usually carried out by Acute hospitals. The results are not immediately accessible by the staff of Mental Health Trusts on the computer due to confidentiality and lack of shared software access between trusts. This has a significant impact on care management of psychiatric patients often resulting in delay in clinical decisions.
We encountered similar problem where the results of the tests ordered by the staff were not immediately accessible to them, as these investigations are carried out by the local acute hospital. To address this issue a project was chartered.
Of the project was to develop a protocol between the trusts so that the staff of Mental Health Trust could access the results of investigation on local computers as soon as they become available and to evaluate its impact on service.
A steering committee including Specialty Registrar, Pharmacist and Matron was constituted. The committee met regularly and evolved strategy with representatives of the Acute Trust. The main concern of the Acute Trust was patient confidentiality and software access. Following regular meetings and correspondence shared-protocol was developed.
It was agreed that the acute trust would install the software on all mental health trust computers. The staff would be trained to use the software and access results. To address the issue of confidentiality, flowchart of sponsorships of the shared-protocol was developed. Accordingly, all the medics would be sponsored for access by Medical Director, Nursing Staff by Matron and Pharmacists by Chief Pharmacist. This protocol ensured that all the staff trained are accounted and IT department could monitor any unauthorised access of data.
We have noticed a big improvement in the quality of clinical practice as a result. Unnecessary delays in clinical decisions have been avoided. We feel such a shared-protocol could be developed in other hospitals that are faced with similar access issues.
Schizophrenia is one of the psychotic mental disorders, characterized by social problems and disorders of thought, behaviour, motor and cognitive functions such as long-term memory, verbal memory, executive functioning and vigilance etc. However, the relation between structural and functional alterations in schizophrenia remains unclear. Therefore, the present study sought to investigate whether functional alterations in schizophrenia are also associated with structural brain aberrations directly in related brain regions or in anatomically closely connected areas.
The current study was conducted to investigate the possible relationship between functional and structural changes for a simple motor task in schizophrenics.
16 controls and 16 schizophrenic patients were chosen for the study. The structural and functional MRI scans were acquired using 3 Tesla whole-body MRI system with a 16 channel head array coil. For fMRI, a block paradigm with alternating blocks of motor task (right finger tapping; 120 taps/min) and rest was carried out. Pre-processing and post-processing of MRI scans were performed using SPM8 software.
The fMRI study showed relatively less activation in the left precentral and postcentral gyrus and right cerebellum in schizophrenic patients as compared to controls during finger tapping task. Voxel-based morphometry (VBM) revealed grey matter decreases in the left precentral and postcentral gyrus and left middle frontal gyrus while white matter decreases in the right cerebellum and right inferior temporal gyrus of schizophrenics as compared to controls.
The present study provides strong evidence for an association between motor functional deficits and structural alterations in schizophrenic patients as compared to controls.
Psychiatry is a multidisciplinary practice with professionals from diverse backgrounds and training contributing to holistic management plan. Despite, this long established model, and policy support to develop education consortia integral to service planing across, health and social care boundaries, there exists no regular model in modern day clinical practice to share knowledge, skills and expertise amongst different professional groups in a structured manner.
In this context, we developed a Combined Educational Activity (CEA) programme amongst various disciplines. Professionals including Nurses, Doctors, Occupational Therapists, Psychologists, Pharmacists and Support Workers were invited to meet once a fortnight during an extended hand over session of one hour to openly share their knowledge and expertise on complex clinical cases and other relevant topics in the fashion of clinical senate.
After three months a survey was undertaken – A Likert questionnaire was distributed amongst the attendees to collect feedback on the content, structure, utility and criticism of the programme. The results of the survey are outlined in detail.
It was perceived that the Combined Educational Activity (CEA) was effective in sharing knowledge and expertise between professionals and also to reduce negative prejudices against various disciplines and appreciate better each member’s contributions to the overall clinical care. There was overall positive feedback about the programme and each member felt valued for their contribution in their clinical role. Further, it also helped We feel replicating and refining this model across teams would be beneficial in overall clinical care and staff morale in multidisciplinary practice.