The lips represent an important role in social life as they are used to ease phonetic articulation, complement the aesthetical structure of the face and, they serve as a means of giving nutrients to the body. In certain cultures, they are crucial external signs of femininity and serve different purposes. Given the complex functions of these structures, reconstruction of labial defects presents a challenge for plastic surgeons not only in the management of tumor pathologies, but also in cases of emergency post-traumatic amputations. In the present study, we shall describe a case of labial reconstruction using a tongue flap after a post-traumatic loss of tissue in the vermilion border. The surgical reconstruction technique will be discussed and then, we will present an overview of the constraints related to the treatment of the flap and finally the initial outcome of the procedures.

Background: Tear of the abductor mechanism is a well-known problem. Most of the published studies in that regard comes from the sport literature but little have been published about it in the THA settings. Abductor mechanism plays a crucial part in hip stability and limb gait hence an injury to it can lead to pain, weakness, and instability after THA. Objective: To review all studies reporting on abductor tear or insufficiency in Total Hip Arthroplasty and present the current state of literature on that. Methods: The Author completed an electronic database search of PubMed, EMBASE and PubMed Central to identify any studies reporting on Abductor mechanism and Total Hip Arthroplasty from the date of inception of the databases until August 2018. The author followed the PRISMA guidelines. The author extracted and summarized data from the identified studies. Only Studies published in the English literature and reported data on Abductor mechanism tear with THA were included. Results: 566 studies were identified. 32 studies met the inclusion criteria and were included in this review. Tear of hip abductor in THA were reported to be between 11-25%. It was more prevalent in women, older age population with no association to comorbidities. There is no clear evidence that the incidence of abductor weakness is higher in lateral than posterior approaches, contrary to the popular opinion. Surgical reconstruction techniques for chronic abductor insufficiency showed good results in the short-term regarding pain and function. Conclusions: Abductor mechanism tear after THA is a known complication that should be considered in patients with substantial lateral hip pain, limb and weak abduction following THA. Repair of the abductors can improve pain, function, and limb in three fourth of the patients specially if identified and repaired early. Promising results have been published for abductor reconstruction procedures for recurrent or chronic tears in short term follow-ups but still lack the long-term results.

The sudden outburst of the pandemic COVID-19, in 2019, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), had caught all by surprise, affected the entire world, and took the lives of many. This led to a desperate need for vaccines and India was one of the 11 countries that went ahead for the discovery of vaccines with manufacturing and export of the same. The first phase of vaccination was directed towards the frontline workers, including dentists, as they were at high risk. As vaccines have faced challenges in acceptability, there is a need to create awareness. The objectives are 1. Assess post-vaccination side-effects among dental professionals after both doses. 2. Assess any particular oral manifestations that can occur post-vaccination. The COVID vaccine was administered to all the healthcare workers of a private Dental College, Mysuru. The first dose was given in January, 28 days later the second dose was given. A questionnaire was developed and sent by email to be filled by those who were vaccinated to record and assess their experiences post-vaccination. A total of 141 responses were acquired and subjected to statistical analysis to evaluate their experiences and challenges. SPSS 22 was used for statistical analysis. The frequency, mean and mode were calculated of the acquired responses. We can conclude that in the absence of any co-morbidity and good immunity, the effects post-vaccination is mild, which can be subsided by taking appropriate symptomatic medications.

Purpose: To analyse demographic data, clinical presentation, intervention and management of Post COVID 19 Rhino- orbito-cerebral- mucormycosis (ROCM) thus improving the knowledge about the disease to provide timely and optimal care for favorable outcome. Method: A retrospective interventional study was conducted on 254 patients admitted in Mucor ward over a duration of 2 months (1st May 2021- 30th June 2021). Demographic data, detailed history, clinical parameters, diagnostic procedures, management and outcome were noted. Factors affecting outcome and mortality were analysed. Results: Mean age of presentation was 50.14 ±13.38 years with male preponderance (64.56%). 55.91% patients presented with ROCM symptoms within 14 days of onset of COVID -19 symptoms. 86% patients were diabetics, 76% had history of corticosteroid use and 27.55% received oxygen therapy. 40 % patients presented with orbital edema as primary symptom. Imaging revealed 28.34% patients had disease limited to the paranasal sinuses (PNS), 56.69% had orbit and PNS involvement and 12.99% had PNS, orbit and CNS involvement. All the patients were treated with Liposomal Amphotericin B and sinus debridement. Eighteen eyes underwent (7.08%) exenteration and 82 patients received Transcutaneous retrobulbar Amphotericin-B. At the time of discharge the final outcome of being alive and having stable disease was found to be significant in stage 2 patients with involvement of PNS and orbit. Conclusion: Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with Amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.

Cystic lymphangioma is a rare malformative congenital tumor of the lymphatic vessels. It is commonly seen in children and mainly occurs in the head and cervicothoracic region. Abdominal and especially retroperitoneal involvement is rare in adults. This tumor is often asymptomatic but it can be manifested by mass effect with polymorphic symptomatology depending on the location and size. Digestive haemorrhage due to retroperitoneal cystic lymphangioma with posterior duodenopancreatic infiltration in an elderly patient is an exceptional manifestation of a benign tumor. We report a case of retro-duodenopancreatic cystic lymphangioma revealed by gastrointestinal bleeding in a 65 year-old man who was treated by tumor resection with organ preservation. The recovery was complicated by a duodenal fistula with spontaneous dry-up within 17 days, the patient left the hospital in 3 weeks.

Background: Propofol is a commonly used intravenous (IV) induction agent. The induction dose of propofol is 1.5 to 2.5 mg/kg in healthy adults producing unconsciousness, depending upon concomitant medications (i.e. opoid analgesics), the patient’s age and physical status, and the extent of surgical stimulation. Objective: To assess the induction dose with ketamine and midazolam co-induction to propofola. Methods: This was a prospective, randomized, double-blind and interventional study conducted at Department of Anesthesiology, Sher-e-bangla Medical College Hospital, Barishal, Bangladesh from January to June 2019. Sixty adult patients undergoing elective surgery to be performed under general anesthesia were randomized to receive 0.3 mg/kg of Ketamine or 0.03 mg/ kg of Midazolam intravenously as co-induction agent. A minute after administration of co-induction agent, anesthesia was induced with Propofol 40 mg bolus then 10 mg every 10 seconds until the loss of verbal response. The hemodynamic response at 0, 1, 2, 5 minutes respectively and the induction dose of Propofol were noted. Results: The mean arterial pressure heart rates were significantly lower at 1, 2 and 5 minutes in midazolam group. However, mean arterial pressure and heart were within the physiological range in both the groups. Propofol dose requirement for induction between the two groups was similar (p>0.05) but co-induction significantly decreased the induction dose of Propofol as compared to standard recommended dose for induction. Conclusion: Our study showed that hemodynamic variables were maintained within the physiological range with midazolam and ketamine co-induction. However, lesser degree of decrease in mean arterial pressure was seen with ketamine but the heart rate was higher. A similar reduction of induction dose of propofol was achieved with both the drugs.

Introduction: Continuing medical education (CME) is the process through which health professionals engage in activities designed to support their continuing professional development. It is a requirement for physician relicensing, and recredentialing. Existing literature shows that CME improves physician performance as well as patient health outcomes. It is incumbent to study the experiences and attitudes of physicians towards CME activities in view of the impact of CME on the professional development. Purpose: To describe experiences and perceptions of CME activities among primary care physicians in Bahrain. Materials and Methods: A cross-sectional study that included all registered primary health care physicians in the ministry of health in Bahrain. Data was collected using self-administered online survey distributed to 350 primary care physicians in Bahrain. The five-point Likert scale questionnaire is composed of five sections: socio-demographic data, participant`s experiences with CME, Reasons for attending CME activities, barriers to attending CME activities and benefits of CME in relation to different delivery methods. Results: Total responses were 210 (60% response rate). The mean age of respondents was 40.8(SD 8.9) and the majority (84.4%) were female. Most of the CMEs were in the form of lectures (88.6%), interdepartmental activities (80.5%) and conferences (78.1%). Driving forces for CME were for credentialing /licensing (92.9%), develop clinical competencies (92.9%), improve clinical services/programs (95.2%) and to introduce new technology/techniques (88.6%). Regarding barriers encountered, financial support was the most encountered (mean 4.11 (SD 0.92)), followed by lack of time (mean 4.05 (SD 1.07)). Conclusion: Despite the barriers encountered, Bahraini physicians had a positive experience and attitude toward undertaking CME. There is a need for financial support and protected time to attend CME activities as well as further studies to explore how best these challenges could be managed and solved.

Background: There are many types of arthritis, but osteoarthritis (OA) is one of the most frequent. IA injections of corticosteroids into the knee joint may improve pain and impairment by relieving joint inflammation. Purpose: To evaluate the effectiveness and safety of hylastan, a novel viscosupplements, with a single intra-articular corticosteroid injection in the treatment of knee osteoarthritis pain (OA). Because of its large molecular weight, the sodium hyaluronate in Hylastan is more likely to stay in the joint for an extended period of time than other viscosupplements. Methods: Multicentered based randomized quasi-experimental comparative study was performed in Shah Mokhdum Medical College, Rajshahi, Bangladesh, from January 2019 to December 2021. Enrolled patients aged ≥40 years. Patients were randomized 1:1:1 to one of three arms: 2 X 4 mL hylastan (n = 129; arthrocentesis then IA hylastan Day 0, same treatment Week 2); 1 X 4 mL hylastan (n = 130; arthrocentesis then IA hylastan Day 0, arthrocentesis only Week 2); steroid (n = 132; arthrocentesis then IA methylprednisolone acetate 40 mg Day 0, arthrocentesis only Week 2). The primary clinical outcome measure was changed from baseline in WOMAC A pain score overall postbaseline visits to Week 26. Results: Statistically significant pain reduction was observed in all three arms, with similar mean (95 % CI) changes in WOMAC A: 2 X 4 mL hylastan -0.9 (-1.0, -0.7); 1 X 4 mL hylastan -0.8 (-0.9, -0.7); steroid -0.9 (-1.0, -0.8); all p < 0.0001 versus baseline. Changes in secondary outcomes were similar in all three arms. Target knee adverse events were comparable for all treatments. Conclusions: An acceptable safety profile and effective pain relief were found with both IA hylastan injection regimens. The hypothesis of better pain relief with IA hylastan was not met compared to IA corticosteroid. The effectiveness and safety of hylastan compared to other viscosupplements require more investigation. Level of evidence Therapeutic study, Level I.

Ovarian vein thrombosis is a rare pathology, which can be encountered postpartum or postabortum. Its severity is linked to the risk of extension to the vena cava and therefore to the resulting risk of pulmonary embolism. Its diagnosis remains difficult due to the existence of misleading signs, but is currently facilitated by new imaging data: ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). The treatment is mainly medical, combining heparin therapy and antibiotic therapy, surgery being reserved for complicated forms. We report a case of postpartum ovarian thrombosis at the Suissi maternity hospital in Rabat in a woman with a sparkling picture of appendicitis.