St. Peter's Hospital

IntroductionDespite various recommended treatments, no effective therapy has been established for the satisfactory rehabilitation of subacute and chronic debilitating facial palsy. To address this, we evaluated the safety and efficacy of a novel therapeutic approach that combines repeated differential facial nerve blocks with facial nerve stimulation using a hypodermic needle.MethodsWe retrospectively reviewed 47 patients (acute, n = 4; subacute, n = 3; chronic, n = 40) who were treated at a private pain clinic between January 2017 and December 2023. Patients with persistent facial palsy who were unresponsive to conventional therapies underwent repeated sessions of bilateral facial nerve block following hypodermic needle stimulation of the facial nerves and branches. Facial function was assessed using the House–Brackmann and Sunnybrook grading systems.ResultsMore than 85% of patients showed significant improvements in facial symmetry and function. In the chronic group, Sunnybrook scores improved from 42 to 78 (P < 0.01), and House-Brackmann grades improved from IV–V to I–II. In the acute and subacute groups, both grading scores showed significant improvement. Transient bruising was noted as a minor adverse event, and the clinical improvement remained stable after treatment.ConclusionsOur novel integrative treatment is demonstrated to be a safe and effective option for treating intractable subacute and chronic facial palsy.

Emergency laparotomy is a life-saving intervention for acute abdominal conditions, yet its impact on patients' long-term quality of life (QOL) remains poorly understood. This systematic review synthesizes evidence on QOL outcomes following emergency laparotomy, with a focus on emergency medicine perspectives, including recovery trajectories, influencing factors, and implications for clinical practice. A comprehensive search of PubMed/Medline, Embase, Web of Science, and Scopus was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In total, 11 studies were included, encompassing prospectiveand retrospective cohorts, cross-sectional surveys, and one randomized controlled trial. The risk of bias was assessed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Narrative synthesis was performed due to heterogeneity in QOL measures. Key findings revealed significant variability in QOL recovery. Survivors of peritonitis without malignancy reported acceptable QOL, while cancer and advanced age predicted worse outcomes. Chronic pain affected 19-45% of patients, particularly after small bowel obstruction surgery, and was linked to long-term functional impairment. Laparoscopy improved QOL in elderly patients compared to laparotomy. Frailty and prolonged hospitalization were associated with declines in physical and social functioning. Patient-reported outcome measures were feasible in emergency settings but highlighted unmet needs in psychological and social recovery. Emergency laparotomy significantly impacts QOL, with recovery shaped by surgical approach, comorbidities, and postoperative pain. Standardized QOL assessment, integrated multidisciplinary care, and targeted rehabilitation are needed to optimize long-term outcomes. Future research should prioritize prospective studies with uniform QOL metrics to guide patient-centered interventions.

Background: Despite global progress in immunization, Nigeria continues to face challenges in achieving adequate vaccination coverage. This study examined the knowledge and practices of primary healthcare workers regarding routine childhood immunization in Osun State, where coverage exceeds national averages but remains below global targets. Methods: A descriptive cross-sectional study was conducted among 273 primary healthcare workers across 48 primary health centers in Osun State. Results: There was a significant disparity between the knowledge (86.5%) and practice of routine childhood immunization (40.6%). Key gaps included inadequate vaccine storage (with 59% failing to maintain temperature records) and inconsistent caregiver communication (only 53.7% consistently obtained consent). Training deficiencies were evident, with 12.3% of staff lacking pre-service immunization training and 60% not having received refresher training within the previous six months. Conclusions: These findings suggest that achieving better immunization outcomes requires more than just knowledge transfer. Health system strengthening should focus on improving cold chain infrastructure, implementing regular competency-based training, and strengthening supervision mechanisms. The study emphasizes the importance of ongoing support for healthcare workers to bridge the gap between knowledge and practice in routine immunization services.

Distributed in four areas of Africa (‘Eastern’—east of the Gregory Rift Valley from central Kenya south to Malawi; ‘Central’—west of the Gregory Rift from western Kenya and western Uganda south to Burundi and eastern Democratic Republic of Congo; ‘Western’—Nigeria and Cameroon plus Bioko; and Angola), Bar-tailed Trogon Apaloderma vittatum is at present widely judged to be monotypic. However, photographic evidence reveals three different facial patterns in these populations, with a bare ear spot and whitish-green bill in Eastern and Angolan birds, a bare ear spot, golden-yellow bill and bare gape line in Central birds, and these same features plus a distinct bare crescent above the eye in Western birds. Central and Western birds also have broader, more distinct barring on the wing panel. Moreover, there is a stepped cline in sizes in these three distinct populations, from Eastern plus Angola (largest) through Central to Western (smallest), with Bioko birds having notably short tails; and songs also decelerate from east to west, but with too much overlap to be diagnosable. Nevertheless, under the Tobias criteria the morphological differences of Central and Western birds vs. Eastern and Angolan populations accord the former species rank, for which the name camerunense is available. This latter species itself breaks into three subspecies, with the nominate in Nigeria and Cameroon, francisci on Bioko, and a new name for the hitherto taxonomically unrecognised Central populations.

We sought to better understand breast-specific sensuality (BSS) in sexually inactive breast cancer survivors. We conducted an anonymous cross-sectional survey of breast cancer survivors during surveillance appointments from 2014 to 2016. Sexual inactivity was defined as no sexual activity within 4weeks prior. Categorical data were analyzed using Fisher's exact test. Multiple logistic regression adjusted for age and menopausal status, and Firth's bias correction accommodated sparse data. Of 585 respondents, 546 (93.3%) were between the ages of 40 and 79 years, of whom 285 (48.7%) were sexually inactive. Favorable post-treatment appearance satisfaction was reported by 413 (71.0%) respondents. Sexually inactive respondents were more likely to score discomfort with their partner seeing their chest after surgery compared with sexually active respondents (41 [20.4%] vs. 34 [11.4%]; p=0.002). Both sexually inactive and active respondents reported that their chest was important in intimacy after surgery but at significantly different rates (117 [44.3%] vs. 217 [72.6%]; p<0.001). Post-surgical appearance satisfaction for sexually inactive respondents was positively associated with level of comfort with partner seeing their chest after surgery (p<0.001) and with rating of a pleasurable caress of the treated breast (p<0.001). Over 40% of sexually inactive respondents reported their chest was important in intimacy after surgery, suggesting that BSS may be a route to intimacy for sexually inactive breast cancer survivors. Post-surgical breast appearance satisfaction significantly correlated with comfort being seen by one's partner and appreciation of a pleasurable breast caress. Optimizing breast cancer surgical aesthetic outcomes may improve survivorship.

ObjectiveThis study aimed to assess the outcomes of outpatient day-care management of unruptured intracranial aneurysm (UIA), and to present the risks associated with different management strategies by comparing the outcomes and adverse events between outpatient day-care management and management with longer admission periods.Materials and MethodsThis retrospective cohort study used prospectively registered data and was approved by a local institutional review board. We enrolled 956 UIAs from 811 consecutive patients (mean age ± standard deviation, 57 ± 10.7 years; male:female = 247:564) from 2017 to 2020. We compared the outcomes after embolization among the different admission-length groups (1, 2, and ≥ 3 days). The outcomes included pre- and post-modified Rankin Scale (mRS) scores and rates of adverse events, cure, recurrence, and reprocedure. Events were defined as any cerebrovascular problems, including minor and major stroke, death, or hemorrhage.ResultsThe mean admission period was 2 days, and 175 patients (191 aneurysms), 551 patients (664 aneurysms), and 85 patients (101 aneurysms) were discharged on the day of the procedure, day 2, and day 3 or later, respectively. During the mean 17-month follow-up period (range 6–53 months; 2757 patient years), no change in post-mRS was observed compared to pre-mRS in 99.6% of patients. Cure was achieved in 95.6% patients; minimal recurrence that did not require re-procedure occurred in 3.5% patients, and re-procedure was required in 2.3% (22 of 956) patients due to progressive enlargement of the recurrent sac during follow up (mean 17 months, range, 6–53 months). There were eight adverse events (0.8%), including five cerebrovascular (two major stroke, two minor strokes and one transient ischemic stroke), and three non-cerebrovascular events. Statistical comparison between groups with different admission lengths (1, 2, and ≥ 3 days) revealed no difference in the outcomes.ConclusionThis study revealed no difference in outcomes and adverse events according to the admission period, and suggested that UIA could be managed by outpatient day-care embolization.

La Grande-Bretagne a-t-elle frôlé la révolution en 1819-20 ? Le ‘massacre de Peterloo’ le 16 août 1819, répression sanglante d’une manifestation de travailleurs exigeant le suffrage universel masculin, est un événement crucial dans l’histoire du radicalisme britannique. La vague de protestations et de troubles qui le suivit fut plus forte et plus étendue que la campagne radicale en elle-même. On y retrouva tout le spectre des opposants de l’époque, des aristocrates Whigs les plus prudents jusqu’aux ouvriers insurgés du nord et aux ultra-radicaux de Londres qui tentèrent d’assassiner les membres du gouvernement dans la conspiration de Cato Street de février 1820. Cet essai, irrigué par l’étude du très riche fonds des Archives Nationales britanniques, examine les liens entre tous ces mouvements afin d’évaluer la viabilité des divers plans d’insurrection. Il conclut que les ultra-radicaux de Londres, quoique présentés comme la force motrice de la rébellion, s’étaient retrouvés isolés et écartés du mouvement radical au cours de l’année 1819. Ce n’est pas la promesse d’un soulèvement national à venir, mais l’échec d’une manifestation déjà passée qui a mené à la conspiration de Cato Street.