 to find out other people’s strange food habits.
Put Peanut butter in the microwave and pour over ice cream.
Of course, then there is always the infamous “fried foods” at fairs and other events. It is, however, Lancaster County. Now, don’t judge before you indulge.
These are crazy but sometimes actually delicious combinations. So as soon as school is out for the day, it looks like I’m going home to try some crazy food combinations.
So… how does one fry ice cream?
News release announcing "The Emerging Objectives of Catholic Education," a nationwide workshop conducted at the University of Dayton, will feature three top Catholic educators from the National Catholic Education Association and the Very Rev. Paul Hoffer, S.M.
"Nationwide Workshop on the Future of Catholic Education to be Conducted at the University of Dayton" (1968). News Releases. 3340.I originally got this idea from watching [this video](https://www.youtube.com/watch?v=t_IxSnWyuiA) of four star duos in the abyss and wanted to try it out with Beidou.

Unfortunately, I couldn't get passed the first floor with only two characters lol.  Bennett and Beidou can clear reasonably well, but my other team had no chance of success.

This ended up being harder than expected, but most of it was since I entered 12-3 with a major energy deficit and didn't want to reset.

[This is the full floor 12 video.](https://youtu.be/jIRisUib_Kg)  I only uploaded the last floor since my gameplay was much better here than in the first two floors.with vinegar, irrigation with normal saline, dressing with honey, and improvised negative pressure wound therapy. Total cost incurred was affordable to patients, and ranged between Kenya shillings 100–360 (USD 1–3.60) weekly. Conclusion: Wound management techniques at MCRH were effective and affordable. Additional studies with a larger sample size are recommended.
@2019 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.
Wound care is one of the most common procedures conducted in surgical departments across health facilities in Kenya. Migori County Referral Hospital (MCRH) is a level four facility serving a population of 917,190 residents (1). With advances in healthcare delivery coupled with rapidly evolving antibiotic resistance by most microorganisms, wound care is rapidly developing (2). Different methods are used in wound care in different areas of the world, depending on wound type and expertise availability (3). Negative pressure wound therapy (NPWT) has been successfully used in several parts of the world since its invention (4). However, resource-limited facilities cannot implement the exact technique of NPWT and have had to improvise, without compromising the outcome (5). The aim of the study was to describe the types of wound dressing techniques used at MCRH. The cost associated with dressing was also determined for each technique.
This is a case series of consenting patients treated for acute wounds in the surgical wards of MRCH for 6 weeks. Patients with pre-existing diabetes mellitus or peripheral vascular disease were excluded. History, biodata and examination findings were documented. The techniques applied for wound dressing were observed and documented progressively until the patients were discharged from hospital. Estimates of daily and cumulative cost of the dressing materials were generated. Quantitative data are presented as tables while the techniques are described qualitatively. Ethical clearance and permission to conduct the study were obtained from the medical superintendent’s office.
Nine patients were admitted at MCRH with various wounds; of these four were excluded, leaving two males and three females. Table 1 shows the demographic and clinical profiles of the patients studied. Wound Dressing Techniques Used Improvised negative pressure wound therapy Negative pressure wound therapy (NPWT) was applied after initial surgical debridement on a patient with a degloving wound on the palmar aspect of the right hand following explosion of an unknown device. Materials used included sterile gauze pad, normal saline (250 mL), natural honey (8 mL) and one tubal end of a urine bag.
Three layers of gauze were created. A piece of sterile gauze soaked in normal saline was applied on the wound bed. Next was a layer of a piece of dry gauze to cover all parts of the first layer while ensuring there was no contact with intact skin. The third layer consisted of gauze with a thin layer of honey. This was covered with a piece of dry gauze. The end-tube of a sterile urine bag was then placed on the top layer of gauze and covered with dry gauze. The entire dressing was sealed with cling film and secured using zinc oxide strapping. Next, the other end of the tube was connected to the suction machine set at –95 mmHg.
The dressing was changed at 24, 48 and 96 hours post application. A second debridement was performed on day 4, followed by subsequent dressing every third day.
One patient with a wound on the dorsum of the foot following debridement for pyomyositis had the wound dressed with vinegar and honey. Materials required were one part vinegar (15 mL) mixed with two parts normal saline (30 mL). This mixture was used to clean the wound, followed by dressing with a thin layer of gauze secured in place by zinc oxide strapping. This was repeated every day for six consecutive days. Prior to each dressing, the wound was soaked in warm water for about 30 minutes.
Irrigation with normal saline and honey was applied to a patient with an open fracture of the distal third of the tibia. The wound was soaked in warm normal saline for approximately 30 minutes. It was irrigated with normal saline to wash off any loose debris and dead tissue until spontaneous bleeding was noted from the wound surface.
Bleeding was controlled by applying pressure and a dressing soaked in honey. The dressing was covered with dry gauze and secured along the edges.
Iodine was used on a patient with pyomyositis secondary to a thorn prick, resulting in an open wound following debridement. The wound was cleaned with normal saline, as described above. Iodine solution (10 mL) was placed on gauze, applied on the wound surface and left to dry.
The wound was cleaned as described above and then covered with a thin sheet of moist gauze. The gauze was strapped at the edges to keep it in place. Cost incurred by patients for various wound dressing techniques Table 2 shows the unit cost of the various dressing techniques, which range from USD 1 to 3.60 (Table 2).
the wound bed. In addition, the intermittent low pressure alters the structure of the cells in the wound area, which then triggers an inflammatory and proliferative cascade that increases the rate of formation of granulation tissue (6). The technique has been in use for about 30 years (10). In MCRH, the improvised NPWT worked effectively in aiding wound healing despite the limitations surrounding the technique. In the ideal set up, a fitting foam dressing is first cut and placed gently over the wound and a draining tube is the placed above the dressing. This dressing is finally covered with adhesive transparent tape (11). In the present study, the foam was substituted with the layers of gauze (12). Most foam dressings are laced with antibiotics, but a modification in the results presented here used honey dressing. In addition, the cling film and urine bag tubing substituted transparent adhesive tape and the drain system, respectively. Fluid in the wound was suctioned by the modified foam into a disposable canister in the negative pressure unit, a suction machine canister in the present study. The dressings were changed every 48 hours, and where an existing wound was infected or electric power fluctuated, every 24 hours. The results presented here showed no infection or accumulation of pus after 24 or 48 hours. These results were consistent with previous observations that showed the dressing may be required for 2–6 weeks, depending on the wound type and the rate of wound healing (13).
The disadvantages of NPWT technique include the need to be connected to a machine for at least 22 hours in a day and initial pain from applying pressure. Potential complications that may arise that warrant discontinuation of the therapy include tubing pressure necrosis, injury to the adjoining skin, growth of granulation tissue within the strands of the foam dressing, contact dermatitis due to the adhesive tape, formation of fistulas and, in rare cases, skin cancer due to increased blood flow in the wound bed (14).
A previous analysis of treatment showed the cost for a fully functional NPWT to the patient is approximately USD 180 weekly excluding the re-usable NPWT system. Another study places the cost at USD 119,224 per 1,000 days (14). On the contrary, the cost incurred by the patients on improvised NPWT in MCRH was KES 360.00 (USD 3.60) per week (Table 2). This is comparatively more cost effective and can be achieved especially in resource-limited settings.
Honey has been used in wound therapy for several decades. Recent studies have shown that honey has an inhibitory effect on approximately 60 bacteria species and acts against aerobes and anaerobes (15). In addition, it has antifungal action against Aspergillus species, yeast and dermatophytes (16). Manuka honey, produced in New Zealand, contains rich chemical ingredients that have, among others, antioxidant effects that aid in rapid wound healing and faster tissue regeneration (15).
The advantages of honey include a high osmotic effect on wounds, which inhibits microbial growth, allowing creation of a perfect osmotic gradient that would mop up exudate from the wound, enabling faster healing. In