Search results for: surgical guides

Authors: Shirin Jalili, Ramin Ghasemi Shayan

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Atrial fibrillation is the foremost common arrhythmia around the world, with expanding recurrence famous with age. Thromboembolic occasions and strokes are the number one cause of mortality and morbidity. For patients who don't react to restorative treatment for rate and beat control, the maze method offers an elective treatment mediation. pharmaco-medical treatment for atrial fibrillation is pointed at the control of rate or cadence, intrusive treatment for atrial fibrillation is pointed at cadence control. An obtrusive approach may comprise of percutaneous catheter treatment, surgery, or a crossover approach. Since the maze method is recognized as the foremost successful way to dispense with AF, combining the maze strategy amid major cardiac surgeries has been received in clinical hone. the maze strategy, moreover known as Cox¬maze iii or the ‘cut¬and¬sew’ method, involves making different incisions within the atria to make an arrangement of scars that dispose of each potential zone of re¬entry. The electrical drive is constrained through a maze of scars that coordinates the electrical drive from the sinus node to the av node. By settling the headstrong period between ranges of scar, re¬entry is disposed of. in this article, we evaluate the Maze surgery method that's the surgical method of choice for the treatment of restorative atrial fibrillation.

Keywords: atrial fibrillation, congenital heart disease, procedure, maze surgery, treatment

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Authors: Benjamin J. Kuo, Silvia D. Vaca, Joao Ricardo Nickenig Vissoci, Catherine A. Staton, Linda Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Lydia Nanjula, Christine Muhumuza, Henry E. Rice, Gerald A. Grant, Michael M. Haglund

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Background: Traumatic Brain Injury (TBI) is disproportionally concentrated in low- and middle-income countries (LMICs), with the odds of dying from TBI in Uganda more than 4 times higher than in high income countries (HICs). The disparities in the injury incidence and outcome between LMICs and resource-rich settings have led to increased health outcomes research for TBIs and their associated risk factors in LMICs. While there have been increasing TBI studies in LMICs over the last decade, there is still a need for more robust prospective registries. In Uganda, a trauma registry implemented in 2004 at the Mulago National Referral Hospital (MNRH) showed that RTI is the major contributor (60%) of overall mortality in the casualty department. While the prior registry provides information on injury incidence and burden, it’s limited in scope and doesn’t follow patients longitudinally throughout their hospital stay nor does it focus specifically on TBIs. And although these retrospective analyses are helpful for benchmarking TBI outcomes, they make it hard to identify specific quality improvement initiatives. The relationship among epidemiology, patient risk factors, clinical care, and TBI outcomes are still relatively unknown at MNRH. Objective: The objectives of this study are to describe the processes of care and determine risk factors predictive of poor outcomes for TBI patients presenting to a single tertiary hospital in Uganda. Methods: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June – 30 November 2016. Research Electronic Data Capture (REDCap) was used to systematically collect variables spanning 8 categories. Univariate and multivariate analysis were conducted to determine significant predictors of mortality. Results: 563 TBI patients were enrolled from 1 June – 30 November 2016. 102 patients (18%) received surgery, 29 patients (5.1%) intended for surgery failed to receive it, and 251 patients (45%) received non-operative management. Overall mortality was 9.6%, which ranged from 4.7% for mild and moderate TBI to 55% for severe TBI patients with GCS 3-5. Within each TBI severity category, mortality differed by management pathway. Variables predictive of mortality were TBI severity, more than one intracranial bleed, failure to receive surgery, high dependency unit admission, ventilator support outside of surgery, and hospital arrival delayed by more than 4 hours. Conclusions: The overall mortality rate of 9.6% in Uganda for TBI is high, and likely underestimates the true TBI mortality. Furthermore, the wide-ranging mortality (3-82%), high ICU fatality, and negative impact of care delays suggest shortcomings with the current triaging practices. Lack of surgical intervention when needed was highly predictive of mortality in TBI patients. Further research into the determinants of surgical interventions, quality of step-up care, and prolonged care delays are needed to better understand the complex interplay of variables that affect patient outcome. These insights guide the development of future interventions and resource allocation to improve patient outcomes.

Keywords: care continuum, global neurosurgery, Kampala Uganda, LMIC, Mulago, prospective registry, traumatic brain injury

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Authors: Ezzati Givi M., Ezzatigivi N., Eimani H.

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Trigeminal Neuralgia (TN) consists of painful attacks often triggered with general activities, which cause impairment and disability. The first line of treatment consists of pharmacotherapy. However, the occurrence of many side-effects limits its application. Acute pain relief is crucial for titrating oral drugs and making time for neurosurgical intervention. This study aimed to examine the long-term anesthetic effect of QX-314 and capsaicin in trigeminal neuralgia using an animal model. TN was stimulated by surgical constriction of the infraorbital nerve in rats. After seven days, anesthesia infiltration was done, and the duration of mechanical allodynia was compared. Thirty-five male Wistar rats were randomly divided into seven groups as follows: control (normal saline); lidocaine (2%); QX314 (30 mM); lidocaine (2%)+QX314 (15 mM); lidocaine (2%)+QX314 (22 mM); lidocaine (2%)+QX314 (30 mM); and lidocaine (2%)+QX314 (30 mM) +capsaicin (1μg). QX314 in combination with lidocaine significantly increased the duration of anesthesia, which was dose-dependent. The combination of lidocaine+QX314+capsaicin could significantly increase the duration of anesthesia in trigeminal neuralgia. In the present study, we demonstrated that the combination of QX-314 with lidocaine and capsaicin produced a long-lasting, reversible local anesthesia and was superior to lidocaine alone in the fields of the duration of trigeminal neuropathic pain blockage.

Keywords: trigeminal neuralgia, capsaicin, lidocaine, long-lasting

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Authors: Adrian Sebastian, Chris Gillespie

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We describe a case of diffuse rectal involvement with cap polyposis, manifesting with a protein-losing colopathy and occurring in the setting of advanced mechanical pelvic floor dysfunction. A 59-year-old male with a 5-year history of persistent excessive flatulence, defecatory difficulties, and diarrhea. He had extensive cap polyposis of the entire rectum endoscopically. His symptoms progressed to severe fecal incontinence with mucus leakage, pelvic pain, weight loss, and hypoalbuminemia. Clinical examination exhibited severe perineal descent, a large rectocele, poor anal squeeze, and a poor defecatory technique. After a trial of nonoperative therapies addressing his defecatory dysfunction, and Helicobacter pylori eradication, surgical resection was offered due to severe symptoms with ongoing incontinence and protein loss with no other reasonable options. A robotic abdominoperineal resection with a permanent colostomy was performed, followed by an uncomplicated recovery. Our observation of coexisting mechanical pelvic floor changes in this patient lends weight to the concept of a prolapse-related phenomenon in the pathophysiology of this rare condition.

Keywords: cap polyposis, pelvic dysfunction, fecal incontinence, case report

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Authors: Nuhi Arslani, Aleks Brumec

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Adhesive small bowel obstruction (ASBO) accounts for 20% of emergency surgical procedures and intraabdominal adhesions account for 65% of such cases. In a 10-year post-operative period of abdominal surgery patients, around 35% of them will be readmitted because of ASBO. The first step in approaching ASBOs is using the Bologna guidelines, which include a thorough initial evaluation to diagnose or rule out an ASBO and then proceed with either further imaging studies or emergency surgery, which can be either open or laparoscopic. The contraindications for a laparoscopic approach include hemodynamic instability of the patient and infections in the peritoneum or port sites. Studies have shown that a laparoscopic approach to adhesiolysis is linked with a significantly smaller risk of readmissions and reoperations as well as with faster recovery time and fewer postoperative infections, but has a higher risk of bowel injuries, so a careful selection of patients is required. Although studies favor a laparoscopic approach, many countries still prefer a laparotomy, often because a laparoscopic approach requires surgeons to be highly skilled in the procedure. In the US and UK, between 50 and 60% of surgeons would approach an ASBO with laparoscopy, while in Italy, this number is around 15% and it is most likely similar in Slovenia. We believe that in the right cases and in the right patients, a laparoscopic approach can be equally feasible for treating ASBOs and is associated with fewer intraoperative and postoperative complications.

Keywords: adhesive small bowel obstruction, laparoscopy, adhesions, adhesiolysis

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Authors: Ehsan A. Yahia, Ayman E. El-Sharkawey, Magda M. Bayoumi

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Background: Wound dressings perform a crucial role in cutaneous wound management due to their ability to protect wounds and promote dermal and epidermal tissue regeneration. Aim: To evaluate the effectiveness of using hydrogel/nano silver-based dressing vs. traditional dressing on diabetic foot wound healing. Methods: Sixty patients with type-2 diabetes hospitalized for diabetic foot wound treatment were recruited from selected Surgical departments. A prospective randomized control study was carried. Results: The results showed that the percentage of a reduction rate of the ulcer by the third week of the treatment in the hydrogel/nano silver-based dressing group was higher (15.11%) than in the traditional wound dressing group (33.44%). Moreover, the mean ulcer size "sq mm" in the hydrogel/nano silver-based dressing group recognized a faster healing rate (15.11±7.89) and considerably lesser in comparison to the traditional in the third week (21.65±8.4). Conclusion: The hydrogel/nanosilver-based dressing showed better results than traditional dressing in managing diabetic ulcer foot.

Keywords: diabetes, wound care, diabetic foot, wound dressing, hydrogel nanosilver

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Authors: A. Olivi, P. Reyes Cabrera

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Ageing and urbanization are two of the main trends that characterize the twenty-first century. Its trending is especially accelerated in the emerging countries of Asia and Latin America. Chile is one of the countries in the Latin American region, where the demographic transition to ageing is becoming increasingly visible. The challenges that the new demographic scenario poses to urban administrators call for searching innovative solutions to maximize the functional and psycho-social benefits derived from the relationship between older people and the environment in which they live. Although mobility is central to people's everyday practices and social relationships, it is not distributed equitably. On the contrary, it can be considered another factor of inequality in our cities. Older people are a particularly sensitive and vulnerable group to mobility. In this context, based on the ageing in place strategy and following the social innovation approach within a spatial context, the "Community Observatory of Territorial Information Control and Management" project aims at the collective search and validation of solutions for the satisfaction of mobility and accessibility specific needs of urban aged people. Specifically, the Observatory intends to: i) promote the direct participation of the aged population in order to generate relevant information on the territorial situation and the satisfaction of the mobility needs of this group; ii) co-create dynamic and efficient mechanisms for the reporting and updating of territorial information; iii) increase the capacity of the local administration to plan and manage solutions to environmental problems at the neighborhood scale. Based on a participatory mapping methodology and on the application of digital technology, the Observatory designed and developed, together with aged people, a crowdsourcing platform for smartphones, called DIMEapp, for reporting environmental problems affecting mobility and accessibility. DIMEapp has been tested at a prototype level in two neighborhoods of the city of Valparaiso. The results achieved in the testing phase have shown high potential in order to i) contribute to establishing coordination mechanisms with the local government and the local community; ii) improve a local governance system that guides and regulates the allocation of goods and services destined to solve those problems.

Keywords: accessibility, ageing, city, digital technology, local governance

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Authors: Pietro Mortini, Marco Losa

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Objective: Resection of large lesions growing into the third ventricle remains a demanding surgery, sometimes at risk of severe post-operative complications. Transcallosal and transcortical routes were considered as approaches of choice to access the third ventricle, however neurological consequences like memory loss have been reported. We report clinical results of the previously described combined interhemispheric sub-commissural translaminaterminalis approach (CISTA) for the resection of large lesions located in the third ventricle. Methods: Authors conducted a retrospective analysis on 10 patients, who were operated through the CISTA, for the resection of lesions growing into the third ventricle. Results: Total resection was achieved in all cases. Cognitive worsening occurred only in one case. No perioperative deaths were recorded and, at last follow-up, all patients were alive. One year after surgery 80% of patients had an excellent outcome with a KPS 100 and Glasgow Outcome score (GOS) Conclusion: The CISTA represents a safe and effective alternative to transcallosal and transcortical routes to resect lesions growing into the third ventricle. It allows for a multiangle trajectory to access the third ventricle with a wide working area free from critical neurovascular structures, without any section of the corpus callosum, the anterior commissure and the fornix.

Keywords: craniopharingioma, surgery, sub-commissural translaminaterminalis approach (CISTA),

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Authors: Christine Demaecker

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Many researchers have underlined the importance of metaphors in specialised language. Their use of specific domains helps us understand the conceptualisations used to communicate new ideas or difficult topics. Within the wide area of specialised discourse, wine tasting is a very specific example because it is almost exclusively metaphoric. Wine tasting metaphors express various conceptualisations. They are not linguistic but rather conceptual, as defined by Lakoff & Johnson. They correspond to the linguistic expression of a mental projection from a well-known or more concrete source domain onto the target domain, which is the taste of wine. But unlike most specialised terminologies, the vocabulary is never clearly defined. When metaphorical terms are listed in dictionaries, their definitions remain vague, unclear, and circular. They cannot be replaced by literal linguistic expressions. This makes it impossible to transfer them into another language with the traditional linguistic translation methods. Qualitative research investigates whether wine tasting metaphors could rather be translated with the cognitive translation process, as well described by Nili Mandelblit (1995). The research is based on a corpus compiled from two high-profile wine guides; the Parker’s Wine Buyer’s Guide and its translation into French and the Guide Hachette des Vins and its translation into English. In this small corpus with a total of 68,826 words, 170 metaphoric expressions have been identified in the original English text and 180 in the original French text. They have been selected with the MIPVU Metaphor Identification Procedure developed at the Vrije Universiteit Amsterdam. The selection demonstrates that both languages use the same set of conceptualisations, which are often combined in wine tasting notes, creating conceptual integrations or blends. The comparison of expressions in the source and target texts also demonstrates the use of the cognitive translation approach. In accordance with the principle of relevance, the translation always uses target language conceptualisations, but compared to the original, the highlighting of the projection is often different. Also, when original metaphors are complex with a combination of conceptualisations, at least one element of the original metaphor underlies the target expression. This approach perfectly integrates into Lederer’s interpretative model of translation (2006). In this triangular model, the transfer of conceptualisation could be included at the level of ‘deverbalisation/reverbalisation’, the crucial stage of the model, where the extraction of meaning combines with the encyclopedic background to generate the target text.

Keywords: cognitive translation, conceptual integration, conceptual metaphor, interpretative model of translation, wine tasting metaphor

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Authors: Marco Camilli

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This article examines the impact of the pandemic outbreak of COVID-19 in the tourism sector in Italy, analyzing the current scenario, the government decisions and the private company reaction for the summer season 2020. The framework of the data analyzed shows how massive it’s the impact of the pandemic outbreak in the tourism revenue, and the weaknesses of the measures proposed. Keywords Travel &Tourism, Transportation, Sustainability, COVID-19, Businesses Introduction The current COVID-19 scenario shows a shocking situation for the tourism and transportation sectors: it could be the most affected by the Coronavirus in Italy. According to forecasts, depending on the duration of the epidemic outbreak and the lockdown strategy applied by the Government, businesses in the supply chain could lose between 24 and 66 billion in turnover in the period of 2020-21, with huge diversified impacts at the national and regional level. Many tourist companies are on the verge of survival and if there are no massive measures by the government they risk closure. Data analysis The tourism and transport sector could be among the sectors most damaged by Covid-19 in Italy. Considering the two-year period 2020-21, companies operating in the travel & tourism sector (Tour operator, Travel Agencies, Hotel, Guides, Bus Company, etc..) could in suffer losses in revenues of 24 to 64 billion euros, especially in the sectors such as the travel agencies, hotel and rental. According to Statista Research Department, from April 2020 estimated that the coronavirus (COVID-19) pandemic will have a significant impact on revenues of the tourism industry in Italy. Revenues are expected to decrease by over 40 billion euros in the first semester of 2020, compared to the same period of the previous year. According to the study, hotel and non-hotel accommodations will experience the highest loss. Revenues of this sector are expected to decrease by 13 billion euros compared to the first semester of 2019 when accommodations registered revenues for about 17 billion euros. According to Statista.com, in 2020, Italy is expected to register a decrease of roughly 28.5 million tourist arrivals due to the impact of coronavirus (COVID-19) on the country's tourist sector. According to the estimate, the region of Veneto will record the highest drop with a decrease of roughly 4.61 million arrivals. Similarly, Lombardy is expected to register a decrease of about 3.87 million arrivals in 2020.

Keywords: travel and tourism, sustainability, COVID-19, businesses, transportation

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Authors: Hsiao-Wen Tsai

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Motor vehicle accident is the first cause of head injury in the world; severe head injury cases may cause conscious disturbance and death. This is a report about a case of a young adult patient suffering from motor vehicle accident leading to severe head injury who passed through three time surgical procedures, and his mother (who is the informal caregiver). This case was followed from 28th January to 15th February 2011 by using Gordon’s 11 functional health patterns. Patient’s cognitive-perceptual and self-perception-self-concept patterns were altered. Anxiety was also noted on his informal caregiver due to patients’ condition. During the intensive care period, maintaining patient’s vital signs and cerebral perfusion pressure were essential to avoid secondary neuronal injury. Multi-sensory stimulation, caring accompanying, supporting, listening and encouraging patient’s family involved in patient care were very important to reduce informal caregiver anxiety. Finally, the patient consciousness improved from GCS 4 to GCS 11 before discharging from ICU. Patient’s primary informal caregiver, his mother, also showed anxiety improvement. This is was successful case with traumatic brain injury recovered from coma.

Keywords: anxiety, multi-sensory stimulation, reduce intracranial adaptive capacity, traumatic brain injury

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Authors: Thayalan Nall, Andreas Putra

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A major offshore reclamation work is currently underway in Southeast Asia for a container terminal. The total extent of the reclamation extent is 2600m x 800m and the seabed level is around -5mRL below mean sea level. Subsoil profile below seabed comprises soft marine clays of thickness varying from 8m to 15m. To contain the dredging spoil within the reclamation area, perimeter bunds have been constructed to +2.5mRL. They include breakwaters of trapezoidal geometry, made of boulder size rock along the northern, eastern and western perimeters, with a sand bund along the southern perimeter. Breakwaters were constructed on a composite bamboo pile and raft foundation system. Bamboo clusters 8m long, with 7 individual Bamboos bundled together as one, have been installed within the footprint of the breakwater below seabed in soft marine clay. To facilitate drainage two prefabricated vertical drains (PVD) have been attached to each cluster. Once the cluster piles were installed, a bamboo raft was placed as a load transfer platform. Rafts were made up of 5 layers of bamboo mattress, and in each layer bamboos were spaced at 200mm centres. The rafts wouldn’t sink under their own weight, and hence, they were sunk by loading quarry run rock onto them. Bamboo is a building material available in abundance in Indonesia and obtained at a relatively low cost. They are commonly used as semi-rigid inclusions to improve compressibility and stability of soft soils. Although bamboo is widely used in soft soil engineering design, no local design guides are available and the designs are carried out based on local experience. In June 2015, when the 1st load of sand was pumped by a dredging vessel next to the breakwater, a 150m long section of the breakwater underwent failure and displaced the breakwater between 1.2m to 4.0m. The cause of the failure was investigated to implement remedial measures to reduce the risk of further failures. Analyses using both limit equilibrium approach and finite element modelling revealed two plausible modes of breakwater failure. This paper outlines: 1) Developed Geology and the ground model, 2) The techniques used for the installation of bamboo piles, 3) Details of the analyses including modes and mechanism of failure and 4) Design changes incorporated to reduce the risk of failure.

Keywords: bamboo piles, ground improvement, reclamation, breakwater failure

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Authors: Shantanu Vyas, Neerja Meena

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Facial infiltrating lipomatosis is a rare lipomatous lesion, first described by Slavin in 1983. It is a benign pseudotumor pathology. It corresponds to a non-encapsulated collection of mature adipocytes infiltrating the local tissue and hyperplasia of underlying bone leading to a craniofacial deformity. Very few cases have been reported in the literature. We report the case of a 19-year-old female patient, who was consulted for a swelling of the right hemiface progressively evolving since birth. Physical examination revealed facial asymmetry. On palpation, the mass was soft, painless, not compressible, not pulsatile, not fluctuating. In view of the asymptomatic nature and slow progression of the lesion, a lipomatous tumour, namely lipoma, was suggested. CT scan image shows a hyperplastic subcutaneous fat on the right hemiface. On the right jugal and temporal areas, there is a subcutaneous formation of fatty density, poorly limited, with no detectable peripheral capsule. It merges with the adjacent fat. In the bone window, there was a hyperplasia of underlying bone. Facial lipomatosis infiltration of the face is a benign pseudotumor pathology. As a result, it can be confused with other disorders, in particular, hemifacial hyperplasia. Combination of physical and radiological findings can establish the diagnosis. Surgical treatment is done for cosmetic purposes.

Keywords: cosmetic correction and facial assemetry, aesthetic results, facial infiltration, surgery

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Authors: Balram Bhushan

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The emergence of social entrepreneurship challenges the strict categorization of not-for-profit, for-profit and hybrid organizations. Although the blurring of boundaries helps social entrepreneurial organizations (SEOs) make better use of emerging opportunities, it poses a significant challenge while mobilizing money from different sources. Additionally, for monetary resources, the legal framework of the host country may further complicate the issue by imposing strict accounting standards. Under such circumstances, the resource providers fail to recognize the suitable engagement strategy with the SEO of their choice. Based on the process of value creation and value capture, this paper develops a guiding framework for resource providers to design an appropriate mix of engagement with the identified SEOs. Essentially, social entrepreneurship creates value at the societal level, but value capture is a characteristic of an organization. Additionally, SEOs prefer value creation over value capture. The paper argued that the nature of the relationship between value creation and value capture determines the extent of blurred boundaries of the organization. Accordingly, synergistic, antagonistic and sequential relationships were proposed between value capture and value creation. When value creation is synergistically associated with value creation, the preferred nature of such action falls within the nature of for-profit organizations within the strictest legal framework. Banks offering micro-loans are good examples of this category. Opposite to this, the antagonist relationship between value creation and value capture, where value capture opportunities are sacrificed for value creation, dictates non-profit organizational structure. Examples of this category include non-government organizations and charity organizations. Finally, the sequential relationship between value capture opportunities is followed for value creation opportunities and guides the action closer to the hybrid structure. Examples of this category include organizations where a non-for-profit unit controls for-profit units of the organization either legally or structurally. As an SEO may attempt to utilize multiple entrepreneurial opportunities falling across any of the three relationships between value creation and value capture, the resource providers need to evaluate an appropriate mix of these relationships before designing their engagement strategies. The paper suggests three guiding principles for the engagement strategy. First, the extent of investment should be proportional to the synergistic relationship between value capture and value creation. Second, the subsidized support should be proportional to the sequential relationship. Finally, the funding (charity contribution) should be proportional to the antagonistic relationship. Finally, the resource providers are needed to keep a close watch on the evolving relationship between value creation and value capture for introducing appropriate changes in their engagement strategy.

Keywords: social entrepreneurship, value creation, value capture, entrepreneurial opportunity

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Authors: Ndje Ndje Mireille

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The improvement in the physical aspects of hysterectomy has tended to make us forget the psychological burden of this operation for many women. African women closely associate fertility and femininity, and they fear that their desire will diminish, that they will be less desirable after having undergone a hysterectomy. Medicine may be tempted to trivialize this surgical intervention by relying on the evolution of current surgery that leaves little or no marks. It is possible to think that the uterus is useless for a nun who has decided to freely disregard her motherhood. We used the clinical research method for this study. Through a semi-directive interview guide, we collected the verbatims of an hysterectomized catholic nun. The verbatims were transcribed and analyzed with the thematic content analysis. This analysis shows that the medical reality does not always correspond to the subjective experience of women, for whom hysterectomy can imply strong symbolic damage. The uterus is not essential to life, but it is essential to give life, and this lack can reactivate a desire for motherhood. The experience of hysterectomy is unique for each woman in relation to her history. This operation will eliminate all hope of pregnancy; it will be felt as intimate mutilation and an attack on femininity, it will bring up concerns about sexuality. Even if a woman has past the age of having children, has gone through menopause, or has freely decided not to have children, she still find it difficult to accept this procedure. The lack of uterus make a woman feel useless.

Keywords: hysterectomy, symbolic damage, desire for motherhood, feminity, nun

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Authors: Mahmoud Tarek, Alaa Obeida, Mai Magdy, Khalid Hussein, Aly Shalaby

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Background: More doctors are complaining of burnout than before, Burnout is a state of physical and mental exhaustion caused by the doctor’s lifestyle, unfortunately, Medical errors are also more likely in those suffering from burnout and these may result in malpractice suits. Methodology: It is a retrospective audit of burnout response on all neonatologists over a 9 months period. We gathered data using burnout questionnaire, it was obtained from 23 physicians, the physicians divided into 5 categories according to the final score of the 28 questions in the questionnaire. Category 1 with score from 28-38 with almost no work stress, category 2 with score (38-50) who express a low amount of job related stress, category 3 with score (51-70) with moderate amount of stress, category 4 with score (71-90) those express a high amount of job stress and begun to burnout, category 5 with score (91 and above) who are under a dangerous amount of stress and advanced stage of burnout. Results: 33 neonatologists have received the questionnaire, 23 responses were sent back with a response rate of 69.6%. The results showed that 61% of physicians fall in category 4, 31% of the physician in category 5, while 8% of physicians equally distributed between category 2 and 3 (4% each of them). On the other hand, there is no physician present in category 1. Conclusion: Burnout is prevalent in SNICUs, So interventions to minimize burnout prevalence may be of greater importance as this may be reflected indirectly on medical conditions of the patients and physicians, efforts should be done to decrease this high rate of burnout.

Keywords: Cairo, work overload, exhaustion, surgery, neonatal ICU

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Authors: Martin Van, Mohammed Javed, Sarah Hemington-Gorse

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Aim: Our aim was to determine the effect of size and tumor depth of basal cell carcinomas (BCCs) on surgical margin clearance. Methods: A retrospective study was conducted at the Welsh Centre for Burns and Plastic Surgery (WCBPS), Morriston Hospital between 1 Jan 2016 – 31 July 2016. Only patients with confirmed BCC on histopathological analysis were included. Patient data including anatomical region treated, lesion size, histopathological clearance margins and histological sub-types were recorded. An independent T-test was performed determine statistical significance. Results: A total of 228 BCCs were excised in 160 patients. Eleven lesions (4.8%) were incompletely excised. The nose area had the highest rate of incomplete excision. The mean diameter of incompletely excised lesions was 11.4mm vs 11.5mm in completely excised lesions (p=0.959) and the mean histological depth of incompletely excised lesions was 4.1mm vs. 2.5mm for completely excised BCCs (p < 0.05). Conclusions: BCC tumor depth of > 4.1 mm was associated with high rate of incomplete margin clearance. Hence, in prospective patients, a BCC tumor depth (>4 mm) on tissue biopsy should alert the surgeon of potentially higher risk of incomplete excision of lesion.

Keywords: basal cell carcinoma, excision margins, plastic surgery, treatment

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Authors: Enkelejda Shkurti, Diamant Shtiza

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Background: Health-related quality of life (HRQoL) is a significant consequence in health care. The objective of our study was to recognize features related to lower HRQoL scores in children with anorectal malformation (ARM) and Hirschsprung disease (HD). Methods: Children younger than 18 years, with HD or ARM, that were assessed at our private clinic in Tirana, Albania, from December 2018 to October 2019, were acknowledged. The outcomes of broad questionnaires concerning diagnosis, symptoms, and preceding health/surgical history and authenticated tools to measure urinary status, stooling grade, and HRQoL were appraised. Results: In patients aged 0-6 years, vomiting and abdominal enlargement were allied with a substantial decrease in total HRQoL scores. In children > 6 years of age, vomiting, abdominal swelling, and abdominal discomfort were also linked to a considerably lower HRQoL. The main indicator of lower HRQoL scores on regression tree analysis in all age clusters was the occurrence of psychosomatic, behavioral, or progressive comorbidity. Conclusion: Children with both HD or ARM that have a psychosomatic, behavioral, or growing problem experience considerably lower HRQoL than patients deprived of such problems, proposing that establishment of behavioral/growing sustenance as part of the care of these patients may have a considerable influence on their HRQoL.

Keywords: anorectal malformation, Hirsch Sprung disease, quality of life, Albania

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Authors: Wangxu Xia

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BACKGROUND BI-RADS 4 lesions raise the possibility of malignancy that warrant further clinical and radiologic work-up. This study aimed to evaluate the predictive performance of diffusion-weighted imaging(DWI) and microcalcifications on mammography for predicting malignancy of BI-RADS 4 lesions. In addition, the predictive performance of DWI combined with microcalcifications was alsocompared with the Kaiser score. METHODS During January 2021 and June 2023, 144 patients with 178 BI-RADS 4 lesions underwent conventional MRI, DWI, and mammography were included. The lesions were dichotomized intobenign or malignant according to the pathological results from core needle biopsy or surgical mastectomy. DWI was performed with a b value of 0 and 800s/mm2 and analyzed using theapparent diffusion coefficient, and a Kaiser score > 4 was considered to suggest malignancy. Thediagnostic performances for various diagnostic tests were evaluated with the receiver-operatingcharacteristic (ROC) curve. RESULTS The area under the curve (AUC) for DWI was significantly higher than that of the of mammography (0.86 vs 0.71, P<0.001), but was comparable with that of the Kaiser score (0.86 vs 0.84, P=0.58). However, the AUC for DWI combined with mammography was significantly highthan that of the Kaiser score (0.93 vs 0.84, P=0.007). The sensitivity for discriminating malignant from benign BI-RADS 4 lesions was highest at 89% for Kaiser score, but the highest specificity of 83% can be achieved with DWI combined with mammography. CONCLUSION DWI combined with microcalcifications on mammography could discriminate malignant BI-RADS4 lesions from benign ones with a high AUC and specificity. However, Kaiser score had a better sensitivity for discrimination.

Keywords: MRI, DWI, mammography, breast disease

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Authors: Shalini Tripathi, Pardeep Kumar

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The method of translating observed symptoms into disease names is known as disease diagnosis. The ability to solve clinical problems in a complex manner is critical to a doctor's effectiveness in providing health care. The accuracy of his or her expertise is crucial to the survival and well-being of his or her patients. Artificial Intelligence (AI) has a huge economic influence depending on how well it is applied. In the medical sector, human brain-simulated intellect can help not only with classification accuracy, but also with reducing diagnostic time, cost and pain associated with pathologies tests. In light of AI's present and prospective applications in the biomedical, we will identify them in the paper based on potential benefits and risks, social and ethical consequences and issues that might be contentious but have not been thoroughly discussed in publications and literature. Current apps, personal tracking tools, genetic tests and editing programmes, customizable models, web environments, virtual reality (VR) technologies and surgical robotics will all be investigated in this study. While AI holds a lot of potential in medical diagnostics, it is still a very new method, and many clinicians are uncertain about its reliability, specificity and how it can be integrated into clinical practice without jeopardising clinical expertise. To validate their effectiveness, more systemic refinement of these implementations, as well as training of physicians and healthcare facilities on how to effectively incorporate these strategies into clinical practice, will be needed.

Keywords: Artificial Intelligence, medical diagnosis, virtual reality, healthcare ethical implications 

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Authors: Zengmin Tian, Bin Lv, Rui Hui, Yupeng Liu, Chuan Wang, Qing Liu, Hongyu Li, Yan Qi, Li Song

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Objective Robot was used for replacement of the frame in recent years. The paper is to investigate the safety and effectiveness of frameless stereotactic surgery in the treatment of children with cerebral palsy. Methods Clinical data of 425 children with spastic cerebral palsy were retrospectively analyzed. The patients were treated with robot-assistant frameless stereotactic surgery of nuclear mass destruction. The motor function was evaluated by gross motor function measure-88 (GMFM-88) before the operation, 1 week and 3 months after the operation respectively. The statistical analysis was performed. Results The postoperative CT showed that the destruction area covered the predetermined target in all the patients. Minimal bleeding of puncture channel occurred in 2 patient, and mild fever in 3 cases. Otherwise, there was no severe surgical complication occurred. The GMFM-88 scores were 49.1±22.5 before the operation, 52.8±24.2 and 64.2±21.4 at the time of 1 week and 3 months after the operation, respectively. There was statistical difference between before and after the operation (P<0.01). After 3 months, the total effective rate was 98.1%, and the average improvement rate of motor function was 24.3% . Conclusion Replaced the traditional frame, the robot-assistant frameless stereotactic surgery is safe and reliable for children with spastic cerebral palsy, which has positive significance in improving patients’ motor function.

Keywords: cerebral palsy, robotics, stereotactic techniques, frameless operation

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Authors: Khalil Ibrahim, Ahmed Ramadan, Mohamed Fanni, Yo Kobayashi, Ahmed Abo-Ismail, Masakatus G. Fujie

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This paper deals with the design process and the dynamic control simulation of a new type of 4-DOFs parallel mechanism that can be used as an endoscopic surgical manipulator. The proposed mechanism, 2-PUU_2-PUS, is designed based on the screw theory and the parallel virtual chain type synthesis method. Based on the structure analysis of the 4-DOF parallel mechanism, the inverse position equation is studied using the inverse analysis theory of kinematics. The design and the stress analysis of the mechanism are investigated using SolidWorks software. The virtual prototype of the parallel mechanism is constructed, and the dynamic simulation is performed using ADAMS TM software. The system model utilizing PID and PI controllers has been built using MATLAB software. A more realistic simulation in accordance with a given bending angle and point to point control is implemented by the use of both ADAMS/MATLAB software. The simulation results showed that this control method has solved the coordinate control for the 4-DOF parallel manipulator so that each output is feedback to the four driving rods. From the results, the tracking performance is achieved. Other control techniques, such as intelligent ones, are recommended to improve the tracking performance and reduce the numerical truncation error.

Keywords: parallel mechanisms, medical robotics, tracjectory control, virtual chain type synthesis method

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Authors: Amanda Aliende da Matta, Maria del Pilar Fogueiras Bertomeu, Valeria de Ormaechea Otalora, Maria Paz Sandin Esteban, Miriam Comet Donoso

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This communication presents proposed questions about the existential in research on the political participation of young women. The study follows a qualitative methodology, in particular, the applied hermeneutic phenomenological (AHP) method, and the general objective of the research is to give an account of the experience of political participation as a young woman. The study participants are women aged 18 to 35 who have experience in political participation. The techniques of data collection are the descriptive story and the phenomenological interview. Hermeneutic phenomenology as a research approach is based on phenomenological philosophy and applied hermeneutics. The ultimate objective of HP is to gain access to the meaning structures of lived experience by appropriating them, clarifying them, and reflectively making them explicit. Human experiences are always lived through existential: fundamental themes that are useful in exploring meaningful aspects of our life worlds. Everyone experiences the world through the existential of lived relationships, the lived body, lived space, lived time, and lived things. The phenomenological research, then, also tacitly asks about the existential. Existentials are universal themes useful for exploring significant aspects of our life world and of the particular phenomena under study. Four main existentials prove especially helpful as guides for reflection in the research process: relationship, body, space, and time. For example, in our case, we may ask ourselves how can the existentials of relationship, body, space, and time guide us in exploring the structures of meaning in the lived experience of political participation as a woman and a young person. The study is still not finished, as we are currently conducting phenomenological thematic analysis on the collected stories of lived experience. Yet, we have already identified some fragments of texts that show the existential in their experiences, which we will transcribe below. 1) Relationality - The experienced I-Other. It regards how relationships are experienced in our narratives about political participation as young women. One example would be: “As we had known each other for a long time, we understood each other with our eyes; we were all a little bit on the same page, thinking the same thing.” 2) Corporeality - The lived body. It regards how the lived body is experienced in activities of political participation as a young woman. One example would be: “My blood was boiling, but it was not the time to throw anything in their face, we had to look for solutions.”; “I had a lump in my throat and I wanted to cry.”. 3) Spatiality - The lived space. It regards how one experiences the lived space in political participation activities as a young woman. One example would be: “And the feeling I got when I saw [it] it's like watching everybody going into a mousetrap.” 4) Temporality - Lived time. It regards how one experiences the lived time in political participation activities as a young woman. One example would be: “Then, there were also meetings that went on forever…”

Keywords: applied hermeneutic phenomenology, existentials, hermeneutics, phenomenology, political participation

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Authors: Fatma Abdel Moneim Al Tawil

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Low back pain (LBP) among nurses has been the subject of research studies worldwide. However, evidence of the influence of patients lifting behaviors and LBP among nurses in Saudi Arabia remains scarce. The purpose of this study was to investigate the relationship between LBP and nurses lifting behaviors. LBP questionnaire was distributed to 100 nurses working in Alsadairy Hospital distributed as Emergency unit(9),Coronary Care unit (9), Intensive Care Unit (7), Dialysis unit (30), Burn unit (5), surgical unit (11), Medical (14) and, X-ray unit (15). The questionnaire included demographic data, attitude scale, Team work scale, Back pain history and Knowledge scale. Regarding to emergency unit, there is appositive significant relation between teamwork scale and Knowledge as r = (0.807) and P =0.05. Regarding to ICU unit, there is a positive significant relation between teamwork scale and attitude scale as r= (0.781) and P =0.05. Regarding to Dialysis unit, there is a positive significant relation between attitude scale and teamwork scale as r=(0.443) and P =0.05. The findings suggest enhanced awareness of occupational safety with safe patient handling practices among nursing students must be emphasized and integrated into their educational curriculum. Moreover, back pain prevention program should incorporate the promotion of an active lifestyle and fitness training the implementation of institutional patient handling policies.

Keywords: low back pain, lifting behaviors, nurses, team work

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Authors: Danny Fraser, James Zhang

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Aim of the study: Our study aims to identify any statistically significant evidence as it relates to PROMs for mastectomy and implant-based reconstruction to guide future surgical management. Method: The demographic, pre and post-operative treatment and implant characteristics were collected of all patients at Basildon hospital who underwent breast reconstruction from 2017-2023. We used the Breast-Q psychosocial well-being, physical well-being, and satisfaction with breasts scales. An Independent t-test was conducted for each group, and linear regression of age and implant size. Results: 69 patients were contacted, and 39 PROMs returned. The mean age of patients was 57.6. 40% had smoked before, and 40.8% had BMI>30. 29 had pre-pectoral placement, and 40 had subpectoral placement. 17 had smooth implants, and 52 textured. Sub pectoral placement was associated with higher (75.7 vs. 61.9 p=0.046) psychosocial scores than pre pectoral, and textured implants were associated with a lower physical score than the smooth surface (34.7 VS 50.2 P=0.046). On linear regression, age was positively associated (p=0.007) with psychosocial score. Conclusion: We present a large cohort of patients who underwent breast reconstruction. Understanding the PROMs of these procedures can guide clinicians, patients and policy makers to be more informed of the course of rehabilitation of these operations. Significance: We have found that from a patient perspective subpectoral implant placement was associated with a statistically significant improvement in psychosocial scores.

Keywords: breast surgery, mastectomy, breast implants, oncology

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Authors: Mohamed Abdelrahman Abdalla

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Apart from their function in producing CSF, the brain ventricles have been recognized as the mere remnant of the embryological neural tube with no clear role. The lack of proper definition of the function of the brain ventricles and the central spinal canal has made it difficult to ascertain the pathophysiology of its different disease conditions or to treat them. This study aims to review the simple physics that could explain the basic function of the CNS ventricular system and to suggest new ways of approaching its pathology. There are probably more physical factors to consider than only the pressure. Monro-Killie hypothesis focuses on volume and subsequently pressure to direct our surgical management in different disease conditions. However, the enlarged volume of the ventricles in normal pressure hydrocephalus does not move any blood or brain outside the skull. Also, in idiopathic intracranial hypertension, the very high intracranial pressure rarely causes brain herniation. On this note, the continuum of the intracranial cavity with the spinal canal makes it a whole unit and hence the defect in the theory. In this study, adding different factors to the equation like brain and CSF density and positions of the brain in space, in addition to the volume and pressure, aims to identify how the ventricles are important in the CNS homeostasis. In addition, increasing the variables that we analyze to treat different CSF pathological conditions should increase our understanding and hence accuracy of treatment of such conditions.

Keywords: communicating hydrocephalus, functions of the ventricles, idiopathic intracranial hypertension physics of CSF

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Authors: Titap Yazicioglu

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To examine the results of two different surgery in patients with severe ptosis and poor levator function. The records of 10 bilateral congenital ptosis patients, who underwent Whitnall’s sling surgery on one eyelid and frontalis sling surgery on the other were analyzed retrospectively. All patients had severe congenital ptosis(>4mm) and poor levator function (LF<4mm). Data regarding eyelid position, cosmetic outcomes, and postoperative complications were evaluated. All patients were assessed for a minimum of one year with regard to the amount of correction, residual ptosis and lagophthalmos. The study consisted of 10 patients, with an average age of 9.2±2.4 years. Preoperative diagnosis for all patients was noted as, the average LF was 3.4±0.51mm, vertical lid height was 3.5±0.52 mm and margin reflex distance-1 (MRD-1) was 0.4±0.51mm. The mean vertical lid height was measured as 7.1±0.73 mm in the frontalis sling group and 7.2±0.63 mm in the Whitnall’s sling group at the postoperative 1st month control. However, in patients with Whitnall’s sling, revision was performed with frontalis sling surgery due to failure in vertical lid height in the late postoperative period, and an average of 7.5±0.52 mm was achieved. Satisfactory results were obtained in all patients. Although postoperative lagophthalmitis developed in the frontalis sling group, none of them developed exposure keratitis. Granuloma was observed as sling infection in 2(20%) of the patients. Although Whitnall’s sling technique provides a natural look appearance without interfering with the functional result, we did not find it as successful as frontalis sling surgery in severe ptosis.

Keywords: congenital ptosis, frontalis suspension, Whitnall ligament, complications

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Authors: M. Ridwanul Hassan, Samuel George

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Aims: Steroid injections are commonly used as a diagnostic tool or an alternative to surgical management of carpal tunnel syndrome (CTS) and are generally safe. Ischaemia is a rare complication with very few cases reported in the literature. Methods: We report a case of a 50-year-old female that presented with a necrotic wound to her left palm one month after a steroid injection into the carpal tunnel. She had a 2-year history of CTS in her left hand that was treated with six previous steroid injections in primary care during this period. The wound evolved from a blister to a necrotic ulcer which led to a painful, hollow defect in the centre of her palm. She did not report any history of trauma, nor did she have any co-morbidities. Clinical photographs were taken. Results: On examination, she had a 0.5 cmx1 cm defect in the palm of her left hand down to aponeurosis. There was purulent discharge in the wound with surrounding erythema but no spreading cellulitis. She had full function of her fingers but was very tender on movements and at rest. She was admitted for intravenous antibiotics and underwent a debridement, washout, and carpal tunnel release the next day. The defect was packed to heal by secondary intention and has now fully healed one month following her operation. Conclusions: This is an extremely rare complication of steroid injections to the carpal tunnel and may have been avoided by earlier referral for surgery rather than treatment using multiple steroid injections.

Keywords: hand surgery, complication, rare, carpal tunnel syndrome

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Authors: Imelda Albert Gisip, Tarsiah T. Z. Taman

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In Asia, particularly in Malaysia women entrepreneurs contribute substantially to economic growth. This paper presents a review of women entrepreneurs’ program, focusing on Creating Millionaires among Young Women Entrepreneurs (CREAM@YWE) program in Sabah Malaysia which aims to accelerate the entrepreneurship among young women in Sabah Malaysia. Entrepreneurs is seen as essential for growth, job creation and social progress and the virtues of small business for Sabah Maju Jaya (SMJ), the Sabah state government Sabah State development plan for the year 2021-2025. SMJ guides the direction of the government's policies and programs, further guiding the implementation in a planned and strategic manner, to achieve targets and goals that coincide with the development needs of the state. One of the government’s agenda is to put its efforts more strongly to ensure that women entrepreneurs are well supported and enhanced. Thus, The CreaM@YWE Program was developed in 2018 with the main objective is to produce competitive young women entrepreneurs in Sabah and achieve "millionaire" status. CreaM@YWE Program is an innovation process which specifically developed to accelerate entrepreneurship sector particularly for women entrepreneurs in Sabah by incorporating strategic partnerships and collaborations with government agencies and industry players. Being the first of its kind in Sabah, the novelty of this project is providing a supportive ecosystem including six months intensive courses, guided through "hands-holding”, collaborations with strategic partners and easy access to government's assistance. Since its inception, the program has significantly impact society’s wellbeing particularly in empowering young women entrepreneurs in Sabah for the past six years and has produced many successful women entrepreneurs with “millionaire” status. Generally, improving women’s enterprise sector in Malaysia needs an overall enabling environment that allows development opportunities for women entrepreneurs including access to resources and support services. Since achieving the goal of women entrepreneurship policy requires effective partnerships and inclusiveness, Cream @YWE Program has managed to practice these in assisting small entrepreneurs among young women in Sabah in accessing public goods and business opportunities. This proves that achieving women’s economic empowerment requires sound policies, a holistic approach and long-term commitment. Thus, this paper presents how Cream@YWE Program has been supporting Sabah young women entrepreneurs by reforming the business environment to help create opportunities for women, while addressing the few existing gender-specific hurdles.

Keywords: entrepreneurship programs, women, Sabah, Malaysia

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Authors: Madhukar Kasarla, Sumit Fogla, Kiran Panuganti, Gaurav Jain, Abhijit Ramanujam, Astha Jain, Shashank Kraleti, Sharat Musham, Arun Chaudhury

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Patients have often chosen to travel for care — making pilgrimages to academic meccas and state-of-the-art hospitals for sophisticated surgery. This culture is still persistent in the landscape of US healthcare, with hundred thousand of visitors coming to the shores of United States to seek the high quality of medical care. One of the major challenges in this form of medical tourism has been the language barrier. Thus, an Iraqi patient, with immediate needs of communicating the healthcare needs to the treating team in the hospital, may face huge barrier in effective patient-doctor communication, delaying care and even at times reducing the quality. To circumvent these challenges, we are proposing the use of a state-of-the-art tool, Talk2All, which can translate nearly one hundred international languages (and even sign language) in real time. The tool is an easy to download app and highly user friendly. It builds on machine learning principles to decode different languages in real time. We suggest that the use of Talk2All will tremendously enhance communication in the hospital setting, effectively breaking the language barrier. We propose that vigorous incorporation of Talk2All shall overcome practical challenges in international medical and surgical tourism.

Keywords: language translation, communication, machine learning, medical tourism

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