Search results for: breast surgery

Authors: Animesh Gupta

Abstract:

Objective: The purpose of this study is to evaluate the versatility and outcome of lateral supra malleolar flap (LSMF) in soft tissue reconstruction of the regions including the distal leg, ankle, dorsal foot and heel. Methods: From March 2021 to April 2023, 18 patients with soft tissue defects in the regions, including the distal leg, ankle, dorsal foot and heel, who underwent LSMF repair for lower limb wound reconstruction were analyzed. The location, size of the defects, etiology, outcome, complications, and other alternative options were studied and presented. Results: The follow-up period of the cases was 3-6 months after surgery. All flaps were successful; however, one flap was complicated by venous congestion and was managed by loosening a few sutures and the patient was required to elevate the affected limb to resolve the issue. Conclusion: The LSMF has numerous advantages in repairing soft tissue defects in areas involving the ankle, distal leg, heel and dorsum of the foot. In comparison to reverse sural flaps for repairing defects in the heel and lower leg, LSMF offers shorter operation time, shorter hospitalization, lower cost, and fewer postoperative complications.

Keywords: lateral supra malleolar flap, LSMF, soft tissue reconstruction, lower leg defect

Procedia PDF Downloads 66

Authors: Karakhalis N. B.

Abstract:

This study aimed to determine the prevalence of heparin resistance among cardiac surgical pediatric and neonatal patients and identify associated risk factors. Materials and Methods: The study included 306 pediatric and neonatal patients undergoing on-pump cardiac surgery. Patients whose activated clotting time (ACT) targets were achieved after the first administration of heparin formed the 1st group (n=280); the 2nd group (n=26) included patients with heparin resistance. The initial assessment of the haemostasiological profile included determining the PT, aPPT, FG, AT III activity, and INR. Intraoperative control of heparinization was carried out with a definition of ACT using a kaolin activator. A weight-associated protocol at the rate of 300 U/kg with target values of ACT >480 sec was used for intraoperative heparinization. Results: The heparin resistance was verified in 8.5% of patients included in the study. Repeated heparin administration at the maximum dose of≥600 U/kg is required in 80.77% of cases. Despite additional heparinization, 19.23% of patients had FFP infusion. There was reduced antithrombin activity in the heparin resistance group (p=0.01). Most patients with heparin resistance (57.7%) were pretreated with low molecular weight heparins during the preoperative period. Conclusion: Determining the initial level of antithrombin activity can predict the risk of developing heparin resistance. The factor analysis verified hidden risk factors for heparin resistance to the heparin pretreatment, chronic hypoxia, and chronic heart failure.

Keywords: congenital heart disease, heparin, antithrombin, activated clotting time, heparin resistance

Procedia PDF Downloads 70

Authors: Majid Khan

Abstract:

Introduction: In this era of microsurgery, free flap holds a remarkable spot in reconstructive surgery. A free flap is well suited for composite defects as it provides sufficient and well-vascularized tissue for coverage. We report our experience with the use of the free flaps for the reconstruction of composite defects. Methods: This is a retrospective case series (chart review) of patients who underwent reconstruction of composite defects with a free flap at Aga Khan University Hospital, Karachi (Pakistan) from January 01, 2015, to December 31, 2019. Data were collected for patient demographics, size of the defect, size of flap, recipient vessels, postoperative complications, and outcome of the free flap. Results: Over this period, 532 free flaps are included in this study. The overall success rate is 95.5%. The mean age of the patient was 44.86 years. In 532 procedures, there were 448 defects from tumor ablation of head and neck cancer. The most frequent free flap was the anterolateral thigh flap in 232 procedures. In this study, the risk factor hypertension (p=0.004) was found significant for wound dehiscence, preop radiation/chemotherapy (p=0.003), and malnutrition (p=0.005) were found significant for fistula formation. Malnutrition (p=0.02) and use of vein grafts (p=0.025) were significant factors for flap failure. Conclusion: Free tissue transfer is a reliable option for the reconstruction of large and composite defects. Hypertension, malnutrition, and preoperative radiotherapy can cause significant morbidity.

Keywords: free flap, free flap failure, risk factors for flap failure, free flap outcome

Procedia PDF Downloads 105

Authors: Yassine Messaoud, Gordon Nigh, Faouzi Messaoud, Han Chen

Abstract:

The effect of climate change on tree growth in boreal and temperate forests has received increased interest in the context of global warming. However, most studies were conducted in small areas and with a limited number of tree species. Here, we examined the height growth responses of seventeen tree species to climate change in Western North America. 37009 stands from forest inventory databases in Canada and USA with varying establishment date were selected. Dominant and co-dominant trees from each stand were sampled to determine top tree height at 50 years breast height age. Height was related to historical mean annual and summer temperatures, annual and summer Palmer Drought Severity Index, tree establishment date, slope, aspect, soil fertility as determined by the rate of carbon organic matter decomposition (carbon/nitrogen), geographic locations (latitude, longitude, and elevation), species range (coastal, interior, and both ranges), shade tolerance and leaf form (needle leaves, deciduous needle leaves, and broadleaves). Climate change had mostly a positive effect on tree height growth. The results explained 62.4% of the height growth variance. Since 1880, height growth increase was greater for coastal, high shade tolerant, and broadleaf species. Height growth increased more on steep slopes and high soil fertility soils. Greater height growth was mostly observed at the leading range and upward. Conversely, some species showed the opposite pattern probably due to the increase of drought (coastal Mediterranean area), precipitation and cloudiness (Alaska and British Columbia) and peculiarity (higher latitudes-lower elevations and vice versa) of western North America topography. This study highlights the role of the species ecological amplitude and traits, and geographic locations as the main factors determining the growth response and its magnitude to the recent global climate change.

Keywords: Height growth, global climate change, species range, species characteristics, species ecological amplitude, geographic locations, western North America

Procedia PDF Downloads 164

Authors: Peri Harish Kumar, Sai Sharan Dwarka, Tajbinder Singh Bains, Suneet John Joseph, Chaitanya Kiran, Sambhu Dutta, Sarah Makram, Mohamed Sayed Zaazouee, Alaa Ahmed Elshanbary

Abstract:

Objective: To identify cancer and non-cancer causes of death in hepatocellular carcinoma (HCC) patients over different time periods after diagnosis and to compare the mortality risk of each cause in HCC patients with the general population. Methods: In this retrospective cohort study, data of 67,637 HCC patients from 1975 to 2016 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. We investigated the association between different causes of death and the following variables: age, race, tumor stage at diagnosis, and treatment (surgery, chemotherapy, and radiotherapy); each according to the periods of <1 year, 1-5 years, 5-10 years, and >10 years following the diagnosis. Standardized mortality ratios (SMRs) and their 95% confidence intervals (CIs) were calculated for cancer and non-cancer deaths in each of the mentioned periods following diagnosis. Results: Data of 67,637 patients, of whom 50,571 patients died during the follow-up period, were analyzed. Most deaths were due to HCC itself (35,535, 70.3%), followed by other cancers (3,983, 7.9%). Common causes of non-cancer mortality included infectious and parasitic diseases including HIV (2,823 patients, SMR=105.68, 95% CI: 101.82-109.65), chronic liver disease (2,719 patients, SMR=76.56, 95% CI: 73.71,79.5), and heart diseases (1,265 patients, SMR=2.26, 95% CI: 2.14-2.39), with higher mortality risk in HCC patients than in the general population. Conclusion: Cancers stand for most deaths in patients with HCC. Besides, infectious, and parasitic diseases including HIV represent the commonest non-cancer cause of mortality.

Keywords: hepatocellular carcinoma, seer, causes of death, mortality

Procedia PDF Downloads 64

Authors: Mohamed Amine Adaour, Mohamed Sadek Bachene, Mosaab Fortassi, Wafaa Siouda

Abstract:

— Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea.The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73%, and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: diabetic foot, bone biopsy, osteitis, algeria

Procedia PDF Downloads 92

Authors: Mohamed Amine Adaour, Mohamed Sadek Bachene, Mosaab Fortassi, Wafaa Siouda

Abstract:

Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea. The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73%, and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic therapy, bone biopsy, diabetic foot

Procedia PDF Downloads 68

Authors: Aamna Tufail, Catherine Anyanwu

Abstract:

Introduction/Aims: Neurosensory deficits following third molar removal affect the quality of life markedly. The purpose of this audit was to evaluate the incidence of IDN and LN damage and to compare departmental rates to an established standard. A secondary objective was to provide a descriptive summary of identified cases for clinical learning. Materials and Methods: A retrospective audit was conducted by a telephone survey of 101 patients who had third molar extractions performed under LA, IVS, or GA from January 2019 to June 2020 at a District General Hospital. The results were compared to a clinical standard identified as Cheng et al1. Data collection included mode of surgery, mode of anaesthesia, grade of clinician, assessment of difficulty, severity, and duration of symptoms. Results/Statistics: A total of 101 patients had 136 third molars extracted. Age range was 18-84 years. 44% extractions were under LA, 52% under GA, and 4% under IV sedation. 30% were simple extractions, 68% were surgical removals, 2% were unspecified. 89% extractions were performed by an Associate Specialist, 5% by a consultant, and 6% by unspecified grade of clinician. The rate of IDN injuries was 2.9% (n=4), higher than standard (0.3%). The rate of LN injuries was 0.7% (n=1), same as standard (0.7%). The 5 cases of neurosensory deficits are discussed in detail. Conclusions/Clinical Relevance: The rate of ID nerve injuries was higher than the standard. The rate of LN complications was lower than the standard.

Keywords: inferior dental nerve, lingual nerve, nerve injuries, third molars

Procedia PDF Downloads 83

Authors: Mohamed Amine Adaour, Mohamed Sadek Bachene, Mosaab Fortassi, Wafaa Siouda

Abstract:

Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea.The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73%, and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic, biopsy, diabetic foot

Procedia PDF Downloads 88

Authors: Suvorov Vasyl, Filipchuk Viktor

Abstract:

Background: If non-surgical treatment of developmental dysplasia of the hip (DDH) fails or if DDH is late-detected, surgery is necessary. Salter pelvic osteotomy (SPO) is an effective surgical option for such cases. The objectives of this study were to assess the results after SPO, evaluate risk factors, and reveal those radiological parameters that may correlate with the results. Mid- and long-term postoperative results after SPO in 17 patients (22 hip joints) were analyzed. Risk factors included those that do not depend on the surgeon (patient's age, value of the acetabular index (AI) preoperatively, DDH Tonnis grade) and those that depend on the surgeon (amount of AI correction). To radiological parameters which may correlate with the amount of AI correction, we referred distance "d" and the lateral rotation angle. Results: SPO allows performing AI correction in ranges 24.1 ± 6.5°. Excellent and good clinical results were obtained in 95.5% of patients; excellent and good radiological results in 86.4% of patients. Risk factors that do not depend on the surgeon were older patient’s age and higher preoperative AI values (p < 0.05). The risk factor that depends on the surgeon was the amount of AI correction (p < 0.05). The distance "d" was recognized as a radiological parameter that may indicate sufficient AI correction (p < 0.05). Conclusion: In older patients with a higher preoperative AI value, the results will be predictably worse. The surgeon may influence the result with a greater amount of AI correction (which may also be indicated radiologically by the distance "d" values).

Keywords: developmental dysplasia of the hip, results, risk factor, pelvic osteotomy, salter osteotomy

Procedia PDF Downloads 115

Authors: H. M. El-Rafie, A. H. Abou Zeid, R. S. Mohammed, A. A. Sleem

Abstract:

Acrocarpus is a genus of flowering plants in the legume family Fabaceae which considered as a large and economically important family. This study aimed to investigate the phytoconstituents of the petroleum ether extract (PEE) of Acrocarpus fraxinofolius bark by Gas chromatography coupled with mass spectrometry (GC/MS) analysis of its fractions (fatty acid and unsaponifiable matter). Concerning this, identification of 52 compounds constituting 97.03 % of the total composition of the unsaponifiable matter fraction. Cycloeucalenol was found to be the major compound representing 32.52% followed by 4a, 14a-dimethyl-A8~24(28)-ergostadien (26.50%) and ß-sitosterol(13.74%), furthermore Gas liquid chromatography (GLC) analysis of the sterol fraction revealed the identification of cholesterol (7.22 %), campesterol (13.30 %), stigmasterol (10.00 %) and β - sitosterol (69.48 %). Meanwhile, the identification of 33 fatty acids representing 90.71% of the total fatty acid constituents. Methyl-9,12-octadecadienoate (40.39%) followed by methyl hexadecanoate (23.64%) were found to be the major compounds. On the other hand, column chromatography and Thin layer chromatography (TLC) fractionation of PEE separate the triterpenoid: 21β-hydroxylup-20(29)-en-3-one and β- amyrin which were structurally identified by spectroscopic analysis (NMR, MS and IR). PEE has been biologically evaluated for 1: management of diabetes in alloxan induced diabetic rats 2: cytotoxic activity against four human tumor cell lines (Cervix carcinoma cell line[HELA], Breast carcinoma cell line [MCF7], Liver carcinoma cell line[HEPG2] and Colon carcinoma cell line[HCT-116] 3: hepatoprotective activity against CCl4-induced hepatotoxicity in rats and the activity was studied by assaying the serum marker enzymes like AST, ALT, and ALP. Concerning this, the anti-diabetic activity exhibited by 100mg of PEE extract was 74.38% relative to metformin (100% potency). It also showed a significant anti-proliferative activity against MCF-7 (IC50= 2.35µg), Hela(IC50=3.85µg) and HEPG-2 (IC50= 9.54µg) compared with Doxorubicin as reference drug. The hepatoprotective activity was evidenced by significant decrease in liver function enzymes, i.e. AST, ALT and ALP by (29.18%, 28.26%, and 34.11%, respectively using silymarin as the reference drug, compared to their concentration levels in an untreated group with liver damage induced by CCl₄. This study was performed for the first time on the bark of this species.

Keywords: Acrocarpus fraxinofolius, antidiabetic, cytotoxic, hepatoprotective

Procedia PDF Downloads 185

Authors: Adaour Mohamed Amine, Bachene Mohamed Sadek, Fortassi Mosaab, Siouda Wafaa

Abstract:

Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea. The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73% and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic therapy, bone biopsy, diabetic foot

Procedia PDF Downloads 94

Authors: Pouya Khaleghi

Abstract:

Dental implants are a successful treatment modality for restoring both function and aesthetics. Dental implant treatment has predictive results in the replacement of the lost teeth and has a high success rate even in the long term. The most important factor which is responsible for the positive course of implant treatment is the process of osseointegration between the implant structure and the host’s bone tissue. During recent years, many studies have focused on surgical and prosthetic factors, as well as the implant-related factors. However, implant failure still occurs despite the improvements that have led to the increased survival rate of dental implants, which suggests the possible role of some host-related risk factors. Vitamin D is a fat-soluble vitamin regulating calcium and phosphorus metabolism in tissues. The role of vitamin D in bone healing has been under investigation for several years. Vitamin D deficiency has also been associated with impaired and delayed callus formation and fractures healing; however, the role of vitamin D has not been clarified. Therefore, it is extremely important to study the phenomenon of a connection formed between bone tissue and the surface of a titanium implant and find correlations between the 25- hydroxycholecalciferol concentration in blood serum and the course of osseointegration. Because the processes of bone remodeling are very dynamic in the period of actual osseointegration, it is necessary to obtain the correct concentration of vitamin D3 metabolites in blood serum. In conclusion, the correct level of 25-hydroxycholecalciferol on the day of surgery and vitamin D deficiency treatment have a significant influence on the increase in the bone level at the implant site during the process of osseointegration assessed radiologically.

Keywords: implant, osseointegration, vitamin d, dental

Procedia PDF Downloads 159

Authors: Karen Boaz, C. R. Charan

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Background: The infiltration of tumour stroma by eosinophils, Tumor-Associated Tissue Eosinophilia (TATE), is known to modulate the progression of Oral Squamous Cell Carcinoma (OSCC). Eosinophils have direct tumoricidal activity by release of cytotoxic proteins and indirectly they enhance permeability into tumor cells enabling penetration of tumoricidal cytokines. Also, eosinophils may promote tumor angiogenesis by production of several angiogenic factors. Identification of eosinophils in the inflammatory stroma has been proven to be an important prognosticator in cancers of mouth, oesophagus, larynx, pharynx, breast, lung, and intestine. Therefore, the study aimed to correlate TATE with clinical and histopathological variables, and blood eosinophil count to assess the role of TATE as a prognosticator in Oral Squamous Cell Carcinoma (OSCC). Methods: Seventy two biopsy-proven cases of OSCC formed the study cohort. Blood eosinophil counts and TNM stage were obtained from the medical records. Tissue sections (5µm thick) were stained with Haematoxylin and Eosin. The eosinophils were quantified at invasive tumour front (ITF) in 10HPF (40x magnification) with an ocular grid. Bryne’s grading of ITF was also performed. A subset of thirty cases was also assessed for association of TATE with recurrence, involvement of lymph nodes and surgical margins. Results: 1) No statistically significant correlation was found between TATE and TNM stage, blood eosinophil counts and most parameters of Bryne’s grading system. 2) Statistically significant relation of intense degree of TATE was associated with the absence of distant metastasis, increased lympho-plasmacytic response and increased survival (diseasefree and overall) of OSCC patients. 3) In the subset of 30 cases, tissue eosinophil counts were higher in cases with lymph node involvement, decreased survival, without margin involvement and in cases that did not recur. Conclusion: While the role of eosinophils in mediating immune responses seems ambiguous as eosinophils support cell-mediated tumour immunity in early stages while inhibiting the same in advanced stages, TATE may be used as a surrogate marker for determination of prognosis in oral squamous cell carcinoma.

Keywords: tumour-associated tissue eosinophilia, oral squamous cell carcinoma, prognosticator, tumoral immunity

Procedia PDF Downloads 233

Authors: Donna L. Roberts

Abstract:

2019 marked 23 years since Purdue Pharma launched its flagship drug, OxyContin, that unleashed an unprecedented epidemic touching both celebrities and common citizens, metropolitan, suburbia and rural areas and all levels of socioeconomic status. From rural Appalachia to East LA individuals, families and communities have been devastated by a trajectory of addiction that often began with the legitimate prescription of a pain killer for anything from a tooth extraction to a sports injury to recovery from surgery or chronic arthritis. Far from being a serendipitous progression of events, the proliferation of this new breed of 'miracle drug' was instead a carefully crafted marketing program aimed at both the medical community and common citizens. This research represents and in-depth investigation of the evolution of the marketing, distribution and promotion of prescription opioids by pharmaceutical companies and its relationship to the propagation of the opioid crisis. Specifically, key components of Purdue Pharma’s aggressive marketing campaign, including its bonus system and sales incentives, were analyzed in the context of the sociopolitical environment that essential created the proverbial 'perfect storm' for the changing manner in which pain is treated in the U.S. The analyses of these series of events clearly indicate their role in first, the increase in prescription of opioids for non-terminal pain relief and subsequently, the incidence of related addiction, overdose, and death. Through this examination of the conditions that facilitated and maintained this drug crisis, perhaps we can begin to chart a course toward its resolution.

Keywords: addiction, opioid, opioid crisis, Purdue Pharma

Procedia PDF Downloads 108

Authors: Ssembatya Joseph Mary

Abstract:

Introduction: Omphalocele, an abdominal wall defect, occurs in 1 out of 4,000 to 6,000 live births. It is characterized by visceral herniation of small and large intestines, liver, and sometimes spleen and gonads are involved. The viscera is always covered by a three-layered sac. The defect in the mesoderm is mainly due to the failure of lateral abdominal wall folds to unite. About 350,000 ventral hernia repairs are done annually in the united states of America. Surgical repair with a mesh is the gold standard surgical method. With conservative management of Omphalocele, children are eventually closed between the age of 1 and 5 years. Herein, we present a late manifestation of ventral hernia following Omphalocele in a female Ugandan. Case presentation: A 56-year-old female with no known chronic illnesses and normal perinatal history presented with an umbilical swelling since birth with no associated symptoms. She is a married woman to one husband and has five children, and all of them are in good general condition with no such symptoms. She had normal vitals with an umbilical defect measuring about 20cm from the xiphoid process and 10 cm from the symphysis pubis. Surgery was done (component separation) on the second inpatient day, and it was uneventful. The patient was discharged on the 4th postoperative day in good general condition with a dry and clean surgical site. Conclusion: Despite adequate literature about Omphalocele and clear management guidelines, there have been reported cases of adult presentation of ventral hernias secondary to Omphalocele.

Keywords: omphalocele, ventral hernia, uganda, late presentation

Procedia PDF Downloads 52

Authors: Md. Abdul Karim, Syed Imran Ahmed, Pandora T. Hardtman

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Informed consent is one of the basic human and ethical rights for childbearing women. It plays a central role in promoting informed decision making between patients and service providers during the labor process. It gives mothers rights to accept or reject any examination and/or procedure, increases the respect and dignity of the mother during pregnancy, delivery and postpartum care. To assess the practices of this right during normal vaginal delivery and immediate postpartum care in tertiary level hospital setting in Bangladesh, a quantitative study with cross-sectional design was conducted in Dhaka Medical College & Hospital (DMCH) and Sir Salimullah Medical College & Mitford Hospital (SSMCH) in Dhaka in November 2015. A prevalence-based sample size of 190 was calculated where prevalence, confidence interval and level of significance were at 9.7%, 98% and 5% respectively. The respondents were the mothers who gave normal vaginal childbirth within past 24 hours and received postpartum care there. They were selected through systematic random sampling technique and their face-to-face interview of 190 mothers was done using a structured questionnaire. Data were entered into the spreadsheet (MS Excel 2013 version) and descriptive analysis of findings was done. The result shows the complete absence of informed consent practices and mostly absence of consented care such as right to information, respect for choices of preferences for examination and/or procedure of childbearing women. Although 95% of the mothers were informed that they were being proceeded with normal vaginal delivery, their choice of preference was absent during the process. Only consent (not informed consent) was taken from 50%-72% mothers for examination (except breast examination ‘0%’) and 8%-83% for any procedures during postpartum care. Only one-ninth (11%) of the mothers could ask service providers regarding the services they received. No consent was taken from 3% of the mothers- neither in the labor process nor in postpartum care. This current practice doesn’t comply with the Respectful Maternity Care (RMC) Charter 2011. The issue is not even clarified in the current Standard Clinical Management Protocols of the country. So, improvement of the existing protocol and increased awareness are essential to address this right of child-bearing women and to practice it during normal vaginal delivery and postpartum care.

Keywords: informed consent, normal vaginal delivery, respectful maternity care, tertiary level hospital

Procedia PDF Downloads 143

Authors: A. Razavykia, A. Esmaeilzadeh, S. Iranmanesh

Abstract:

Many orthopedic implants like proximal humerus cases require lower surface roughness and almost immediate/short lead time surgery. Thus, rapid response from the manufacturer is very crucial. Tool path strategy of milling process has a direct influence on the surface roughness and lead time of medical implant. High-speed milling as promised process would improve the machined surface quality, but conventional or super-abrasive grinding still required which imposes some drawbacks such as additional costs and time. Currently, many CAD/CAM software offers some different tool path strategies to milling free form surfaces. Nevertheless, the users must identify how to choose the strategies according to cutting tool geometry, geometry complexity, and their effects on the machined surface. This study investigates the effect of different tool path strategies for milling a proximal humerus head during finishing operation on stainless steel 316L. Experiments have been performed using MAHO MH700 S vertical milling machine and four machining strategies, namely, spiral outward, spiral inward, and radial as well as zig-zag. In all cases, the obtained surfaces were analyzed in terms of roughness and dimension accuracy compared with those obtained by simulation. The findings provide evidence that surface roughness, dimensional accuracy, and machining time have been affected by the considered tool path strategy.

Keywords: CAD/CAM software, milling, orthopedic implants, tool path strategy

Procedia PDF Downloads 201

Authors: Mostafa Mohammadpour, Christoph Kapeller, Christy Li, Josef Scharinger, Christoph Guger

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Interictal spikes provide valuable information on electrocorticography (ECoG), which aids in surgical planning for patients who suffer from refractory epilepsy. However, the shape and temporal dynamics of these spikes remain unclear. The purpose of this work was to analyze the shape of interictal spikes and measure their distance to the seizure onset zone (SOZ) to use in epilepsy surgery. Thirteen patients' data from the iEEG portal were retrospectively studied. For analysis, half an hour of ECoG data was used from each patient, with the data being truncated before the onset of a seizure. Spikes were first detected and grouped in a sequence, then clustered into interictal epileptiform discharges (IEDs) and non-IED groups using two-step clustering. The distance of the spikes from IED and non-IED groups to SOZ was quantified and compared using the Wilcoxon rank-sum test. Spikes in the IED group tended to be in SOZ or close to it, while spikes in the non-IED group were in distance of SOZ or non-SOZ area. At the group level, the distribution for sharp wave, positive baseline shift, slow wave, and slow wave to sharp wave ratio was significantly different for IED and non-IED groups. The distance of the IED cluster was 10.00mm and significantly closer to the SOZ than the 17.65mm for non-IEDs. These findings provide insights into the shape and spatiotemporal dynamics of spikes that could influence the network mechanisms underlying refractory epilepsy.

Keywords: spike propagation, spike pattern, clustering, SOZ

Procedia PDF Downloads 50

Authors: Parveen Kundu, Nitika Chawla, Ruchi Agarwal, Swaran Kaur

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Background: Mature cystic teratoma is a benign, most common tumor of the ovary occurring mostly in young and middle-aged females. This study consists of 19 cases of mature cystic teratomas which were received in the Department Of Pathology over a period of two years. There were malignant transformations observed in three cases, which makes it very important for pathologists to thoroughly examine the entire specimen of mature cystic teratomas. Material and Methods: Nineteen reported cases of mature cystic teratomas were received in Deptt. Of Pathology, BPS GMC Khanpur Kalan, Sonepat, over a two-year period from November 2020 to October 2022 and reviewed retrospectively. Data regarding age, size, laterality, gross, morphological features, and surgery performed were retrieved from pathological archives. Results: In our study, the most common age of presentation was the 20-40 year age group. The most common presenting complaint was fullness in the abdomen or abdominal distension. Four out of 19 cases studied cases presented with bilateral ovarian cysts. Tumor size ranged from 6 to 20 cm in diameter. In seven cases, cysts were greater than or equal to 10 cm in diameter. Three cases showed malignant transformation. Conclusion: It is very important to thoroughly examine the contralateral ovary to rule out bilateral presentation. A furthermost thorough examination is advised in tumors of size >10 cm and in tumors with solid areas to rule out any malignant transformation.

Keywords: teratoma, ovary, malignant, transformation

Procedia PDF Downloads 71

Authors: Mehrdad Taghipour, Mina Rostami, Mahdi Eskandarlou

Abstract:

Partial-thickness skin graft is the cornerstone for scalp defect repair. Given the potential side effects following harvesting from these sites, this study aimed to compare the outcomes of graft harvesting from scalp and lower limb. This clinical trial was conducted among a sample number of 40 partial thickness graft candidates (20 case and 20 control group) with scalp defect presenting to Plastic Surgery Clinic at Besat Hospital, Hamadan, Iran during 2018-2019. Sampling was done by simple randomization using random digit table. The donor site in case group and control group was scalp and lower limb respectively. Overall, 28 patients (70%) were male and 12 (30%) were female. Basal cell carcinoma (BCC) and trauma were the most common etiology for the defects. There was a statistically meaningful relationship between two groups regarding the etiology of defect (P=0.02). The mean diameter of defect was 24.28±45.37 mm for all of the patients. The difference between diameters of defect in both groups were statistically meaningful while no such difference between graft diameters was seen. The graft “Take” was completely successful in both groups according to evaluations. The level of postoperative pain was lower in the case group compared to the control according to VAS scale and the satisfaction was higher in them per Likert scale. Scalp can safely be used as donor site for skin graft to be used for scalp defects associated with better results and lower complication rates compared to other donor sites.

Keywords: donor site, graft, scalp, partial thickness

Procedia PDF Downloads 78

Authors: T. C. Ng, R. Radzi, T. K. Ng, H. C. Chen

Abstract:

The analgesic effects of lidocaine-bupivacaine block in cats undergoing routine orchiectomy were determined in this controlled, randomized, and blinded study. Twelve cats were randomly assigned to two groups. Cats in local block group received subcutaneous infiltration of 1 mg/kg of 2% lidocaine and 1 mg/kg of 0.5% bupivacaine into the scrotal sac. Cats in control group received equivolume of saline. Both groups were induced with mixture of ketamine (15 mg/kg) and acepromazine (0.1 mg/kg) intramuscularly and maintained on sevoflurane via facemask. Non-invasive blood pressures (BP), heart (HR), and respiratory rate (RR) were measured intra-operatively at specific events. Post-operatively, all cats received meloxicam, 0.2 mg/kg subcutaneously. Pain scores were determined at 4, 8, and 24 hours postoperatively. Mechanical pressure thresholds (MPT) at the perineum and metatarsus were determined at 2, 4, 8, and 24 hours postoperatively. Intra-operatively, the BP and HR tended to be higher in the control group. The increment in HR peaked during traction and autoligation of the spermatic cord in the control group. There was no treatment difference in RR. Post-operatively, pain scores in the group given local blocks were lower than the control group at 4 hour post-operation. There was no treatment difference in the post-operative HR, RR, BP and MPT values. In conclusion, subcutaneous infiltration of lidocaine-bupivacaine into the scrotal sac before orchiectomy improved intra-operative hemodynamic stability and provided better analgesia up to 4 hours post-surgery.

Keywords: analgesia, bupivacaine, cat, lidocaine, local block, orchiectomy

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Authors: H. Noureddine, P. Rao, R. Guru, A. Chandratreya

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The nice guidance for elective total knee replacements states that patients should be given mechanical thrombo-prophylaxis, and if no contraindications chemical thromboprophylaxis in the form of Dabigatran etexilate, Rivaroxiban, UFH, LMWH, or Fondaparinux sodium (CG92, 1.5.14, January 2010). In Practice administering oral agents has been the dominant practice as it reduces the nursing needs, and shortens hospital stay and is generally received better by patients. However, there are well documented associated bleeding risks, and their effects are difficult to reverse in case of major bleeding. Our experience with oral factor 10 inhibitors used for thromboprophylaxis was marked with several patients developing complications necessitating return to the theatre for wound washouts. This has led us to try a different protocol for thromboprophylaxis that we applied on our patients undergoing total and unicondylar knee replacements. We applied mechanical thromboprophylaxis in the form of intermittent pneumatic pressure devices, and chemical thromboprophylaxis in the form of a dose of prophylactic LMWH pre-op, then 150 mg of Aspirin to start 24 hours after the surgery and to continue for 6 weeks, alongside GI cover with PPIs or antihistamines. We also administered local anaesthetics intra-operatively in line with the ERAS protocol thus encouraging early mobilization. We have identified a cohort of 133 patients who underwent one of the aforementioned procedures in the same trust, and by the same surgeon, where this protocol was applied and examined their medical notes retrospectively with a mean follow-up period of 14 months, to identify the rate and percentage of patients who had thrombo-embolic events in the post-operative period.

Keywords: aspirin, heparin, knee arthroplasty, thromboprophylaxis

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Authors: Anshul, Rajni Kalia, Sachin Kumar

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Introduction: The costoclavicular approach, a modification to the infraclavicular approach, has been described for anesthesia for upper limb surgeries. Material And Methods: In this randomized and single-blind study, fourty patients undergoing emergency/elective upper limb surgery were allocated to two groups. Group C and S received ultrasound-guided Costoclavicular block and Supraclavicular block, respectively, with 20 ml 0.5 % ropivacaine with 8 mg dexamethasone under strict asepsis. The primary outcome assessed was the total duration of sensory and motor block in the postoperative period. Secondary outcomes were to compare the time taken to perform the procedure, block characteristics in terms of onset of motor and sensory blockade, the efficacy of analgesia with respect to the time of administration of the first rescue analgesic dose with both the blocks and note the side effects pertaining to either of the blocks. Results: The mean total duration of sensory and motor blockade was longer in group C vs. group S (p=0.002 and 0.024, respectively). The mean duration to perform a block in group S was more than in group C (p=0.012). The mean onset of sensory and motor Blockade Time in group S was more than in group C (p<0.001 and <0.001, respectively). The mean duration to perform a block in group S was more than in group C (p=0.012). Conclusion: The costoclavicular approach is better than supraclavicular in terms of rapid execution, faster onset of sensory-motor blockade, prolonged postoperative analgesia and similar PONV and safety profile.

Keywords: costoclavicular, supraclavicular, ropivacaine, dexamethasone

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Authors: Nicholas Fletcher, Zachary Houston, Yongmei Zhao, Christopher Howard, Kristofer Thurecht

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One promising approach to enhance nanomedicine therapeutic efficacy is to include a targeting agent, such as an antibody, to increase accumulation at the tumor site. However, the application of such targeted nanomedicines remains limited, in part due to difficulties involved with biomolecule conjugation to synthetic nanomaterials. One approach recently developed to overcome this has been to engineer bispecific antibodies (BsAbs) with dual specificity, whereby one portion binds to methoxy polyethyleneglycol (mPEG) epitopes present on synthetic nanomedicines, while the other binds to molecular disease markers of interest. In this way, noncovalent complexes of nanomedicine core, comprising a hyperbranched polymer (HBP) of primarily mPEG, decorated with targeting ligands are able to be produced by simple mixing. Further work in this area has now demonstrated such complexes targeting the breast cancer marker epidermal growth factor receptor (EGFR) to show enhanced binding to tumor cells both in vitro and in vivo. Indeed the enhanced accumulation at the tumor site resulted in improved therapeutic outcomes compared to untargeted nanomedicines and free chemotherapeutics. The current work on these BsAb-HBP conjugates focuses on further probing antibody-nanomaterial interactions and demonstrating broad applicability to a range of cancer types. Herein are reported BsAb-HBP materials targeted towards prostate-specific membrane antigen (PSMA) and study of their behavior in vivo using ⁸⁹Zr positron emission tomography (PET) in a dual-tumor prostate cancer xenograft model. In this model mice bearing both PSMA+ and PSMA- tumors allow for PET imaging to discriminate between nonspecific and targeted uptake in tumors, and better quantify the increased accumulation following BsAb conjugation. Also examined is the potential for formation of these targeted complexes in situ following injection of individual components? The aim of this approach being to avoid undesirable clearance of proteinaceous complexes upon injection limiting available therapeutic. Ultimately these results demonstrate BsAb functionalized nanomaterials as a powerful and versatile approach for producing targeted nanomedicines for a variety of cancers.

Keywords: bioengineering, cancer, nanomedicine, polymer chemistry

Procedia PDF Downloads 130

Authors: Arnab Hazra

Abstract:

Breath analysis is a quick, noninvasive and inexpensive technique for disease diagnosis can be used on people of all ages without any risk. Only a limited number of volatile organic compounds (VOCs) can be associated with the occurrence of specific diseases. These VOCs can be considered as disease markers or breath markers. Selective detection with specific concentration of breath marker in exhaled human breath is required to detect a particular disease. For example, acetone (C₃H₆O), ethanol (C₂H₅OH), ethane (C₂H₆) etc. are the breath markers and abnormal concentrations of these VOCs in exhaled human breath indicates the diseases like diabetes mellitus, renal failure, breast cancer respectively. Nanomaterial-based vapor sensors are inexpensive, small and potential candidate for the detection of breath markers. In practical measurement, selectivity is the most crucial issue where trace detection of breath marker is needed to identify accurately in the presence of several interfering vapors and gases. Current article concerns a novel technique for selective and lower ppb level detection of breath markers at very low temperature based on TiO₂ nanotube array based vapor sensor devices. Highly ordered and oriented TiO₂ nanotube array was synthesized by electrochemical anodization of high purity tatinium (Ti) foil. 0.5 wt% NH₄F, ethylene glycol and 10 vol% H₂O was used as the electrolyte and anodization was carried out for 90 min with 40 V DC potential. Au/TiO₂ Nanotube/Ti, sandwich type sensor device was fabricated for the selective detection of VOCs in low concentration range. Initially, sensor was characterized where resistive and capacitive change of the sensor was recorded within the valid concentration range for individual breath markers (or organic vapors). Sensor resistance was decreased and sensor capacitance was increased with the increase of vapor concentration. Now, the ratio of resistive slope (mR) and capacitive slope (mC) provided a concentration independent constant term (M) for a particular vapor. For the detection of unknown vapor, ratio of resistive change and capacitive change at any concentration was same to the previously calculated constant term (M). After successful identification of the target vapor, concentration was calculated from the straight line behavior of resistance as a function of concentration. Current technique is suitable for the detection of particular vapor from a mixture of other interfering vapors.

Keywords: breath marker, vapor sensors, selective detection, TiO₂ nanotube array

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Authors: Monika Bansal

Abstract:

Background: Placement of dental implant in narrow alveolar ridge is challenging to be treated. GBR procedure is currently most widely used to augment the deficient alveolar ridges and to treat the fenestration and dehiscence around dental implants. Thus, the objectives of the present study were to evaluate as well as compare the clinical performance of collagen membrane and titanium mesh for horizontal bone augmentation at dehisced implant sites. Methods and material: Total 12 single edentulous implant sites with buccal bone deficiency in 8 subjects were equally divided and treated simultaneously with either of the two membranes and DBBM(Bio-Oss) bone graft. Primary outcome measurements in terms of defect height and defect width were made using a calibrated plastic periodontal probe. Re-entry surgery was performed to remeasure the augmented site and to remove Ti-mesh at 6th month. Independent paired t-tests for the inter-group comparison and student-paired t-tests for the intra-group comparison were performed. The differences were considered to be significant at p ≤ 0.05. Results: Mean defect fill with respect to height and width was 3.50 ± 0.54 mm (87%) and 2.33 ± 0.51 mm (82%) for collagen membrane and 3.83 ± 0.75 mm (92%) and 2.50 ± 0.54 mm (88%) for Ti-mesh group respectively. Conclusions: Within the limitation of the study, it was concluded that mean defect height and width after 6 months were statistically significant within the group without significant difference between them, although defect resolution was better in Ti-mesh.

Keywords: collagen membrane, dehiscence, dental implant, horizontal bone, augmentation, ti-mesh

Procedia PDF Downloads 97

Authors: Arlan S. Freitas, Leila M. Carvalho, Adriana L. Soares, Arnoud Neto, Marta S. Madruga, Elza I. Ida, Massami Shimokomaki

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The objective of this work was to evaluate the influence of microclimatic profile of broiler transport trucks under commercial conditions over the breast meat quality and DOA (Death On Arrival) in a tropical Brazilian regions as the North East where routinely the season is divided into dry and wet seasons. The temperature remains fairly constant and obviously the relative humidity changes accordingly. Three loads of 4,100 forty seven days old broiler were monitored from farm to slaughterhouse in a distance of 4.3 km, morning period of October 2015 rainy days. The profile of the environmental variables inside the container truck throughout the journey was obtained by the installation of thermo anemometers in 6 different locations by monitoring the heat index (HI), air velocity (AV), temperature (T), and relative humidity (RH). Meat qualities were evaluated by determining the occurrence of PSE (pale, soft, exudative) meat and DFD (dark, firm dry) meat. The percentage of birds DOA per loaded truck was determined by counting the dead broiler during the hanging step at the slaughtering plant. The analysis of variance was performed using statistical software (Statistica 8 for windows, Statsoft 2007, Tulsa, OK, USA). The Tukey significance test (P<0.05) was applied to compare means from microenvironmental data, PSE, DFD and DOA. Fillet samples were collected at 24h post mortem for pH e color (L*, a* e b*) determination through the CIELAB system. Results showed the occurrence of 2.98% of PSE and 0.66% de DFD and only 0.016% of DOA and overall the most uncomfortable container location was at the truck frontal inferior presenting 6.25% of PSE. DFD of 2.0% were obtained from birds located at central and inferior rear locations. These values were unexpected in comparison to other results obtained in our laboratories in previous experiments carried out within the country south state. The results reported herein were lower in every aspect. Reasonable explanation would be the shorter distance, wet conditions throughout around 15-20 min journeys and lower T and RH values as observed in samples taken from the rear location as higher DFD values were obtained. These facts mean the animals were not under heat stressful condition but in fact under cold stress conditions as the result of DFD suggested in association to the lower number of DOA.

Keywords: cold stress, DFD, microclimatic profile, PSE

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Authors: A. Zuchowska, A. Buta, M. Mazurkiewicz-Pawlicka, A. Malolepszy, L. Stobinski, Z. Brzozka

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In recent years, graphene-based materials are finding more and more applications in biological science. As a thin, tough, transparent and chemically resistant materials, they appear to be a very good material for the production of implants and biosensors. Interest in graphene derivatives also resulted at the beginning of research about the possibility of their application in cancer therapy. Currently, the analysis of their potential use in photothermal therapy and as a drug carrier is mostly performed. Moreover, the direct anticancer properties of graphene-based materials are also tested. Nowadays, cytotoxic studies are conducted on in vitro cell culture in standard culture vessels (macroscale). However, in this type of cell culture, the cells grow on the synthetic surface in static conditions. For this reason, cell culture in macroscale does not reflect in vivo environment. The microfluidic systems, called Lab-on-a-chip, are proposed as a solution for improvement of cytotoxicity analysis of new compounds. Here, we present the evaluation of cytotoxic properties of graphene oxide (GO) on breast, liver and colon cancer cell line in a microfluidic system in two spatial models (2D and 3D). Before cell introduction, the microchambers surface was modified by the fibronectin (2D, monolayer) and poly(vinyl alcohol) (3D, spheroids) covering. After spheroid creation (3D) and cell attachment (2D, monolayer) the selected concentration of GO was introduced into microsystems. Then monolayer and spheroids viability/proliferation using alamarBlue® assay and standard microplate reader was checked for three days. Moreover, in every day of the culture, the morphological changes of cells were determined using microscopic analysis. Additionally, on the last day of the culture differential staining using Calcein AM and Propidium iodide were performed. We were able to note that the GO has an influence on all tested cell line viability in both monolayer and spheroid arrangement. We showed that GO caused higher viability/proliferation decrease for spheroids than a monolayer (this was observed for all tested cell lines). Higher cytotoxicity of GO on spheroid culture can be caused by different geometry of the microchambers for 2D and 3D cell cultures. Probably, GO was removed from the flat microchambers for 2D culture. Those results were also confirmed by differential staining. Comparing our results with the studies conducted in the macroscale, we also proved that the cytotoxic properties of GO are changed depending on the cell culture conditions (static/ flow).

Keywords: cytotoxicity, graphene oxide, monolayer, spheroid

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Authors: Shao-Cyuan Yewang, Yu-Wen Chen

Abstract:

Background: Exercise training is well known to alleviate chronic pain syndromes improve of chronic pain. This study investigated the effect of swimming exercise training on thoracotomy and rib retraction-induced allodynia. Methods: Male Sprague Dawley rats that received animal model of persistent postthoracotomy pain. All rats were divided into three groups: sham operations group (Sham), thoracotomy and rib retraction group (TRR), and TRR with swimming exercise training for 90min/day, 7 days a week for 4 weeks (TRR-SEW). The sham group did not receive retraction of the ribs. Thus, they received a pleural incision. The levels of mechanical and cold allodynia were measured by von Frey and acetone test. Results: In von Frey test, the level of mechanical allodynia in the TRR group was significantly higher than the sham group. The level of mechanical allodynia in the TRR-SEW group was significantly lower than the TRR group. In acetone test, the level of cold allodynia in the TRR group was significantly higher than the sham group. The level of cold allodynia in the TRR-SEW group was significantly lower than the TRR group. Conclusions: These results suggest that swimming exercise training decreases persistent postthoracotomy pain caused by TRR surgery. It may provide one of the new therapeutic effects of swimming exercise training could alleviate persistent postthoracotomy pain.

Keywords: chronic pain, thoracotomy pain, swimming, von Frey test, acetone test

Procedia PDF Downloads 197