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One percent to 3% of contemporary non-cemented total hip arthroplasties (THAs) present with symptomatic mechanically assisted crevice corrosion (MACC). The incidence of this problem, however, as well as the rate of asymptomatic elevations in serum cobalt, is unknown.Cobalt and chromium levels were obtained in conjunction with radiographs at routine 10-year surveillance follow-up of THAs from a single manufacturer with a titanium stem, cobalt alloy femoral head, and cross-linked polyethylene countersurface.Ten-year follow-up of patients with 162 consecutive THAs revealed that 17 patients with 18 hips had died of unrelated causes prior to metal ion testing. Two hips were revised for other reasons, and of the remaining 142 hips, 33 were in patients who were lost, leaving 109 hips (77% of those in alive patients and unrevised for other reasons and 67% of the entire cohort) for investigation. Sixty-three patients (58%) had a serum cobalt less than 1 ppb, and 35 (32%) a cobalt of ≥1 ppb, a cutoff consistent with MACC. Of the 32 hips with definite MACC, 15 of 32 (47%) patients were symptomatic, 16 of 30 (53%) patients had adverse local tissue reaction on magnetic resonance imaging, and 19 of 32 (59%) patients have undergone revision surgery for MACC to date.At 10-year follow-up, a minimum of 22% (35/162) of hips had a cobalt level more than 1 ppb, consistent with MACC. Symptoms and adverse local tissue reactions are each present about one-half of the time, and 59% of those with documented MACC have undergone revision.

Introduction Dyspnoea is common in patients with giant paraoesophageal hernia (PEH). Pulmonary aspiration has not previously been recognised as a significant contributory factor. Aspiration pneumonia in association with both gastro-oesophageal reflux disease (GORD) and PEH has a high mortality rate. There is debate about routine anti-reflux measures with surgical repair. Reflux aspiration has been examined in a consecutive cohort using scintigraphic scanning and symptoms. Methods Reflux aspiration scintigraphy (RASP) results and symptoms were evaluated in consecutive patients with PEH managed in our service between January 2012 and March 2017. Results PEH was diagnosed in 96 patients. Preoperative reflux pulmonary scanning was performed in 70 patients: 54 were female (77.1%) and the mean age was 68 years (range 49–85). Dyspnoea was the most common symptom (77.1%), and a symptomatic history of aspiration was seen in 18 patients (25.7%). Clinical aspiration was confirmed by RASP in 13 of these cases. Silent RASP aspiration occurred in a further 27 patients without clinical symptoms. RASP was negative in five patients with clinical symptoms of aspiration. No aspiration by either criterion was present in 27 patients. Dysphagia was negatively related to aspiration on RASP (pConclusion GORD, dyspnoea and silent pulmonary aspiration are frequent occurrences in the presence of giant PEH. Subjective aspiration was the most specific and positive predictor of pulmonary aspiration. Dyspnoea in PEH patients may be caused by pulmonary aspiration, cardiac compression and gas trapping. The high rate of pulmonary aspiration in PEH patients may support anti-reflux repair.

Craniofacial tissue defects caused by trauma, developmental malformation, or surgery are critical issues of high incidence, which are harmful to physical and psychological health. Transplantation of engineered tissues or biomaterials is a potential method to repair defects and regenerate the craniofacial tissues. Revascularization is essential to ensure the survival and regeneration of the grafts. Since microvessels play a critical role in blood circulation and substance exchange, the pre-establishment of the microvascular network in transplants provides a technical basis for the successful regeneration of the tissue defect. In this study, we reviewed the recent development of strategies and applications of prevascularization in tissue engineering and regeneration of craniofacial tissues. We focused on the cellular foundation of the

Retrograde intramedullary nailing (RIMN) is the favored over antegrade intramedullary nailing in fractures of the distal femur. It provides a longer working length and allows for multiple distal screw insertion and therefore a more stable construct. Concerns remain regarding the violation of the knee cartilage and the effect this has on knee function. Many studies have shown high incidence of knee pain with reports varying from 20 to 86%. We describe a novel technical trick aiming at partially restoring the knee cartilage of the operated side and decreasing the hemorrhage stemming from the medullary canal. Our experience of the technique and the case series shows that closing the entrance point of the medullary canal after a RIMN procedure leads to better function and less knee pain in the postoperative period.

Введение. Выбор оптимальной методики остеосинтеза внесуставных переломов большеберцовой кости продолжает обсуждаться в научной литературе. При открытых переломах, высокоэнергетической травме, повреждениях мягких тканей, особенно в нижней трети голени, нередко используется метод наружной фиксации. Отказ от более широкого его применения объясняется опасениями воспалительных осложнений и неудобствами для больного. Цель исследования: анализ опыта применения наружного чрес­костного остеосинтеза при внесуставных переломах костей голени и обоснование показаний к его использованию. Материалы и методы. Проведен ретроспективный анализ лечения 67 пострадавших с внесуставными переломами большеберцовой кости методом наружного остеосинтеза. Изучены осложнения и результаты лечения. Проанализированы показания к применению, при которых преимущества метода превосходят неудобства, связанные с наличием внешнего модуля. Результаты. Несросшиеся переломы отмечены у 4 (5,9 %) пострадавших, воспалительные осложнения — у 2 (2,9 %), контрактуры голеностопного сустава — у 4 (5,9 %). Хороший результат отмечен у 55 (80,9 %) пострадавших, удовлетворительный — у 8 (11,1 %), неудовлетворительный — у 5 (7,3 %). Пациенты в период лечения сохраняли мобильность, возможность самообслуживания, осуществляли осевую нагрузку и движения в суставах. Анализ показаний к применению наружного остеосинтеза показал, что при некоторых ситуациях (переломы, сопровождающиеся травматическими или трофическими нарушениями со стороны мягких тканей; переломы большеберцовой кости типа С, двойные (тройные) переломы; перелом костей голени как компонент политравмы; внесуставные переломы костей обеих голеней; лечение несросшихся переломов и дефектов костей) преимущества, которые обеспечивает применение внешней фиксации, превышают неудобства, связанные с наличием наружной конструкции. Выводы. Таким образом, наружный чрескостный остеосинтез является эффективным методом лечения внесуставных переломов костей голени. Опасения, связанные с высокой частотой воспалительных осложнений и неудобствами пребывания в аппарате, при использовании современных конструкций являются преувеличенными. Условием эффективного применения метода является использование конструкций, предусматривающих возможность осевой нагрузки и движений в суставах, этапного воздействия на костные фрагменты, строгое соблюдение технологии вмешательства.

Background Cervical pedicle screws (CPS) in the subaxial cervical spine (C3-C6) are faced with high incidence of perforating the lateral pedicular cortex endangering the vertebral artery (VA). The present study analyzes the pedicle width (PW) from C3 to C6 and defines the relation of VA with regard to pedicle and transverse foramen (TF) to determine the safety margin in cases of lateral pedicular breach. Methods Computed tomography angiograms of 500 patients were retrospectively studied to identify the pedicle width (PW), VA area, TF area, and the lateral pedicle to vertebral artery distance (LPVA). Occupancy ratio (OR; the percentage area of transverse foramen occupied by VA) and safety margin (SM; permissible displacement of VA in TF), along with LPVA were considered to be protective parameters against VA injury if lateral pedicle breach happens. Results PW was 4.7 mm at C3, 4.83 mm at C4, 5.26 mm at C5 and 5.41 mm at C6. Mean LPVA at different levels was between 0.97 mm and 1.15 mm, OR was around 20% at all levels, and mean SM was between 2.34 mm and 2.92 at various levels. Sex differences were statistically significant for PW but not for LPVA, SM, or OR. Conclusions This study gives us an idea about the various parameters in placement of cervical pedicle screw in subaxial cervical spine and the probable reasons there are few vertebral artery injuries despite high incidence of cervical pedicle breach. LPVA, safety margin, and OR may explain why even very significant CPS misplacement does not lead to vascular injury or neurologic deficit.

Objective Interleukin-1 (IL-1) is a pro-inflammatory cytokine which may be related to urolithiasis. Genetic polymorphisms of the interleukin-1β (IL-1β) have been proposed as markers for urolithiasis in some areas. Due to the high incidence of urolithiasis in Uighur children (Xinjiang, China) and existence of ethnic difference, our aim is to explore the potential of IL-1 gene polymorphisms and urolithiasis among these children. Methods Genomic DNA extracted from peripheral blood of 115 patients and 98 controls were used for genotype polymorphisms analyses. IL-1 receptor antagonist gene (IL-1RN) variable numbers of a tandem repeat (VNTR) gene polymorphisms were analyzed by PCR method. PCR-based restriction analysis was done for the IL-1β (−511) and IL-1β (+3954) gene polymorphisms by endonucleases Ava I and Taq I, respectively. The genotype distribution, allele frequencies, carriage rate and haplotype frequencies were statistically analyzed. Results No significant differences were observed in genotypic frequencies between pediatric urolithiasis patients and control group for IL-1RN gene (χ2 = 1.906, p = 0.605), IL-1β (−511) gene (χ2 = 0.105, p = 0.949), or IL-1β (+3954) gene (χ2 = 3.635, p = 0.169). There were yet no significant differences of the allele frequencies of IL-1RN VNTR gene (p = 0.779), IL-1β (-511) gene (p = 0.941), and IL-1β (+3954) gene (p = 0.418) in the case and control groups, as well as the carriage rate and haplotype of them (all p > 0.05). Conclusions The associations between IL-1RN VNTR, IL-1β (-511) and IL-1β (+3954) genes polymorphisms and urolithiasis were not significant in Uighur children. The results need to be confirmed in studies with larger population sample size, as well as in other ethnic groups.

Purpose: To evaluate surgical complications and oncological outcomes of patients submitted to primary radical inguinal surgical debulking (PRISD) and myocutaneous pediculate flap reconstruction (MPFR) for locally advanced penile cancer (PC). Materials and Methods: Forty-two patients with ulcerated and/or fixed bulky inguinal masses underwent unilateral or bilateral PRISD with MPFR. Tensor fascia lata flap (TFL) was the standard of care for all patients. Additional use of the gracilis flap (GF) was carried out when necessary. Contra-lateral radical inguinal lymphadenectomy (RIL) was conduced when PRISD was performed unilaterally. Surgical complications were analyzed and stratified into minor and major according to the Bevan-Thomas classification. Adjunctive treatments were assessed and oncological outcomes analyzed. Results: Of the 42 patients evaluated, 10 (23.8%) underwent bilateral PRISD and 32 (76.2%) unilateral PRISD with contra-lateral RIL, totaling 84 lymphadenectomies. A total of 62 MPFRs were performed, 52 with TFL and 10 with GF. A total of 53 complications were identified, 49 related to PRISD with MPFR and 4 to RIL. Adjuvant chemotherapy was carried out in 16 patients. Median follow-up was 10.8 months with a median overall survival (OS) of 14.0 months against 6.0 months (p=0.006) for patients submitted to PRISD with adjuvant chemotherapy in relation to surgery alone. Conclusions: PRISD alone for advanced loco-regional PC is unlikely to promote long-term survival, although it can lead to temporary local control of the disease. Despite the feasibility of the procedure, it is related to high incidence of complications. Surgical treatment with adjuvant chemotherapy is associated with improved OS.

Aim: The high incidence and prevalence of fungal infections call for new antifungal drugs. This work was to develop naphthalimide thiazoles as potential antifungal agents. Results & methodology: These compounds showed significant antifungal potency toward some tested fungi. Especially, naphthalimide thiazole 4h with excellent anti- Candida tropicalis efficacy possessed good hemolysis level, low toxicity and no obvious resistance. Deciphering the mechanism showed that 4h interacted with DNA and disrupted the antioxidant defense system of C. tropicalis. Compound 4h also triggered membrane depolarization, leakage of cytoplasmic contents and LDH inhibition. Simultaneously, 4h rendered metabolic inactivation and eradicated the formed biofilms of C. tropicalis. Conclusion: The multifaceted synergistic effect initiated by naphthalimide thiazoles is a reasonable treatment window for prospective development.

Despite the high incidence of constipation in people with cancer, there is little research on management strategies for opioid-induced constipation (OIC). This project used the Plan-Do-Study-Act model to examine implementation of the Oncology Nursing Society GuidelinesTM to improve constipation management in patients with cancer. Nurse champions at four sites identified practice gaps, including providing education on OIC for patients who are new to opioids and increasing follow-up assessment. This project demonstrates that multisite, collaborative projects are feasible and may enhance patient quality of life and decrease anticipated complications.

Objective After percutaneous endoscopic lumbar discectomy (PELD), most patients with lumbar disc herniation (LDH) experience relief from the typical symptoms of low back and leg pain. However, for a small number of patients, these symptoms are relieved immediately after surgery but aggravated soon after, and then relieved after short‐term full rest or conservative treatment. The aim of the study was to demonstrate this short‐term recurrent phenomenon, termed rebound pain. Methods A retrospective study was conducted on 144 patients who underwent single‐segment PELD from May 2017 to June 2020. Postoperative patients were divided into a rebound pain group and a non‐rebound pain group. For the former group, general information, symptom characteristics and visual analogue score (VAS) changes in rebound pain were summarized. For both groups, postoperative efficacy was evaluated by recent VAS of low back and leg pain in the remission stage, the Oswestry disability index (ODI) and the modified MacNab criteria at the last follow‐up. Logistic regression analysis was used to identify predictors for rebound pain. Results The VAS and ODI exhibited significant improvements at the last follow‐up of average 15.4 months (P 45 days was found as a protective factor for rebound pain (p = 0.031). Conclusion Although rebound pain with multiple characteristics and a short duration had no significant effect on long‐term postoperative efficacy, its high incidence often caused unnecessary concern in both patients and doctors. As a result, careful differentiation of rebound pain from other postoperative complications is needed., For patients with lumbar disc herniation, most received relief from low back and leg pain after percutaneous endoscopic lumbar discectomy (PELD). However, 10.4% of patients had short‐term pain recurrence after PELD, termed rebound pain, which could be alleviated by adequate rest and conservative treatment.

Objective Gynecologic Sarcomas are rare, aggressive tumors. The aim of this study was to explore the incidence and outcomes of gynecologic sarcomas in a large national data registry and to compare them with reports from other countries. Study Design Records of gynecologic sarcomas diagnosed in Israel (1980–2014) were extracted from the National Cancer Registry and classified according to International Classification of Diseases for Oncology-3 and characterized according to anatomical site, morphology and demographics. Age-standardized incidence rates and 1, 3, 5 and 10-year relative survival rates were calculated for 3 time periods (1980–1994, 1995–2001 and 2005–2014) according to patient age, stage and years of diagnosis. Results During 1980–2014, 1271 new gynecologic sarcomas were diagnosed in Israel, with incidence slightly increasing in 1980–2004, to an age-standardized incidence rate of 13 per million women. The most common histologic diagnosis was leiomyosarcoma (48%) and the most common anatomical site was the uterus (89%). The age-standardized incidence rate for uterine sarcoma is higher in Israel (10.55 per million) than in England (7.4 per million) and Germany (5.8 per million) respectively. The 5-year overall survival was significantly poorer in patients >70-years, as compared to younger patients (p Conclusions Uterine leiomyosarcoma was the most common gynecologic sarcoma found in the Israeli, European and American registries. Older patients and those with leiomyosarcoma have the worst prognoses. Histological and anatomical variations in Israel are comparable with global statistics, but the incidence in Israel seems higher than in Europe.

Background: Degenerative pathology of the facet joints of the lumbar spine remains a significant medical and social problem due to persistent pain syndrome, high incidence and disability rate. Clinical case description: A patient complaining of pain and discomfort in the lumbosacral spine on the right, arising in the upright position, intensifying with bending and flexion-extension of the trunk, and periodically spreading to the right gluteal region and along the posterior surface of the thigh, was admitted to the neurosurgical department of the Irkutsk Scientific Center of Surgery and Traumatology. A surgical treatment was performed in the form of dereception of the LIILIII, LIIILIV, LIVLV arch-process joints. In the postoperative period, the patient noted a decrease in the intensity of pain in the lumbosacral spine to 3 points by a visual analog scale and was discharged from the department on the 5th day after the surgery in a satisfactory condition. Conclusion: Facet joint pathologies represent a most common nosological form of the degenerative-dystrophic process (spondyloarthrosis) and a potential source of pain with the formation of instability of the spinal motion segment and chronic pain syndrome. The complex anatomical and topographic relationships between the facet joints, intervertebral discs, and radicular nerves force clinicians to pay attention to the pathology of facet syndrome. Understanding the morphological, clinical, and radiological features of the course of the facet joint degeneration makes it possible to increase the diagnostic capabilities for detecting facet syndrome of the lumbar spine and effectively apply transcutaneous surgical technologies for the treatment of chronic pain syndromes.

Perihilar cholangiocarcinoma (pCCA) is one of the most complex challenges for hepatobiliary surgeons. Poor results and high incidence of morbidity after Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) for pCCA discouraged this indication. It has been proposed that minimally invasive approach for ALPPS first stage, as well as combination of surgical liver partition and radiologic portal vein embolization (PVE), may improve outcomes reducing interstage morbidity. We report a case of right trisectionectomy with enbloc caudatectomy ALPPS scheduled for pCCA with robotic approach at stage-1, the full video is provided as supplementary material. Due to intraoperative presence of portal vein tumor infiltration during hilar dissection (no evidence in the pre-operative work-up), a radiologic right PVE was performed after stage-1 instead of portal vein ligation, followed by portal vein resection and biductal hepatico-jejunostomy at stage-2 with open approach. The patient was a 74-year-old female diagnosed with 3-cm mass-forming pCCA. The total clean liver volume was 1231 cc, with future liver remnant (FLR) volume of 25.1% (segments II and III). She was discharged in the interstage interval on postoperative day (POD) 4; CT scan on POD 12 showed that FLR increased up to 33% (369 cc) (Fig. 1). ALPPS was completed on POD 17, the postoperative course was uneventful, and the patient was discharged in good general condition on POD 19 after stage-2. Besides the already demonstrated advantages in terms of reduced interstage morbidity, robotic ALPPS represents a promising strategy to expand surgical indication in patients with pCCA. The combination of liver partition and PVE may increase the opportunities to perform radical resections in selected patients with pCCA and portal vein infiltration. Supplementary Information The online version contains supplementary material available at 10.1007/s13304-021-01209-x.

Diabetes is the third chronic disease threatening human health after cardiovascular and cerebrovascular diseases and malignant tumors. The latest survey shows that there are as many as 463 million diabetic patients in the world, most of which are type 2 diabetes, and present a state of high incidence. Therefore, preventing and controlling the occurrence of type 2 diabetes is of great strategic significance for protecting human health and saving medical resources. This paper uses the SVM classification technology in data mining to establish a type 2 diabetes risk prediction model based on the SVM classifier, and uses the model to predict the original data of diabetic patients in the endocrinology department of a third-class hospital in Wuhan. Finally, an evaluation tool is used to evaluate the prediction performance and quality of the prediction model. The experimental results show that the prediction model based on the SVM classifier has the advantages of high prediction accuracy, good stability, fast learning speed and good classification effect under complex clinical data sets. It has important guiding significance for assisting the clinical diagnosis and risk prediction of type 2 diabetes.

Background Cutaneous leishmaniasis (CL) is a tropical infection with a relatively high incidence rate in Iran. The present study aimed to explore the time trend and associated factors of CL in Dezful, in southwest Iran. Methods This case series study was conducted on all CL patients registered from 2014 to 2019. The descriptive analysis of the data was done using SPSS 20 software and the time series model on the number of cases was run through Interactive Time Series Modeling software. Results A total of 5349 leishmaniasis cases were identified in the study area during 2014–2019. The highest incidence rate was 35 840 per 100 000 in 2014. The fitted time series model revealed a decreasing trend with an annual periodic pattern. The mean age of infection was 19.82 y (standard deviation 21.87). The infection was most frequent in the 1–10 y age group (41.7%). Also, females were more prone to leishmaniasis (54.7%). Most lesions were located on the hand (23.1%), face (19.7%), and forearm (17.75%) and 48.5% of patients had only one lesion. Conclusions The results revealed a decreasing trend of leishmaniasis in Dezful. It has been predicted that this infection will reach a minimum rate (300 per 100 000) in the winter of 2021.

Introduction: Creutzfeldt-Jakob disease (CJD), a spongiform encephalopathy, caused by a transmissible misfolded cellular prion protein, is a rapidly progressive, debilitating neurodegenerative disorder with no effective treatment. The estimated global incidence is at 1/million inhabitants. This retrospective study examined the incidence of CJD in South Western Sydney Local Health District (SWSLHD) from 2014 to 2020. Background: SWSLHD had an estimated population of 1,038,534 in 2020, with CJD data being limited. Methods: The New South Wales (NSW) Health Information Exchange (HIE) database, for all admissions with CJD diagnoses in SWSLHD, between 2014 and 2020, was reviewed according to the WHO diagnostic criteria, consistent with the Australian national CJD registry. Only probable CJD cases were included. Incidence was calculated based on the projected SWSLHD population. Results: Thirty-five patients, diagnosed with CJD, were identified. Each was evaluated by 2 independent investigators, including clinical presentation, MRI, EEGs, 14-3-3, and RT-QuIC results, before assigning CJD-probable status. Four failed the CJD criteria and were excluded. Of the 31 CJD-probable cases, most (59%) were male and older (37%, range 61–70 years). The incidence rate peaked at 9/million in 2017 and was above 2/million, throughout the 7 years, with an average of 4.859/million/year. Conclusions: The incidence of CJD, in SWSLHD, exceeds the national average of 1/million. Cost-effective, adequate diagnostic and screening tools, implementable over a large population, will become increasingly essential.

Chilli (Capsicum annum L.) is a common spice crop grown in India. During 2018, twig blight symptoms were first observed in experimental plots of chilli in ICAR-IIHR-Central Horticultural Experimental Station, Odisha, India. High incidence of twig blight to the tune of 23% was documented during 2018 Kharif crop of chilli. There was no occurrence of twig blight in rabi and summer crops. This study reported the detailed cultural and micro-morphological characteristics of Choanephora cucurbitarum infecting chilli and pathogen identity was confirmed by molecular phylogenetic analyses. Pathogenicity tests were repeated twice with same results. To best of our knowledge, C. cucurbitarum infecting chilli is the first report in the state of Odisha, India.

Qingqing Qi,1 Qingxu Song,2 Yufeng Cheng,2 Nana Wang2 1Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People’s Republic of China; 2Department of Radiation Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People’s Republic of ChinaCorrespondence: Nana WangDepartment of Radiation Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People’s Republic of ChinaEmail wangna03@163.comBackground: Prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) are the most common factors to estimate nutritional and inflammatory status. The aim of this study is to systematically evaluate the prognostic significance of above nutritional and inflammatory indexes for overall survival (OS) and surgical complications in esophageal cancer patients.Methods: Esophageal cancer patients who underwent esophagectomy were retrospectively collected. PNI, NLR, PLR, and SII were introduced to evaluate the baseline nutritional and inflammatory status.Results: A total of 407 patients were included in the present study. Kaplan–Meier survival analysis revealed that PNI-low group, NLR-high group and PLR-high group, all showed a significantly shorter OS (34.38% vs 49.46%, P < 0.001; 36.13% vs 48.26%, P = 0.026 and 33.33% vs 48.52%, P = 0.001 respectively), while no significant difference was found in SII groups (42.33% vs 46.31%, P = 0.067). Multivariable analyses identified PNI (P = 0.002) was an independent prognostic factor for OS, but NLR (P = 0.672) and PLR (P = 0.186) were not. Postoperative complications occurred significantly more frequently in the low-PNI group (29.69% vs 13.26%, P < 0.001). However, no significant differences were found in the postoperative complication rates between different NLR (16.67% vs 22.69%, P = 0.124), PLR (18.03% vs 19.61%, P = 0.867) and SII (15.34% vs 20.49%, P = 0.326) groups. Multivariate logistic regression analysis showed only PNI (P = 0.008) was an independent prognostic factor for postoperative complications.Conclusion: Preoperative low PNI was not only an independent prognostic factor for worse survival in esophageal cancer patients but also associated with high incidence of postoperative complications.Keywords: esophageal cancer, prognostic nutritional index, prognosis, postoperative complications

Most existing biocontainment units (BCUs) in U.S. hospitals are designed to care for a limited number of patients infected with epidemiologically significant pathogens. The COVID-19 pandemic presented substantial challenges to hospital preparedness and operations because of its high incidence rate and the high risk of transmission to staff members. This article describes a novel practice innovation: a hospital-wide deployment of nurses on a trained BCU team to support hospital staff in safely caring for patients with COVID-19. Their responsibilities included assisting in the development of guidelines and providing training on safety protocols and the appropriate use of personal protective equipment. The authors show how this deployment contributed significantly to staff education and support during the pandemic.

Chronic obstructive pulmonary disease (COPD) is a disease with high incidence rate and mortality rates worldwide. It is the third leading cause of death in the world. Nevertheless, little progress has been made in treating and preventing the disease. Under these circumstances, the concept of “early COPD” was proposed. Although this concept is not new, most health-care workers do not fully understand early COPD and tend to confuse it with mild COPD. In this review, we mainly discuss the definition of early COPD and the developmental trajectory of lung function. Although patients with early COPD have no symptoms, their lung function is already lower than that of normal people. A relatively complete definition is needed to identify this group of people. Reduced lung function is the diagnostic criterion for COPD, but lung development is a long-term dynamic process. In addition to smoking and air pollution, we should pay more attention to prenatal and childhood risk factors, for example, parents smoking, birth weight, preterm birth, mode of delivery, childhood respiratory infections and childhood asthma. Health-care workers need to be fully aware of early COPD, to reduce the morbidity of COPD and take effective measures to prevent these risk factors.

Gastroesophageal reflux disease (GERD) is a common disease in patients with obesity. The incidence of de novo GERD and the effect of bariatric surgery on patients with pre-existing GERD remain controversial. Management of GERD following bariatric surgery is complicated and can range from medical therapy to non-invasive endoscopic options to invasive surgical options. To address these issues, we performed a systematic review of the literature on the incidence of GERD and the various modalities of managing GERD in patients following bariatric surgery. Given the increased number of laparoscopic sleeve gastrectomy (LSG) procedures being performed and the high incidence of GERD following LSG, bariatric surgeons should be familiar with the options available to manage GERD following LSG as well as other bariatric procedures.

SETTING: Migrants to Europe face a disproportionate burden of infections, including TB, yet little is known about the approach taken by primary and secondary care providers to screening and treatment. We therefore explored policy and practice relating to screening of active TB and latent TB infection (LTBI) in France.METHODS: We conducted an online national survey of French primary and secondary care physicians regarding their practices in relation to TB/LTBI screening among migrants.RESULTS: 367 physicians responded to the questionnaire among which 195 (53.1%) were primary care physicians, 126 (34.3%) were TB specialists in secondary care, and 46 (12.5%) other physicians; 303 (85.5%) were involved daily in the care of migrants. Most respondents recommended systematic TB screening with chest X-ray for migrants from medium and high-incidence countries (71.9%). Primary care physicians were less likely to offer screening than physicians in other settings (aOR 0.21, 95% CI 0.09–0.48). 220 (61.8%) offered LTBI screening for children (CONCLUSION: Improving awareness on TB screening is a critical next step to improve health outcomes in migrant groups and meet regional targets for tackling TB.

Los profesionales de la salud de las unidades de endoscopia tienen un posible riesgo de infección por SARS-CoV-2 por diferentes vías: inhalación de gotitas en el aire, aerosoles, contacto conjuntival y transmisión fecal-oral. Objetivo Describir la detección del SARS-CoV-2, en una serie de pacientes, programados para endoscopia digestiva en el Hospital Santa Caterina. Salt. (Girona). Métodos Estudio descriptivo de una serie de casos de pacientes programados para endoscopia durante el mes de mayo de 2020, en el reinicio de la actividad endoscópica después del pico pandémico, siguiendo las recomendaciones de SCD, SEED, AEG y ESGE. Examinamos muestras nasofaríngeas 48-72 horas antes de la cita, mediante RT-PCR a todos los pacientes. La extracción del ARN se hizo mediante kits: Qiagen®-adaptado, BiosSprint®96-DNA-Blood-Kit (384). Para amplificación-detección del SARS-CoV-2 se siguieron métodos recomendados por la OMS y el CDC. Resultados Se programaron 110 pacientes asintomáticos sin contacto estrecho con positivo los 14 días previos; 105 (96,4%) fueron negativos y 5 (4,5%) positivos. Dos pacientes desarrollaron clínica respiratoria después del diagnóstico (presintomáticos) y 3 continuaron asintomáticos. Los 5 pacientes eran casos autóctonos y sin antecedentes de viaje o residencia en otra ciudad o país asociado a alta prevalencia de infección. Cuatro casos fueron mujeres entre 60-81 años. El gen N fue detectado en todos los casos. Conclusiones Se detectó una alta prevalencia de infección por SARS-CoV-2 en pacientes programados por endoscopia digestiva. Dado el riesgo de transmisión a los profesionales, consideramos recomendable realizar RT-PCR del SARS-CoV-2 48-72 horas antes de la exploración en situaciones de alta incidencia poblacional.

Background Active screening for tuberculosis (TB) involves systematic detection of previously undiagnosed TB disease or latent TB infection (LTBI). It may be an important step toward elimination of TB among Inuit in Canada. We aimed to evaluate the cost-effectiveness of community-wide active screening for TB infection and disease in 2 Inuit communities in Nunavik. Methods We incorporated screening data from the 2 communities into a decision analysis model. We predicted TB-related health outcomes over a 20-year time frame, beginning in 2019. We assessed the cost-effectiveness of active screening in the presence of varying outbreak frequency and intensity. We also considered scenarios involving variation in timing, impact and uptake of screening programs. Results Given a single large outbreak in 2019, we estimated that 1 round of active screening reduced TB disease by 13% (95% uncertainty range -3% to 27%) and was cost saving compared with no screening, over 20 years. In the presence of simulated large outbreaks every 3 years thereafter, a single round of active screening was cost saving, as was biennial active screening. Compared with a single round, we also determined that biennial active screening reduced TB disease by 59% (95% uncertainty range 52% to 63%) and was estimated to cost Can$6430 (95% uncertainty range -$29 131 to $13 658 in 2019 Can$) per additional active TB case prevented. With smaller outbreaks or improved rates of treatment initiation and completion for people with LTBI, we determined that biennial active screening remained reasonably cost-effective compared with no active screening. Interpretation Active screening is a potentially cost-saving approach to reducing disease burden in Inuit communities that have frequent TB outbreaks.

Brain abscesses due to odontogenic infection are infrequent, but they deserve attention due to the high incidence of serious complications and the high mortality rate. This article aimed to report five cases of cerebral abscess due to odontogenic infection, of patients attended in the Clinical Hospital of Medical School of the University of Sao Paulo (HCFMUSP). In all cases, treatment consisted of draining the brain abscess, antibiotic therapy and extraction of all teeth responsible for the infection. Streptococcus sp. was the causative agent of all the cases reported in this article. The purpose of the study was to highlight the importance of the dental approach for the resolution of cases.

espanolLa enfermedad coronaria es una de las complicaciones mas frecuentes en los pacientes con enfermedad renal cronica, debido en parte a la alta incidencia de factores de riesgo comunes, como la hipertension arterial o la diabetes mellitus, y a factores dependientes de la propia enfermedad renal, como lo es el hiperparatiroidismo. Diversos estudios han demostra-do la existencia de una relacion entre un mayor riesgo cardiovascular y la presencia de hiperparatiroidismo, bien sea este primario o secundario. Dicha relacion parece atribuible, a un aumento de la prevalencia de los factores de riesgo cardio-vascular entre aquellos pacientes con hiperparatiroidismo primario asintomatico. La elevacion de la hormona paratiroidea se relaciona con el desarrollo de eventos coronarios agudos en pacientes con nefropatia sometidos a hemodialisis y, el valor de corte de 500 pg/dl o mas, hace que sea frecuente la aparicion de complicaciones cardiovasculares. El enfoque general del presente trabajo es dar a conocer la incidencia de los Niveles de Parathormona en la aparicion de eventos coronarios agudos en pacientes con enfermedad renal cronica. Los resultados se obtuvieron mediante el desarrollo de una investigacion de tipo bibliografica, delimitada a una metodologia de revision, que permite concluir que el hecho de tener niveles de Paratohormona (PTH) elevados, resulta ser un factor de riesgo importante para la aparicion de eventos coronarios agudos, sin embargo, todavia es muy pobre la evidencia en lo que respecta a la relacion existente entre los ni-veles de PTH y el pronostico una vez la enfermedad coronaria esta establecida, por lo que se recomienda realizar estudios prospectivos que permitan ampliar los hallazgos encontrados en la presente investigacion. EnglishCoronary heart disease is one of the most frequent complications in patients with chronic kidney disease, due in part to the high incidence of common risk factors, such as high blood pressure or diabetes mellitus, and factors dependent on the kidney disease itself, such as it is hyperparathyroidism. Several studies have shown the existence of a relationship between an increased cardiovascular risk and the presence of hyperparathyroidism, whether it is primary or secondary. This relationship seems to be attributable to an increase in the prevalence of cardiovascular risk factors among those pa-tients with asymptomatic primary hyperparathyroidism. The elevation of parathyroid hormone is related to the development of acute coronary events in patients with nephropathy undergoing hemodialysis, and the cut-off value of 500 pg / dl or more makes the appearance of cardiovascular complications frequent. The general approach of this work is to show the incidence of Parathormone Levels in the appearance of acute coronary events in patients with chronic kidney disease. The results were obtained through the development of a bibliographic research, limited to a review methodology, which allows to conclude that having elevated Parathyroid hormone (PTH) levels turns out to be an important risk factor for the appearance of coronary events However, the evidence regarding the relationship between PTH levels and prognosis once coronary artery disease is established is still very poor, so prospective studies are recommended to expand the findings found in the present investigation

Resumen: La vía de PD-1/PD-L1 atenúa la destrucción de tejidos al limitar la actividad de las células T, situación que el cáncer puede utilizar a su favor. El bloqueo de la vía PD-1/PD-L1 proporciona entonces, una base para la inmunoterapia contra el cáncer, lo cual resulta muy prometedor al considerar las altas tasas de incidencia y mortalidad que presenta dicha enfermedad en la actualidad. La presente investigación consiste en una revisión bibliográfica descriptiva realizada mediante la consulta de la base de datos Sistema de Bibliotecas, Documentación e Información (SIBDI) de la Universidad de Costa Rica y el sitio web Google Scholar (Google Académico). El objetivo de esta revisión es determinar la función de la vía de PD-1/PD-L1 como punto de control inmunológico, junto con la aplicación y el alcance de los fármacos inhibidores de PD-1 y PD-L1 en la inmunoterapia contra el cáncer. Se concluye que los inhibidores de PD-1/PD-L1 presentan altas tasas de respuesta antitumoral y supervivencia, así como una mejor tolerancia en comparación a fármacos antitumorales tradicionales. Finalmente, se recomienda la terapia combinada y el uso de biomarcadores para obtener una mayor supervivencia libre de progresión tumoral, una terapia personalizada y un resultado favorable para el paciente.

Introduction: The high incidence of fires in the DKI Jakarta area certainly increases the risk for DKI Jakarta Firefighters, so Personal Protective Equipment is mandatory for officers when carrying out firefighting operations to prevent and control potential hazards for firefighters. It was recorded that 76 officers were injured and 1 officer died while carrying out firefighting operations in the last 5 (five) years. So it is necessary to know the factors that influence the behavior of using the SCBA (Self Contained Breathing Apparatus) respiratory Personal Protective Equipment. Methods: This quantitative descriptive study with a cross-sectional approach was carried out at the DKI Jakarta Provincial Fire and Rescue Service in 2021 with a population of all DKI Jakarta firefighters and a total sample of 208 firefighters. The instrument used is a questionnaire. Results: The results of data analysis carried out univariate and bivariate using the chi square test with = 0.05 showed a significant relationship between the behavior of using PPE SCBA with the availability of PPE (Pvalue = 0.000), Regulations (SOP) related to the use of PPE (Pvalue = 0.000) and Supervision (Pvalue = 0.000). However, there is no significant relationship between the behavior of using PPE SCBA with knowledge of PPE (Pvalue = 0.180), Age (Pvalue = 0.111), years of service (Pvalue = 0.065), training (Pvalue = 0.087) and PPE comfort (Pvalue = 0.513). Discussion: The behavior of using SCBA PPE for DKI Jakarta firefighters in 2021 is still relatively low because only 54.5% of respondents from firefighters stated that they used SCBA PPE in every fire fighting operation. So it is necessary to increase knowledge related to PPE and skills in using PPE for operational officers through education and training activities, training and technical guidance.

The high incidence of back pain in older people, its effect on quality and duration of life, and insufficient effectiveness of existing treatment methods determine the need to search for methods of back pain treatment that will reduce inflammatory and degenerative changes and the pain syndrome itself. The review analyzes the epidemiology, pathogenesis, current methods of pharmacotherapy for back pain, the role of genetic changes and biomarkers of chronic pain, discusses current prospects for the use of targeted therapy for the treatment of chronic nonspecific back pain based on pathogenetic mechanisms (genetic changes, aseptic inflammation, immune disorders, disorders of chondrogenesis, etc.).

O envelhecimento populacional somado à alta incidência de doenças crônicas degenerativas é um desafio para o Sistema Único de Saúde. O presente estudo teve por objetivos (i) realizar o levantamento do perfil alimentar de pacientes idosos com Hipertensão Arterial Sistêmica e Diabetes Mellitus, atendidos pela Unidade Básica de Saúde Campo da Água Verde em Canoinhas/SC; (ii) classificar os indivíduos em grupos homogêneos, com base em seu perfil alimentar; e, (iii) mensurar a contribuição das características dos indivíduos para a sua classificação nos grupos pré-determinado. A metodologia estudo consitiu em coleta de dados, obtidos através de entrevista formal, em que foram abordados aspectos relacionados às características individuais (idade, sexo, peso, altura, prática de exercícios físicos) e quais os alimentos consumidos durante as refeições diárias. Os dados coletados foram analisados através de estatística descritiva, análise de cluster, teste de Mann-Whitney e Regressão Logit. Entre os resultados obtidos: frequência de citações dos alimentos consumidos nas refeições diárias; os participantes foram divididos em dois grupos de acordo com o seu perfil alimentar; os idosos pertencentes ao Grupo A apresentaram melhor qualidade de dieta, com maior consumo de alimentos minimamente processados no almoço e jantar, quando comparados aos indivíduos do Grupo B, que apresentaram maior consumo de alimentos processados e ultraprocessados no jantar. Por fim, concluiu-se que o aumento de 1 ponto no IMC de um indivíduo que se enquadram nas condições do estudo implica num aumento de 14% das chances deste indivíduo apresentar uma alimentação menos saudável.

The existence of limitations for children with mental retardation causes an inability to protect themselves so that they often become victims of sexual harassment. Preventive efforts are something that needs to be improved for prevention, considering the worse risks to children. The importance of an effort to prevent sexual abuse of children with mental retardation in connection with the lack of knowledge about sexual abuse and the inability of children to face the dangers that threaten themselves. From the results of research conducted in the United States in 1994, nearly 90% of children with mental retardation disorders had experienced sexual abuse, as many as 49% had experienced sexual abuse more than ten times. The high incidence of sexual abuse experienced by children with mental retardation is due to various factors, namely the condition of children's limitations, lack of supervision and protection of children by parents and the environment. Efforts that can be made are increasing knowledge about sexual abuse and self-protection skills through the Behavioral Skills Training Group Program, where children are trained to recognize threatening objects and situations (sexual abuse). Increasing knowledge about sexual abuse and providing training (self-protection skills) is a significant primary preventive measure to reduce the risk of sexual abuse in children with mental retardation.

Background: Coronavirus disease-19 (COVID-19) is a growing pandemic around the globe that was initially discovered in Wuhan in December 2019. Despite the relatively high incidence of cutaneous manifestations in COVID-19, their role in early recognition and disease progression has not been fully investigated. Aim of this study: To report the possible incidence of the cutaneous lesion in COVID 19 patients and to describe various cutaneous manifestations and their correlation with other clinical features in Covid-19 positive patients to facilitate diagnosis and prognostications toward this virus. Methods: This research was conducted as a cross-sectional study. Skin lesions photography and their analysis were collected by dermatologists from 18 cities in Iraq between September 2020 to January 2021. The data were processed using statistical package SPSS version 23. Results: A total of 3117 confirmed COVID-19 cases were included in this study. Around 268 patients developed skin lesions with age ranged between 8 to 84 years. Of these skin lesions, 46.2% developed during the illness with minority erupting during the prodromal phase, whilst 38.8% appeared after hospitalization. The most common skin lesion was in the form of urticarial 36.74% followed by herpetic lesions 28.4%, maculopapular rash 11.74% and the remainder being candidiasis, oral thrush, chilblains, and other skin conditions. The most affected area was the torso (46%) followed by limbs, face, fingers, and toes. Conclusion: This study demonstrated the high incidence rate of dermatological lesions in different phases of COVID-19 with urticarial rash being the most frequent clinical pattern.

Bariatric surgery is of great importance due to the high incidence of morbid obesity. Techniques such as laparoscopic gastric bypass, laparoscopic tubular gastrectomy, and other bariatric techniques with gastrointestinal anastomosis are used for its treatment. The incidence of internal hernias in the late postoperative period after bariatric surgery ranges from 0.4 to 8.8%. As a consequence, there may be obstruction of the lymphatic vessels. Although chylous ascites is a rare pathology in bariatric surgery, several cases have been reported in the literature. We present two cases of patients who presented as a late complication of an internal hernia associated with chyloperitoneum.

Background and aims Mobile phone addiction (MPA) has recently aroused much attention due to its high incidence and considerable health hazards. Although some existing studies have documented that physical activity is negatively associated with MPA, it is little known about the potential effects underlying this relation. The aim of this study was to investigate the relationship between physical activity and MPA among undergraduates in China, and to further examine the moderating effect of exercise type in the relation between them. Methods By the quota sampling, a total of 650 participants engaged in this survey and completed relevant measurements including physical activity rating scale-3 (PARS-3) and mobile phone addiction tendency scale (MPATS). Results Gender (β = 0.271, P < 0.05) and major (β = −0.169, P < 0.05) could significantly predict MPA, respectively, and physical activity was an imperative protective factor to decrease MPA (β = −0.266, P < 0.001). While the physical activity level enhanced from none exercise to medium exercise, an optimum dose-response relationship would emerge between physical activity and MPA (F (3,604) = 4.799, P < 0.01). Most important, the relation between physical activity and MPA can be moderated by exercise type. Especially in terms of aerobic endurance exercise, the higher level of physical activity the undergraduates performed, the lower degree of MPA would be suffered by them (β = −0.266, P < 0.001). Discussion These findings could be conducive to better understand the positive and potential effects of physical activity on the intervention in MPA, and served as a persuasive evidence that as for university students, actively engaging in aerobic endurance exercise with the medium activity level would be a practicable exercise strategy to deal with MPA in daily lifestyle behavior.

Background Given the high incidence of perinatal maternal depression, implementation of preventive actions is crucial. In France, two prenatal preventive measures are available to the general population: early prenatal interview (EPI) and antenatal classes (ANC). Objective To explore the independent associations between EPI and / or ANC and maternal depressive symptoms at 2 months postpartum. Method We used data from the Etude Longitudinale Francaise depuis l'Enfance (ELFE), a French national representative cohort of children and their parents, followed-up from birth to early adulthood. Data concerning characteristics were collected from the mothers during the maternity stay and between 6/8 weeks’ post-partum. The level of depressive symptoms was scored by the French version of the Edinburgh Postnatal Depression Scale (EPDS) between 6/8 weeks’ post-partum. We considered EPDS score ≥10 indicative of postnatal psychological distress (PPD) and EPDS ≥12 for postnatal depressive symptoms (PNDS). After data imputation, multivariate logistic regression analysis was performed. Results Among the 16,411 mothers included in our sample, 26% benefited both from EPI and ANC, 31.1 % of ANC, 7.7% of an EPI and 35% of neither; 20,1% presented PPD and 12,1% PNDS. The likelihood of presenting PPD was significantly higher in mothers who had neither had EPI nor ANC (OR = 1.15 (95% CI : 1.01–1.30). There was no association between receiving or not an EPI and/or ANC and presenting PNDS. Conclusions Antenatal preventive measures may be helpful to prevent PPD at 2 months’ post- partum, while PNDS do not seem to be influenced by these actions.

Background Women are among the susceptible groups to Coronavirus disease-19 (COVID-19) in Ardabil, north-west of Iran, despite the current global status. The underlying causes of high incidence and fatality rate of women in Ardabil are not fully understood. Hence, this study aimed to investigate the healthy behaviours in women of Ardabil and its relationship with COVID-19 mortality. Methods We conducted a case–control study to compare the adherence to health protocols and behaviours with respect to COVID-19 between the infected (261 patients) and healthy (515 persons) women. Health protocols and behaviours such as using mask, gloves, disinfectants, history of travelling and contacting, and attending various gatherings and places during the COVID-19 pandemic along with demographic variables were defined as independent variables, and COVID-19 death rate was defined as the dependent variable. Multivariable logistic regression methods were used to explore the risk factors associated with COVID-19 mortality. Results Chi-square and Fisher tests showed significant differences between infected and healthy women in terms of history of contact and traveling (p p p p = 0.038). Multivariable logistic regression disclosed that the age group over 80 years: 8.97 times (95% CI 2.27–29.85), women with underlying chronic diseases: 4.14 times (95% CI 1.61–10.64), and obese women: 3.01 times (95% CI 1.04–6.03) were more likely to die from COVID-19 than other women. Conclusion Considering the high incidence and mortality rate in Ardabil women due to COVID-19 and the corresponding health behavioural factors, special emphasis should be given to the increase of women awareness on the importance of healthy behaviours, diet, and life-style.

The present study will involve conducting surveillance for a zoonotic bacterial agent, Listeria monocytogenes in domestic animals and human in Egypt. The aim was to help in recording much more data concerning such disease and determining the most likely sources of Listeriosis infecting humans and the distribution of the various serotypes in the region. This information is important in order to optimize and determine appropriate intervention strategies and management of Listeriosis cases in animals especially ruminants and rabbits livestock. The results revealed that the occurrence of L. monocytogenes in the examined animal samples was 1.5 % (9/620) with high incidence in cows 1.3% (4/300) and in human acute blood samples was 0.8% (2/250). Most of the recovered isolates (72.7 %) showed high incidence of L. monocytogenes serotype 4 (8/11). Antibiogram was done for the recovered isolates and showed high resistance patterns for phenicols, polypeptides, cephalosporines and lincosamides. Genotypic analysis for the recovered isolates was carried out by using PCR with specific nucleotides sequence for prfA genes followed by sequencing and phylogenetic analysis. This analysis revealed that cows act as natural niches for that emerging pathogen.

Cystitis is the most common pathology of the urinary tract in women both in our country and abroad. The high incidence of this disease in women in the population is influenced by anatomical, physiological features of the female body, violations of personal and sexual hygiene, burdened with an obstetric and gynecological (OAG) history, etc. In the current domestic and foreign recommendations for the diagnosis and treatment of cystitis in women, it is noted that in the vast majority of cases (up to 80% cases), the causative agent of cystitis is Escherichia coli, sensitive to nitrоfuran drugs.The purpose of the work. To demonstrate the effectiveness of the use of nifuratel (Nifuratel-SZ, Northern Star Co., Russia) in women with cystitis of various age groups using clinical examples. In the first clinical example, the high effectiveness of the use of nitrоfuran was shown in a woman of active reproductive age with OAG, in the second, in a teenager with an acute inflammatory process, in the 3rd-in a postmenopausal patient with concomitant multiple organ pathology.Conclusion. Nifuratel (Nifuratel-SZ, Northern Star Co., Russia) has proven to be a highly effective and safe drug with a wide range of antibacterial effects in patients with cystitis of different age groups.

Connective tissue dysplasia is widespread genetically determined disturbance of this tissue development in the process of intrauterine and postnatal ontogenesis which is characterized by the defects of its fibrous structures and ground substance. The indicated changes result in homeostasis derangements in tissues, organs and organism as a whole. They manifest themselves by different external, visceral and locomotor abnormalities with progressive course. The presence of connective tissue dysplasia has a considerable influence on the peculiarities of associated diseases as well as pharmacokinetics and pharmacodynamics of medicines which are used for treatment of these diseases. Nowadays, they distinguish differentiated (classified, monogenic) and undifferentiated (unclassified, multifactorial) forms of connective tissue dysplasia. Simultaneous respiratory diseases in children and adolescents are still one of the most urgent medical and social problem that is determined by their high incidence, complicated diagnosis and the risk of chronic respiratory pathology development. Therefore, scientific researches regarding the mechanisms and degree of connective tissue dysplasia influence on the appearance and course of respiratory diseases are well-grounded. According to the literature sources, acquired respiratory diseases in children and adolescents against the background of undifferentiated connective tissue dysplasia have considerably more severe and prolonged clinical signs with impaired effectiveness of traditional treatment. They are inclined to untypical and recurrent course and more frequent and more severe complications as well. However, the direction of such influence in the process of child development remains largely undefined. It should be noted that the majority of scientific researches on the combination of connective tissue dysplasia and respiratory diseases has been carried out among school-age children and adolescents. In this connection, the early prediction of connective tissue dysplasia in infants and small children, when its external manifestations are infrequent and ill-defined, seems quite promising. The detection of systemic connective tissue dysplasia exactly on the early stages of postnatal ontogenesis can be a ground for timely and purposeful administration of some appropriate preventive measures.

Lightning is a massive electrostatic discharge caused by the circulation of warm moisture-filled air through unbalanced electric field in the atmosphere, accompanied by the loud sound of thunder. Aims & Objectives : The present study was conducted to ascertain the pattern of lightning cases along with distribution of cases based on age, sex, season, location, activity of the victim and injury pattern in the corpse. Materials & Methods : The present cross sectional retrospective study was carried out in the department of Forensic Medicine at Govt. Medical College, Raigarh, CG. All autopsy cases of lightning deaths from 2018 to 2019 (two years) were considered for the study. Discussion : Most of the deceased were in the age group of 31-40 years. All incidents happened in open field. High incidence of lightning deaths occurred during monsoon season and peak incidence in evening hours. In most cases arborescent mark was found as pathognomonic finding. Conclusion : Lightning incidents are always accidental in nature. They are fatal and need prompt resuscitative measures. Lightning injuries have bizarre presentation in the body, therefore the autopsy surgeon needs meticulous and detailed methodical approach during autopsy. Keywords: Lightning, Electric, Thunder, Corpse, Autopsy

Objective: Ventricular Septal Rupture (VSR) following Acute Myocardial Infarction (AMI) is a fatal mechanical complication with high incidence of mortality. The aim of this study is to explore the clinical outcomes and to identify the factors related to early mortality in patients with VSR after AMI. Materials and Methods: This was a retrospective study and we collected clinical data of 21 adult patients with VSR following AMI from April 2012 and October 2020 who got admitted at our tertiary care centre. The patients were classified into two groups. The first group consisted of patients who died within two weeks from the diagnosis of VSR following AMI and the second group comprised of patients who survived more than two weeks after VSR. Results: A total of 21 patients (mean age of 66.19±9.47 years) were enrolled in this study. The most common MI was Anterior MI (71.4%) and the location of VSR was predominantly in the anterior and apical septum (76.2%). The overall early mortality was 85.9% (n=18). 80.95% (n=17) of patients died within two weeks of diagnosis of AMI. Of the 4 patients who survived more than two weeks, three patients survived. The operative mortality in our study was 47%. Conclusion: The prognosis for VSR in AMI remains poor. Renal failure is accompanied with high rate of early mortality in patients with VSR complicating AMI. History of smoking is associated with poor outcome.

Vestibular migraine (VM) and Menière’s disease (MD) are common neurotological disorders causing episodic vertigo. Sometimes, VM is accompanied by cochlear symptoms suggestive for MD. Therefore, in those cases, the differential diagnosis between the two disorders can be difficult. Moreover, a comorbidity with migraine in MD patients is widely reported, up to the hypothesis of a possible MD-VM overlapping syndrome. In this brief case report, we consider the clinical history of a family presenting high incidence of subjects fulfilling the diagnostic criteria of VM and single case fulfilling criteria for definite MD. The relationship between VM and MD is still under debate; anyway, it can be speculated that commonly shared genetic mutations could play a role as predisposing factors in both disorders. A congenital nystagmus in the family was present too, but its correlation with the other conditions is still not clear. Future goal of our work will be to assess genetics in this family.