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Autologous Fascia Lata Graft for Contour Restoration and Camouflage in Tertiary Rhinoplasty
Tertiary rhinoplasty is a surgical procedure to correct nasal deformities that have been developed after prior unsuccessful surgeries. Such surgery requires complicated manipulations and tissue grafting for proper restoration. In the current study, we report the use of fascia lata graft combined with cartilage grafts for contour restoring and camouflage. Twenty-three patients who had severe nasal deformities were included, of whom 14 were men and 9 were women. Their ages ranged between 24 and 34 years (mean, 29 y). All patients were twice previously operated on by surgeons other than the authors. An informed consent was obtained from all patients. After harvesting the costal cartilage, the fascia lata graft (mean size, 2-3 cm) was uniformly harvested from the right lateral thigh. Application of the fascia lata and the cartilage graft was achieved through the open rhinoplasty incision. The fascia lata was applied over the cartilage in the dorsal region in 20 patients (86.9%), applied over the reconstructed alar and dome area in the nasal tip in 8 patients (34.7%), and applied over both areas simultaneously in 4 patients (17.3%). Postoperative follow-up was between 14 and 35 months (mean, 24.5 mo); clinical evaluation, photographic documentation, and a questionnaire form related to donor-site morbidity and patient satisfaction were applied after 12 months of the follow-up period. Results showed that all patients had an improved aesthetic result, and no apparent irregularities were observed in the integument of the aesthetic lines. No complications or no requirement for revision surgery was observed later on. In conclusion, refinements of the nasal dorsum and the nasal tip in tertiary rhinoplasty are indeed important and difficult to be managed. Placing the fascia lata over the applied cartilage grafts provide a good cover that conceals the possible irregularities or distortions that may appear in the late postoperative period.
Primary Retroperitoneal Mucinous Cystadenocarcinoma: 5th Male Case in the Literature
Retroperitoneal primary mucinous tumor is an extremely rare malignancy. To date, only 52 cases of primary retroperitoneal mucinous cystadenocarcinoma (PRMC) have been reported in the literature, with the majority being women. Our patient is the 5th known male case. A 57-year-old male patient presented with a two year history of an undefined abdominal pain. Computed tomography demonstrated a 12 x 9.5 cm cystic mass lesion extending superiorly from right iliac fossa, while localizing below the abdominal wall and close to the psoas muscle. According to the laparotomy, iliopsoas muscle was infiltrated by the mass in the retroperitoneal region. Pathological diagnosis was mucinous cystadenocarcinoma. The asymptomatic patient was followed up without applying an adjuvant chemotherapy, since the clinical course of the tumor is known to be slow and postoperative therapy is not recognized as a standardized treatment. The clinical course of PRMC is generally indolent, however, it may manifest an aggressive course, as well. It has no definitive and clear pathogenesis. The treatment is contentious, as well. Diagnosis and treatment require surgical excision but data on adjuvant chemotherapy is limited.
Global overview of health systems oversight and financing for kidney care
Reliable governance and health financing are critical to the abilities of health systems in different countries to sustainably meet the health needs of their peoples, including those with kidney disease. A comprehensive understanding of existing systems and infrastructure is therefore necessary to globally identify gaps in kidney care and prioritize areas for improvement. This multinational, cross-sectional survey, conducted by the ISN as part of the Global Kidney Health Atlas, examined the oversight, financing, and perceived quality of infrastructure for kidney care across the world. Overall, 125 countries, comprising 93% of the world's population, responded to the entire survey, with 122 countries responding to questions pertaining to this domain. National oversight of kidney care was most common in high-income countries while individual hospital oversight was most common in low-income countries. Parts of Africa and the Middle East appeared to have no organized oversight system. The proportion of countries in which health care system coverage for people with kidney disease was publicly funded and free varied for AKI (56%), nondialysis chronic kidney disease (40%), dialysis (63%), and kidney transplantation (57%), but was much less common in lower income countries, particularly Africa and Southeast Asia, which relied more heavily on private funding with out-of-pocket expenses for patients. Early detection and management of kidney disease were least likely to be covered by funding models. The perceived quality of health infrastructure supporting AKI and chronic kidney disease care was rated poor to extremely poor in none of the high-income countries but was rated poor to extremely poor in over 40% of low-income countries, particularly Africa. This study demonstrated significant gaps in oversight, funding, and infrastructure supporting health services caring for patients with kidney disease, especially in low- and middle-income countries.
Relationship between fetal peak systolic velocity in Middle cerebral artery and umbilical blood gas values and hemoglobin levels in diabetic pregnant women
PurposeTo assess the relationship between peak systolic velocity in the middle cerebral artery (MCA-PSV) and fetal hypoxia in diabetic pregnant women requiring insulin therapy.
Which Unicondylar Prosthesis Has Better Mid-Term Results: Fixed or Mobile?
Objective: Osteoarthritis, which is one of the most common causes of pain and motion loss, is an important medical disease that particularly affects elderly people. Unicondylar knee arthroplasty treatment is still a challenge for obese and/or ACL deficient patients. In addition, surgeons face a challenge of deciding whether to perform either fixed or mobile insert design prosthesis. The objective of this study was to evaluate the effect of fixed or mobile insert design prosthesis on the mid-term results of patients that we followed up for 8 years or more.
Early Left Atrial Mechanics and Volume Abnormalities in Subjects with Prehypertension: A Real Time Three-Dimensional Echocardiography Study
The aim of this study was to evaluate left atrial (LA) volume and mechanical functions by real time three-dimensional echocardiography (RT3DE) in prehypertensive subjects. The study included 54 (34 male and 20 female) prehypertensive subjects and 36 (14 male and 22 female) healthy control subjects. Transthoracic echocardiography and RT3DE were performed in all patients. Interventricular septum thickness and isovolumetric relaxation time were significantly higher in prehypertensives than in controls (10.7 +/- 0.7 vs. 10.1 +/- 0.8 P = 0.001 and 89.9 +/- 10 vs. 82.4 +/- 11 P = 0.002, respectively). LA maximum volume, volume before atrial contraction, total and active stroke volume, total and active emptying fractions, expansion index, and LA max volume index were significantly higher in prehypertensives when compared with controls (P < 0.0001 for all). However, the passive emptying fraction was significantly lower in prehypertensives than controls (45.7 +/- 5.6 vs. 48.6 +/- 4.1, P = 0.006), and the minimum LA volume between the two groups was similar. The main finding of this study was that although LA volume and LA active systolic functions were significantly increased in prehypertensive people, there was a reduction in passive LA systolic functions. These parameters may be important in showing hemodynamic and structural changes in cardiac tissue caused by prehypertension. (Echocardiography 2012;29:1211-1217)
Violence related behaviours among adolescent students and factors affecting thereto
© 2015 Eker HH, et al.Background: Violence among young people is an important public health problem in society. Act of violence seen in schools is disturbing students- learning processes and inhibiting their developments generally results in emotional abuse, physical injury and death. Objectives: This study is conducted in order to find out the prevalence of and exposure to violence, which is an important public health problem, in schools and to determine the factors affecting thereto. Specific factors investigated were exposure to violence, gender, age, type of school, economic status of families and level of education of mothers. Method: This cross-sectional study was performed between March 2012 and May 2012. The population is 1575 students from 9th grade and the study is completed with 1405 students accepting to participate therein. A study questionnaire form established based on the -Youth Risk Behaviour Survey (YRBS)- prepared by CDC (Center for Disease Control and Prevention) is used as data collecting tool. Results: The ratios of each violence-related behaviour are 35.8% and 14.1%, respectively for boys whereas 20.4% and 6.4% for girls. These behaviours are statistically more common among boys than girls (p < 0.05). It was found out that there is a significant relationship between the students- family income level and getting involved in a physical fight in school (p < 0.05).Though no significant relationship is detected between mother-s educational level and getting involved in a physical fight and carrying weapons, ratios of gang membership is 6.2% for students whose a mother is illiterate and is 14.3% for student whose mother-s educational level is high school and above (p < 0.05) Conclusions: It is observed that each violence-related behaviour is more common among boys and with the increase in the mother-s education, tendency of being a member of a gang and getting involved in a physical fight accordingly increases.
Is postpartum depression a specific diagnosis? A prospective study
Objective: The studies investigating the prevalence and incidence of postpartum depression (PPD), as well as its nosologic status have controversial results. This article is part of a prospective, epidemiological study concerning postpartum depression in Erzurum City, Eastern Turkey. The present study focuses on the prevalence and incidence of PPD at sixth weeks after delivery and its diagnostic distribution according to DSM-IV. Methods: Four hundred and seventy-nine pregnant women in their third trimester were arranged to be visited by trained community midwives at 7-10 days and sixth weeks after delivery. Data were collected by use of the questionnaires on detailed sociodemographic and health information at each visit and the participitants filled out the Edinburgh Postpartum Depression Scale (EPDS) at six weeks after delivery. Finally, mothers who had PPD diagnosis according to EPDS were visited by a psychiatrist in their homes where the SCID was administered to make a DSM-IV diagnosis and determine whether the depression occurred before or after delivery. Results: The prevalence rate of PPD measured by EPDS was 14% in this population. The incidence of PPD was estimated as 6% with clinical interviews. Most of the depressed mothers (74.0%) were diagnosed as major depressive disorder according to DSM-IV, but there were some other depressive states too. Conclusion: The prevalence and incidence rates of PPD do not appear to be significantly different from those of non-childbearing women. PPD should not be seen as a specific clinical entity as far as its diagnostic distribution is concerned. (Anatolian Journal of Psychiatry 2012;13:16-23)
Serum endocan levels in women with restless legs syndrome.
Background: Endocan is a recently introduced marker of endothelial dysfunction. The objective of this study was to compare serum endocan levels in patients with restless legs syndrome (RLS) and control subjects in order to elucidate whether RLS is associated with endothelial dysfunction. Methods: A total of 31 drug naïve female patients with RLS and 31 age- and BMI-matched women were included in the study. Patients with pathological or physiological conditions or with a history of medication use that could potentially influence endothelial functions were excluded, as well as those with alcohol or drug abuse history. The two groups were compared with routine blood tests and serum endocan levels. Results: Patients with RLS had lower serum endocan levels than the controls (P=0.037). There was a negative bivariate correlation between RLS severity score and serum endocan levels (r=-0.406, P=0.023). While white blood cell count was significantly higher in RLS group, 25-hydroxy vitamin D3, vitamin B12, transferrin saturation rate, and HDL-cholesterol were significantly lower. Creatininemia and diastolic blood pressure were also marginally insignificantly lower in RLS group. Due to the presence of differences between two groups in these variables, a linear regression analysis was performed that showed a positive association between endocan and creatininemia (β=0.310, P=0.022), and a negative association between endocan and RLS (β=-0.502, P,0.001). Conclusion: The results of this study seem to suggest that patients with RLS may have better endothelial functions when compared with the general population and that these patients may be better protected against atherosclerosis
Workplace violence against medical student- A Turkish perspective
Background: Workplace violence against healthcare providers including the medical students being an important issue all over the World. The aim of this study is to survey the medical students about exposure to workplace violence (WPV) while they are doing their medical training in private tertiary hospitals. Methods: This was a cross-sectional study carried out among all medical students (4th, 5th, and 6th class) attending a teaching hospital at Bezmialem Vakif University (BVU), Istanbul, Turkey. A total of 150 students in the 2017-2018 academic year were recruited in this study. Data were collected using a modified questionnaire through a face to face interview. Data were analyzed using SPSS 16. Results: About one-third of the surveyed students (54, 36.0%) exposed to violence and 71.3% of them witnessed incidents of violence against healthcare providers at the workplace. The prevalence of physical violence and verbal abuse among medical students was reported at 5.5% and 92.6% respectively. About 81.5% were females compared to 18.5% of their counterparts. Patients (38.9%) and their relatives (61.1%) were the main sources of the violence respectively. More than half (57.0%) of students exposed to violence at outpatient services and 25.9% at the emergency room and 16.7% at inpatient wards. Few of them (22, 14.7%) thought that they will get support if they make a complaint. Conclusion: Being a medical student and has direct contact with patients and their relative is not always safe practice. Our results suggested a high prevalence of verbal and physical abuse against medical students. Health sector authorities should adopt a restrictive and clear strategy to protect medical students and other healthcare providers.