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Staged feminizing genitoplasty with total urogenital sinus mobilization
No full textBackground: The diagnosis and treatment of individuals with Disorders of Sexual Development is a complex process and requires a multidisciplinary approach. Each individual should be evaluated objectively and the treatment process of each individual has its own unique differences. The aim of this study is to discuss the effectiveness of staged feminizing genitoplasty operations using the total urogenital mobilization technique.Material and methods: Hospital records of patients who underwent vaginoplasty using the TUM technique between 2014 and 2019 by a single surgeon in a pediatric surgery center of a tertiary pediatric hospital were retrospectively reviewed.Results: All ten patients who underwent TUM had 46 XX chromosomes. The TUM procedure for vaginoplasty was performed in all patients by the author. A clitorolabioplasty had been previously performed in six patients with congenital adrenal hyperplasia. The follow-up period of the patients was 1-6 years. No serious complications developed in any of the patients. Neither infection nor tissue necrosis occurred. A second surgical procedure was not required for urinary fistula, vaginal stenosis, urinary incontinence, or early suture dehiscence.Conclusion: This study shows that vaginoplasty can be performed in a single session in infancy for patients with low confluence and a short Urogenital Sinus (UGS). Apart from this, postponing vaginoplasty surgeries to the adolescence period and performing UGS mobilization surgery seem to carry successful results.</p
Refractory electrical storm in coronary artery disease patient, challenges of dying heart
No full textElectrical storm most often occurs in patients with coronary artery disease and left ventricular dysfunction. We report a case of recurrent ventricular Tachycardia (VT) in a 49-year-old male patient previously known to have an inferior myocardial infarction and hypertension, presented with ischemic chest pain accompanied by dizziness, hypotension, and tachycardia. An electrocardiogram showed monomorphic VT. A prompt synchronized electrical cardioversion under sedation has reverted the rhythm to the sinus. An echocardiogram showed left ventricular segmental wall motion abnormalities and ejection fraction of 37%. Then the condition complicated by recurrent VT necessitates multiple electrical cardioversions and defibrillation given for recurrent ventricular Fibrillation (VF) and short cardiopulmonary resuscitations that revived the patient from cardiac arrests. The patient had received a total of 103 electrical shocks over 15 days during which, he developed circulatory and respiratory compromise that required mechanical ventilation on twice occasions. Meticulous care including central monitoring and inotrope for hypotensive episodes was provided. A coronary angiogram showed normal left anterior descending and circumflex coronary arteries and a totally occluded right coronary artery which was failed to be revascularized in an attempt of angioplasty. The patient was successfully weaned off the ventilator and run a quiet course afterward. An implantable cardioverter-defibrillator was placed while maintained on oral amiodarone, mexiletine, metoprolol, and omega-3-acid ethyl esters, then discharged asymptomatic without recorded dysrhythmias. This case report underscores the challenges encountered throughout the management of such particular life-threatening ventricular arrhythmias and their impact on patient safety.</p
Return to sport after capsuloplasty with a bone block in shoulder instability
No full textObjective: Propose a post-surgical rehabilitation program identifying the steps necessary for a progressive recovery of the joint function in compliance with the surgical needs.Material & method: In the anterior and posterior glenohumeral instability, the presence of bone defects, especially at the glenoid side requires surgery and the use of the bone block, associated with the repair of the soft tissues (capsuloplasty). The arthroscopic technique, compared to open surgery, allows respecting the periarticular anatomical structures, essential for optimal functional recovery.Results: The post-surgical rehabilitation program follows a progressive recovery timing, divided into 3 phases: phase 1 pain control and joint mobility recovery, phase 2 the recovery of strength and specific sport movements and finally phase 3 the return to sports activities. The rehabilitation progress must achieve two objectives: ROM recovery without disturbing the bone graft area, to achieve its integration.Conclusion: the rehabilitation program is ultimately guided by the surgeon considering the strategy adopted in the operating room, the use of the bone-block technique and above all the sealing of the grafts. The physiotherapist following the proposed steps will optimize the final functional result.</p
Relationship between Atherosclerosis and Cancer: An observational outcome study
No full textBackground and aims: It was investigated whether there is a relationship between advanced atherosclerosis of the carotid artery and cancer. Method: The carotid Total Plaque Area (TPA), the maximum plaque thickness, and the cardiovascular risk based on Framingham calculator using body-mass-index were determined in healthy subjects using ultrasound. We compared the outcome in subjects with advanced atherosclerosis of the carotid artery (type III-IV b finding) with and without statin treatment. The follow-up was collected as part of occupational health check-ups.Result: In 4207 healthy men aged 35-65 years (50±8 years) we found 578 subjects with advanced atherosclerosis of the carotid artery (type III-IV b finding). A follow-up was available for 566 (97.9%) subjects. The average follow-up time was 48 months (range 0 to 139 months). Ten subjects were excluded because of missing data on treatment. A total number of 230 subjects was treated with a statin, 326 received no statin. Within the group of these subjects (54±6 years), 33 men died (15 cancer, 4 strokes, 11 heart attacks, 1 COPD, 1 sepsis, 1 cirrhosis of the liver).In the group with CVD death, two subjects were treated with a statin, 13 were untreated. In the group with cancer death, two subjects were treated with a statin, 13 were untreated. The death rate because of cancer and CVD was 1.7% for the treated subjects and 8.0% for the untreated subjects.In the group with low risk (n= 1890), six men died (2 traffic accidents, 1aneurysm bleeding, 2 cancer, 1 unclear, a follow-up examination has been completed for 43.9% (n= 830) of the subjects, mean follow-up time of 65 months (0-137 months). One man died (Parkinson) within the group with intermediate risk. In this group (n= 482) a follow-up examination has been completed for 55% (n= 265) with a mean follow-up time of 55 months (total range: 0-130 months). In the reference group (no atherosclerosis; n= 1257) follow-up has been completed in 38.3% (n= 482) with a mean follow-up time of 60 (0-145) months and nobody died.In 3203 healthy women aged 35-65 years nobody died of cancer.Conclusion: The development of cancer in men with advanced atherosclerosis of the carotid artery appears to be noticeable. The question of whether there is a causal relationship requires further investigations.</p
Prevalence and pattern of psychological disorders among key populations living with HIV/AIDS: findings from ECEWS supported global fund IMPACT project OSS centers in Southern Nigeria
No full textNigeria ranks third among countries with the highest burden of Human Immuno-Deficiency Virus (HIV) infection in the world. The 2019 Nigeria National HIV/AIDS Indicator and Impact Survey showed that 1.9 million people were living with HIV and AIDS in Nigeria as of 2018 [1].</p
Oral impacts of number of natural teeth and posterior occluding pairs on daily performance of geriatric population of Bareilly city: A cross-sectional study
No full textBackground: Poor oral health among the elderly has been measured in terms of tooth loss, dental caries, high prevalence rates of periodontal disease, xerostomia, and oral precancer/cancer around the world. Aim: The study's goal is to see how posterior occluding pairs and the total number of natural teeth in the mouth affect everyday activity in the elderly. Materials and methods: It was cross-sectional research with 300 participants drawn from a physiotherapy hospital by convenience sampling. The participants were asked about their age, gender, cigarette usage, oral hygiene practices, regularity of use, type of materials utilized, quality of life dental health and other xerostomia symptoms. The oral influences on the daily performance index were used to measure the effects on daily performance. The number of NT and POPs was counted during a clinical evaluation. Results: The studied population's general average age was 63.81 4.50, with no statistically significant differences between men and women. Overall, the research sample had a mean number of NT of 24.76 7.21, with men having 25.90 6.29 and women having 23.32 8.03.Conclusion: The number of NT and POPs was discovered to be important determinants of daily performance among the geriatric population.</p
A case of primary aldosteronism
No full textPrimary aldosteronism, also known as Conn’s Syndrome, is one of the most common causes of secondary hypertension. It is a disorder of the adrenal glands that is caused by the hypersecretion of the hormone aldosterone from the adrenal glands. </p
<i>In Silico</i> modeling of immune-cardiovascular-endocrine interactions
No full textThe immune system provides an intricate, balanced response to combat the effects of inflammatory stimuli. It incorporates both positive and negative feedback from multiple physiological systems such as the cardiovascular and endocrine systems including mechanisms functioning on a variety of time scales. They have been studied individually via scientific experiments and using mathematical modeling. However, more analysis is needed to study the interactions between these three systems during an inflammatory event. We present the first dynamical systems model studying immune, cardiovascular and endocrine responses to a 2 ng/kg bolus dose of endotoxin. The model is calibrated to experimental data from two endotoxin challenge studies and we use this model to investigate the effects of endotoxin dosage, administration timing and administration method. Our model shows that most repercussions of endotoxin administration clear the system within 24 hours, but effects can linger for up to 72 hours.</p
Quantitative nuclear cardiology and assessment of areas under risk via adenosine stress protocol-A pictorial assay for cardiologists and cardiovascular surgeons during era of COVID
No full textCoronary Artery Disease (CAD) is one of the most important causes of mortality and morbidity in the world. Nevertheless, Myocardial Perfusion Scintigraphy (MPS) using Single-Photon Emission Computed Tomography (SPECT) with radiopharmaceuticals is still widely used for the non-invasive diagnosis of obstructive CAD and functional imaging of the myocardium at stress.MPS provides comprehensi</p
Ambiguities of care in Alzheimer’s disease: To care/become a caregiver by obligation or by the charity
No full textObjective: To understand the meaning of the ambiguities of being a caregiver experienced by family caregivers of people with Alzheimer’s disease and health workers inserted in community Mutual Help Groups.Method: a study based on the ontology of Maurice Merleau-Ponty’s experience based on the notion of the body itself. It is revealed by the participation of 12 women, family caregivers, and health workers, members of community mutual aid groups, in the city of Jequié, Bahia, Brazil. The production of the experiential descriptions took place in three Focus Group meetings, during April and December 2019, whose resulting material was submitted to the Ambiguity Analysis. Results: The results reveal the ambiguities of taking care mobilized by the tradition of fulfilling social, cultural, and religious duties. Inserted in the groups, they experience openness to the other, reconfiguring “doing for doing” in “doing for pleasure” in care practices, becoming another. Conclusion: the experience of caring as an obligation, which was previously expressed by anguish, sadness, and illness, after insertion in the group, opens up to the experience of the other and makes care a manifestation of otherness, which privileges the care of the self to care from the other. The study points out the group strategy in health services as a possibility of transforming social actors in the community in the context of Alzheimer’s disease.</p