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« Neglected » Endothoracic Goitres : The Point of View of Thoracic Surgeon
No full textIntroduction : Neglected endothoracic goiter is an endothoracic mediastinal portion that was neglected during the surgical removal of a plunging cervical goiter in contrast to autonomous ectopic mediastinal goiter which has its own mediastinal vascularization without connection between the two components and but who was not diagnosed during the cervical thyroidectomy. The aim of this work is to report the point of view of thoracic surgeon to avoid "forgetting" this endothoracic component.Materiel and methods : This is a retrospective study involving four patients, all operated for an endothoracic goiter only by thoracotomy.Results : Among four patients, it was 3 women and one men with an average age of 46 years. All Four cases have already been operated for cervical goiter by cervicotomy alone. Also, for all patients, the discovery was accidental. the cervicothoracic scan found a posterior mediastinal heterogeneous mass, with calcification lesions in 2 patients, and necrosis zone in 2 patients. The four patients were operated by posterolateral thoracotomy. Operative outcome was simple in all patients except 2 cases of wound infection.Conclusion : Neglected endothoracic goiter poses a diagnostic and also a therapeutic problem because its a difficult surgery due to the adhesions already formed following a first cervical thyroid surgery and therefore it is essential not to miss the diagnosis of any diving goiter
Intramuscular Myxoma of the Thigh: A Case Report
No full textIntroduction: Myxomas are rare benign tumors of soft tissue, represent 1% of adult cancers, they are most often located in the intramuscular compartment, particularly in the thigh. They are most often observed in elderly patients between the fifth and seventh decade, particularly females.Case report: We present the case of a 60-year-old man with a painless and several years progressive mass of the medial aspect of the left thigh. Magnetic Resonance Imaging (MRI) has shown a tissue mass with a cystic lesion. In addition, histopathological diagnosis of the specimen was in favor of an intramuscular myxoma without signs of malignancy. Short and long-term follow-up of two years did not detect any recurrence.Conclusion: The slowly growing character is not an argument of benignity, in contrast to other situations. Therefore, the myxoid component may be present in other soft tissue malignant tumors, specially liposarcoma. This difficulty sometimes imposing more specimen verification or a second opinion. Although myxomas are rare, it is important to keep them in mind when a myxoid component is present and distinguish them from sarcomas
Surgical Treatment of Skin Substances Loss: Study of 40 Cases Followed Up at University Hospital of Bangassou in Central African Republic
No full textIntroduction: The aims of this study was to describe the results of the treatment of skin substance loss in a rural area hospital in Central African Republic and draw the resulting conclusions.Patients and Methods: This is a cross-sectional study carry out from January 2017 to December 2018 including patients of both sexes, regardless of age, treated for a loss of skin substance without tendency to scarring at the General Surgery Department of the Regional and University Hospital of Bangassou.Results: During the period 2500 patients were followed in the service. The frequency of patients with a loss cutaneous substances was 1.6%. Male subjects made up 65% of the workforce. All age groups were represented. The average age was 35.5 years (Extremes: 8 months and 77 years). In 60% of cases, the patients came from remote areas of the urban center and most of them lived in precarious conditions (71.8%). The primary lesions were 2nd degree burns (22.5%) and 3rd degree (2.5%), open limb fractures (10%); ulcers (32.5%) and necrotizing fasciitis (32.5%). These lesions were found much more in the limbs (67.5%). In half of the cases, the lesions were in the budding phase. After a preparation phase, the procedures performed were mesh grafting (87.5%), lozenge grafting (10%) and the flap (2.5%). According to the evolution, scarring was obtained in 67.5% of cases 14 days after surgery. The average length of hospital stay was 14 days with extremes of 8 and 58 days.Conclusion: This study shows the advantage of using methods for recovering losses of skin substances to speed up the healing process of lesions. We recommend emphasizing the initial treatment of lesions which must be adapted to the stages of healing as well as the management of risk factors. In areas where there is a shortage of specialists, general practitioners must be trained in skin grafting techniques which are easy to perform
Analysis of the Charles De Gaulle Aircraft Carrier Covid19 Epidemic: Infectivity and Fatality in the Young, Healthy, Active Population : Lesson from the Charles de Gaulle Aircraft Carrier Covid19 Experience
No full textThe case of the Charles De Gaulle aircraft carrier Covid19 outbreak indicates those young, healthy and active, apart from very few exceptions, do not get infected even if challenged, or are only very mild or asymptomatic if infected. As per April 20, 2020, of almost 2,000 people challenged, 1,081 got infected. Of the 1,081, only 24 ended up in a hospital. Of the 24, only 1 was reported in need of intensive care. As per April 29, 2020, only 5 were still in the hospital, and 1 was in intensive care. As per May 4, 2020, there were only 2 still in the hospital, 1 of them in need of intensive care. On May 11, 2020, only the 1 previously in intensive care was still hospitalized but out of intensive care. Thus, infectivity and fatality are much lower than thought for the young, healthy, active populatio
Evaluation of Radiographers’ Practices with Paediatric Digital Radiography Based on PACS’ Data
No full textObjective: The purpose of the study is to evaluate radiographer practice with advanced digital radiography in terms of the values of exposure indices and deviation indices between hospitals in Saudi Arabia. Materials and Methods: The study is based on PACS’ data of paediatric radiographic images limited to the chest and abdomen performed during the last year from four hospitals in Saudi Arabia. P-value was calculated to investigate any significant differences exist between the values of exposure indices and deviation indices of the images, which will be acquired from the DICOM file of image data.Results: Most of the paediatric radiographic images (54%) were underexposed, as these images had deviation index with less than -1 from four hospitals compared to expected results. However, in one hospital, 58% of the images were overexposed. The majority of the underexposed paediatric radiographic images were chest and abdomen radiographic exam (50% and 66% separately). Results also show that most of the underexposed radiographic images were using a grid (66%); on the other hand, in the overexposed radiographic images, 59% did not use the grid.Conclusions: The findings of the study show the need for radiographers for further knowledge and training courses to improve their performance in digital radiography and paediatric imaging. 
Study on Prevalence of Foreign Bodies in ENT
No full textIntroduction- Foreign body is a substance that doesn’t belong to a location where it is found. Ear,nose and throat are common location for occurence of foreign bodies. It is a common problem encountered in both adults and children. Objective- 1) To analyse the different kinds of foreign bodies in ear ,nose and throat and their prevalence in different age groups. 2) To analyse the most prevalent site of foreign body among ear, nose and throat.Methods- A cross-sectional study was performed in our tertiary care hospital in Navi-mumbai. The study period was from august 2017 to august 2019. The study population were the patients who came to the out patient department and emergency room of this hospital.Result- A total of 100 patients as sample size with foreign bodies in ear, nose or throat were taken on first come basis. 62 were males and 38 were females. Of the 100 patients, 36 had foreign body in ear, 47 in nose and 17 in the throat. The foreign body was removed under local anaesthesia in 4% patients, with general anaesthesia in 30 % and with no anaesthesia at all in 66% patients. The most common age group affected was less than 10 years among both male and female patients.Conclusion- The most frequent site of foreign body occurrence was found to be nose. The most common site requiring general anaesthesia for foreign body removal was throat. Although most of the foreign bodies could be removed without any anaesthesia in the emergency room or outpatient department
The Patterns of Explicit and Subtle Racism and Self-reported Color in Health Services
No full textIn this research, racism is defined as a multidimensional configuration of beliefs, emotions and behavioral guidelines to discriminate against black individuals.
A representative survey was applied to 634 workers of public and private health services in the municipality of Camaçari, State of Bahia, Brazil, to explore technical knowledge, perceptions, attitudes and behaviors regarding to inequalities and racism. Principal Component Analysis was used to reduce and classify 40 sentences into standardized profiles of sets of components represent the sharing of social attitudes, beliefs on racism among health personnel.
Results show that racism is expressed mainly through subtle expressions. Most of the health personnel disagree to asking the patients’ color. Health personnel who self-declare as white would accept explicit expressions of racism: that black patients would be more violent by nature; those who self-declared as brown would accept that humiliating jokes against black patients are normal expressions of Brazilian culture. These perceptions are based more on social prejudices, oriented by ideology, with contradictions and ambiguities in racism perceptions and with the values in modern society, such as universalism and equality. Racism in health services works as a barrier to complete and improve data on color-race inequalities in health and to implement affirmative policies
The Role and Priming Effect of Pre-Acquired Memories in Abstract Decision-Making
No full textFrom a neuropsychological perspective, the brain is confronted daily by decision-making processes. Decision-making is influenced by many factors, from biological stimuli to reward assessments. In abstract decision-making, where no logical decision is forthcoming, choices still need to be made. Many priming factors can be involved in these decision-making situations. There is a need to understand what role pre-acquired memories (verbal, aesthetic, color, phonetic, emotional, etc.) play in abstract decision-making. Therefore, we conducted a survey of 40 people, including 14 (35%) men and 26 (65%) women aged 20 years (deviation = ±1.5), with medical backgrounds. All the questions in the survey form were abstract, non-binary, result-oriented, and had no specific logical answers. There was no specific priming information or reference clue that could direct participants towards a specific answer. This approach was taken so as to discover the real primer that the brain relies on when confronting abstract decision-making situations. From our analysis we found that previously acquired memories can influence persons’ choices in abstract decision-making situations. Furthermore, we concluded that these memories have unconscious, subtle, and long-term priming effects
Tensegrity Informed Observations in Human Cadaveric Studies - A Clinical Anatomists Perspective
No full text19th century anatomy took a systematic, uniform approach as efforts were made to give each anatomical structure a precise description. Concerning red contractile proteins observed within a gastor, descriptive words provided little or no information concerning the anatomy or physiology of such structures. Latin names were provided describing shape (i.e. trapezius), size (i.e. maximus), number (i.e. quadriceps) and anatomical location (i.e. posterior) but did little to inform learners concerning a global view of human form and function. Such a reductionist view concerning muscles was delineated by their assumed tendonous origin/insertion attachment to bone. Bespoke human dissections performed on embalmed cadavers, embracing a (bio)tensegrity focus, provides innovative insights concerning the topics of human anatomy, form and function. Such dissection shifts attention away from the solely mechanistic observations made since the time of Erasistratus (ca. 290 BC) and Giovanni Alfonso Borelli (1608-1679) which led to nebulous interpretations and isolated “parts”. Long held concepts such as muscle origins and insertions are not supported as factual evidenced by biotensegrity focused dissections. Borelli’s explanations of human movement, based on man-made objects, included wheels, clocks, watches and two-bar pinned joints. Mechanical models require construction materials such as 1st, 2nd and 3rd class levers, pulley systems with pins and screws for functional operation. Embryology does not require surgical intervention to attach an upper or lower limb, a liver, spleen or blood vessel. The embryo grows and develops such structures in a temporal sequalae orchestrated by the forces and the environment wherein it emerges. To-date it has been averred that the human body is a combination of ‘parts’ comprising of levers and pinned-joints. This observational-based report offers anatomically accurate cadaveric imagery supporting a paradigm shift in human anatomy moving towards a model dependent reality of continuity and wholeness, “Biotensegrity-Anatomy for the 21st century”
The Functional Outcome of Spontaneous Hypertensive Supratentorial Intracerebral Haemorrhage after Surgery
No full textThis study was to determine the different parameters that affect the outcome and the functional recovery after surgical evacuation of spontaneous hypertensive supratentorial intracerebral haemorrhage. This cross-sectional analytic study was conducted in the Department of Neuro- surgery, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh during a period of 4 years from January 2016 to December 2019 and total 96 patients were included in this study. Patients with post-traumatic hematomas, intracranial space-occupying lesions with bleeds, haemorrhagic transformation of an ischemic stroke, vascular malformations, aneurysms, and infratentorial haemorrhages were excluded from the study. Decompressive craniotomy and evacuation of clot was performed in most of the cases. The outcome of the patients was categorized according to the Glasgow Outcome Scale. Outcome was classified as “favourable” if the Glasgow Outcome Scale (GOS) score was 5 or 4, and classified as “unfavorable” if GOS score was 3 or less. The mean age of the patients was 57.99±12.74 years with male and female ratio was 1.66. The mean blood volume was 28±19.99 cc and all patients were hypertensive. There was significant difference (p <0.001) in outcome in relation of age and volume of blood. Age > 70 years, GCS < 8 on admission, clot volume above 40 cc, and intraventricular extension remain the most consistent predictors of mortality and poor outcome following surgical evacuation of spontaneous supratentorial intracerebral hematoma. The present study could only assess mortality and the functional outcome. Since a proportion of survivors had an unfavorable outcome, quality of life measures is important and need to be addressed in future studies