119 research outputs found
Healthcare workers preparedness for COVID-19 pandemic in the occupied Palestinian territory: a cross-sectional survey
No full textHealthcare workers preparedness for COVID-19 pandemic in the occupied Palestinian territory: a cross-sectional surve
Using routinely collected data to estimate postoperative complication rates, temporal trends, and geographical variation in Dupuytren's disease surgical management in England: Dupuytren's disease surgical treatment in England
No full textIntroduction: Dupuytren's disease (DD) is a common fibro-proliferative condition of the hand and it is usually treated surgically. The primary aim of this thesis was to evaluate DD surgical management in terms of patient characteristics, risk of postoperative complications and reoperation, temporal trend and geographical variation in England. Secondary aim was to investigate the association between DD and non-genetic factors. Methods: A longitudinal population-based cohort study was conducted using Hospital Episode Statistics database. Cumulative incidence and self-controlled case series methods were used to investigate postoperative complications. Directly standardised rates were calculated to evaluate temporal trends and geographical variation of primary Dupuytren’s disease surgery. To investigate the association between DD and non-genetic factors a systematic review was undertaken. Results: Between 1 April 2007 and 31st March 2017, 158,119 DD operative procedures were performed in 121,488 adult patients in England. DD surgery was most commonly performed in male, elderly, white patients living in less financially deprived areas and few comorbidities. Most operations performed were primary limited fasciectomy (LF). There was a significant incidence of local and serious systemic complications following DD surgery. The rate of reoperation was highest after primary percutaneous needle fasciotomy compared to primary LF or dermofasciectomy. There was an overall increasing trend and striking variation in the rates of primary DD surgery in England. A strong association was found between DD and advanced age, male gender, family history of DD, diabetes, heavy alcohol drinking, cigarette smoking and manual work exposure. Conclusions: The study findings have significant clinical importance as they helps to better understand DD surgical management
Using routinely collected data to estimate postoperative complication rates, temporal trends, and geographical variation in Dupuytren's disease surgical management in England
No full textIntroduction: Dupuytren's disease (DD) is a common fibro-proliferative condition of the hand and it is usually treated surgically. The primary aim of this thesis was to evaluate DD surgical management in terms of patient characteristics, risk of postoperative complications and reoperation, temporal trend and geographical variation in England. Secondary aim was to investigate the association between DD and non-genetic factors. Methods: A longitudinal population-based cohort study was conducted using Hospital Episode Statistics database. Cumulative incidence and self-controlled case series methods were used to investigate postoperative complications. Directly standardised rates were calculated to evaluate temporal trends and geographical variation of primary Dupuytrenâs disease surgery. To investigate the association between DD and non-genetic factors a systematic review was undertaken. Results: Between 1 April 2007 and 31st March 2017, 158,119 DD operative procedures were performed in 121,488 adult patients in England. DD surgery was most commonly performed in male, elderly, white patients living in less financially deprived areas and few comorbidities. Most operations performed were primary limited fasciectomy (LF). There was a significant incidence of local and serious systemic complications following DD surgery. The rate of reoperation was highest after primary percutaneous needle fasciotomy compared to primary LF or dermofasciectomy. There was an overall increasing trend and striking variation in the rates of primary DD surgery in England. A strong association was found between DD and advanced age, male gender, family history of DD, diabetes, heavy alcohol drinking, cigarette smoking and manual work exposure. Conclusions: The study findings have significant clinical importance as they helps to better understand DD surgical management. </p
The evidence behind the use of platelet-rich plasma (PRP) in scar management: a literature review
No full textIntroduction:
Autologous platelet-based concentrates represent increasingly popular adjuncts to a variety of medical, surgical and aesthetic interventions. Their beneficial potential rests on the ability to deliver a high concentration of growth factors to the target tissues. There are currently no reports in the literature appraising the evidence behind the use of platelet-rich plasma (PRP) in scar management.
Methods:
A detailed English literature review was conducted using PubMed Medline, Embase and Web of Science; the manuscripts were appraised and classified according to the Joanna Briggs Institute Levels of evidence. The results are presented in descending order of evidence separately for atrophic, keloid, surgical and traumatic scars.
Discussion:
On the basis of level 1 evidence currently available, it appears that PRP can improve the quality of atrophic acne scars treated with ablative fractional CO2 laser and decrease the duration of laser-related side effects including oedema and erythema. Regarding surgical scars, the current data suggest that PRP may improve wound healing and early scar quality; furthermore, incorporation of PRP in fat-grafting procedures undertaken in conjunction with non-ablative, fractional laser can contribute to better wound healing as well as a significant improvement in texture, colour and contour in traumatic scar resurfacing. There are no high level studies at present to support the incorporation of autologous platelet-based concentrates in the management of keloid scars.
Conclusion:
PRP is a promising adjunct in scar management practice. Further research with long-term follow-up is warranted to delineate the value of this modality in different subtypes of scars
Treatment Options for Dupuytren’s Disease: Tips and Tricks
No full textUNLABELLED: Dupuytrens disease (DD) is a common fibroproliferative condition of the hand. METHODS: Management of DD includes observation, non-operative management, and operative management. Operative treatments include percutaneous needle fasciotomy (PNF), open fasciotomy (OF), Clostridium collagenase histolyticum (CCH) injections, limited fasciectomy (LF) and dermofasciectomy (DF). The various methods of DD treatment are reviewed. RESULTS: We summarize the highlights of each treatment option as well as the strengths and weaknesses. PNF has an immediate improvement, but a higher recurrence rate, potential problematic skin tears, and rare tendon or nerve complications. Limited fasciectomy removes the thickened, diseased tissue but has a more prolonged recovery and has a higher rate of significant complications. Dermofasciectomy has the highest complication rate, and the lowest recurrence. Also, secondary fasciectomy after a previous dermofasciectomy has an unexpected amputation rate as high as 8%. Collagenase injections require two visits, have an increased number of minor side effects such as skin tears, and have rare but significant side effects such as tendon rupture. CONCLUSIONS: This article gives an overview of different treatment options for DD and each of their strengths and weaknesses and provides procedural tips
Esophageal caustic injuries in pediatrics: a sobering global health issue
No full textCaustic material ingestion by children is considered a global healthcare issue, especially in low-to-middle income countries. The aim of this article was to review the epidemiology, prevention, and management of caustic material ingestion in pediatric patients, comparing low-to-middle income countries with high-income countries. We conducted an English literature review using PubMed with the following keywords: (caustic OR corrosive) AND ingestion AND (pediatric OR pediatric). Our search retrieved 253 citations; all abstracts were screened by the authors, and 52 articles were finally included in our review. Prevention is key in tackling this issue, but legislation is scarce in low-to-middle income countries. Diagnosis of caustic ingestion is mostly achieved using flexible endoscopy, computed tomography, and endoscopic ultrasound, but access is limited in low-to middle income countries and diagnosis is often delayed. After stabilizing patients, the mainstay of treatment is graded endoscopic dilatation, and rarely, esophageal replacement. We concluded that caustic ingestion represents a serious condition where prevention is the key. Once a child suffers an injury, rapid and careful evaluation of the injury with endoscopy, and a course of close observation and dilations if needed, will often avoid esophageal replacement. When necessary, the stomach is the best first option if it is viable, followed by the colon, and finally, the jejunum
Rebuilding Global Plastic Surgery Services and Safeguarding Workforce Density after COVID-19
No full textThe effect of the 50-day conflict in Gaza on children: a descriptive study
No full textBackground
The UN has estimated that the conflict in Gaza between July 8 and August 26, 2014, resulted in the deaths of 2204 Palestinians, mostly civilians, and permanent disabilities in thousands of people. The aim of this study was to describe the pattern and extent of effects on children from this attack.
Methods
We reviewed surveys and reports from governmental and international bodies (ministry of health and UN) and independent non-governmental organisations to compile statistics. Additionally, we reviewed the findings of 24 researchers who interviewed 430 eye witnesses of 144 Israeli attacks on civilian gatherings (houses, hospitals, schools, mosques, shops, and streets) in which at least two Palestinians were killed. We separated attacks that resulted in death of children (age <18 years). Each attack was categorised as being direct or indirect (direct attack means that bombing was intentional with no fighting in the vicinity) and we recorded whether a child was killed or injured and what the killed children were doing before attack.
Findings
530 children were killed, accounting for 24% of the 2147-total people killed. Children accounted for an estimated 30% (3303) of the 10 870 total people wounded. The field researchers of Euro-Mediterranean Human Rights Monitor covered 338 (64%) of the total 530 children killed. They focused extensively on mass attacks because it was difficult to cover hundreds of attacks taking place at the same time for 50 days. 54 597 (90%) of the raids were judged to be direct and 53 990 (89%) of these were in densely populated areas. 297 (88%) of children who were killed died in their homes. 71 (21%) of these were sitting with their families; 95 (28%) were asleep; 34 (10%) were eating; 27 (8%) were watching television or using computers. 41 (12%) of the killed children died while fleeing their houses; 31 (6%) were killed while sheltering in basements or at UN Relief and Works Agency schools; 20 (6%) died while playing; and 31(9%) were killed while doing other activities. Furthermore, the UN reported that 373 000 children needed specialised psychological support and around 1000 children will suffer permanent disabilities.
Interpretation
Our findings suggest that children injured or killed accounted for a substantial proportion of civilian casualties during this conflict
Palliative Reconstructive Surgery for Advanced Maxillofacial Osteosarcoma in the Peak of COVID-19 Pandemic: A Matter of Ethical Decision-making
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