Recent Articles

According to the literature, the term “poly-trauma” was first used by Tscherne et.al, in 1966 for patients who demonstrated a combination of at least two “severe head, chest or abdominal injuries” or “one of them in association with an extremity injury. Trauma, despite all efforts to control its impact, is now a recurrent cause of high incidence of mortality and morbidity worldwide. Studies show that road traffic injuries are currently the leading cause of death among people aged between 1 and 45-years old. Only 21 countries in the WHO (World Health Organization), European Region have implemented legislative changes regulating drink-driving, with blood alcohol test limits varying between ≤0.02 g/dl and ≤0.05 g/dl. INTRODUCTION: It is well known that poly-trauma is a challenge for the clinician, regardless of specialization. In this regard, we wanted to present this case to raise an alarm on the approach to poly-trauma, which involves, in addition to the pre-hospital, hospital and follow-up stages, the follow-up of victims after discharge, in an attempt to identify possible causes of death and their prevention. CASE PRESENTATION: In this clinical case, we present the outcome of a 44-year-old patient who presented to the emergency room with multiple trauma injuries resulting from a road traffic accident. During her admission to the neurosurgery department of the Emergency “Sfântul Apostol Andrei”, Clinical Hospital of Galati, the patient underwent numerous clinical and imaging investigations, which provided findings statistically associated with increased mortality and morbidity rates. CONCLUSION: The management of patients presenting with poly-trauma is continuous, dynamic and extremely challenging in terms of the staff involved, the multidisciplinary team that will monitor the patient’s progress. All this is a goal that can only be achieved through good interdisciplinary and inter-hospital communication, providing standards of care and quality-oriented cooperation, increasing efficiency through the use of existing…

The superficial musculoaponeurotic system is of fundamental importance in facial anatomy. One of its primary functions is to harmoniously integrate the facial mimic muscles by coordinating their movements with each other. The continuity of the superficial musculoaponeurotic system with the platysma also creates an effective unitary connection with the mandibular and cervical areas. For these areas, where the signs of aging are first shown with soft tissue ptosis and cervical bands, we propose our lower face-lift technique with SMAS-flap transposition. This technique is not characterized by the section of the aponeurosis at the earlobe or lower level and by its rotation, but it is characterized by an higher SMAS section at tragus level with transposition of the mobilized pre-parotid and platysma aponeurosis to the high mastoid area. This manoeuvrer allows us for an effective platysma extension-lift and for his secure fixation to the upper mastoid area, resulting in greater stability and duration of the treatment.

Conventionally TOS has been thought to represent a group of diverse disorders that result in compression of the neurovascular bundle exiting the thoracic outlet. Until recently, TOS classification has been based on symptoms, rather than the underlying pathology, with the subgroups consisting of neurogenic (NTOS), venous (VTOS or PSS), and arterial (ATOS). Neurogenic TOS accounts for over 95% of the cases, followed by venous (3–5%) and arterial (1–2%). Neurogenic TOS (NTOS) has been further divided into True NTOS (TNTOS) and Disputed NTOS (DNTOS), with DNTOS reportedly representing 95–99% of all neurogenic cases. In order to decrease confusion and to improve therapeutic results with TOS, the disease should be classified based on the underlying pathologic entity. Acquired and traumatic abnormalities of the clavicle and first rib should be classified separately. Clearly after the more common and objectively supported diagnoses of conditions that result in neurovascular symptoms of the upper extremity, such as cervical spine disease, carpal tunnel disease, and nerve entrapment syndromes, have been ruled out, there remains a group of patients who are suspected of having TOS. In these patients, rather than the more usual classification such as arterial, venous, or neurogenic, the more accurate approach from a diagnostic and therapeutic approach is to classify them as: Cervical Rib Disease: Patients with cervical rib syndrome (CRS) can have complications relating to compression of the subclavian artery (previously referred to as ATOS) and the brachial plexus(previously referred to as True NTOS) secondary to a well-formed cervical rib, or to an incompletely formed first rib, fibrous band associated with a rudimentary cervical rib, or a giant transverse process of C7. Thoracic Outlet Disease or “Subclavian Vein Compression Syndrome”: In these patients an abnormal first rib at its junction with the sternum results in compression of the subclavian vein at the subclavian-innominate junction….

Introduction: Esophageal cancer (EC) is one of the deadliest malignancies worldwide and is often diagnosed in advanced stages. It is the 8th most common cancer in the world and is the 6th most common cause of cancer related deaths, having a 5-year survival rate of less than 20% despite advances in treatment. It has a poor prognosis due to the late diagnosis and the lack of early presenting symptoms. In the United States, stage IV is the most common stage at the time of diagnosis. Methods: Eighty-seven fit patients were recruited for this multi-institutional clinical prospective study in the period from the start of January 2014 to the end of December 2020, diagnosed as cancer esophagus in by endoscopic biopsy and underwent surgical treatment according to stage at the centers participating in this study. Results: In pre-operative biopsy, Adenocarcinoma was diagnosed in 39/87 cases (44.8%) distributed as (5 in GEJ and 34 diagnosed in lower esophagus) while squamous cell carcinoma (SCC) diagnosed in 48/87 cases (55.2%) distributed as (28 in lower part, 10 in middle part and 9 in upper esophagus respectively) and only one case out of 87 cases diagnosed as undifferentiated carcinoma of lower esophagus. We found significant association between the increased tumor size and the increase depth of invasion and thenumber of harvested lymph nodes. Conclusion: As the tumor size increased (cutoff point 3cm), the depth of invasion through the layers of esophagus and the number of the infiltrated lymph nodes will increase, and this is associated with poor prognosis and increase in mortality rate from the esophageal cancer.

Small bowel diverticular disease is usually asymptomatic, but complicated small bowel diverticular disease can present as an acute abdomen, manifesting as diverticulitis, perforation, abscess, obstruction or bleeding. Due to the rarity of the disease, very few studies have been conducted on complicated small bowel diverticular disease. Therefore, there are no clear guidelines on management. General peritonitis remains the best indication for surgical management due to its correlation with high mortality and prolonged hospital stay. Traditionally, perforated small bowel diverticular disease is managed with exploratory laparotomy, primary bowel resection and anastomosis regardless of acute presentation. However, more recent studies demonstrated a trend towards conservative or less invasive surgical management. Here, we report two perforated small bowel diverticulitis cases at our institution that underwent different management and had different outcomes.

Objective: To identify the causes of the vaccine refusal and thus the severities that the anti-vaccine movement reflected in the population. Methods: Extended abstract of the literature review, researched papers documents in the Virtual Health Library (VHL) databases, the Journal Coordination Portal of Improvement of Higher-Education Personnel (CAPES), Scielo (Scientific Electronic Library Online), and Google Scholar applying exclusion criteria. Results: In their study Hu et al, 2019, observed 24.9% of vaccine refusal, a higher percentage compared to a sample of 285, where 33.7% have doubt in relation to the efficacy of the vaccine, 34% distrust the pharmaceutical industry, 38.2% are concerned with the vaccine safety, and 37.2% do not consider the vaccine essential, strongly characterizing the anti-vaccine movement. Fonseca et al, 2018, study shows a smaller percentage of vaccine refusals, 0.14%, which is considered low. This result may possibly be related to educational level of the sampled population. 74% of the participants in his study had higher education degrees indicating a possible correlation between education levels and acceptance of vaccination. Conclusion: Results of this study shows a need for further research on the repercussions of the anti-vaccine movement. It also demonstrate a need for additional outreach programs based on awareness and education of the population regarding vaccination.

Objetive: Describe the contribution of the State Hospital Epidemiological Surveillance Network of Pernambuco (VEH/PE) for the registration of cases of diseases and conditions of immediate compulsory notification, in Pernambuco, 2018. Methods: Descriptive study, type of experience report, of surveillance of 31 hospitals of the VEH / PE Network, in 2018. The data sources were from the Notifiable Diseases Information System and the data referring to DNCI were from FormSus, available on the Center’s Platform Strategic Health Surveillance Information. The proportions of notifications for Compulsory Notification Disease from the VEH/PE Network were calculated in relation to the total number of notifications made at Sinan. Results: Among the DNC notifications registered by Sinan (Net, Online and Web influenza, 30,1% came from the 31 hospitals of the VEH/PE Network. When analyzed, by information system, the Network was responsible for 28,4% of the records made in Sinan Net by 2.687 reporting units, in Sinan Online, 25,9% in relation to 1.247 reporting units and for Sinan Web Influenza the contribution was 82,3% in relation to the 69 reporting units. Immediate compulsory notification diseases/conditions communicated to CIEVS, 50,2% of the communications came from the Network As for the opportunity for immediate notification of diseases and conditions, 90,7% were communicated in due time by the VEH/PE Network. Conclusion: It is important to strengthen the Network aiming at surveillance, disease/disease control and operationalization of information systems, in order to support the manager in decision making.

Kyrle’s disease (KD) is a Chronic skin condition first described by Austrian pathologist Josef Kyrle in 1916. Kyrle referred to this condition as hyperkeratosis follicularis & parafollicularis in cutem penetrans. These diseases are characterized by the phenomenon of transepidermal elimination of denatured dermis an acquired form of perforating dermatosis [14]. It is characterized by keratotic crater plugs that develop in hair follicles penetrating the epidermis and extending into the dermis [4]. This trans epithelial migration and elimination of proteinaceous components is associated with systemic disorders like renal, liver diseases, chronic heart failure and diabetes mellitus. We present two case scenarios of a young Males with multiple chronic papular eruptions along with a review of literature for Kyrle’s disease (KD).

Instruments for identifying risk of terrorist offenders could help counterterrorism practitioners define parameters of effective rehabilitation and detect a change in risk level of offenders before and after treatment. This study aims to develop Motivation-Ideology-Capability Risk Assessment, known as MIKRA, to examine the level of risk of terrorist offenders. The study involved Indonesian counterter-rorism experts and practitioners for examining the construct validity of MIKRA and terrorist offenders at a maximum-security prison for analysing the external and criterion-related validity. External validity was implemented by comparing offenders’ MIKRA scores with their risk categories reported by Counterterror-rism Special Task Force. Internal consistency reliability (Cronbach’s Alpha) was also applied to examine MIKRA’s psychometric properties. The results indicate alpha reliability α= 0.933. Furthermore, offenders’ MIKRA scores are correlated significantly with categories of risk released by the official, but not correlated with the non-offenders’ scores. This means MIKRA is valid to investigate risks of terrorist offenders.

The global epidemiological trends led to the declaration of coronavirus (COVID-19) as a pandemic by the World Health Organization (WHO) on March 11, 2020. This necessitated the closure of schools, parks, and recreation and community facilities in most parts of the globe. As a result, there was a rapid shift to online education delivery, and even virtual school graduation ceremonies. Thus, children became part of the sudden behavioural changes needed to mitigate the spread of COVID-19. These changes include social distancing, frequent handwashing and stay-at-home restrictions. Some families had to cancel planned vacations, and others were forced to go into isolation or quarantine as recommended by the public health policies and guidelines. This paper reviews the psychological and behavioural impacts of the COVID-19 pandemic on school-age children.