Ethical approval process considerations for research in resource limited settings globally

The purpose of this study was to determine whether the Alvarado score is beneficial in identifying complicated versus uncomplicated acute appendicitis in elderly patients. A retrospective review was conducted of patients aged 65 years and older who underwent an appendectomy for pathologically confirmed appendicitis. A review of 310 operative reports and patient charts from October 2012 to December 2016 yielded 216 patients. Patients were grouped based on complicated versus uncomplicated appendicitis. One hundred ten patients had complicated appendicitis, whereas 106 patients were uncomplicated. Among the complicated appendicitis patients, 76.4 per cent were perforated, 38.2 per cent were gangrenous, and 34.5 per cent had an abscess. The complicated appendicitis group had a higher mean duration of symptoms (2.70 ± 3.41 days vs 2.09 ± 3.08 days, P = 0.011). Appendectomies that were open or converted to open were more likely to be associated with complicated appendicitis (75% vs 48%, P = 0.012). Mean hospital length of stay was greater in those with complicated appendicitis (5.34 ± 5.56 days vs 3.12 ± 2.86 days, P \u3c 0.001). The two groups did not differ on mean Alvarado score (complicated = 6.96 ± 1.99 vs uncomplicated = 6.72 ± 1.85, P = 0.36). Only 62.5 per cent of patients had an Alvarado score that met the cutoff for acute appendicitis. The Alvarado score was not able to differentiate complicated from uncomplicated appendicitis in elderly patients

Enhancing Philtrum Morphology Using Fat Grafting Combined with Percutaneous Rigottomy in Repaired Unilateral Cleft Lip: Three-Dimensional Morphometric- and Panel Assessment-Based Outcome Study

SUMMARY: Improving the philtrum morphology of patients with a secondary cleft lip deformity has been a challenge in cleft care. Combining fat grafting with percutaneous rigottomy has been advocated for treatment of volumetric deficiency associated with a scarred recipient site. This study assessed the outcome of synchronous fat grafting and rigottomy for improvement of cleft philtrum morphology. Consecutive young adult patients (n=13) with a repaired unilateral cleft lip who underwent fat grafting combined with rigottomy expansion technique for enhancement of philtrum morphology were included. Preoperative and postoperative three-dimensional facial models were used for 3D morphometric analyses including philtrum height, projection, and volume parameters. Lip scar was qualitatively judged by a panel composed by two blinded external plastic surgeons using a 10-point visual analogue scale. 3D morphometric analysis revealed a significant (all p0.05) between cleft and noncleft sides. The postoperative 3D projection of the philtral ridges was significantly (p<0.001) larger in cleft (1.01±0.43 mm) than noncleft sides (0.51±0.42 mm). The average philtrum volume change was 1.01±0.68 cm3, with an average percentage fat graft retention of 43.36±11.35 percent. The panel assessment revealed significant (p<0.001) postoperative scar enhancement for qualitative rating scale, with mean preoperative and postoperative scores of 6.69±0.93 and 7.88±1.14, respectively. Synchronous fat grafting and rigottomy improved philtrum length, projection, and volume and lip scar in patients with repaired unilateral cleft lip. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.Published version, accepted version (12 month embargo)Not hel