Use of cephalic vein for venous anastomosis in head and neck reconstruction: A case series

Purpose: To describe the use of the cephalic vein as a recipient vessel for venous outflow in head and neck reconstruction. The cephalic vein is used as a vessel in cases where there is a paucity of veins in the neck. This may be due to previous surgery, previous radiation therapy, or advanced cancer. The cephalic vein may also be used to salvage a failing free flap. Methods: It is a retrospective review of 230 free flaps that had been used in head and neck reconstruction performed from July 2014 to July 2018 by a single surgeon. Results: There were 6 patients in whom the cephalic vein was used as a recipient vessel. The cephalic vein was used in 2 cases where a tumor was involved with the internal jugular vein, in 1 case where a previous neck dissection had been done, in 1 case where internal jugular vein had iatrogenic damage, and in 2 cases a salvage procedure was done. In all cases, the cephalic vein was rotated above the clavicle. The cephalic vein easily reached the free flap vein and had a good caliber. There were no failures in any of the patients. Conclusion: The cephalic vein is a good option for venous anastomoses in patients in whom there is a paucity of recipient vessels in the neck

Health-seeking behaviour of stroke patients in a rural area of Bangladesh

Background: Improper health-seeking behaviours (HSB) have been correlated with detrimental health outcomes, elevated rates of illness and mortality. The study aimed to investigate how stroke patients in a rural community of Bangladesh seek health care. Methods: A cross-sectional survey was conducted in the Raiganj sub-district of Sirajganj district from January to June 2016, using a validated screening tool to identify stroke patients at the household level. Neurologists confirmed the diagnosis after examining all suspected cases. Out of the 419 suspected cases identified during the screening process, 186 cases were officially reported after undergoing a confirmed diagnosis. Information on health-seeking behaviour was collected through face-to-face interviews with patients or their attendants. Results: After experiencing a stroke, approximately 35% of patients received treatment from unregistered care providers and over 40% received treatment outside of a hospital setting. Males were significantly more likely than females to receive treatment from registered physicians or hospitals (P<.05 and P<.01). A significantly higher proportion of educated individuals sought healthcare from registered physicians or hospitals (P<.05). Although better health-seeking behaviour was observed among higher-income groups, the findings were not statistically significant. Around 67% of patients were found to be hypertensive, with about one-third of them not taking any medication for their elevated blood pressure. Approximately 37% of patients had elevated blood glucose levels but only 22% were taking medication. Conclusion: A notable proportion of stroke patients in rural Bangladesh sought treatment from unqualified service providers. Health-seeking behaviour was associated with factors such as gender, education, and economic condition. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(2): 75-8

Effect of an Enhanced Self-Care Protocol on Lymphedema Status among People affected by Moderate to Severe Lower-Limb Lymphedema in Bangladesh, a Cluster Randomized Controlled Trial

Background: Lymphatic filariasis (LF) is a major cause of lymphedema, affecting over 16 million people globally. A daily, hygiene-centered self-care protocol is recommended and effective in reducing acute attacks caused by secondary infections. It may also reverse lymphedema status in early stages, but less so as lymphedema advances. Lymphatic stimulating activities such as self-massage and deep-breathing have proven beneficial for cancer-related lymphedema, but have not been tested in LF-settings. Therefore, an enhanced self-care protocol was trialed among people affected by moderate to severe LF-related lymphedema in northern Bangladesh. Methods: Cluster randomization was used to allocate participants to either standard- or enhanced-self-care groups. Lymphedema status was determined by lymphedema stage, mid-calf circumference, and mid-calf tissue compressibility. Results: There were 71 patients in each group and at 24 weeks, both groups had experienced significant improvement in lymphedema status and reduction in acute attacks. There was a significant and clinically relevant between-group difference in mid-calf tissue compressibility with the biggest change observed on legs affected by severe lymphedema in the enhanced self-care group (∆ 21.5%, −0.68 (−0.91, −0.45), p < 0.001). Conclusion: This study offers the first evidence for including lymphatic stimulating activities in recommended self-care for people affected by moderate and severe LF-related lymphedem

Insights on Lymphedema Self-Care Knowledge and Practice in Filariasis and Podoconiosis-Endemic Communities in Bangladesh and Ethiopia

Lymphedema is a life-long sequelae to several neglected tropical diseases (NTD). In Bangladesh the main cause is lymphatic filariasis (LF) and Ethiopia is endemic for both LF and podoconiosis. The World Health Organization (WHO) recommends daily self-care including meticulous washing and drying of affected skin and attention to entry lesions, limb exercises and elevation. Adherence to this regime reduces secondary infections which cause disabling episodes of acute dermato-lymphangitis (ADL). Self-care practices must be integrated into family life, supported by community and monitored by health staff; however, little is known about the influence of personal and socio-demographic factors on adherence. People affected by lymphedema (n=272), adult caregivers (n=272), and health workers (n=68) in Bangladesh and Ethiopia were trained in lymphedema management according to WHO recommendations. Surveys on the causes and management of lymphedema were collected at baseline and 24-weeks, and patients completed a daily journal of self-care activities and symptoms. At baseline knowledge on causes and management of lymphedema was greater among health workers (&amp;gt;70%) than patients and caregivers (&amp;lt;20%) in both countries, and there were significant between-country differences in patient reported use of limb washing (Bangladesh = 7.7%. Ethiopia = 51.1%, p = 0.001). At 24-weeks knowledge on lymphedema causes and management had increased significantly among patients and caregivers, there was &amp;lt;70% adherence to limb washing and exercises, but lesser use of limb elevation in both countries. A range of patient characteristics were associated with significant variation in self-care, except for limb washing. Performance of fewer leg exercises was significantly associated with increased age or severe lymphedema in Bangladesh, and with being female or in paid work in Ethiopia. Patient journals recorded ADL symptoms and working days lost due to lymphedema more frequently than were reported by recall during the 24-week survey. Core elements of lymphedema self-care education, training and monitoring are the same for multiple etiologies. This creates opportunities for cross-cutting implementation of integrated service delivery across several skin NTDs. Sustainability will depend on community level ownership and research on factors affecting adherence to lymphedema self-care are urgently needed.</jats:p

Stem cells on YouTube: National vs international content

YouTube is one of the most popular video-based social media sites across the globe. The role of stem cell transplant has not been deeply explored on YouTube. The current narrative review was planned to assess the viewership of content available on YouTube related to stem cells. The videos were classified based on type of content, duration, number of views, comments and number of likes. A total of 40 videos were downloaded under the search terms “stem cells in Pakistan” and “stem cells”. Of them, 6(15%) were repeat videos, and 34(85%) were unique. The findings revealed that in 10(25%) most viewed videos from Pakistan, 6(60%) contained opinions from non-expert physicians. Among the 10(25%) most viewed international videos, the information providers were science educators in 4(40%) videos and researchers in 2 (20%). Notably, no content from Pakistan was present among the top relevant international videos. ---Continu

Islam

Buku ini berisi tentang perkembangan umum islam selama empat belas abad keberadaannya. Buku ini bukan hanya sekadar penggalan-penggalan deskripsi mengenai fenomena-fenomena atau segi-segi perkembangan Islam yang tampaknya terpisah-pisah. Buku ini juga dimaksudkan untuk melihat efek yang ditimbulkan Islam bagi pemeluknya dan pembaca yang seharusnya dilihat dan dipandang secara objektif kepada sejarah agamanya, khususnya bagaimana melaksanakan ajaran-ajaran agamanya.xxix, 393 hlm.; 14 c

Adipose derived stem cells for the peripheral nerve regeneration: review of techniques and clinical implications

Adipose tissue is considered as a multipotent organ with multiple cellular varieties, like adipose derived stem cells with ability to differentiate into nerve cells. This review is an attempt to summarize the techniques of harvesting, isolating and delivery of adipose derived stem cells to injured nerve area and various interactions involved in the release of neurotrophic and angiogenic factors from stem cells. Neuro-regenerative potential of ADSCs is explained on the basis of “Paracrine hypothesis”, according to which ADSCs secrete multiple neurotrophic factors and upregulates secretion of these neurotrophic factors by Schwann cells, leading to improved myelination, regeneration and decreases nerve fibrosis. ADSCs are easily available in abundance and undergo multi-step processing before grafting to nerve injury site. Acute inflammation, hypoxia and co-culturing with Schwann cells promotes neural differentiation of ADSCs. ADSCs and Schwann cells are reported to have similar mitogenic and differentiation factors, Continued..