The management of auricular defect using retroauricular flap

Management of auricular defect is still a challenge for reconstructive plastic surgeons. The complexity of anatomy and shape will make the reconstruction complicated. It is also inevitable that choosing the right donor to close the defect that resembles the original contour is one of the success indicators of any ear reconstruction. There are wide selections of techniques for the management of auricular defect. Retroauricular flap is one of the best choices in auricular reconstruction due to its vascular richness, low of failure rate, similarity of tissue contour and the ease of closing the donor-site defect primarily. This article reported three cases of auricular defect with various causes: crushed injury, human bite, and tumor excision. Two stages of surgeries were performed on all three patients. After sufficient debridement, the ear defect is planted beneath retroauriculomastoid dermis. The second stage, three weeks from the first surgery, the donor flap is separated from it host. One week follow up after the second stage surgery, all of the post-operative wounds showed no signs of infection, minimal scar formation and has satisfied aesthetic outcomes. The retroauricular flap has the advantages of simple dissection, low failure rate and has a good shape, texture, color for a very good aesthetic results. This flap may be considered as a good solution in the management of auricular defect and a flap bank for ear reconstruction

Resection of localized cheek infantile hemangioma in the proliferative phase: a case report

Infantile hemangioma (IH) is the most common vascular tumor which is characterized by proliferative phase, involuting phase, and involuted phase. As the regression will ultimately occur at the end of the phase, the choice of treatment become controversial. Although surgical management often advocated for complicated and conservative therapy failure cases, early resection may give some benefits both to the patients and parents. This case report described a 9-month-old female with cheek IH who underwent tumor resection followed by cheek flap as the procedure to close the defect. After two days post-operation, the patient was discharged from hospital without any complication observed. The surgical scar was favorable in the first month after surgery. Early resection can be established as one of the treatment choices for fast-growing hemangioma in the proliferative phase to avoid undesirable aesthetic sequelae in the future

The characteristics and patterns of maxillofacial fractures at Mangusada general hospital, Badung-Bali

Background: Trauma is one of the leading causes of death among people under 40 years of age and approximately 10 percent of the cases have been maxillofacial trauma. There was limited number of studies on maxillofacial fractures in Indonesia. Thus, this research attempted to investigate the characteristics and patterns of maxillofacial fractures at Mangusada General Hospital in Badung-Bali.Methods: This research was a cross-sectional descriptive study which conducted at Mangusada General Hospital in the period of 1 January 2016 - 31 December 2017. The 127 samples selected using non-probability sampling. The inclusive criteria involved all maxillofacial trauma cases and the exclusive criteria focused on maxillofacial fractures that received intervention or with incomplete medical records. Each data was collected from the medical records and then analysed descriptively.Results: From 127 samples, male dominated the sample on the gender-based criteria (70.1%) and the highest frequency of all age groups is 21-30 years old on the age group based criteria (23.6%). Maxillary fractures are the most occurring maxillofacial cases, which took up 33.6%. The main cause of the cases is traffic accidents (89.0%).Conclusions: Maxillary fractures are the highest maxillofacial cases at Mangusada General Hospital on 1 January 2016 - 31 December 2016 period of time. The productive male age groups are the most affected groups due to traffic accidents

Retrospective cohort study assessing coverage, uptake and associations with hepatitis B vaccination among females who engage in sex work attending sexual health services in England between 2015 and 2019

Objectives: Females who engage in sex work (FSW) are at high risk of hepatitis B virus (HBV) and are eligible for HBV vaccination. The objective of this analysis was to explore coverage, uptake and correlates of HBV vaccination among FSW who attend sexual health services (SHS) in England. // Methods: Data on all attendances at SHS in England were obtained from the GUMCAD STI Surveillance System. Attendees were eligible for inclusion if they were female, had not been previously diagnosed with HIV and sex work was recorded between 2015 and 2019. Bivariable and multivariable logistic regression models were used to investigate sociodemographic factors (age, ethnicity, region of birth and region of residence) associated with having received an HBV vaccination on or after an attendance where sex work was reported. // Results: There were 13 769 FSW attending SHS in England between 2015 and 2019 (median age 30 years, 71% white ethnicity). HBV vaccination coverage was 37% (n=5050/13 751, 95% CI 35.9%–37.5%). Among those that first reported sex work between 2015 and 2019, HBV vaccination uptake was 30% (n=3249/10 681, 95% CI 29.6%–31.3%). In multivariable analyses, HBV vaccination uptake was associated with younger age (5-year increase: OR=0.87, 95% CI 0.85, 0.89) and being born in South America (37%, adjusted OR (aOR)=1.40, 95% CI 1.18, 1.66) compared with being born in the UK. Being of Asian ethnicity (19%, aOR=0.63, 95% CI 0.45, 0.89) compared with white ethnicity was associated with reduced odds of HBV vaccination. Sixteen FSW were diagnosed with HBV after their first attendance where sex work was recorded. // Conclusions: To achieve the WHO goals of elimination of HBV as a public health threat by the year 2030, further research is needed to understand the individual and structural barriers to the offering and uptake of HBV vaccination among FSW, as well as using health promotion methods to improve uptake

STI testing, diagnoses and online chlamydia self-sampling among young people during the first year of the COVID-19 pandemic in England

PURPOSE: COVID-19 control measures reduced face-to-face appointments at sexual health services (SHSs). Remote access to SHSs through online self-sampling was increased. This analysis assesses how these changes affected service use and STI testing among 15-24 year olds ('young people') in England. METHODS: Data on all chlamydia, gonorrhoea and syphilis tests from 2019-2020, among English-resident young people were obtained from national STI surveillance datasets. We calculated proportional differences in tests and diagnoses for each STI, by demographic characteristics, including socioeconomic deprivation, between 2019-2020. Binary logistic regression was used to determine crude and adjusted odds ratios (OR) between demographic characteristics and being tested for chlamydia by an online service. RESULTS: Compared to 2019, there were declines in testing (chlamydia-30%; gonorrhoea-26%; syphilis-36%) and diagnoses (chlamydia-31%; gonorrhoea-25%; syphilis-23%) among young people in 2020. Reductions were greater amongst 15-19 year-olds vs. 20-24 year-olds. Amongst people tested for chlamydia, those living in the least deprived areas were more likely to be tested using an online self-sampling kit (males; OR = 1.24 [1.22-1.26], females; OR = 1.28 [1.27-1.30]). CONCLUSION: The first year of the COVID-19 pandemic in England saw declines in STI testing and diagnoses in young people and disparities in the use of online chlamydia self-sampling which risk widening existing health inequalities

Effects of COVID-19 Pandemic Response on Service Provision for Sexually Transmitted Infections, HIV, and Viral Hepatitis, England

Since the coronavirus disease pandemic response began in March 2020, tests, vaccinations, diagnoses, and treatment initiations for sexual health, HIV, and viral hepatitis in England have declined. The shift towards online and outreach services happened rapidly during 2020 and highlights the need to evaluate the effects of these strategies on health inequalities

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Pengaruh Rasio Tegangan Dan Delaminasi Terhadap Distribusi Tegangan Pada Fiber Metal Laminates

Kemajuan teknologi dewasa ini berbanding lurus dengan perkembangan material komposit. Salah satu jenis komposit berdasarkan material penguatnya adalah Fiber Metal Laminates (FMLs). Fiber Metal Laminates merupakan gabungan antara lapisan tipis logam dan komposit yang disatukan dengan menggunakan perekat. Bentuk kerusakan yang dapat terjadi pada Fiber Metal Laminates salah satunya adalah delaminasi. Delaminasi merupakan proses terpisahnya antar lapisan pada komposit yang dapat timbul karena adanya retak awal dan rasio tegangan yang kemudian mempengaruhi distribusi tegangan pada komposit tersebut. Delaminasi akan mempengaruhi kekuatan dan kemampuan material dalam menahan beban fatigue. Oleh karena itu dilakukanlah penelitian menggunakan simulasi dengan software berbasis metode elemen hingga untuk mengetahui pengaruh rasio tegangan dan delaminasi terhadap distribusi tegangan pada fiber metal laminates. Pada penelitian ini material komposit yang digunakan adalah Glass Reinforced Aluminium Laminate dan aluminium paduan, Perekat yang digunakan pada antarmuka aluminium dan fiberglass menggunakan epoxy. Dimensi spesimen yang digunakan memiliki tebal keseluruhan sebesar 1.8 mm, panjang 200 mm, dan lebar 40 mm. Pemodelan daerah ujung retak pada masingmasing retakan pada ujung spesimen dianggap sama (double edge crack). Tegangan maksimum yang diberikan adalah 28 MPa dengan variasi rasio tegangan yang diberikan adalah 0; 0,2; 0,3; 0,4 dan 0,5, dan ukuran delaminasi yang diberikan adalah 3, 4, 5, 6, 7, 8, 9, 10, 11, dan 12 mm. Pengujian dilakukan dengan dua step, yaitu step 1 dengan tegangan maksimum, dan step 2 dengan tegangan yang diberikan variasi rasio tegangan. Dari hasil simulasi didapatkan bahwa semakin besar rasio tegangan yang diberikan dan semakin besar ukuran panjang retak dan delaminasi akan menimbulkan distribusi tegangan pada daerah disekitar ujung retak yang akan semakin besar. Penyebabnya adalah adanya pengaruh konsentrasi tegangan yang terjadi di daerah ujung retak akan semakin besar ketika panjang retak meningkat. Selain itu semakin jauh jarak sebuah daerah dari ujung retak, maka konsentrasi tegangan yang terjadi akan semakin menurun karena timbulnya distribusi tegangan yang tidak merata. Begitu pula, tegangan yang terjadi pada setiap permukaan yang saling terhubung akan berbeda nilainya disebabkan karena adanya perbedaan modulus elastisitas yang dimiliki oleh masing-masing material penyusun komposit tersebut

PERENCANAAN STRATEGI SISTEM DAN TEKNOLOGI INFORMASI DI UNIT DISTRIBUSI PT. XL AXIATA DENGAN METODE ENTERPRISE ARCHITECTURE

PERENCANAAN STRATEGI SISTEM DAN TEKNOLOGI INFORMASI DI UNIT DISTRIBUSI PT. XL AXIATA DENGAN METODE ENTERPRISE ARCHITECTURE

The Correlation between High-Risk Pregnancy > 35 Years Old with Labioschizis Congenital Disorders

Abnormalities of the lip and palate or commonly referred to as cleft lip or labioschizis, are congenital abnormalities of the gap between the right and/or left sides of the lip. Palatoschizis is the most common congenital abnormality after labioschizis with multifactorial causes and is found in every nation in the world. This congenital anomaly is ranked the third most common based on a survey conducted in 13 major hospitals in Indonesia, and the incidence of cleft lip with or without cleft palate is 1 per 700-1000 births worldwide, and Asians have the highest risk. Among the factors causing it, genetics is agreed to be the main factor. Infants die or are disabled; even mothers die during childbirth, which often occurs in pregnancies aged > 35 years and over. Giving birth at the age of > 35 years and over, babies born are susceptible to genetic disorders. This study is to report cleft lip due to high-risk pregnancy > 35 years old at regional public hospital Drs. H. Amri Tambunan, Deli Serdang, which is a type B regional hospital in North Sumatra, Indonesia. This was a descriptive analysis with the cross-sectional retrospective study by using medical records of high-risk pregnancy > 35 years old patients treated from January to December 2019. The data are presented in tabular and pie form. In this study, there were 86 samples of patients with high-risk pregnancies > 35 years, and there were 49 (56.9%) patients in this study. The highest incidence rate was congenital cleft lip in 39 (45.3%) patients. Operations on children with congenital abnormalities such as labioschizis, labiopalatoschizis, and labiopalatognatoschizis are mostly performed when children are > 3 months – 12 months old, as many as 11 (28.2%) patients while 16 (41.1%) patients do not have surgery in this research. The results of this study did not show a relationship between the age of pregnant women > 35 years with the incidence of abnormalities under the cleft lip with a p-value of 0.230 which means a sig value > 0.05. However, based on the data that researchers got, respondents with maternal age of > 35 years tend to experience labioschizis, meaning that the older the age of pregnant women, the riskier they give birth to babies with labioschizis