Operative mortality in resource-limited settings: the experience of Medecins Sans Frontieres in 13 countries.

OBJECTIVE: To determine operative mortality in surgical programs from resource-limited settings. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of 17 surgical programs in 13 developing countries by 1 humanitarian organization, Médecins Sans Frontières, was performed between January 1, 2001, and December 31, 2008. Participants included patients undergoing surgical procedures. MAIN OUTCOME MEASURE: Operative mortality. Determinants of mortality were modeled using logistic regression. RESULTS: Between 2001 and 2008, 19,643 procedures were performed on 18,653 patients. Among these, 8329 procedures (42%) were emergent; 7933 (40%) were for obstetric-related pathology procedures and 2767 (14%) were trauma related. Operative mortality was 0.2% (31 deaths) and was associated with programs in conflict settings (adjusted odds ratio [AOR] = 4.6; P = .001), procedures performed under emergency conditions (AOR = 20.1; P = .004), abdominal surgical procedures (AOR = 3.4; P = .003), hysterectomy (AOR = 12.3; P = .001), and American Society of Anesthesiologists classifications of 3 to 5 (AOR = 20.2; P < .001). CONCLUSIONS: Surgical care can be provided safely in resource-limited settings with appropriate minimum standards and protocols. Studies on the burden of surgical disease in these populations are needed to improve service planning and delivery. Quality improvement programs are needed for the various stakeholders involved in surgical delivery in these settings

Osteoid osteoma of the foot : Presentation, treatment and outcome of a multicentre cohort

Funding Information: The current study did not receive any funding. Publisher Copyright: © 2021, The Author(s).Background: Osteoid osteomas of the foot are rare, with a varying and atypical clinical as well as radiological presentation impeding early diagnosis and treatment. The aim of the present multicentre study was to 1) analyze epidemiological, clinical and radiological findings of patients with foot osteoid osteomas and to 2) deduce a diagnostic algorithm based on the findings. Methods: A total of 37 patients (25 males, 67.6%, mean age 23.9 years, range 8–57 years) with osteoid osteomas of the foot were retrospectively included, treated between 2000 and 2014 at 6 participating tertiary tumor centres. Radiographic images were analyzed, as were patients’ minor and major complaints, pain relief and recurrence. Results: Most osteoid osteomas were located in the midfoot (n = 16) and hindfoot (n = 14). Painful lesions were present in all but one patient (97.3%). Symptom duration was similar for hindfoot and midfoot/forefoot (p = 0.331). Cortical lesions required fewer x‑rays for diagnosis than lesions at other sites (p = 0.026). A typical nidus could be detected in only 23/37 of x‑rays (62.2%), compared to 25/29 CT scans (86.2%) and 11/22 MRIs (50%). Aspirin test was positive in 18/20 patients (90%), 31 patients (83.8%) underwent open surgery. Pain relief was achieved in 34/36 patients (outcome unknown in one), whilst pain persisted in two patients with later confirmed recurrence. Conclusions: As previously reported, CT scans seem to be superior to MRIs towards detection of the typical nidus in foot osteoid osteomas. In patients with unclear pain of the foot and inconclusive x‑rays, osteoid osteoma should be considered as differential diagnosis.publishersversionPeer reviewe

From Beads on a String to the Pearls of Regulation: the Structure and Dynamics of Chromatin

The assembly of eukaryotic chromatin, and the bearing of its structural organization on the regulation of gene expression, were the central topics of a recent conference organized jointly by the Biochemical Society and Wellcome Trust. A range of talks and poster presentations covered topical aspects of this research field and illuminated recent advances in our understanding of the structure and function of chromatin. The two-day meeting had stimulating presentations complemented with lively discourse and interactions of participants. In the present paper, we summarize the topics presented at the meeting, in particular highlighting subjects that are reviewed in more detail within this issue of Biochemical Society Transactions. The reports bring to life the truly fascinating molecular and structural biology of chromatin

Türkiye’nin batısındaki dermatoloji hastaların alternatif ve tamamlayıcı tedavileri kullanımı

Aim:The aims of this study were to determine the use of CAM  therapies by  dermatology patients, reasons behind this use, satisfaction and information about CAM, and any side effects.Methods: This definitive research study was undertaken at the Dermatology Clinic of a training hospital in Western Turkey. A total of 297 patients, who applied to the dermatology polyclinic or who were admitted to the clinic, constitute the sample of the study. Chi-square tests were used to compare the demographic characteristics of those who did and did not use CAM. Findings: The findings indicated that 21% of the individuals, all of whom had dermatological ailments, used the CAM method. The CAM was most commonly applied by individuals with dermatological ailments such as pruritis (35.5%), acne (17.7%) and alopecia (14.5%). Almost all patients herbs were used intensively. After the use of herbs, the most used method was prayer (16.2%). More than the half of the patients using alternative therapies (75.8%) reportedly did not discuss the use of CAM with their healthcare professionals. Conclusions: Physicians and nurses could play a role in informing patients about the benefits and risks of using the CAM. Further studies and detailed examination of the beneficial and harmful effects of each method are necessary to provide more extensive and useful information on CAM methods.Ama&ccedil;: Bu &ccedil;alışmanın ama&ccedil;ları; dermatoloji hastaları tarafından TAT tedavilerinin kullanımı, bunları kullanma nedenleri, memnuniyetleri ve hastaların TAT tedavileri hakkındaki bilgi d&uuml;zeyi ile diğer yan etkilerini tanımlamaktır.Y&ouml;ntem: Bu tanımlayıcı araştırma, T&uuml;rkiye'nin batısındaki bir eğitim hastanesindeki dermatoloji kliniğinde ger&ccedil;ekleştirilmiştir. &Ccedil;alışmanın &ouml;rneklemini, dermatoloji polikliniğine başvuran veya klinikte yatmakta olan toplam 297 hasta oluşturmuştur. TAT tedavilerini kullanan ve kullanmayan hastaların demografik verilerini karşılaştırmak i&ccedil;in ki-kare testleri kullanılmıştır. Bulgular: Bulgular, dermatoloji hastalarının %21'inin TAT tedavilerini kullandığını g&ouml;stermektedir. TAT tedavilerini b&uuml;y&uuml;k &ccedil;oğunlukla kaşıntı (%35.5), akne (%17.7) ve alopesi (%14.5) gibi dermatoloji hastalığı olan bireyler kullanmaktadır. Bu y&ouml;ntemi kullanan hemen hemen b&uuml;t&uuml;n hastalar yoğun olarak bitkisel kaynaklı terapileri kullanmaktadır. Bitkilerin kullanımından sonra en &ccedil;ok kullanılan y&ouml;ntemin "dua etme" (%16.2) y&ouml;ntemi olduğu saptanmıştır. TAT tedavilerini kullanan hastaların yarısından fazlasının bu y&ouml;ntemleri kullandığını sağlık profesyonelleri ile paylaşmadıkları belirlenmiştir.Sonu&ccedil;: Hekimler ve hemşireler TAT tedavilerinin kullanımı konusundaki riskler ve yararları hakkında &ouml;nemli bir rol oynamaktadırlar. TAT tedavileri hakkındaki kullanışlı ve daha yaygın verilerin sağlanması i&ccedil;in, her metodun yararlı ve zararlı etkilerinin ayrıntılı incelenmesi ve bu konuya ilişkin daha &ccedil;ok &ccedil;alışmanın yapılması gereklidir

A flap graft technique for the reconstruction of extensor mechanism of the knee in a case of peri-articular synovial sarcoma managed by limb salvage

Synovial sarcoma is a malignant soft tissue tumour arising from the primitive mesenchymal cells which has a delayed progression has a slow progression and often mis-diagnosed. A fifty-two years old female presented with complaint of swelling, pain and inability to move her left knee for three years duration. Presented with recurrence for which Wide excision of the tumour, with reconstruction of knee using custom mega-prosthesis and extensor mechanism reconstruction was done. Patient had a good functional outcome and no recurrence

A systematic review of how homeopathy is represented in conventional and CAM peer reviewed journals

BACKGROUND: Growing popularity of complementary and alternative medicine (CAM) in the public sector is reflected in the scientific community by an increased number of research articles assessing its therapeutic effects. Some suggest that publication biases occur in mainstream medicine, and may also occur in CAM. Homeopathy is one of the most widespread and most controversial forms of CAM. The purpose of this study was to compare the representation of homeopathic clinical trials published in traditional science and CAM journals. METHODS: Literature searches were performed using Medline (PubMed), AMED and Embase computer databases. Search terms included "homeo-pathy, -path, and -pathic" and "clinical" and "trial". All articles published in English over the past 10 years were included. Our search yielded 251 articles overall, of which 46 systematically examined the efficacy of homeopathic treatment. We categorized the overall results of each paper as having either "positive" or "negative" outcomes depending upon the reported effects of homeopathy. We also examined and compared 15 meta-analyses and review articles on homeopathy to ensure our collection of clinical trials was reasonably comprehensive. These articles were found by inserting the term "review" instead of "clinical" and "trial". RESULTS: Forty-six peer-reviewed articles published in a total of 23 different journals were compared (26 in CAM journals and 20 in conventional journals). Of those in conventional journals, 69% reported negative findings compared to only 30% in CAM journals. Very few articles were found to be presented in a "negative" tone, and most were presented using "neutral" or unbiased language. CONCLUSION: A considerable difference exists between the number of clinical trials showing positive results published in CAM journals compared with traditional journals. We found only 30% of those articles published in CAM journals presented negative findings, whereas over twice that amount were published in traditional journals. These results suggest a publication bias against homeopathy exists in mainstream journals. Conversely, the same type of publication bias does not appear to exist between review and meta-analysis articles published in the two types of journals

Analysis of margin classification systems for assessing the risk of local recurrence after soft tissue sarcoma resection

Purpose: To compare the ability of margin classification systems to determine local recurrence (LR) risk after soft tissue sarcoma (STS) resection. Methods: Two thousand two hundred seventeen patients with nonmetastatic extremity and truncal STS treated with surgical resection and multidisciplinary consideration of perioperative radiotherapy were retrospectively reviewed. Margins were coded by residual tumor (R) classification (in which microscopic tumor at inked margin defines R1), the R+1mm classification (in which microscopic tumor within 1 mm of ink defines R1), and the Toronto Margin Context Classification (TMCC; in which positive margins are separated into planned close but positive at critical structures, positive after whoops re-excision, and inadvertent positive margins). Multivariate competing risk regression models were created. Results: By R classification, LR rates at 10-year follow-up were 8%, 21%, and 44% in R0, R1, and R2, respectively. R+1mm classification resulted in increased R1 margins (726 v 278, P &lt; .001), but led to decreased LR for R1 margins without changing R0 LR; for R0, the 10-year LR rate was 8% (range, 7% to 10%); for R1, the 10-year LR rate was 12% (10% to 15%) . The TMCC also showed various LR rates among its tiers (P &lt; .001). LR rates for positive margins on critical structures were not different from R0 at 10 years (11% v 8%, P = .18), whereas inadvertent positive margins had high LR (5-year, 28% [95% CI, 19% to 37%]; 10-year, 35% [95% CI, 25% to 46%]; P &lt; .001). Conclusion: The R classification identified three distinct risk levels for LR in STS. An R+1mm classification reduced LR differences between R1 and R0, suggesting that a negative but &lt; 1-mm margin may be adequate with multidisciplinary treatment. The TMCC provides additional stratification of positive margins that may aid in surgical planning and patient education

Simulation in Medical Student Education: Survey of Clerkship Directors in Emergency Medicine

<p>Introduction: The objective of this study is to identify (1) the current role of simulation in medical student emergency medicine (EM) education; (2) the challenges to initiating and sustaining simulationbased programs; and (3) educational advances to meet these challenges.</p> <p>Methods: We solicited members of the Clerkship Directors in Emergency Medicine (CDEM) e-mail list to complete a Web-based survey addressing the use of simulation in both EM clerkships and preclinical EM curricula. Survey elements addressed the nature of the undergraduate EM clerkship and utilization of simulation, types of technology, and barriers to increased use in each setting.</p> <p>Results: CDEM members representing 60 EM programs on the list (80%) responded. Sixty-seven percent of EM clerkships are in the fourth year of medical school only and 45% are required. Fewer than 25% of clerkship core curriculum hours incorporate simulation. The simulation modalities used most frequently were high-fidelity models (79%), task trainers (55%), and low-fidelity models (30%). Respondents identified limited faculty time (88.7%) and clerkship hours (47.2%) as the main barriers to implementing simulation training in EM clerkships. Financial resources, faculty time, and the volume of students were the main barriers to additional simulation in preclinical years.</p> <p>Conclusion: A focused, stepwise application of simulation to medical student EM curricula can help optimize the ratio of student benefit to faculty time. Limited time in the curriculum can be addressed by replacing existing material with simulation-based modules for those subjects better suited to simulation. Faculty can use hybrid approaches in the preclinical years to combine simulation with classroom settings for either small or large groups to more actively engage learners while minimizing identified barriers.</p

Vantagens e desvantagens do e-Learning para cursos de emergência em medicina

BACKGROUND: E-learning techniques are spreading at great speed in medicine, raising concerns about the impact of adopting them. Websites especially designed to host courses are becoming more common. There is a lack of evidence that these systems could enhance student knowledge acquisition. GOAL: To evaluate the impact of using dedicated-website tools over cognition of medical students exposed to a first-aid course. METHODS: Prospective study of 184 medical students exposed to a twenty-hour first-aid course. We generated a dedicated-website with several sections (lectures, additional reading material, video and multiple choice exercises). We constructed variables expressing the student's access to each section. The evaluation was composed of fifty multiple-choice tests, based on clinical problems. We used multiple linear regression to adjust for potential confounders. RESULTS: There was no association of website intensity of exposure and the outcome - beta-coeficient 0.27 (95%CI - 0.454 - 1.004). These findings were not altered after adjustment for potential confounders - 0.165 (95%CI -0.628 - 0.960). CONCLUSION: A dedicated website with passive and active capabilities for aiding in person learning had not shown association with a better outcome.INTRODUÇÃO: Websites especialmente contruídos para auxiliar cursos são comuns, mas não há dados sobre o impacto na aquisição de conhecimento. OBJETIVO: Avaliar o impacto da utilização de ferramentas de um website exclusivamente-dedicado no aprendizado cognitivo de alunos de medicina em curso de primeiros socorros. MÉTODOS: Estudo prospectivo de 184 estudantes de medicina que realizaram curso curricular de primeiros socorros (carga horária - 24horas). Um website foi construído para auxiliar o curso com várias seções (aulas, material de leitura adicional, vídeo e exercícios de múltipla escolha). O acesso a cada seção educativa foi documentado para cada aluno. A avaliação foi composta de cinquenta testes de múltipla escolha, baseados em problemas. Regressão linear múltipla foi utilizada para corrigir possíveis fatores de confusão. RESULTADOS: Não houve associação entre a intensidade de do uso das seções do website e o desempenho na avaliação - beta-coeficiente 0.27 (95% CI - 0.454 - 1.004). Os achados não se alteraram após o ajuste - 0.165 (95%CI -0.628 - 0.960). CONCLUSÃO: O use de um website para auxiliar o aprendizado em alunos de medicina não implicou em melhor desempenho

Prediction of Osteoarthritis in the Knee by KOA Diagnosis Using Artificial Intelligence Based Techniques

Knee Osteoarthritis is the most common form of knee arthritis. A healthy knee's articular cartilage, a smooth, slick tissue, allows for simple bending and straightening. The ends of the leg bones that make up your knee are covered, safeguarded, and cushioned by this material. Two c-shaped segments of meniscal cartilage between your bones serve as "shock absorbers" to cushion your knee joint. Osteoarthritis develops gradually. The cartilage becomes rough and ragged as it ages. It hurts to move the bones along this exposed area. The most prevalent signs and symptoms of knee osteoarthritis are pain and stiffness. After being inactive for a while or in the morning, symptoms typically worsen. The earlier you begin treatment, the better, as osteoarthritis gets worse with time. Your doctor may prescribe additional tests after reviewing your symptoms and medical history, such as X-rays, which can reveal bone and cartilage damage as well as the existence of bone spurs, and magnetic resonance imaging (MRI) scans. So, the KOA diagnosis will be based on two modalities: X-rays and MRIs. Depending upon the patient’s opinion about their knee problems, the doctor will decide whether to take X-rays or MRIs for KOA diagnosis.&nbsp; To avoid such severe knee issues, researchers used many various techniques for KOA diagnosis in the existing system in order to treat it at an early stage of knee problems. In order to do that, we conducted a survey of research articles based on the KOA diagnosis published in the years 2021 and 2022 for this work. From the conducted survey, the methodologies which are AI-based techniques used for KOA diagnosis are discussed and their performance metrics are compared. The current review paper's goal is to do research on the various KOA diagnosis approaches employed in the years 2021 and 2022. As a result of this study, the methodologies which are AI-based techniques used for KOA diagnosis achieves good efficiency in predicting the osteoarthritis in the knee