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Abstract

Radial forearm flap is an axial flap that has become an important technique in reconstructive surgery as a free flap or as a pedicled flap. Defects of the skin and other tissues on the hand are very common and most often they are work-related injuries. In deep defects, flap must be used, as well as in reconstruction of the amputated thumb. There are many flaps that provide adequate soft tissue coverage for the hand. Therefore, the aim of this paper is to present the results of the use of radial forearm flap in various reconstructions on the hand. The retrospective study included 35 patients who underwent reconstruction with radial forearm flaps due to defects of the skin and other tissues on the hand, in the period 1997-2019. Results and complications of the surgery were analyzed. The functional and aesthetic outcome was assessed using Michigan Hand Outcome Qusteionnarire. All patients were followed for a minimum of 1 year. Fasciocutaneous flap was the most commonly used (65.71%), followed by adiposofascial (20%) and osteocutaneous (14.29%). The size of the fasciocutaneous flap ranged from 2.2x3.1cm to 9x13.5cm. The majority of donor sites were closed with split-thickness skin grafts (56.52%), and less frequently with direct suture, local skin flap, and full-thickness skin graft. There were no complete flap losses in the study. Marginal necrosis was noted in 8.57%, and graft failure at the donor site in 14.29%. Secondary surgical procedures were performed in 13 patients. The functional-aesthetic result of the operation, based on the MHQ score, ranged from 31 (1/35) to 130 points (3/35). The ultimate aim of hand reconstruction is to restore sufficient function and form, also, closing the wound within three days following the injury is desirable. Meticulous intraoperative dissection of radial flap and early physical therapy after surgery are mandatory. The radial flap is a suitable method, especially for large and more distal skin defects on the hand, and a very good method for thumb reconstruction.

Abstract

Introduction: Introduction: Both dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD) are important dementia syndromes that overlap in their clinical features and clinical course, neuropathological abnormalities, and also therapeutic approach. Nevertheless it is still unclear whether DLB and PDD are two different disorders that require differentiation or are one clinical entity within a spectrum of Lewy body disease. Currently these disorders are mainly distinguished on the basis of the relative timing of the onset of symptoms of dementia and parkinsonism. The present paper presents current concepts on the pathogenesis of both disorders and their possible overlap.

Material and methods: Online databases in the field of DLB and PDD were searched for to find potentially eligible articles. Only most recent articles published after the year 2000 were chosen.

Results: The clinical features of DLB and PDD are similar and include dementia with hallucinations and cognitive fluctuations, as well as parkinsonian signs. Also cognitive deficits are similar in PDD and in DLB, with predominance of executive dysfunction, visual-spatial deficits and memory impairment. Neuropathological changes in both disorders involve the presence of Lewy bodies and Lewy neurites within brainstem, limbic and neocortex, as well as loss of midbrain dopamine cells, and loss of cholinergic neurons in the nuclei of ventral forebrain.

Conclusions: Similarities in clinical manifestation, neuropsychological deficits and neuropathological abnormalities may suggest that both DLB and PDD are two different phenotypes of the same disorder. This review article presents current knowledge on similarities and differences between these two clinical entities and raises the question whether they require differentiation or not.

Abstract

Objective: The purpose of the study is to analyze and define the content, specifics, and procedures of social and psychological work with citizens who have expressed a desire to become mentors for orphans.

Introduction: In Ukraine, there are more than 750 foundations of institutional care and upbringing of children, in which approximately 106,000 children live. Only 8% among them have the status of orphans and children deprived of parental care; the other 92% have parents, but due to some difficult life circumstances of parents or presence of special needs or disability in children, they cannot live or be brought up in the family. It means that 92% of children without the status of orphans or children deprived of parental care cannot be adopted or placed for living and upbringing to other forms of family placement (guardianship/care, foster family, family-type orphanage). Along with this, out of 8% of orphan children and children deprived of parental care, there are no opportunities to be accommodated in any family forms of upbringing the following children: teenagers and youngsters, brothers and sisters from families with many children, and children with disabilities. In such children, close emotional relationships with meaningful, constant adults, which is a vital necessity for their psycho-emotional development and well-being, have been lost or were not formed at all. Accordingly, the introduction of mentoring for orphans and children deprived of parental care who live in relevant institutions is motivated by the necessity to satisfy the need of every child in emotional support, assistance and protection by a significant, authoritative person, and friend.

Methods: The study uses an experience which was gained during the realization of the project as the author-developer of the methodology of socio-psychological work with citizens and children concerning preparations for mentoring and training for both coordinators and mentors of the Mentoring Program in cooperation with specialists of the “One Hope” non-governmental organization; in the role of educator for the preparation of coordinators for the Mentoring Program implementation, as well as in the role of expert during the implementation of Mentoring Program by the community organization “One Hope” during the 2009-2016 period [1]. Also, authors participated in developing of the mentors preparing program over orphans and children deprived of parental care in order to receive approval at the state level.

Results: Mentoring for orphans and children deprived of parental care residing in institutions has been implemented in Ukraine since 2009 by the “One Hope” (“Odna Nadia”) public organization in cooperation with the Kyiv City Children’s Service and the Kyiv City Center of Social Services for Families, Children and Young People. The project “One Hope” was launched in the city of Kyiv and the Kyiv region during 2009-2016. Since 2016, mentoring as an individual form of support and assistance for a child living in a residential institution has been introduced in Ukraine at the state level.

Conclusions: If an orphan child or a child deprived of parental care is unable to live and being brought up in a family, then the mentor’s role in the life of this child is of paramount importance. This is due to the fact that such a form of individual support through mentoring will facilitate the preparation of every orphan child for independent living in the future.

Abstract

Under the Under the project Support for Environmental Assessment and Management (SEAM), This project is being implemented by Reduction of Milk Losses at Miser Company for Dairy and Food, Mansoura, Egypt. It was implemented under the National Industrial Pollution Prevention Programmers (NIPPP). NIPPP focuses on the introduction and promotion of low-cost improvement measures, which can be easily and quickly implemented by factories. It also emphasizes the importance of economic benefits of any such intervention, particularly those with short pay-back periods. A summary of how these improvements were identified and the underlying problems solved, follows. Waste minimization through improved quality control procedures was implemented at Edfina Company for Preserved Foods, Alexandria, Egypt. A number of interventions costing LE 65,200 (Egyptian Pound) have yielded annual savings of LE 382,622. Quality control training and the implementation of Hazard Analysis and Critical Control Point (HACCP) system will lead to improved product quality and further savings. Although it is difficult to quantify at this stage further savings of LE 550,000 could be expected in the short term.

Abstract

The high number of patients infected with the SARS-CoV-2 virus requiring care for ARDS puts sedation in the critical care unit (CCU) to the edge. Depth of sedation has evolved over the last 40 years (no-sedation, deep sedation, daily emergence, minimal sedation, etc.). Most guidelines now recommend determining the depth of sedation and minimizing the use of benzodiazepines and opioids. The broader use of alpha-2 adrenergic agonists (‘alpha-2 agonists’) led to sedation regimens beginning at admission to the CCU that contrast with hypnotics+opioids (“conventional“ sedation), with major consequences for cognition, ventilation and circulatory performance. The same doses of alpha-2 agonists used for ‘cooperative’ sedation (ataraxia, analgognosia) elicit no respiratory depression but modify the autonomic nervous system (cardiac parasympathetic activation, attenuation of excessive cardiac and vasomotor sympathetic activity). Alpha-2 agonists should be selected only in patients who benefit from their effects (‘personalized’ indications, as opposed to a ‘one size fits all’ approach). Then, titration to effect is required, especially in the setting of systemic hypotension and/or hypovolemia. Since no general guidelines exist for the use of alpha-2 agonists for CCU sedation, our clinical experience is summarized for the benefit of physicians in clinical situations in which a recommendation might never exist (refractory delirium tremens; unstable, hypovolemic, hypotensive patients, etc.). Because the physiology of alpha-2 receptors and the pharmacology of alpha-2 agonists lead to personalized indications, some details are offered. Since interactions between conventional sedatives and alpha-2 agonists have received little attention, these interactions are addressed. Within the existing guidelines for CCU sedation, this article could facilitate the use of alpha-2 agonists as effective and safe sedation while awaiting large, multicentre trials and more evidence-based medicine.

Abstract

The inherent properties of albumin facilitate its effective use as a raw material to prepare a nanosized drug delivery vehicles. Because of the enhanced surface area, biocompatibility, and extended half-life of albumin nanoparticles, a number of drugs have been incorporated in albumin matrices in recent years. Furthermore, its ability to be conjugated to various receptor ligands makes albumin an ideal candidate for the increased delivery of drugs to specific sites. The present review provides an in-depth discussion of production strategies for the preparation of albumin and conjugated albumin nanoparticles and for the targeting of these formulations to specific organs and cancer cells. This review also provides insights into drug loading, release patterns, and cytotoxicity of various drug-loaded albumin nanoparticles.

Abstract

Unscrupulous food business operators may use recycled frying oil to save costs. Of particular concern is the recycled frying oil is usually taken from nonhalal food premises which should not be used by halal food premises, and indeed may posing health treats to consumers. Hence, the objective of this paper is to analyse pork adulteration in recycled frying oils by using the combination of Raman spectroscopy and Principal Co mponent Analysis (PCA). Samples of frying oils from homemade fried pork, fried chicken, fried fish and fried banana were analyzed. Spiked samples were prepared by adding frying oil from homemade fried pork ranging from 10% to 50% (v/v) to frying oils from homemade fried chicken, fried fish and fried banana. The results found that Raman spectroscopy and PCA are able to differentiate adulterated frying oil and unadulterated frying oils. However, it could not distinguis h the percentage of pork adulteration in the spiked samples. This method would beneficial to ensure food integrity in the frying oils.

Abstract

Background

Septic events complicated by hemodynamic instability can lead to decreased organ perfusion, multiple organ failure, and even death. Acute renal failure is a common complication of sepsis, affecting up to 50-70 % of cases, and it is routinely diagnosed by close monitoring of urine output. We postulated that analysis of the minute-to-minute changes in the urine flow rate (UFR) and also of the changes in its minute-to-minute variability might lead to earlier diagnosis of renal failure. We accordingly analyzed the clinical significance of these two parameters in a group of critically ill patients suffering from new septic events.

Methods

The study was retrospective and observational. Demographic and clinical data were extracted from the hospital records of 50 critically ill patients who were admitted to a general intensive care unit (ICU) and developed a new septic event characterized by fever with leukocytosis or leukopenia. On admission to the ICU, a Foley catheter was inserted into the urinary bladder of each patient. The catheter was then connected to an electronic urinometer – a collecting and measurement system that employs an optical drop detector to measure urine flow. Urine flow rate variability (UFRV) was defined as the change in UFR from minute to minute.

Results

Both the minute-to-minute UFR and the minute-to-minute UFRV decreased significantly immediately after each new septic episode, and they remained low until fluid resuscitation was begun (p < 0.001 for both parameters). Statistical analysis by the Pearson method demonstrated a strong direct correlation between the decrease in UFR and the decrease in the systemic mean arterial pressure (MAP) (R = 0.03, p = 0.003) and between the decrease in UFRV and the decrease in the MAP (R = 0.03, p = 0.004). Additionally, both the UFR and the UFRV demonstrated good responses to fluid administration prior to improvement in the MAP.

Conclusion

We consider that minute-to-minute changes in UFR and UFRV could potentially serve as early and sensitive signals of clinical deterioration during new septic events in critically ill patients. We also suggest that these parameters might be able to identify the optimal endpoint for the administration of fluid resuscitative measures in such patients.