POSTOPERATIVE ANALGESIC EFFICACY OF TRANSVERSUS ABDOMINIS PLANE BLOCK WITH CLONIDINE AFTER LAPAROSCOPIC CHOLECYSTECTOMYWritten by Guido Nicola Zanghì et al.
Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of symptomatic gallbladder diseases such as cholecystitis and cholelithiasis and it is the most performed procedure in general surgery with more than 1.5 million cholecystectomies performed annually in the United States. The reasons behind the increasing number of laparoscopic surgeries are improved postoperative pain and improved healing time as compared to open cholecystectomy resulting in earlier recovery and discharge from the hospitals. However, even if it is considered a minimally invasive technique, the intensity of pain on the first postoperative day is significant. Appropriate pain control is essential for optimizing the clinical outcomes and to ensure the patient can walk as early as possible after surgery.
KNOWLEDGE AND VIEWPOINTS ON THE EFFECTS OF CORRUPTION ON HEALTHCARE: A SURVEY CONDUCTED AMONG STUDENTS OF PALERMO UNIVERSITY MEDICAL SCHOOL, ITALY.Written by Giuseppe Luigi Marco Lanza et al.
Corruption affects healthcare effectiveness and efficiency and limits equity in access to health services. Aim of the survey was to document knowledge and viewpoints on the impact of corruption on healthcare system in a sample of students attending pre-lauream healthcare professional courses at Palermo University Medical school and to evaluate any improvement in their awareness on this topic after a dedicated multidisciplinary educational intervention. An anonymous questionnaire was administered to students before and after the intervention. Absolute and relative frequency of correct and incorrect answers was computed. Chi-squared test was used to compare answers given before and after the educational intervention. Approximately less than a quarter of the respondents were able to correctly estimate impact of corruption, inappropriateness and waste in healthcare on NHS. The study documented how improving students’ knowledge of the impact of corruption in the healthcare system could represent a possible strategy to prevent corruption in healthcare.
Pleomorphic adenoma is the most common benign tumor of the salivary glands. It arises mainly from the parotid, less frequently from the minor salivary glands of the oral cavity and, exceptionally, from the accessory glands widespread in the upper aero-digestive tract. Intranasal localization is rare and mainly affects the glands sited in the nasal septal mucosa. There are isolated case reports in literature regarding adult patients. We report a rare case of a young 14-year-old girl with pleomorphic adenoma arising from the nasal septum.
Coffee contains a wide variety of bioactive compounds including polyphenols, melanoidins, and diterpenes. Coffee consumption may have either neutral or beneficial effects toward human health. In this review, we summarize current evidence regarding the association between coffee consumption and breast, endometrial and ovarian cancer, as well as molecular mechanisms underlying the beneficial effects of coffee. The epidemiological evidence suggests a protective effect of coffee towards postmenopausal breast and endometrial cancer. However, no statistical association was found between coffee and ovarian cancer. The chemo-preventive effects of coffee phytochemicals may include activation of anti-oxidative and anti-inflammatory response. Finally, coffee bioactive components where shown to inhibit cancer cell proliferation and metastasis, as well as modulation of impaired angiogenesis.
We present our experience in the treatment of fractures of the tibial plateau with arthroscopic assistance. Between January 1997 and September 2001, we evaluated 23 patients with fractures of the tibial plateau. After their clinical and radiological evaluation, we included 17 patients in this study. Fractures were classified using the Schatzker classification. 14 patients were treated with arthroscopic reduction and percutaneous fixation, while 3patients underwent open reduction and osteosynthesis with platelets under arthroscopic control. The arthroscopic technique allows for a better articular visualization, decreases dissection of the tissues, and allows for an adequate diagnosis and treatment of the associated lesions. Arthroscopic reduction and percutaneous fixation can be considered the treatment of choice in a select group of fractures of the tibial plateau (Schatzker I and III).
Currently, surgical training of physicians in Italy has limited possibilities.Surgical training can be performed on dissection of human bodies as well as in animal laboratories, but experience is very poor. We conducted a survey through an anonymous questionnaire in order to evaluate the opinions of post-graduate physicians on their need for experience training on both human and animal bodies during their medical studies. A total of 165 young Sicilian physicians responded to the survey. Only 14 of them (8.5%) declared they had specific training on a live animal, while 46 (27.9%) reported they already attended cadaver labs. Over 70% assigned the maximum score to the utility of such courses as integration of medical academic offer. Our results showed that the majority of the subjects interviewed expressed a need for training using these practices and that it might be necessary to investigate patterns to promote the opportunity for direct practice on human and animal bodies.
Little is known about the relationship between laryngopharyngeal reflux (LPR) and periodontal or dental lesions. This study investigates the association of dental and periodontal involvement in patients with LPR compared to a control group. A prospective study was carried out on 102 patients complaining of LPR symptoms. The authors used the Reflux Symptom Index (RFS), Reflux Findings Score (RSI) and 24-h ambulatory pH monitoring to diagnose LPR disease. Two study groups were established, the LPR group included patients with LPR diagnosis and a control group selected from excluded patients. All patients underwent an oral examination for the evaluation of dental and periodontal status. Plaque index, gingival index and hemorrhage index were collected too. LPR was revealed to be associated with both an increased incidence of chronic periodontitis with significantly higher values of plaque index (p=0.018), hemorrhage index (p=0.048) , gingival recession (p=0.039) and higher tooth wear scores when compared to those of the control group. We support the view that laryngopharyngeal reflux might play a considerable role in the manifestation of periodontal and dental lesions.
This paper is a retrospective study examining 328 cadavers deceased from traffic accidents (252 drivers and 76 front seat passengers). Specifically, the skeletal injuries of the cranial, spine, chest, upper and lower limbs were examined. The purpose of the study is to ascertain whether it is possible to identify, through the skeletal injury patterns, who was driving at the time of the traffic accident. A statistical analysis was used to detect injuries that could differentiate between driver and front passenger. Drivers more frequently reported chest injuries, especially sternal injuries, due to the collision with the steering wheel. On the other hand, front passengers more frequently reported skull and spinal injuries. Furthermore, a greater incidence of pelvis fractures in front passengers was observed compared to drivers. The chest injury pattern resulted to be the most effective for distinguishing the driver from the front passenger.
THE BIAS (BULLYING IN SICILIAN SCHOOL) PILOT STUDY: INVESTIGATING THE PREVALENCE OF BULLYING IN SCHOOL OF PALERMO CITY. A RESEARCH STUDY PROTOCOL.Written by Claudia Marotta et al.
Being a serious threat to physical and emotional health of children and adolescents all over the world, bullying in school represents an important public health issue. Since 2007, in Italy, the Ministry of Education (MIUR) has promoted activities to face and prevent bullying in schools of all levels while at the same time national and local Health Authorities have implemented effective social-health strategies. To date, the lack of consistent data needed to properly describe the concerning increase of this Public Health phenomenon prevents both the ability to systematically survey and measure the effectiveness of the public health strategies against bullying. The Bullying In Sicilian Schools (BIAS) pilot study’s aims: i) to estimate the prevalence of bullying in a sample of secondary first-grade schools of Palermo, the largest city in Sicily, investigating its characteristics, and ii) to assess the feasibility of alternative methods for the detection of the prevalence of bullying in schools. Here we present the research protocol and the questionnaires that will be used.
Humeral reconstruction post tumor resection is a challenging quest. Reconstruction strategies depend first of all on age and general conditions of the patient, tumor dimensions, local invasion and bone quality. Many kinds of surgery are described in literature, mostly megaprosthesis, hemiartoplasty or alloprosthetic composite (APC) implants or allograft, allograft arthrodesis, clavicola pro-humeri or vascolarized fibula reconstructions. One of the most important goals of this surgery is to achieve implant stability. Surgical planning varies according to deltoid muscle, rotator cuff and axillary nerve conditions. When all these structures are conserved, an allograft or composite (anatomic or reverse arthroprosthesis) reconstruction could be a more suitable option for younger patients. When deltoid muscle function is impaired due to tumoral resection or axillary nerve disfunction, especially in elderly patients, surgeons prefer to implant endoprosthesis. The purpose of this paper is to describe the surgical technique to implant humeral megaprosthesis associated with tendon transfers and tips on how to achieve implant stability.
The aims of the present study were to determine the association between IGF-1gene polymorphism with obese individuals. This case– control analysis was performed on 50 subjects ,obese (n=30) and control (n=20) groups for age ranged (20-40 year).The results showed that genotype distribution of AA and AB in IGF-1 gene polymorphism were 83.3% and 16.7% respectively in the patients of obese group, while it was 90.0% and 10.0% respectively in the control group .Meantime the allele frequency of A and B in IGF-1 gene polymorphism were 91.65% and 8.35% respectively in obese group, whereas it was 95.0% and 5.0% respectively in the control group. Several single nucleotide polymorphisms (SNPs), was obtained between the two resolved haplotypes and between the IGF1 gene, exon3 Primer3 plus reference of the study. The results demonstrate that there is no association between AA and AB polymorphisms with in obese (OR=0.87,CI[0.71-1.17]) as in comparison with control groups.
The main aim of the study is to critically analyze the impact of defense medicine in the Italian healthcare system, considering the rapid spread of this phenomenon in the last years and its influence in the everyday medical practice. The authors use the Amenable Mortality Index (i.e. the number of premature deaths which could have been avoided in individuals younger than 74 years of age) to rate the performance status of the analyzed healthcare system and to compare different countries and Italian regions. The result of the study is that the Italian health system is valid, despite the economic difficulties of the last years, but much can be done to ameliorate its status. In fact, the authors want to promote a “no-blame culture” as an important factor for the overall improvement of the NHS, focusing only on patients’ health.
NURSES' STUDENTS' ATTITUDES TOWARD DEATH AND CARING FOR DYING CANCER PATIENTS DURING THEIR PLACEMENTWritten by Loai Abu Sharour et al.
Caring of cancer patients requires special skills and knowledge that facilitates the professionals’ care during the patients' illness and palliative phases. This study was conducted to explore the nursing students' attitudes toward death and caring for dying cancer patients during their Placement. A descriptive study was conducted using the Formmelt Attitude toward Care of the Dying (FATCOD) scale and Death Attitude Profile-Revised (DAP-R) scale. Nursing students from AL-Zaytoonah University of Jordan. A sample of one hundred nursing students was recruited. The current study showed statistically significant difference among age group in relation to total score of death scale (p-value: 0.000) and fear of death, neutral acceptance, approach acceptance, and escape- acceptance subscales. The results indicated that younger students have more negative thoughts, attitudes, and emotions toward caring for dying cancer patients. In addition the results indicated that students with higher academic levels have a more positive attitude and are more eligible to provide nursing care for dying cancer patients as compared to students with less experience. In addition, the results showed that students with less experience had a greater fear of death than students with a higher academic level. According to the study results, Nurses' attitudes toward caring for dying and dead cancer patients can be considered an important predictor of quality of life among cancer patients.
Anal fistula has been recognized for centuries, and yet, its treatment remains a challenge for surgeons till today. In this study, a 30 year experience of treating anal fistula is being reported and discussed in light of the various recognized management methods. A total of 320 patients were treated by fistulotomy, fistulectomy, fistula plugging or seton technique. Data showed that fistula plugging carried the highest failure rate (89%) seconded by fistulectomy (37%), seton procedure (24.5%) and fistulotomy (15.6%). High transsphincteric fistulas were more likely to predict failure compared to low transsphincteric, intersphincteric and subcutaneous fistulas (37.5% versus 9.5%, 7.3% and 0%, respectively). In conclusion, the scales seem to support fistulotomy. However, no standardized algorithm exists to guide the care of patients and the choice of operation is based on patient-related factors, the patient’s surgical history, and the surgeon’s experience and familiarity with the various techniques for treating anal fistula.