Severe Degloving Injury with Covid-19 Infection – Successful Outcome and Hard Lessons Learnt

Here we share an interesting case of severe trauma with tissue loss to nearly half of the back and a lacerated perineum in a Covid-19 positive patient in septic shock. This article highlights our experiences and hard lessons learnt in successful management of this complicated injury. Managing severe trauma is a challenge especially with respiratory failure resulting from Covid-19 infection. The patient reported to the hospital during a very difficult period, when proper medical care was difficult as hospitals and wards were filled with Covid positive patients. Managing patients was difficult especially wearing personal protective equipment round the clock. It’s a challenge when an entire team of surgeon, anesthesiologist, nursing staff and paramedics, rose above their daily call of duty to save the patient for her children. It was a fight against time and an many unknown enemy over three months for the entire team. The challenge to save a middle-aged patient from the claws of death against all odds was really miraculous. It was highly rewarding to see the patient going back to the family with a smile.

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Nonunion Rates After Anterior Cervical Discectomy and Fusion: Comparison of Polyetheretherketone vs Structural Allograft Implants

Neurosurgery ◽

10.1093/neuros/nyab079 ◽

2021 ◽

Author(s):

Won Hyung A Ryu ◽

Dominick Richards ◽

Mena G Kerolus ◽

Adewale A Bakare ◽

Ryan Khanna ◽

...

Keyword(s):

Smoking Status ◽

Posterior Instrumentation ◽

Patient Reported Outcome ◽

Anterior Cervical Discectomy ◽

Successful Outcome ◽

Cervical Discectomy ◽

Structural Allograft ◽

Modifiable Factors ◽

Patient Reported ◽

The Impact

Abstract BACKGROUND Although advances in implant materials, such as polyetheretherketone (PEEK), have been developed aimed to improve outcome after anterior cervical discectomy and fusion (ACDF), it is essential to confirm whether these changes translate into clinically important sustained benefits. OBJECTIVE To compare the radiographic and clinical outcomes of patients undergoing up to 3-level ACDF with PEEK vs structural allograft implants. METHODS In this cohort study, radiographic and symptomatic nonunion rates were compared in consecutive patients who underwent 1 to 3 level ACDF with allograft or PEEK implant. Prospectively collected clinical data and patient-reported outcome (PRO) scores were compared between the allograft and PEEK groups. Regression analysis was performed to determine the predictors of nonunion. RESULTS In total, 194 of 404 patients met the inclusion criteria (79% allograft vs 21% PEEK). Preoperative demographic variables were comparable between the 2 groups except for age. The rate of radiographic nonunion was higher with PEEK implants (39% vs 27%, P = .0035). However, a higher proportion of nonunion in the allograft cohort required posterior instrumentation (14% vs 3%, P = .039). Patients with multilevel procedures and PEEK implants had up to 5.8 times the risk of radiographic nonunion, whereas younger patients, active smokers, and multilevel procedures were at higher risk of symptomatic nonunion. CONCLUSION Along with implant material, factors such as younger age, active smoking status, and the number of operated levels were independent predictors of fusion failure. Given the impact of nonunion on PRO, perioperative optimization of modifiable factors and surgical planning are essential to ensure a successful outcome.

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The management of stress urinary incontinence: A case report

South African Journal of Physiotherapy ◽

10.4102/sajp.v71i1.229 ◽

2015 ◽

Vol 71 (1) ◽

Author(s):

Preshani Reddy

Keyword(s):

Urinary Incontinence ◽

Case Report ◽

Stress Urinary Incontinence ◽

Conservative Management ◽

Treatment Plan ◽

Exercise Programme ◽

Successful Outcome ◽

Successful Management ◽

Tailored Treatment ◽

Programme Improvement

Introduction: Conservative management is the first option for patients with stress urinary incontinence (SUI). However, successful management of women diagnosed with SUI is dependent on a proper assessment and a tailored treatment plan. This case report aims to show the effectiveness of physiotherapy management in a 42-year-old patient diagnosed with SUI.Patient presentation: The patient’s main complaints were involuntary loss of urine on coughing, sneezing and lifting of heavy objects, which started following the birth of her third child.Management and outcome: The patient was taught the ‘Knack’ manoeuvre and provided with a tailored pelvic floor exercise programme. Improvement was noted at the third visit and the patient no longer had involuntary episodes.Conclusion: This case report shows the successful outcome of conservative management in a patient with stress urinary incontinence.

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One step up and two steps back? The Italian debate on secularization, heteronormativity and LGBTQ citizenship

Social Compass ◽

10.1177/0037768618800750 ◽

2018 ◽

Vol 65 (5) ◽

pp. 591-607 ◽

Cited By ~ 2

Author(s):

Elisa Bellè ◽

Caterina Peroni ◽

Elisa Rapetti

Keyword(s):

Critical Discourse Analysis ◽

Political Conflict ◽

Interesting Case ◽

Critical Discourse ◽

Political Events ◽

The Family ◽

One Step ◽

Definition Of ◽

Shed Light

The aim of this article is to furnish insights of the Italian public debate on the recognition of LGBTQ rights, which can be understood as an interesting case study of the complex relationship between (multi)secularisation processes and re/definition of citizenship models. More specifically, the article analyses two political events related to this debate that took place in Rome in June 2015. The first is the Family Day demonstration, promoted by conservative Catholic groups; the second is the LGBTQ Pride parade, promoted by various gay, lesbian and transsexual/gender associations. We analyse the official statements issued by the two organising committees of the demonstrations, adopting the framework and methods of the Critical Discourse Analysis. Above and beyond an evident political conflict between the two discourses, we try to shed light on their mutual construction on the basis of what we call ‘naturalization’ and ‘universalization’ processes.

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Salvage Secondary Reconstruction of the Mandible with Vascularized Fibula Flap

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0039-1685460 ◽

2019 ◽

Vol 12 (4) ◽

pp. 274-283

Author(s):

Dinesh Kadam

Keyword(s):

Soft Tissue ◽

Tissue Loss ◽

Successful Outcome ◽

Primary Reconstruction ◽

Reconstruction Plate ◽

Secondary Reconstruction ◽

Fibula Flap ◽

Skeletal Defects ◽

Vascularized Fibula ◽

Free Fibula

Primary restoration of the mandibular continuity remains the standard of care for defects, and yet several constraints preclude this objective. Interim reconstructions with plate and nonvascular bone grafts have high failure rates. The secondary reconstruction, when becomes inevitable, remains a formidable task. This retrospective study evaluates various issues to address secondary reconstruction. Twenty-one patients following mandibulectomy presented with various complications between 2012 and 2016 were included in the study. The profile of primary reconstruction includes reconstruction plate ( n = 9), reconstruction plate with rib graft ( n = 3), soft tissue only reconstruction ( n = 4), free fibula ( n = 2), inadequate growth of reconstructed free fibula during adolescence ( n = 1), nonvascular bone graft alone ( n = 1), and no reconstruction ( n = 1). All had problems or complications related to unsatisfactory primary reconstruction such as plate fracture, recurrent infection, plate exposure, deformity, malocclusion, and failed fibula reconstruction. All were reconstructed with osteocutaneous free fibula flap with repair of soft-tissue loss. All flaps survived and had satisfactory outcome functionally and aesthetically. Dental rehabilitation was done in four patients. One flap was reexplored for thrombosis and salvaged. The challenges in secondary reconstruction include difficulty in recreating true defects, extensive fibrosis and loss of planes, unanticipated soft-tissue and skeletal defects, reestablishing the contour and occlusion, insufficient bone strength, dearth of suitable recipient vessels, nonpliable skin, tissue contraction to accommodate new mandible, need of additional flap for defect closure, and postirradiation effects. Notwithstanding them, the reasonable successful outcome can be attainable.

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Family Conference In Primary Care Practice

Journal Of The Indonesian Medical Association ◽

10.47830/jinma-vol.70.12-2020-339 ◽

2021 ◽

Vol 70 (12) ◽

pp. 243-245

Author(s):

Retno Asti Werdhani ◽

Dhanasari Vidiawati Trisna

Keyword(s):

Primary Care ◽

Family Environment ◽

Primary Care Practice ◽

Care Physician ◽

Care Practice ◽

Successful Management ◽

Inhibiting Factor ◽

Family Conference ◽

The Family ◽

Physician Family

From the Epidemiology Triangle, we can see that a person’s health status is influenced by 3 factors: host, agent, and the environment. The environment plays the biggest role as the cause of health problems, one of which is the family environment. Family can become a supporting factor or inhibiting factor in the successful management of patient’s cases. Therefore, a primary care physician/family physician needs to conduct family meetings to discuss and agree on solutions with the patient’s family by paying attention to inhibiting and supporting factors and find common solutions for the benefit of the patient.

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The Trouble with Race in Forensic Identification

Science Technology & Human Values ◽

10.1177/0162243919899467 ◽

2020 ◽

Vol 45 (5) ◽

pp. 804-828 ◽

Cited By ~ 6

Author(s):

Amade M’charek ◽

Victor Toom ◽

Lisette Jong

Keyword(s):

Forensic Genetics ◽

Family Relations ◽

Interesting Case ◽

Forensic Identification ◽

Criminal Investigation ◽

Science And Society ◽

The Family ◽

Genetic Technologies ◽

The Individual ◽

Absent Presence

The capacity of contemporary forensic genetics has rendered “race” into an interesting tool to produce clues about the identity of an unknown suspect. Whereas the conventional use of DNA profiling was primarily aimed at the individual suspect, more recently a shift of interest in forensic genetics has taken place, in which the population and the family to whom an unknown suspect allegedly belongs, has moved center stage. Making inferences about the phenotype or the family relations of this unknown suspect produces suspect populations and families. We discuss the criminal investigation following the Marianne Vaatstra murder case in the Netherlands and the use of forensic (genetic) technologies therein. It is in many ways an interesting case, but in this paper, we focus on how race surfaced in science and society. We show that race materializes neither in the technologies used nor in the bodies at stake. Rather, race emerges through a material semiotic relation that surfaces in the translation that occurs as humans and things move across sites. We argue that race is enacted, firstly, in the context of legislation as biology reduced to bodily characteristics; secondly, in the forensic analyses as patterns of absent presence; and, thirdly, in society as a process of phenotypic othering.

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Successful Outcome of Chronic Intrahepatic Cholestasis in an Adult Patient with Sickle Cell/β+Thalassemia

Case Reports in Hematology ◽

10.1155/2014/213631 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Efthymia Vlachaki ◽

Panagiotis Andreadis ◽

Nikolaos Neokleous ◽

Aleka Agapidou ◽

Evaggelia Vetsiou ◽

...

Keyword(s):

Sickle Cell Disease ◽

Adult Patient ◽

Sickle Cell ◽

Intrahepatic Cholestasis ◽

Interesting Case ◽

Successful Outcome ◽

Variant Form ◽

Cell Disease ◽

Hb S ◽

Chronic Intrahepatic Cholestasis

Sickle cell/β+thalassemia (Hb S/β+thal) is considered as a variant form of sickle cell disease. Acute episodes of vasoocclusive pain crisis are characteristic for sickle cell disorders and may be complicated by an acute or chronic life-threatening organ dysfunction. Chronic intrahepatic cholestasis is a rare and severe complication in sickle cell disease, characterized by marked hyperbilirubinemia and acute hepatic failure with an often fatal course. Despite the fact that patients with Hb S/β+thal usually have a mild type of disease, herein we describe an interesting case of chronic intrahepatic cholestasis with successful outcome in an adult patient with Hb S/β+thal.

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A successful outcome using a minimal invasive approach to manage a severe trauma to the primary maxillary incisor in a toddler

Dental Traumatology ◽

10.1111/j.1600-9657.2010.00872.x ◽

2010 ◽

Vol 26 (3) ◽

pp. 294-297 ◽

Cited By ~ 1

Author(s):

Senda Charone ◽

Erika Calvano Kuchler ◽

Marcelo De Castro Costa ◽

Lucianne Cople Maia

Keyword(s):

Severe Trauma ◽

Minimal Invasive ◽

Successful Outcome ◽

Maxillary Incisor ◽

Invasive Approach ◽

Minimal Invasive Approach

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Segmental Posthetomy in a Four Stallions Case Series

Animals ◽

10.3390/ani11041145 ◽

2021 ◽

Vol 11 (4) ◽

pp. 1145

Author(s):

Adriana Palozzo ◽

Gianluca Celani ◽

Giulia Guerri ◽

Paola Straticò ◽

Vincenzo Varasano ◽

...

Keyword(s):

Surgical Resection ◽

Single Case ◽

Case Series ◽

Scar Tissue ◽

Successful Outcome ◽

First Case ◽

Degloving Injury ◽

End To End ◽

Circumferential Segment

Segmental posthetomy, also referred to as circumcision, reefing or posthioplasty, consists of removing a circumferential segment of the internal preputial lamina (internal preputial fold) followed by end-to-end anastomosis of skin edges. The purpose of this case series is to describe the successful outcome of segmental posthetomy for treating different diseases involving the internal or/and external preputial fold, while restoring the normal telescopic function. In this paper, we report the first case of complete degloving injury of the equine penis in the literature (case 1) and describe three different common lesions of the equine prepuce/penis (preputial scar tissue in case 2, preputial sarcoid in case 3 and penile/preputial wound in case 4). The amount of prepuce (safe minimums) that can be removed from a stallion without disrupting the proper telescopic function of the internal/external preputial fold and normal copulatory ability, has not been established. In this case series, all Equidae stallions maintained the telescopic function after preputial surgical resection. However, the surgeon must carefully evaluate every single case, especially when performing the Adam’s procedure.

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Impact of Cancer on Family Relationships

Blood ◽

10.1182/blood.v128.22.687.687 ◽

2016 ◽

Vol 128 (22) ◽

pp. 687-687

Author(s):

Craig Erker ◽

Ke Yan ◽

Liyun Zhang ◽

Kristin Bingen ◽

Julie A. Panepinto

Keyword(s):

Cancer Therapy ◽

Social Relationships ◽

Family Relationships ◽

Patient Reported Outcome ◽

Anxiety And Depression ◽

T Score ◽

Patient Reported ◽

The Family ◽

The Difference ◽

The Impact

Abstract Introduction: Family relationships are the subjective experience of feeling involved, important and accepted in one's family. A new patient-reported outcome (PRO) domain has been developed as part of the NIH pediatric PROMIS (patient reported outcome measurement information system) which measures for the first time the child's perspective of family relationships. Previous research has demonstrated the impact of cancer on the family from the parent's perspective. This project sought to determine the impact of cancer and cancer therapy on family relationships in children with cancer and their siblings, both on and off therapy. Our primary hypotheses were that 1) Siblings have worse family relationships compared to their brother or sister with cancer and 2) Children receiving active cancer therapy have worse family relationships compared to childhood cancer survivors. Our secondary hypothesis was that children with poor family relationships would have impairment in depression, anxiety, and social relationship domains. Methods: We conducted a cross sectional study of children with cancer and their siblings aged 8-17 years old. The children belonged to one of four groups: 1) On-therapy patients (children receiving cancer directed therapy), 2) Siblings of on-therapy patients, 3) Off-therapy patients (children who completed cancer therapy at least 6 months ago), 4) Siblings of off-therapy patients. All subjects completed the self-reported PROMIS family relationships domain and PROMIS domains of depression, anxiety, and social relationships. The family relationships domain asks questions such as: "my family and I have fun together" and "my parents listen to me". PROMIS is a validated PRO tool that uses a mean T-score of 50 and standard deviation of 10. Recently, the minimally important difference (MID) for PROMIS was estimated to be 2-3 points on the T-score scale. The Mann-Whitney test was used to test the difference between therapy groups while the Wilcoxon signed-rank test was used to test the difference between patients and siblings. Social relationships, anxiety and depression PROMIS domains were correlated to the family relationships domain using Pearson's correlations. P-values <0.05 were considered as significant. Results: One-hundred and ninety children completed the assessments. Forty-eight were on-therapy patients and 62 were off-therapy patients. Paired data included 25 pairs of on-therapy patients and siblings and 31 pairs of off-therapy patients and siblings. The median and range of age was 12[8-17] years for patients and 13[8-17] for siblings. Fifty-four percent of the children enrolled were male and 65% of patients had leukemia or lymphoma. Off-therapy siblings had lower family relationships T-score than off-therapy patients (p=0.004, median (IQR) of 44.1 (41.1, 48.6) for siblings vs. 47.4 (43.1, 53.2) for patients). Off-therapy patients had higher family relationships T-scores than on-therapy patients (p=0.042, median (IQR) of 48.6 (43.1, 53.2) for off-therapy patients vs. 46.3 (42.1, 48.6) for on-therapy patients). No significant difference was found in family relationships T-scores between on-therapy patients vs. their siblings (p=0.22) or between the two groups of siblings (p=0.58). The correlations between family relationships T-scores and depression or anxiety scores were significantly different from zero for off-therapy patients and their siblings (p<0.001 for patients and p<0.005 for siblings). Impaired family relationships were related to increased depression and anxiety. Also, the correlation between family relationships T-scores and social relationships scores were significantly different from zero for off-therapy patients (p=0.031). Worse family relationships were related to worse social relationships. Conclusion: Off-therapy patients report better family relationships than their siblings and on-therapy patients. Also worse family relationships scores often correlate with increased levels of anxiety and depression. This study provides important information for pediatric oncology staff to help identify at-risk families in need of support. Disclosures No relevant conflicts of interest to declare.

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