scholarly journals Influence of advanced age on postoperative outcomes and total loss following breast reconstruction: a critical assessment of 560 cases

2018 ◽  
Vol 45 (2) ◽  
Author(s):  
WALTER KOITI MATSUMOTO ◽  
ALEXANDRE MENDONÇA MUNHOZ ◽  
ALBERTO OKADA ◽  
EDUARDO MONTAG ◽  
EDUARDO GUSTAVO ARRUDA ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Breast Reconstruction ◽  
The Elderly ◽  
Advanced Age ◽  
World Health ◽  
Elderly Age ◽  
Significant Difference ◽  
Health Organization

ABSTRACT Objective: to evaluate the role of age in the risk of postoperative complications in patients submitted to unilateral breast reconstruction after mastectomy, with emphasis on total reconstruction loss. Methods: we conducted a retrospective study of patients submitted to breast reconstruction, whose variables included: oncological and reconstruction data, postoperative complications, including loss of reconstruction and complications of surgical wound. We divided the patients into two groups, according to the classification of the Brazilian National Elderly Policy and the Statute of the Elderly: young (age <60 years) and elderly (60 years or more). We also grouped them according to the World Health Organization classification: young people (age <44 years), middle age (45-59 years); elderly (age 60-89 years) and extreme advanced age (90 years or older). We applied the surgical risk classification of the American Society of Anesthesiologists to investigate the role of the preoperative physical state as a possible predictor of complications. Results: of the 560 patients operated on, 94 (16.8%) were 60 years of age or older. We observed a local complication rate of 49.8%, the majority being self-limited. The incidences of necrosis, infection and dehiscence were 15.5%, 10.9% and 9.3%, respectively. Patients older than 60 years presented a chance of complication 1.606 times greater than the younger ones. Forty-five (8%) patients had loss of the reconstruction; there was no statistically significant difference in the mean age of the patients who presented this result or not (p=0.321). Conclusion: in selected patients, breast reconstruction can be considered safe; most documented complications were limited and could be treated conservatively.

scholarly journals Age and Overweight Are Not Contraindications for a Breast Reconstruction with a TMG-Flap—A Risk and Complication Analysis of a Retrospective Double Center Study Including 300 Patients

2021 ◽  
Vol 10 (5) ◽  
pp. 926
Author(s):  
Karl Schwaiger ◽  
Laurenz Weitgasser ◽  
Maximilian Mahrhofer ◽  
Kathrin Bachleitner ◽  
Selim Abed ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Data Extraction ◽  
Free Flaps ◽  
Risk Groups ◽  
The Elderly ◽  
Demographic Development ◽  
Autologous Breast Reconstruction ◽  
Significant Difference

Introduction: The transverse myocutaneous gracilis (TMG) flap has become a popular and reliable alternative for autologous breast reconstruction. Initially described as a valuable tissue source for women with low body-mass index, indications nowadays have widely expanded. The Western civilization demographic development with its aging population and the steady growing average BMI has led to increasing breast reconstructions with TMG flaps in overweight and aged individuals. Patients and Methods: A total of 300 TMG free flaps for unilateral autologous breast reconstruction were evaluated in the form of a retrospective double center cohort study. Data extraction, study group formation and statistical analysis (One-way analysis of variance (ANOVA), Pearson’s chi-squared statistical analysis and relative risk calculation) were done specifically to evaluate age and BMI as risk factors for postoperative complications and outcome. Results: No significant differences in patients’ age and BMI in the complication groups compared to the no-complication group could be found. No significant difference regarding the occurrence of complications could be found in any of the formed risk-groups. No significant increase of minor-, major- or overall complications, flap loss or revision surgeries were found in the elderly patient groups or for patients with overweight. Conclusion: Age and overweight do not significantly increase the risk for postoperative complications after breast reconstructions with free TMG flaps. The findings of this study support the fact that microsurgical breast reconstruction with a free TMG flap should not solely be reserved for younger patients and females with a lower BMI.

scholarly journals A Basic Approach to Lymph Node and Flow Cytometry Fine-Needle Cytology

2016 ◽  
Vol 60 (4) ◽  
pp. 284-301 ◽  
Author(s):  
Helena Barroca ◽  
Cristina Marques
Keyword(s):  
Flow Cytometry ◽  
Fine Needle Biopsy ◽  
Molecular Techniques ◽  
World Health ◽  
Joint Work ◽  
Fine Needle ◽  
Preanalytical Phase ◽  
Health Organization

According to the World Health Organization (WHO), the new classification of lymphomas is mainly based on morphological, immunophenotypical, and molecular criteria. Consequently, this new approach has led from the substantial role that architecture played in the past to a secondary panel highlighting the role of fine-needle biopsy (FNB). Applied together with other ancillary techniques, such as flow cytometry (FC), FNB is a potential tool for the diagnosis of lymphomas, and enlarged lymph nodes represent an excellent target for the implementation of this technique. Despite the difficulties inherent in this technology, which might pose problems in differential diagnosis, in the majority of cases this joint work allows an accurate diagnosis of malignancy and even correct subcharacterization in routine lymphomas. Additionally, in selected cases, other molecular techniques like FISH and PCR can also be performed on FNB specimens, helping in the characterization and diagnosis of lymphomas. In this review, we discuss the basic aspects of the combination of FNB cytology and FC in the diagnosis and subclassification of lymphomas. The preanalytical phase is extensively discussed. The advantages, disadvantages, and technical limitations of this joint work are addressed in general and in terms of the accurate subclassification of lymphomas.

Recent Changes in Suicide Rates in Selected Eastern European and Other European Countries

1995 ◽  
Vol 7 (2) ◽  
pp. 301-308 ◽  
Author(s):  
Norman Sartorius
Keyword(s):  
Western Europe ◽  
The Elderly ◽  
European Countries ◽  
World Health ◽  
Eastern European ◽  
Elderly Age ◽  
Factors Affecting ◽  
Suicide Rates ◽  
Eastern European Countries ◽  
Health Organization

Recent major political changes in Eastern European countries might have affected their suicide rates. For this article, suicide statistics available to the World Health Organization were used to compare data from eight Eastern European countries to those from seven countries in Northern or Western Europe. Comparisons were made between 1987 and 1991/92 data using total suicide rates for each country, rates by gender, and rates for the elderly (age 75 and older). The total rates indicated an increase in suicide in Eastern European countries and a decrease in other European countries. The ratio of male-to-female suicides in the Eastern European countries increased during this time as well, more than in other European countries. Among those over the age of 75, however, rates of suicide in Eastern European countries decreased; this pattern was less clear in the European countries chosen for comparison. The article discusses the role of economic, cultural, and health service factors affecting these trends.

scholarly journals Role of Personal Protective Measures in Prevention of COVID-19 Spread Among Physicians in Bangladesh: a Multicenter Cross-Sectional Comparative Study

2020 ◽  
Vol 2 (10) ◽  
pp. 1733-1739 ◽  
Author(s):  
Md. Musab Khalil ◽  
Md Mashiul Alam ◽  
Mostafa Kamal Arefin ◽  
Mamunur Rashid Chowdhury ◽  
Muhammad Rezeul Huq ◽  
...  
Keyword(s):  
Comparative Study ◽  
Healthcare Workers ◽  
World Health ◽  
Cross Sectional ◽  
Protective Measures ◽  
Significant Difference ◽  
Baseline Information ◽  
Health Organization ◽  
Risk Assessment And Management

Abstract This study aims to determine the role of personal protective measures in the prevention of COVID-19 spread among the physicians working at different health facilities in Bangladesh. This hospital-based cross-sectional comparative study was conducted from May to June 2020. A total of 98 COVID-19 positive physicians and 92 COVID-19 negative physicians (physicians with no symptoms of COVID-19 or who tested negative) were enrolled. The questionnaire was adapted from a tool developed by the World Health Organization (WHO) for risk assessment and management of exposure of healthcare workers in the context of COVID-19. Data were collected from the respondents online using Google forms. There was no significant difference in baseline information between COVID-19 positive and COVID-19 negative physicians. The physicians, who were unaware of direct participation in COVID-19 patient care, had higher odds of being COVID-19 positive (OR = 4.018; CI: 1.532–10.535). Additionally, the physicians, who were unaware of the COVID-19 status while performing the aerosol-generated procedure (AGP), had a higher chance of being COVID-19 positive (OR = 2.522; CI: 1.020–6.233). Using face shields/goggles (OR = 0.437; CI:0.228–0.837) and regular decontamination of the patient’s surroundings (OR = 0.392; CI:0.176–0.873) while usual take care of patients and use of N95 masks while performing AGP (OR = 0.372; CI:0.159–0.873) had protective roles against COVID-19 among the physicians. The physicians who had reused the medical gown had two times more chances of being tested positive for COVID-19 than those who had not reused it (OR = 2.3; CI:1.251–4.259). The use of face shields/goggles and N95 masks and decontamination of the patient’s surroundings may give protection against COVID-19. Additionally, reusing medical gowns should be avoided as much as possible.

Is Homosexuality Normal?

1998 ◽  
Vol 26 (2) ◽  
pp. 219-259
Author(s):  
Norman Q. Brill
Keyword(s):  
Family Environment ◽  
International Classification Of Diseases ◽  
World Health ◽  
The Family ◽  
Classification Of Diseases ◽  
Health Organization ◽  
Genetically Determined ◽  
Disturbed Relationships

In 1973 the American Psychiatric Association removed homosexuality from its list of diagnoses, thereby implying that it is a normal variant of sexual behavior. Since then, when homosexuals have sought professional help for emotional problems, psychiatrists have tended increasingly to assist them to believe that their emotional discomfort is the result of society's bias and intolerance and to accept and enjoy their preference for individuals of the same sex. The World Health Organization, however, still includes homosexuality as a medical diagnosis in the International Classification of Diseases. Normally, a child can be expected to develop into an adult with its genetically determined sex. When a boy who is physically and hormonally normal develops a preference for sex with another male, it is an indication that something is amiss. A pathologic family environment is often present in the family of homosexuals. Yet not all boys exposed to a pathologic family during early development become homosexuals. Because of this, the role of disturbed relationships in causing homosexuality is questioned. However, psychoanalyses of male homosexuals have convincingly revealed the existence of a fear of heterosexuality in individuals with genetically predisposed personalities.

scholarly journals The Updated World Health Organization Glioma Classification: Cellular and Molecular Origins of Adult Infiltrating Gliomas

2017 ◽  
Vol 141 (12) ◽  
pp. 1633-1645 ◽  
Author(s):  
David J. Pisapia
Keyword(s):  
Central Nervous System ◽  
Animal Models ◽  
Who Classification ◽  
World Health ◽  
Central Nervous System Tumors ◽  
Nervous System Tumors ◽  
Cells Of Origin ◽  
Health Organization

Context.— In the recently updated World Health Organization (WHO) classification of central nervous system tumors, our concept of infiltrating gliomas as a molecular dichotomy between oligodendroglial and astrocytic tumors has been codified. Advances in animal models of glioma and a wealth of sophisticated molecular analyses of human glioma tissue have led to a greater understanding of some of the biologic underpinnings of gliomagenesis. Objective.— To review our understanding of gliomagenesis in the setting of the recently updated WHO classification of central nervous system tumors. Topics addressed include a summary of an updated diagnostic schema for infiltrating gliomas, the crucial importance of isocitrate dehydrogenase mutations, candidate cells of origin for gliomas, environmental and other posited contributing factors to gliomagenesis, and the possible role of chromatin topology in setting the stage for gliomagenesis. Data Sources.— We conducted a primary literature search using PubMed. Conclusions.— With multidimensional molecular data sets spanning increasingly larger numbers of patients with infiltrating gliomas, our understanding of the disease at the point of surgical resection has improved dramatically and this understanding is reflected in the updated WHO classification. Animal models have demonstrated a diversity of candidates for glioma cells of origin, but crucial questions remain, including the role of neural stem cells, more differentiated progenitor cells, and glioma stem cells. At this stage the increase in data generated from human samples will hopefully inform the creation of newer animal models that will recapitulate more accurately the diversity of gliomas and provide novel insights into the biologic mechanisms underlying tumor initiation and progression.

scholarly journals DEPRESSION  DEFINITION, HISTORY OF VIEWS, RECOGNITION

10.23856/3010 ◽  
2018 ◽  
Vol 30 (5) ◽  
pp. 99-106
Author(s):  
Barbara Szczygieł ◽  
Bartosz Wanot ◽  
Mariana Magerčiaková
Keyword(s):  
Depressive Disorders ◽  
The Elderly ◽  
Chronic Fatigue ◽  
The Body ◽  
World Health ◽  
Elderly Age ◽  
History Of ◽  
Health Organization ◽  
Clinical Conditions ◽  
Light Form

The concept of depression includes clinical conditions whose main disorder concerns mood or affect. Traditionally, this group includes depressive disorders, mania and submaniacal states, and anxiety disorders. A light form of depression is often unrecognized. The person feels chronic fatigue, weariness and discouragement to life. Depression caused by reactive factors is manifested by a smaller number of psychosomatic symptoms. According to the WHO (World Health Organization) report, by 2020 depression may become the second largest health risk after cardiovascular disease. The clinical picture of depression is dominated primarily by the depressed mood, which is felt by the patient as a state of gloom, resignation, and sadness. The patient is unable to experience joy, happiness and satisfaction. Anhedonia appears, or inability to feel any pleasures. A separate problem is the recognition of depression in the elderly age, when symptoms characteristic to depression are very often considered a normal manifestation of the body aging or as an inherent element of the somatic disease. Currently, it is estimated that as many as 40% of cases of depression in people over 65 remain undiagnosed.

scholarly journals Immune targeted therapies for COVID-19 Infection: A Promising Outlook

2020 ◽  
Author(s):  
Bahareh Forouzani-Haghighi ◽  
Alireza Rezvani ◽  
Afsaneh Vazin
Keyword(s):  
Immune Response ◽  
Immune System ◽  
Checkpoint Inhibitors ◽  
The Elderly ◽  
World Health ◽  
Laboratory Findings ◽  
System A ◽  
Disease Prognosis ◽  
Health Organization

In December 2019, the coronavirus disease-19 (COVID-19) outbreak emerged in Wuhan, China. On March 11, 2020, the WHO (World Health Organization) officially declared it a pandemic. Reports indicated that the associated mortality of the infection is quite higher in the elderly, patients with specific comorbidities (like diabetes mellitus), and generally the ones with a compromised immune system. A cohort study of 452 patients with laboratory-confirmed COVID-19 in Wuhan, China, reported a dysregulated immune response in these patients. As a result of this suppressed immune response, the increase of neutrophil to lymphocyte ratio (NLR), T lymphopenia, and decrease of CD4+ T cells was considered as common laboratory findings, especially in severe cases. On the other hand, there is also clear evidence of T cell exhaustion in severely ill patients. So, the immune system seems to play an important role in disease prognosis and pathogenesis. This study aims to review the evidence on the immune response dysregulation in COVID-19 infection and the potential role of immunoregulatory treatments such as immune checkpoint inhibitors, interferons, and CD200 inhibitors in altering disease prognosis, especially in critically ill patients.

A preliminary cross-national study of a possible relationship between elderly suicide rates and tuberculosis

2009 ◽  
Vol 21 (6) ◽  
pp. 1190-1195 ◽  
Author(s):  
Ajit Shah
Keyword(s):  
The Elderly ◽  
World Health ◽  
National Study ◽  
Elderly Age ◽  
Cross Sectional ◽  
Suicide Rates ◽  
Elderly Suicide ◽  
Health Organization ◽  
Cross National Study ◽  
Cross National

ABSTRACTBackground: The elderly are at high risk of developing tuberculosis. The prevalence and incidence of depression and anxiety are higher in those with tuberculosis than in the general population. A positive correlation between national suicide rates and rates of mortality due to tuberculosis has been reported.Methods: The relationships between elderly suicide rates and (i) the prevalence of tuberculosis, (ii) the proportion of detected cases of tuberculosis, and (iii) the proportion of cured cases of tuberculosis were examined in a cross-national study using data from the World Health Organization and the United Nations.Results: There were no significant correlations between elderly suicide rates and the prevalence of tuberculosis and the proportion of detected cases of tuberculosis. There were weak but significant negative correlations between the proportion of cured cases of tuberculosis and suicide rates for both sexes in both elderly age-bands.Conclusion: Caution should be exercised in interpreting the findings and the direction of the causal relationship from this cross-sectional ecological study because of ecological fallacy. However, if the findings are true then potentially the study has important implications for prevention of elderly suicides, particularly in countries with a high prevalence of tuberculosis.

scholarly journals Construction and validation of content of one instrument to assess falls in the elderly

2018 ◽  
Vol 16 (2) ◽  
Author(s):  
Michele Bittencourt Silveira ◽  
Ricardo Pedrozo Saldanha ◽  
José Carlos de Carvalho Leite ◽  
Thamyres Oliveira Ferreira da Silva ◽  
Thiago Silva ◽  
...  
Keyword(s):  
Content Validity ◽  
Fall Risk ◽  
The Elderly ◽  
World Health ◽  
International Classification Of Functioning ◽  
Online Questionnaire ◽  
Validity Coefficient ◽  
Elderly Health ◽  
Health Organization

ABSTRACT Objective To develop and validate the content of the online Questionnaire for Fall Risk Assessment in the Elderly. Methods The instrument was developed based on the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization. Initially, the set of items was submitted to evaluation of judges (healthcare professionals with experience in elderly health), who could suggest inclusion or exclusion of questions from the instrument; they were also asked to rate each question according to the expected scope. At this stage, clarity and relevance levels for each item were evaluated, generating a total of Content Validity Coefficient (CtVC). Results Content Validity Coefficient values were satisfactory for both clarity (CtVC=0.76) and relevance (CtVC=0.82) of the questions. Next, a group of elderly volunteers participating in a socializing group evaluated the questionnaire for comprehension. The level of comprehension for each item was identified on a Likert scale, ranging from 0 to 5. The questionnaire was considered easy to understand by most participants (95%), with a mean of 4.75 (±0.11) points for each item. Conclusion The instrument showed acceptable psychometric qualities for screening fall risk among the elderly population. Future studies shall investigate different validation aspects of construct for this measure.

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