Pinch Anatomy of Forehead: An Injection Guide for Forehead Filler Treatment

With the popularity of filler injections globally, more and more injectors are using them for facial shaping and reversing the aging changes of the face. Detailed knowledge of facial anatomy, especially of important vessels and tissue planes is essential for injectors. While performing filler injections, injectors tend to pinch the tissue layers with their non-dominant hand for ease of doing the procedure. Such deformational forces cause some changes in the anatomy of tissue layers held in a pinch. During a deep pinch, the important arteries in that area can get pulled up in the pinch's tissue layers, or they can stay in their position being unaffected by pinching. The ‘pinch and pull’ can also improve the tissue space for injections, by pulling away the mobile tissue layers from the fixed ones. Knowledge of the ‘pinch anatomy’ in the forehead can be used to the injector's advantage to avoid important arteries and place filler in the correct plane. By knowing the anatomical changes during the pinched state of tissue layers, filler injections in the forehead can be performed with relative safety in the correct tissue plane.

RISK ASSESSMENT AND PREDICTION OF THE POSSIBILITY OF ACUTE TOXIC EFFECTS ON WORKERS WHEN APPLYING OBERON RAPID 240 SC

the issue of uncontrolled pesticides application is quite acute in the system of state control over the use of chemical plant protection products and is of a global nature. Indeed, the dangerous effect of chemicals is a potential toxic effect on professional and non-professional contingents. Therefore, the study and forecasting of possible risks of negative effects of pesticides is an integral part of their implementation in the practical activities of agricultural and private farms. The aim was to predict the occurrence of acute toxic effects on workers involved in the treatment of crops with formulation based on the new insecticide spiromesifen and a representative of avermectins, abamectin. Materials and methods. To calculate the coefficients of possible inhalation poisoning, the physic-chemical properties and consumption rates of the studied active ingredients of the Oberon Rapid 240 SC formulation, the methodical approaches from State Standard 8.8.1.002-98 wase used, and to determine the possibility of acute toxic effects, taking into account the selectivity of their action, we used the Sergeev’s S.G. method, taking into account two ways of potential entry of chemicals into the body – inhalation and dermal. Results. According to the "Hygienic classification of pesticides by the degree of hazard", spiromesifen and abamectin, as well as formulation based on them, belong to the Ⅳth hazard class according to the coefficient of possible inhalation poisoning, which was less than 0.5. In terms of inhalation and dermal coefficients of selectivity of action, the studied compounds were classified as substances with a high selectivity of action, except for the value of the coefficient of inhalation action of abamectin, which was less than 100 and made it possible to classify the compound as substances with a relatively low selectivity of action. Conclusions. The obtained data indicate a low possibility of acute poisoning when using formulations based on insecticides – spiromesifene and abamectin, as well as their relative safety in the occurrence of acute toxic effects when inhaled and in contact with the skin.

Studying insecurity from relative safety — Dealing with methodological blind spots

Qualitative empirical enquiries into dynamics of security and insecurity often include a blind spot that bear theoretical ramifications because only those areas and respondents that allow for relatively safe fieldwork are studied. To transparently articulate the spheres of projection that creep into our knowledge production, we propose a distinction between inner and outer circles as highly fluid but separate geographical, socio-political and methodological spaces. Drawing on fieldwork in the Central African Republic and South Sudan, we discuss the risks posed by incomplete data and subsequently flawed inferences. We argue that the perceptions of fear projected onto the outer circle shape people’s behaviour more than measurable insecurity incidents and that increased interaction between actors in both circles reduces the perceived threats coming from the outer circles. We demonstrate how studying insecurity from inner circles risks securitizing outer circles while further centralizing the inner ones. We thus urge transparency in data collection and the related inferences that underpin our knowledge production.

Field Efficacy of Different IPM Modules for Management of Aphid on Cumin (Cuminum Cyminum L.) Under Semi-Arid Conditions

Aphid, Myzus persicae (Sulzer) and Aphis gossypii Glower (Hemiptera: Aphididae) are the two major species damaging cumin crop throughout the cumin growing states of India. Its infestation initiated on cumin crops at 20 days after seed germination with very low incidence and became abundant at 70-80 day after seed germination during second week of January till February when crops are in full grown stage. Since cumin is most important seed spice crop, having huge nutritional, medicinal and aromatic properties, and its seed and essential oil is exporting in many countries over the world, hence quality production is the major challenge for the growers. The multiple sprays of chemical pesticides with heavy doses for pest management induce resistance in aphids, harmful to natural enemies and also enhance the pesticide residue level in the produce (seed). With this approach, the present study was conducted for two consecutive years to evaluate the cumulative effect of botanicals, cultural and physical methods, bio-pesticides, and bio-control agents and insecticides in the form of IPM module for the management of aphid and relative safety to natural enemies in cumin under field conditions. In this study, amongst eight different IPM modules evaluated against aphid, module M-5 consisted by seed treatment with imidacloprid 600FS @ 3ml/kg seed followed by foliar spray of ker plant extract @ 10ml/litre, Verticillium lecanii (1x108cfu/g) @ 6g/litre, and fipronil 5%SC @ 0.035% at definite interval secured efficient management of aphids (>92% mortality) with relative safety to natural enemies and minimized pesticide residue in the seeds. The highest seed yield (934 kg/ha), test weight (5.24 g), essential oil (5.98%), economics (Rs.1.08 Lakh) and B: C ratio (3.69:1) was obtained by the application of IPM modules M-5. Similarly, the higher seed yield 1072.5 kg per hectare (21.19% appreciation over farmers practices) was also recorded in field validation study under non replicated field in large area, proved its effectiveness by the farmers. Consequently, it recommends that IPM module M-5 consisted with botanical product, entomopathogenic fungi and insecticides exhibited sustainable aphid management module for cumin, comparatively safer to natural enemies and lower residue level in the seeds.

Phytotherapeutic agents on anxiety control in dentistry: a literature review

The aim of this work is to review the literature on the use of herbal medicines to control dental anxiety. For this purpose, articles were searched in the databases ScienceDirect, Pubmed and The Cochrane Library. 57 articles were included in this study. The research evidence points to Valeriana officinalis and Passiflora incarnata as the most studied herbal medicines for the control of anxiety, and their adverse effects are also investigated. Studies prove the relative safety of these medications, as well as their effectiveness, low cost, lower concentration of active ingredients with better effects and fewer side effects when compared to benzodiazepines. The use of these medicinal plants requires further clarification as to their real effectiveness, correct dosage and side effects in conscious sedation in Dentistry.

Biodegradable Polymer DES (Ultimaster) vs. Magnesium Bioresorbable Scaffold (BRS Magmaris) in Diabetic Population with NSTE-ACS: A One-Year Clinical Outcome of Two Sirolimus-Eluting Stents

Background. Cardiovascular disease (CVD) with significant involvement of coronary artery disease (CAD) remains a major cause of death and disability among the diabetic population. Although percutaneous coronary intervention (PCI) continues to evolve, type 2 diabetes mellitus (T2DM) is a well-established marker of poor clinical prognosis after PCI, which is mainly attributed to the rapid progression of atherosclerosis requiring recurrent revascularizations. Hence, the use of bioresorbable materials could provide some solution to this problem. Material and Methods. The study was divided into two arms. For the first one, we qualified 169 patients with NSTE-ACS treated with PCI who received the drug-eluting stent (DES) coated with a biodegradable polymer Ultimaster (Terumo, Tokyo, Japan). The second arm was composed of 193 patients with ACS who underwent PCI with a magnesium bioresorbable scaffold Magmaris (Biotronik, Berlin, Germany). Both arms were divided into two subsequent groups: the T2DM (59 and 72) and the non-DM (110 and 121, respectively). The primary outcomes were cardiovascular death, myocardial infarction, and in-stent thrombosis. The main secondary outcomes included target lesion failure (TLF) and were recorded at a 1-year-follow-up. Results. There were no significant differences between the diabetic and nondiabetic populations in primary endpoints or main secondary endpoints (TLF, scaffold restenosis, death from any reason, and other cardiovascular events) either in the Ultimaster or Magmaris group. At a 1-year-follow-up, the primary endpoint in the DM t.2 population was recorded in 2.7% Ultimaster vs. 5.1% Magmaris, respectively. At the same time, the TLF occurred in the diabetic group in 4.1% Magmaris and 3.3% in the Ultimaster arm, respectively. Conclusion. Both, Ultimaster and Magmaris revealed relative safety and efficiency at a one-year follow-up in the diabetic population in ACS settings. The observed rates of TLF were low, which combined with a lack of in-stent thrombosis suggests that both investigated devices might be an interesting therapeutic option for diabetics with ACS. Nevertheless, further large randomized clinical trials are needed to confirm fully our results.

Towards compatibility of EUnetHTA JCA methodology and German HTA: a systematic comparison and recommendations from an industry perspective

Objective The transferability of the EU joint clinical assessment (JCA) reports for pharmaceuticals for the German benefit assessment was evaluated by systematically comparing EU JCA and German clinical assessments (CA) based on established assessment elements for HTA and assessing the potential impact of differences on Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) ability to derive the therapeutic added value. Methods Identification of all pharmaceuticals undergoing both, EU JCA and German CA between January 2016–June 2020. Qualitative review and data extraction from the assessments, assessment of methodological differences using a hierarchical model. Recommendations for harmonisation were developed and consented with pharmaceutical industry stakeholders. Results Differences with potentially major impact: (1) View on differing treatment algorithms and definition of corresponding subpopulations/respective comparators. (2) Clinical relevance of surrogate/intermediate endpoints. Inclusion of different/surrogate morbidity endpoints resulting in different relative effectiveness conclusions. (3) Tolerance of study interventions not used according to marketing authorisation. (4) Different operationalisation and/or weighting of individual safety endpoints leading to differing relative safety conclusions. Differences with potentially minor impact: (1) Disagreement in risk of bias assessment for overall survival and its robustness against study limitations. (2) Use of patient-reported outcome symptom scales as measurements for health-related quality of life instruments. Conclusion While many synergies between EU JCA and German CA exist, we identified several aspects in HTA methodology that would benefit of harmonisation and ensure the transferability of future EU JCA to the German HTA process without duplicated evaluation requirements. For those, a set of recommendations was developed.

Treatment tactics and outcomes of complications of intrastromal MyoRing implantation and corneal crosslinking in keratoconus

Purpose. To analyze the nature and frequency of intra - and postoperative complications during MyoRing implantation and corneal crosslinking in patients with keratoconus and to develop methods for their treatment and prevention. Material and methods. We conducted a study of the results of MyoRing implantation in 131 patients (147 eyes) with keratoconus II-III. Corneal rings with a diameter of 5-6 mm and a thickness of 280-320 µm were implanted. PocketMaker microkeratome (Dioptex GmbH, Austria) was used to create a stromal pocket during the implantation of the ICR. The patients were divided into the control group (32 patients, 34 eyes) – using the standard ICR implantation technology and the main group (38 patients, 42 eyes) – ICR implantation using the developed tools. Results. Among the complications, intraoperatively, the eruption of the stromal pocket was noted due to the loss of vacuum during the application of the applicator in 4 cases. In the long term, after 10 and 12 months, patients underwent ICR reimplantation with a positive result. In 2 cases, the surface location of the implant led to ring extrusion, which may have been due to the thinning of the surface layers, and subsequently keratoplasty was performed on the patients. In 1 case, the patient's pronounced deposition of lamellar deposits caused dissatisfaction of a cosmetic nature. At the request of the patients, the rings were removed, and in the following terms, the patient made up for the visual defect by wearing hard contact lenses. Conclusion. A moderate number of complications indicates the relative safety of the method of intrastromal keratoplasty. The use of the proposed instruments during the operation provides a significant reduction in the frequency of complications compared to the results with the standard technique of forming a corneal tunnel. Thus, it was found that the optimized method of implantation of MyoRing intrastromal rings reduces corneal trauma, simplifies the manipulation of the ring and reduces the total operation time by 1.4 times. Key words: keratoconus, intrastromal corneal rings, MyoRing, corneal crosslinking, complications.

A systematic review of the use of magnetic resonance imaging in non-conditional pacemakers and implantable defibrillators

Background Cardiac implantable electronic devices (CIEDs) were long considered a contraindication for magnetic resonance imaging (MRI). Modern devices are now MRI conditional, but still the majority of CIEDs in the population are legacy devices and are classified as unsafe for MRI. There is growing consensus that MRI is also safe in these patients. Purpose The purpose of this study was to perform an up to date systematic review of the evidence evaluating the use of MRI in patients with non-conditional CIEDs. Methods Searches of the PubMed, CINAHL and Embase databases were performed. Studies that assessed the rate of adverse outcomes after MRI in patients with non-conditional CIEDs were included. Studies were excluded if they did not disclose the conditionality of patients CIEDs. Case reports or case series were not included. Results 36 cohort studies were identified. No patient in these studies died during or immediately after MRI. Symptom associated with either torque or heating occurred in <1% of patients. Electrical resets occurred 1–2% of patients. There were no cases of non-conditional lead or generator failure. Inappropriate pacing occurred in <1% of patients. No ICD shocks occurred during MRI. Changes in CIED parameters occurred in 1–4% of patients. Conclusions This systematic review highlights the relative safety of the use of MRI in patients with non-conditional CIEDs. Demonstrated be the fact that no deaths or device shocks have been suffered as a consequence of MRI in any of these studies, and the extremely low incidence of device or lead related complications. Still strict selection and monitoring protocol should be used when imaging these patients. FUNDunding Acknowledgement Type of funding sources: None.

Characteristics of Newborns from Mothers with SARS-CoV-2 Infection in a Portuguese Hospital

Introduction: Guidance for pregnant women has been particularly problematic since the beginning of the COVID-19 pandemic. The aim of this study was to describe the characteristics and outcomes of pregnant women with SARS-CoV-2 infection and their newborns.Material and Methods: Case review of clinical records of pregnant women with SARS-CoV-2 infection admitted for delivery and their newborns from April to December 2020 at a hospital in the Lisbon metropolitan area.Results: From 1755 births, 81 (4.6%) were from SARS-CoV-2 positive mothers. Most (83.9%) were term newborns. Almost 16% were preterm, while there was an overall prematurity rate of 9.9%. Most women (88.6%) were asymptomatic. Rooming-in occurred in 80.8% cases and 19.2% newborns were admitted to the Neonatal Intensive Care Unit. From the total, 56.7% newborns were breastfed from birth and 43% had mixed feeding. None of the newborns had symptoms related to COVID-19 infection, and all had negative rt-PCR for SARS-CoV-2 at birth and at 48 hours of life. The majority (85.2%) was discharged home with their mothers.Discussion: Pregnant women with COVID-19 have shown immune characteristics resembling healthy pregnancies, and it is not yet clear if SARS-CoV-2 can be vertically transmitted. Recent updates on neonatal guidance now recommend rooming-in and support the relative safety of breastfeeding.Conclusion: This study supports other published articles regarding maternal and neonatal outcomes of SARS-CoV-2 infected pregnant women, including the absence of short-term adverse outcomes with rooming-in and breastfeeding.