A Randomized, Crossover-Controlled Evaluator-Blinded Trial Evaluating Cannula- Vs Needle-Assisted Hyaluronic Acid Injections for Infraorbital Deformities

Background Periorbital deformities can be corrected using hyaluronic acid (HA) injections. However, previous studies have not evaluated the effect of using different injection techniques (eg, a needle versus cannula) on efficacy and safety. Objectives To investigate the efficacy and safety of HA for the correction of periorbital deformities, when using either needle or cannula-assisted injections. Methods This was a prospective, randomized-controlled (with crossover), evaluator blinded study. Forty-two subjects were recruited, with a mean age of 44.82 ± 11.62 years. Subjects underwent two treatment sessions, spaced two weeks apart and attended one follow up visit at Week 4, following the last treatment. Subjects were randomized in a 3:3:1 ratio, whereby 18 subjects received injections by needle, 18 received injections by cannula and 6 were randomized to act as their own control at Baseline. Those in the control group were randomized (n = 3) to needle or cannula injections at Week 4 and proceeded with the same visit schedule as those treated at Baseline. At Weeks 2 and 4 post-treatment, subject satisfaction was evaluated and information on adverse effects (AEs) was collected. A blinded reviewer assessed subject imagery using standardized efficacy scales. Results Chi-square tests did not reveal any associations between treatment group and efficacy, safety, nor subject satisfaction scores (p > = 0.05). AEs reported in subject diaries were mild-to-moderate in nature and expected. Conclusions For the treatment of infraorbital deformities, hyaluronic acid injections performed using either a cannula or needle result in similarly high efficacy and safety ratios.

Withdrawal of life-prolonging treatment in the face of severely limited resources: Ethical and legal analysis of the law in Israel

The provision of lifesaving treatment subject to severely limited resources can lead to serious moral dilemmas and legal challenges on many levels. The issue becomes particularly acute in a crisis such as the current Covid-19 pandemic. In this context, legal questions arise regarding withdrawal of treatment, particularly withdrawal of ventilation. Israeli law prohibits withdrawal of ventilation, a situation that affects the prioritization criteria for patients who can benefit from ventilation. This issue is discussed in the context of the Covid-19 pandemic where the legal prohibition may lead to a situation in which patients will not have access to ventilators. In addition, a theoretical framework is proposed that includes not only beneficence, nonmaleficence, and distributive justice but also a relational approach to autonomy and justice. We also propose potential solutions under the current legal framework. Based on the legal analysis, it is proposed that Israeli law be amended so that more patients will have access to ventilation during a pandemic. It is argued that clinicians cannot act beneficently to prolong life if they ignore patients’ fundamental rights or the distributional effects of ethical policies. Autonomy and justice and their accompanying liberal and relational perspectives should remain relevant even during a pandemic, a time when resources are scarce.

La dialyse à domicile : une dynamique interactive complexe pour les couples

(English abstract at the end) La dialyse à domicile est reconnue comme étant la technique la moins coûteuse. Pourtant, elle est la moins choisie en France. Pourquoi la France se montre-t-elle frileuse quant au choix de cette technique ? Nous nous centrons, dans cet article, sur les aspects psychologiques de la prise en charge, par les conjoints, des patients hémodialysés à domicile. A ce sujet, les études sont contradictoires, certaines rapportent un mal-être des couples, tandis que d’autres mettent en évidence une meilleure qualité de vie pour les deux partenaires. Après avoir émis une critique concernant la méthodologie utilisée dans certains travaux qui évacuent la part subjective et certains éléments cliniques qualitatifs pourtant essentiels pour comprendre le phénomène, nous avons fait l’hypothèse que trois niveaux imbriqués méritent d’être pris en compte, jusqu’à être décisifs dans le choix de la dialyse : la dynamique psychologique de chacun des partenaires, la dynamique du couple et l’investissement psychologique du domicile. Nous concluons sur l’idée selon laquelle l’intégration du conjoint dans la prise en charge du malade peut être un atout pour les suites du traitement, sous réserve de certaines conditions : premièrement, une évaluation de la dynamique psychique du couple afin de limiter les échecs thérapeutiques et la souffrance psychologique ; deuxièmement, une sensibilisation des médecins et des soignants à ces questions, car le couple peut développer une relation d’autant plus pathologique que le traitement se fait à huit clos ; enfin, l’ouverture d’un espace de parole afin que les couples puissent exprimer leurs difficultés et être rassurés. Abstract Home dialysis is recognized as the least expensive technique. Yet it is the least chosen in France. Why is France being cautious about the choice of this technique? In this article, we focus on the psychological aspects of spousal management of home hemodialysis patients. In this regard, the studies are contradictory, some report a discomfort in couples, while others highlight a better quality of life for both partners. After criticizing the methodology used in some of the works that remove the subjective and some qualitative clinical elements that are essential to understanding the phenomenon, we hypothesized that three nested levels deserve to be taken into account, up to to be decisive in the choice of dialysis: the psychological dynamics of each partner, the dynamics of the couple and the psychological investment of the home. We conclude on the idea that the integration of the spouse in the care of the patient can be an asset for the continuation of treatment, subject to certain conditions: first, an assessment of the psychic dynamics of the couple to limit the therapeutic failures and psychological suffering; secondly, raising the awareness of doctors and caregivers about these issues, because the couple can develop a relationship which is all the more pathological as the treatment is done in camera; finally, the opening of a space of speech so that couples can express their difficulties and be reassured. Cette revue est mise à disposition selon les termes de la Licence Creative Commons Attribution 4.0 International.

PERBANDINGAN PEMBERIAN BUFFERED PEHAKAIN DENGAN FRESHLY MIXED LIDOKAIN- EPINEFRIN PADA PERSEPSI NYERI KARENA INFILTRASI ANESTESI LOKAL

Over the last decade, there has been a rise in the number of surgical procedures being perfomed under local anethesia. The infiltration of the local anesthetic is the most painful part of this procedures, and pain associations can develop into avoidance behaviors in future procedures. Several techniques were used to reduce the pain of local anesthetic infiltration. The objective of this study is comparing the effect of Buffered Pehacaine versus freshly mixed lidocaine-epinephrin in reducing the pain of local anesthetic infiltration. Six subject were recruited for this study. Each subject was received 2 kind of treatment. Subject rated pain using Visual Analog Score. Pain score were compared using paired t test. Sixty seven percent (67%) subjects reported that pain of infiltration was lower in Buffered pehacaine than freshly mixed lidocaine-epinephrine. The difference was not statistically significant. There are no significant difference between Buffered Pehacaine versus freshly mixed lidocaine-epinephrin in reducing the pain of local anesthetic infiltrationKeywords : local anesthetic infiltration, lidocaine, pehacaine

Spatial distribution of ignitions in Mediterranean periurban and rural areas: the case of Catalonia

Fire prevention requires a specific treatment subject to the innate characteristics of a territory and to the social interaction that takes place there. The present article deals with very different fire behaviors in two neighboring environments, in which unequal ignitory patterns have been identified. The analyzed environments constitute two prototypes of Mediterranean landscape in the region of Catalonia (Spain). The periurban-fire pattern is identified with the Metropolitan Area of Barcelona. The rural-fire pattern is observed in the county of Bages, with a far more sparse population structure. Sample observations were drawn from databases containing a compilation of ignitions occurring in these two environments during the period from 1987 to 1998. Analysis shows that the distribution of ignitions in the more urban areas is much more concentrated, whereas ignitions in rural areas are far more dispersed, and therefore more difficult to detect. The importance of the present article lies in the identification of the factors determining the patterns of development of ignitions in two very different territories, affected by diverse external pressures. Finally, guidelines for preventive policies adapted to these situations are given, taking into account the specific and differentiated characteristics relevant to each case.