ANALYSIS AND EVALUATION OF ADVANTAGES FROM LAPAROSCOPIC APPENDECTOMY

Purpose: The aim of the study is to evaluate the advantages of laparoscopic appendectomy fromour clinical experience in UMHATEM "Pirogov" which resulted in reduced postoperative complications, pain, length of hospital stay, and early return to work. Material and Methods: Data from a study of a patient group in the Department of General, Visceral and Emergency Surgery of UMBALSM "H. I. Pirogov "for the six-month period (01.01.2019 до 01.07.2019) were collected.Eighty-one patients with acute appendicitis who underwent laparoscopic appendectomy were selected. Indicators characterizing basic clinical and pathological features (epidemiology, demography, degree of pathological impairment), surgical approach and its outcomes (postoperative complications, postoperative duration), influence of concomitant factors were studied. Results: The study included 81 patients. The majority of patients were women - 46 (56.79%), men- 35 (43.21%). The mean age of male patients was 31.4 years and for female-28.6 years respectively. Hospitalization times are usually short - most patients are given up to 72 hours (70- 86.42%). Only eleven patients (13.58%) had an extended hospital stay for observation and additional therapy. Conclusion: Laparoscopic appendectomy was verified as an optimal and safe surgical procedure. Laparoscopic approach reduces post-operative pain, shortens hospital stay, reduces complications, and thereby reducing treatment costs.

The Impact of Music Training on the Cognitive Development of Preschool and Junior School Children: A Review of Research

The review presents the results of studies of the impact of music training on the cognitive development of preschool and junior school children. It is shown that music lessons can contribute to the development of reading, writing, listening and speaking as well as mathematical skills, memory, intelligence, and executive functions. After analyzing a number of relevant studies, the authors came to the following conclusions: (1) the impact of music lessons on the development of the cognitive sphere in children is associated with concomitant factors, such as: parental involvement in music lessons and home musical environment, age when a child begins to take music lessons and their duration, socioeconomic status of the family; and 2) it is systemic music training, which includes singing, playing musical instruments and solfeggio, that can have a beneficial effect on cognitive development. The mechanisms by which music training promote the cognitive development of children were also examined. While a vast body of work confirms the beneficial effects of music training in this regard, there are a number of studies showing no such effects. Special consideration is also given to the reasons why positive research results can be erroneous. In conclusion, the authors give recommendations for designing further research on this topic as well as for organizing music lessons for children of preschool and junior school age.

Retrospective Analysis of Hanging Cases Between 2016 and 2020 in Urban India

Background: Death by hanging is a vital health hazard worldwide; it is classified as violent mechanical deaths resulting from asphyxia. The manner of death in hanging is suicide in the majority of the cases, and accidental hanging is less common, and homicidal hanging is still less common. The study was aimed towards analyzing sociodemographic patterns, precipitating factors for committing hanging at Vijayanagar Institute of Medical Sciences (VIMS), Ballari, India. Methods: A retrospective study was conducted at the mortuary of VIMS, Ballari, Karnataka, India. From January 01, 2016, to December 31, 2020, 356 alleged hanging cases were brought to the mortuary for postmortem examination, and the cause of death was attributed to hanging. The necessary data were collected with the help of history, inquest reports, meticulous postmortem examination, etc. The results were obtained after tabulating and data analyzed with a cross-sectional study. Results: Of 356 cases of hanging, the majority of the cases were in the age group of 31-40 years (140 patients; i.e., 39.32%). Male preponderance was detected in 235(66%) cases, and most victims have married 199(56%) subjects. Concerning seasonal variation, we noted that the maximum number of suicides by hanging was reported in July to September 141(39.60%). Out of 356 hanging cases, 178(50%) were employed. The predisposing factor was Chronic illness in 136(38.20 %) cases, followed by financial stress and psychological problems in 120(33.70%) and 50(14.04%) cases, respectively. Most of the victims belonged to the Hindu religion, 290(82%) cases. Moreover, 320(90%) of cases had no suicide note. Conclusion: Hanging is challenging to prevent due to numerous concomitant factors, but psychological counseling, economic support, and education can reduce the incidence of hanging.

Static Culture Combined with Aeration in Biosynthesis of Bacterial Cellulose

One of the ways to enhance the yield of bacterial cellulose (BC) is by using dynamic aeration and different-type bioreactors because the microbial producers are strict aerobes. But in this case, the BC quality tends to worsen. Here we have combined static culture with aeration in the biosynthesis of BC by symbiotic Medusomyces gisevii Sa-12 for the first time. A new aeration method by feeding the air onto the growth medium surface is proposed herein. The culture was performed in a Binder-400 climate chamber. The study found that the air feed at a rate of 6.3 L/min allows a 25% increase in the BC yield. Moreover, this aeration mode resulted in BC samples of stable quality. The thermogravimetric and X-ray structural characteristics were retained: the crystallinity index in reflection and transmission geometries were 89% and 92%, respectively, and the allomorph Iα content was 94%. Slight decreases in the degree of polymerization (by 12.0% compared to the control―no aeration) and elastic modulus (by 12.6%) are not critical. Thus, the simple aeration by feeding the air onto the culture medium surface has turned out to be an excellent alternative to dynamic aeration. Usually, when the cultivation conditions, including the aeration ones, are changed, characteristics of the resultant BC are altered either, due to the sensitivity of individual microbial strains. In our case, the stable parameters of BC samples under variable aeration conditions are explained by the concomitant factors: the new efficient aeration method and the highly adaptive microbial producer―symbiotic Medusomyces gisevii Sa-12.

555 Torsade-de-pointes electrical storm late after treatment with hydroxychloroquine and azithromycin for COVID-19

A 78-year-old woman was admitted to our hospital due to multiple brief episodes of transient loss of consciousness. She was recently hospitalized elsewhere for SARS-CoV-2 infection and she had been discharged two days before. During the previous hospitalization she had been treated with hydroxychloroquine 400 mg twice daily on Day 1, followed by Hydroxychloroquine 400 mg daily together with azithromycin 500 mg daily for 7 days, leading to symptomatic resolution and two consecutive negative RT-PCR tests at discharge. Her medical history included dilated cardiomyopathy and in 2017 she underwent CRT-D implantation for primary prevention; over the past 3 years, she did not experience any ICD intervention. Her home therapy included amiodarone, bisoprolol, warfarin, and trazodone. Baseline ECG obtained 6 month before admission is shown in Figure 1, Panel A. On admission, her ECG showed sinus bradycardia with biventricular pacing and significant QT prolongation (i.e. 640 ms, Figure 1 B). On day 2 of hospitalization, she reported multiple brief episodes of transient loss of consciousness. An interrogation of her device revealed 27 torsade-de-pointes episodes in a 48-hour period, treated with 11 shocks. All episodes were preceded by a variable period of bigeminal rhythm due to one or two premature ventricular beats coupled to the prolonged QT segment of the preceding basic beat in a ‘short-long-short’ sequence (Figure 2). The patient experienced a torsade-de-pointes TdP during COVID-19 disease. She had multiple concomitant factors for QT prolongation (TISDALE SCORE 13): mainly, female sex, cardiac disease, inflammation, electrolyte imbalances and multiple QT-prolonging drugs. Amiodarone and bisoprolol were subsequently stopped and potassium and magnesium were supplemented, with rapid resolution of torsade-de-pointes. No more episodes of TdP were detected after two weeks of hospitalization. The remote monitoring assessment of her device did not show any further episodes during subsequent follow-up. To our best knowledge, this is the first ICD-documented report of a TdP electrical storm in a COVID-19 patient, treated with HCQ/AZT, who had multiple concomitant factors for QT prolongation. 555 Figure 1

Predictive Factors Influencing Functional Results After Proximal Hamstring Tendon Avulsion Surgery: A Patient-Reported Outcome Study After 227 Operations From a Single Center

Background: Although debilitating, proximal hamstring tendon avulsion injuries are rare and often overlooked or misdiagnosed. Consequently, delayed diagnosis and surgical treatment may result in poor outcomes. Studies investigating a correlation between postoperative functional outcomes and this delay in surgical treatment or other concomitant factors in large cohorts have not yet been performed to our knowledge. Purpose/Hypothesis: The purpose of this study was to conduct an investigation in a large patient group regarding factors that could influence a patient’s functional outcome after hamstring surgery. We hypothesized that this outcome would significantly correlate to the time between trauma and surgery. Study Design: Case series; Level of evidence, 4. Methods: Patients who received surgical treatment of proximal hamstring tendon avulsion injuries in our institution between the years 2010 and 2020 were asked to complete a validated, injury-specific outcome measurement, the Perth Hamstring Assessment Tool (PHAT; 0-100 points). In addition to calculating these outcomes, we evaluated the association of the obtained results with possible predictive factors such as age, sex, stump retraction shown on magnetic resonance imaging (MRI), and timing and duration of surgery. Results: A total of 226 patients (227 operations) were eligible for the study, and 204 cases of hamstring tendon avulsion injury met our inclusion criteria. The return rate for the PHAT questionnaire was 85.3%. The mean PHAT score revealed good results (79.8 ± 19.1). Irrespective of concomitant factors, the scores of male patients were significantly higher compared with those of female patients (83.8 ± 16.9 vs 75.8 ± 20.6 respectively; P = .004). The mean time to surgery was 5.7 weeks after trauma, and more delayed surgery correlated significantly with lower PHAT scores ( P = .003; r = –0.228). The mean degree of stump retraction on MRI (5 cm) did not significantly influence PHAT scores ( P = .525; r = –0.06). Conclusion: Delay of surgery and female sex were disadvantageous in terms of a good functional outcome measure (PHAT score) after hamstring tendon refixation surgery. By contrast, patient age as well as the retraction of the tendon stump on preoperative MRI did not influence PHAT scores in the present study.

Family history of obesity and the influence on physical activity and dietary adherence after bariatric surgery

Background The causes of obesity are multifactorial, with genetic, environmental, behavioural and societal contributions. These factors also affect adherence to diet and exercise after bariatric surgery. The objective of this study was to evaluate changes in perceived obesity-related stigma, exercise and dietary adherence perioperatively as well as what demographic factors most influence the magnitude of these changes. Methods Validated questionnaires regarding perception of stigma and adherence to diet and exercise regimens were administered to 104 bariatric surgery patients preoperatively and postoperatively at three, six and 12 months. Scoring was compared for improvement, and concomitant factors were analysed for effect on magnitude of improvement. Results Our study found overall improvement in perception of stigma as well as adherence to diet and exercise regimens. Those with a family history of obesity had less robust improvement compared to those without a family history of obesity. Those who were Caucasian also did not have as robust of an improvement in their scores. Conclusions Patient perception of obesity-related stigma and adherence to diet and exercise regimens improve after bariatric surgery. However, a patient with a family history of obesity and/or a Caucasian ethnicity may have a less robust improvement in these facets.

Human biomarkers associated with low concentrations of arsenic (As) and lead (Pb) in groundwater in agricultural areas of Thailand

Human biomarkers were used to evaluate the lead (Pb) and arsenic (As) exposure of local people who lived in an agricultural area with intense agrochemical usage and who consumed groundwater. Although the heavy metals/metalloids in the groundwater were at low concentrations, they could cause adverse effects due to a high daily water intake rate over the long term. Biomarkers (hair, fingernails and urine) were collected from 100 subjects along with the local shallow groundwater and tap water, which is the treated deep groundwater, and investigated for the concentrations of As and Pb. Shallow groundwater had an average pH of 5.21 ± 1.90, ranging from 3.77 to 8.34, with average concentrations of As and Pb of 1.311 µg/L and 6.882 µg/L, respectively. Tap water had an average pH of 5.24 ± 1.63, ranging from 3.86 to 8.89, with the average concentrations of As and Pb of 0.77 µg/L and 0.004 µg/L, respectively. The levels of both As and Pb in the hair, fingernails and urine of shallow groundwater-consuming residents were greater than those in the hair, fingernails and urine of tap water-consuming residents. Interestingly, the As level in urine showed a linear relationship with the As concentration in groundwater (R2 = 0.91). The average water consumption rate was approximately two-fold higher than the standard; thus, its consumption posed a health risk even at the low As and Pb levels in the groundwater. The hazard index (HI) ranged from 0.01 to 16.34 (average of 1.20 ± 2.50), which was higher than the acceptable level. Finally, the concomitant factors for As and Pb in the urine, hair and nails from both binary logistic regression and odds ratio (OR) analysis indicated that groundwater consumption was the major concomitant risk factor. This study suggested that direct consumption of this groundwater should be avoided and that the groundwater should be treated, especially before consumption. In conclusion, urine is suggested to be a biomarker of daily exposure to As and Pb, while for long-term exposure to these metals, fingernails are suggested as a better biomarker than hair.

Pharyngocutaneous Fistulas Following Total Laryngectomy

Total laryngectomy is still the final therapeutic solution in cases of locally advanced laryngeal cancer, as well as in cases of therapeutic failure of organ-sparing surgery or radiation therapy. Following excision of the larynx, the remaining pharynx is reconstructed to obtain continuity of the upper digestive tract. One of the most common complications in these patients, despite constant refinement of the procedure, is the development of a pharyngo-cutaneous fistula. These fistulas prolong hospital stay and often require a second surgical procedure, increasing morbidity and cost for the patient, while diminishing his quality of life. Some risk-factors have been identified, but only some may be corrected before surgery to lower this risk. Managing the fistula once present depends on multiple factors, essential being the size of the fistula as well as the position and concomitant factors, with options ranging from conservative measures to aggressive reconstructive surgery with local miocutaneous flaps. Modern vocal rehabilitation with T.E.P. (tracheo-esophageal puncture) and vocal prosthesis placement presents a new challenge – because of the risk of developing a tracheo-esophageal fistula, with an even higher risk for the patient because of tracheal aspiration. Understanding healing mechanisms of these structures is key to proper management of this complication.

Sexual Violence Against Children and Transitional Justice: Bearing Witness and Preserving Testimony About Injustice in Childhood

Efforts to come to terms with sexual violence against children and adolescents are predicated on a desire to achieve justice. Based on the work done by the Independent Inquiry into Child Sexual Abuse in Germany, this article attempts to identify the interfaces between the Inquiry’s undertakings and the field of transitional justice. Using an approach informed by the theory of childhood, it examines the issues that arise when survivors bear witness to past childhood events. This must adopt a perspective that is sensitive to childhood and adolescence as unique life phases. That, in turn, requires accounting for concomitant factors, such as the context presented by a child’s growth and development, the function of families, the role played by educational institutions, and the legal position accorded children by society. The article thus adopts a framework rooted in childhood theory that considers children both generally as human beings and specifically as children.