Deep Scars Research Articles

Ecthyma Gangrenosum in Children With Cancer: Diagnosis at a Glance: A Retrospective Study From the Infection Working Group of Italian Pediatric Hematology Oncology Association.

To depict ecthyma gangrenosum (EG) clinical presentation and evolution in a large multicenter pediatric retrospective collection of children with malignancies or bone marrow failure syndromes, to facilitate early diagnosis. EG episodes diagnosed in the period 2009-2019 were identified by a retrospective review of clinical charts at centers belonging to the Italian Pediatric Hematology Oncology Association. Thirty-eight cases of EG occurring in children (male/female 16/22; median age 5.2 years) with hematologic malignancy (29), allogeneic stem cell transplantation (2) or relapsed/refractory solid tumor (3) were collected. The involved sites were: perineal region (19), limbs (10), trunk (6), head and the iliac crest (3). Bacteremia was present in 22 patients. Overall, the germs isolated were Pseudomonas aeruginosa (30), Stenotrophomonas maltophilia (3) and Escherichia coli (1); 31% of them were multidrug-resistant. All patients received antibacterial treatment, while surgery was performed in 24 patients (63.1%). Predisposing underlying conditions for EG were severe neutropenia (97.3%), corticosteroid treatment (71%) and iatrogenic diabetes (23.7%). All patients recovered, but EG recurred in 5 patients. Nine patients (24%) showed sequelae (deep scars, with muscle atrophy in 2). Four patients (10.5%) died, 1 due to relapse of EG with Carbapenem-resistant Enterobacteriaceae co-infection and 3 due to the progression of the underlying disease. EG requires early recognition and a proper and timely treatment to obtain the recovery and to avoid larger necrotic lesions, eventually evolving in scarring sequelae.

Fully armed photodynamic therapy with spear and shear for topical deep hypertrophic scar treatment

5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) has emerged as a promising therapy for hypertrophic scar (HS). However, the poor permeability of ALA across biological barriers and pro-survival autophagy of fibroblasts largely restricted the efficacy of PDT. Herein, PDT was well equipped with spear and shear to overcome the therapeutic resistance. Specifically, hyaluronidase (HAase) based dissolving microneedles (MN)with improved stiffness and permeability were developed as a spear to deliver ALA into deep lesions by combating the dual barriers of stratum corneum and dense extracellular matrix (ECM). Besides, metformin (Met) MN was applied as a shear to intervene the respiration and autophagic process for amplified PDT. HAase significantly enhanced the in vitro and in vivo transdermal delivery efficiency of ALA, while the combination of HAase and Met successfully amplified the anti-scarring efficacy of PDT by elevating cytotoxicity, promoting permeation, activating signal pathways, and interdicting the autophagy process simultaneously. The pharmacodynamics study revealed that the combination therapy achieved the lowest scar elevation index (SEI), downregulated expression of collagen I and TGF-β1, and decreased LC3 II/I ratio, showing excellent therapeutic efficacy. Therefore, such a fully armed PDT integrating double-prolonged attack on the physiological and pathological barriers offers a promising topical treatment for deep HS.

Surgical Management of Fuchs Endothelial Corneal Dystrophy: A Treatment Algorithm and Individual Patient Meta-Analysis of Descemet Stripping Only.

This study aims to determine predictive factors for success of Descemet stripping only (DSO) in Fuchs corneal endothelial dystrophy and propose a DSO treatment algorithm. Ovid MEDLINE, Embase, and Cochrane CENTRAL databases were searched to evaluate DSO case series, including combined phacoemulsification and DSO, and the use of Rho-kinase inhibitors (ROC-i). Our primary outcome was success of corneal clearance. Secondary outcomes included the time to corneal clearance, the postoperative endothelial cell count (ECC), and the impact of ROC-i. Sixty-eight cases were evaluated with a mean follow-up of 12.4 months. DSO corneal clearance was achieved in 85% (n = 58) with a mean time of 4.9 weeks for the ROC-i group compared with 10.1 weeks in the observation group (P < 0.0001). The mean central ECC postoperatively was higher in the ROC-i group compared with the observation group 1151 ± 245 versus 765 ± 169 cells/mm2, respectively (P < 0.018). The postoperative best-corrected visual acuity (BCVA) improved in 61 eyes (90%), with mean final BCVA of 0.17 (0.26) logMAR (P = 0.001), which was statistically significant compared with preoperative BCVA. Factors influencing success were 4-mm descemetorhexis size, a clear peripheral ECC with no clinical sequelae of decompensation or guttae, and a low central corneal thickness. No intraoperative complications were noted. The commonest postoperative complication was deep corneal stromal scars noted at the descemetorhexis edge (n = 9). DSO has a role in the treatment of a subset of patients with Fuchs corneal endothelial dystrophy and that adjuvant treatment with ROC-i may lead to faster corneal clearance.

COVID-19 through a cultural lens

COVID-19 through a cultural lens

Genesis of the Second World War in Contemporary Polish Historical and Political Discourse

The Second World War has undoubtedly left a deep scar on the historical memory of the Polish people. The hardest ordeal for the Polish Republic was the military confrontation with Nazi Germany, which resulted in the loss of statehood and the horrors of the German occupation regime. As a result of World War II, Poland lost almost 40% of its national wealth and about 6 million of its people. The issue of political interpretations of historical events in contemporary Polish historical and political discourse is of particular importance. Reflected in educational literature, it is no less important than the positions set out in academic journals. Yesterday's schoolboy and student today is a minister's assistant and an officer, tomorrow a minister and a general. At the same time, there is no certainty that they will again turn to systemic education. One should also take into account the current status of the Polish Republic, its fundamental economic achievements and the apparent desire for an independent line in the European Union. All this makes the dialogue actual even in the current extremely difficult conditions.

The Otherness of Motherhood in the Selected Novels of Buchi Emecheta

This paper focuses on the role of women, especially the role of a mother during the pains of daughters. Deliberately or unknowingly mother often causes their female children deep scars in their lives and they remain perpetually. In consequence for that behavior, a girl child suffers at the hands of mother like figure, directly responsible for the upbringing, the protagonist metes out to her own girl child. The earlier African novels describe mother as Supreme Being and root of African culture, but in reality, the situations of women and mother like being are entirely different. The author brings out the hidden truth and exposes it to the world. The male authors focus on the positive aspects of motherhood and highlight the character of mother as a symbol of sacrifice and fertility. It is always shown as the mother character as an embodiment of all good qualities. However, Emecheta a careful observer of her culture and also a spectator of other cultures narrated the otherness of motherhood in her novels. In her earlier novels, she primarily focused on two aspects that is the otherness of motherhood and the oppressive elements of patriarchal society. This paper focuses on the otherness of motherhood in the novels of Buchi Emecheta. Keywords: Motherhood, Patriarchal Society, Feminism, Otherness.

Smart Monitoring Pad for Prediction of Pressure Ulcers with an Automatically Activated Integrated Electro-Therapy System

Pressure ulcers (PU) are deep scars on the skin that cause pain, infections and severe health complications. Most movement-impaired subjects are vulnerable to PU, leading to permanent and irreversible skin damage. The system proposed in this paper aims to prevent PU formation with the design and implementation of a wirelessly controlled device that predicts PUs before their occurrence and attempts to prevent it using therapeutic feedback. A flexible pad that consists of multiple types of sensors is used, theses sensors continuously and non-invasively monitor ulcer-related vital signs in vulnerable areas, and uses these data to predict PU with a decision-making process. When PU is detected an electrical stimulation (ES) unit is automatically activated. Stimulation prevents PU formation by increasing local blood flow to the simulated area and eliminating the main factor that leads to PU formation. The system successfully monitored and predicted PU; tests were performed on three healthy volunteers and one volunteer with sacral ulcers. Results including readings of blood oxygenation, force, humidity and temperature were recorded as graphs to monitor decay/increase in values more efficiently.

Nature, Politics, and the Traumas of Europe

AbstractNature has been the major source of demographic shocks until the nineteenth century, after which Politics has gradually become the main factor of catastrophic traumas. During the first part of the past century, war, violence, forced migration, man‐made famines, and the epidemics unchained by them were responsible for tens of millions of deaths. They left deep scars in the survivors, distorted the age structure, altered the equilibrium between the sexes and between generations, and affected in multiple ways the continental European demographic system, including the geographical distribution of the population. A quantitative assessment of the victims of these Politics‐driven traumas is here attempted, as is a first exploration of the political conviction that drove them: that populations and their number, structure, and geographical location, could be manipulated by the state. The collapse of multinational multiethnic, multicultural, and multilingual empires, however illiberal, led to the identification of the state with the nation, and of the nation with an ethnic group, and bred an intolerant hyperethnicism, culminating in ferocious episodes of ethnic cleansing and genocide whose consequences resonate to this day in Europe and beyond.

Digital social innovation: An overview and research framework

Digital social innovation: An overview and research framework

أثر السیاسات الدولیة على إدارة منظمة الصحة العالمیة لأزمة کورونا

الملخص جاءت جائحة فيروس کورونا COVID-19 کأشد أزمة صحية عالمية وأکبر تحد واجهه العالم منذ الحرب العالمية الثانية، فمنذ ظهور الفيروس في مدينة وهان الصينية في أواخر عام 2019، انتشر في جميع أنحاء العالم حتى تجاوزت الإصابات أکثر من مائة مليون مواطن حول العالم، فالوباء هو أکثر بکثير من مجرد أزمة صحية حيث يعتبر أزمة اجتماعية اقتصادية غير مسبوقة حيث خلف ورائه آثار اجتماعية واقتصادية وسياسية مدمرة تترک ندوبا عميقة وطويلة الأمد داخل العديد من الدول، ومن هنا جاء دور منظمة الصحة العالمية لتعمل من أجل وقف انتقال الفيروس ومنع انتشاره لإنقاذ الأرواح حيث أصدرت خطة التأهب والاستجابة الاستراتيجية التي تحدد الإجراءات الرئيسية التي يتعين على الدول اتخاذها والموارد اللازمة لتنفيذها، فمن بين المنظمات والمؤسسات الدولية تأتي منظمة الصحة العالمية شبکة عالمية تتمتع بخبرة کبيرة تجمع بين المهنيين والعلماء في مجال الصحة، بما في ذلک علماء الأوبئة والأطباء وعلماء الفيروسات، لضمان أن تکون الاستجابة شاملة وموثوقة قدر الإمکان. Abstract The COVID-19 pandemic came as the most severe global health crisis and the biggest challenge the world faced since World War II, since the emergence of the virus in the Chinese city of Wuhan in late 2019, it has spread all over the world until more than a hundred million citizens have been infected around the world. Much more than a health crisis, as it is considered an unprecedented socio-economic crisis, as it left behind devastating social, economic, and political effects that leave deep and long-term scars in many countries, hence the role of the World Health Organization to work to stop the transmission of the virus and prevent its spread to save lives. A strategic preparedness and response plan that defines the main actions that countries must take, and the resources needed to implement them. Among the international organizations and institutions, the World Health Organization comes a global network with great experience that brings together health professionals and scientists, including epidemiologists, doctors, and virologists, to ensure that the response is as comprehensive and reliable as possible.

PARALEGALS AND HUMANITARIAN RESPONSIBILITIES IN ADVOCATING SURVIVORS OF THE MOST SERIOUS CRIMES: LEARNING FROM WOMEN VOLUNTEERS FOR HUMANITY IN NORTH ACEH DISTRICT

The most serious crimes that occurred in North Aceh left a deep scar for the victims. The birth of impunity causes victims to be naturally forced to survive. However, various fundamental rights that are difficult to access are a significant problem for survivors due to post-conflict trauma, making it difficult for survivors to open up to the local government. Therefore, the Women Volunteer Advocacy Institute for Humanity (RPuK) is here to bridge the fundamental rights needs of survivors with advocacy to local governments. This study aimed to determine the existence of RPuK in accommodating the fundamental rights of survivors. The method used is empirical legal research with interview and observation techniques. The study results reveal that the existence of RPuK for ten years in North Aceh Regency has built a unique advocacy program with the Regional Government in terms of fulfilling integrated service programs and unique service bazaars for survivors of the most serious crimes. Both programs focus on making identity cards, health insurance cards, marriage certificates, service mental health, employment assistance, and other fundamental rights. This success is a form of reparations as part of the fulfillment of transitional justice to the survivors. Interestingly, RPuK made a breakthrough in its food security advocacy program for the survivors during the pandemic. Thus, RPuK sees a new perspective that is far more important, prioritizing the survivors during the pandemic, fulfilling the survivors' economic, social, and cultural rights to fulfill human rights and transitional justice.

Iceland: 2021 Article IV Consultation-Press Release; Staff Report; Staff Statement; and Statement by the Executive Director for Iceland

The Icelandic economy has been severely affected by the pandemic. Sharp tourism contraction and containment measures caused real GDP to plummet by 6.6 percent in 2020. A modest recovery will take hold in 2021. Recovery prospects in the tourism sector depend on control of the epidemic and progress in global and domestic vaccine distribution, spelling a challenging outlook with possibly deep medium-term scarring. Fiscal policy should continue to support the economy for now. Policy buffers accumulated over the last decade provided space for a large fiscal support and accommodated substantial automatic stabilizers. Additional stimulus is planned in 2021 to address still large slack in the economy, mitigate scarring, and provide confidence in the event of downside risks. Medium-term policies should ensure that public debt is firmly on a downward path, while limiting the drag on growth.

Freedom camping in Aotearoa New Zealand: an exploration of stakeholder perceptions

The global COVID-19 health pandemic has shaken the most stable political systems, and left deep economic scars across industries. With global and national travel at a standstill, the tourism industry is among the most heavily hit. The gradual lifting of restrictions has already fuelled tourism demand, and previous hopes of rebuilding and transforming tourism more sustainably are vanishing. To ensure that pre-COVID-19 situations of unsustainable development do not resurface, it is of critical importance to go beyond economically driven crisis recovery. Instead, governments need to reconsider pre-crisis challenges, such as imbalances between tourists and residents, infrastructure shortages, and questions around the efficiency of regulations and policies. In New Zealand, issues related to freedom camping have fuelled these debates, with headlines relating to tourists defecating in public space, dropping garbage, and being ‘freeloaders’ with little economic value. Adopting a multiple stakeholder approach, this research note empirically explores stakeholder perceptions of challenges associated with freedom camping in the context of New Zealand. Semi-structured interviews were conducted with 20 stakeholders representing host communities, local councils, national agencies, tourism businesses, and regional tourism organisations. Qualitative data analysis reveals positive changes and reduced impacts as results of additional infrastructure funding, educational measures, and locally enforced bylaws. However, participants also noted the need for a national framework, and clear statements and messages regarding domestic demand. Considering that nature-based experiences that allow for social distancing, such as (freedom) camping, have grown significantly during the pandemic and that domestic tourists will be crucial to post-COVID tourism recovery, this original multiple stakeholder approach delivers policy-relevant insights and provides avenues for future research with regard to a responsible and sustainable tourism restart.

The political vow of Jephthah in Judges 11:30-31

This study responds to Jephthah’s ambiguous vow that led to a heart-wrenching and outrageous tragedy. There are conflicting ideologies held by Jephthah and the Deutronomist tradition in laying the biblical theology foundations. The church is challenged to be vigilant in vowing. To achieve this goal, the text of Judges 11:30–31 is explored by using an ideological critique approach. The focus of this study is to underline the concept of Jephthah’s ideology of victory on the fighting against the enemy of Israel as a political way to prove one’s identity and get out of social discrimination at the expense of everything including his own family. Jephthah’s act was not aligned with what the Deuteronomists promoted. Attempts to incorporate any sacrificial foreign cult (including anyone) resulted in deep scars on the faith history of the Israelites. In addition, it shows that Jephthah’s leadership, which is contrary to God’s ideals, is unable to maintain its existence in international relations when it is able to maintain its religious exclusivity. This study contributes to the interpretation of biblical texts by exposing the ideological aspects of the reader to take the right stance to be aware of the tendency to cause gender violence with a vow.Intradisciplinary and/or interdisciplinary implications: This is a multidisciplinary study because it integrates biblical hermeneutics with the context of the political constellation of Christian leaders. Apart from that, it serves as a reference for reflection and dialogue that corrects, criticises or legitimises the situation in the context of ideology, history, poverty, social conflicts, political problems and gender justice for readers.

Pandemics (coronavirus disease-2019), experiences, lessons learn, and the future

The coronavirus disease 2019 (COVID-19) pandemic is the defining global health crisis of our time andthe greatest challenge we have faced since World War Two. Since its emergence in Asia in 2019, thevirus has spread everywhere except Antarctica. We have now reached the tragic milestone of more than2 million deaths, and the human family is suffering under an almost intolerable burden of loss. However,the pandemic is much more than a health crisis, it’s also an unprecedented socioeconomic crisis. Stressingevery one in the countries, it has the potential to create devastating social, economic, and political effectsthat will leave deep and long-standing scars. Every day, people are losing jobs and income, with noway of knowing when normality will return. Small island nations, heavily dependent on tourism, haveempty hotels and deserted beaches. We have been supporting countries since the very early stages ofthis crisis, donating essential protective medical equipment. As the response evolves, and after assessingthe immediate, medium- and long-term needs, we are moving into the socioeconomic response. It willrequire all of society to limit the spread of COVID-19 and to cushion the potentially devastating impactit may have vulnerable economies. We must rebuild trust and cooperation, within and among nations, andbetween people and their governments.

Media propaganda vs public dialogue: the spatial memorialisation of conflict in Belgrade after the 1999 NATO bombing

Two events marked the turn of the millennium in what remained of former Socialist Yugoslavia: the NATO bombing of Serbia, and to a smaller extent Montenegro, in 1999, and the fall of Slobodan Milošević’s regime in 2000. This was the infamous epilogue of the turbulent 1990s, a decade of successive violent conflicts that tore the federal state apart, destroyed its heterogeneous culture, divided its territory along ethnic borders, and definitively rejected socialism to embrace an unhinged variant of neoliberal capitalism. Serbia played a complex role in those events, both as an aggressor accused and convicted for war crimes, and as the target of an asymmetric conflict with NATO that led to the separation of its southern province of Kosovo and left deep scars in its urban environment. The effort to reconstruct these damaged buildings, therefore, poses deeper questions about understanding the past, facing unpleasant truths, and setting the course for an uncertain future. This article will illuminate those multifarious processes by examining the role of media propaganda and public dialogue in the reconstruction of two structures in Belgrade that were damaged during the 1999 NATO bombing. Both buildings, the Avala Tower and the television headquarters on Aberdareva Street, were in use by the Radio Television of Serbia (RTS). In a fragmented society that is still struggling to make sense of these difficult issues, I argue that state-controlled media has a decisive influence on steering public debate, creating the false image of social consensus, and weighing in on architectural design, while downplaying the role of architects.

Patients with major medical illness seek cosmetic procedures to preserve a healthy appearance and avoid looking ill

Patients with major medical illness seek cosmetic procedures to preserve a healthy appearance and avoid looking ill

There and Back Again: A Commentary on Social Welfare Policy in the Wake of 2020

There and Back Again: A Commentary on Social Welfare Policy in the Wake of 2020

We Who Work the West: Class, Labor, and Space in Western American Literature by Kiara Kharpertian

Reviewed by: We Who Work the West: Class, Labor, and Space in Western American Literature by Kiara Kharpertian Daniel Clausen Kharpertian, Kiara. We Who Work the West: Class, Labor, and Space in Western American Literature. Lincoln: U of Nebraska P, 2020. 288 pp. Hardcover, $60; e-book, $60. Grounded in a winning insistence that "belonging can become a force available to all of us and that literature provides a laboratory in which to test its properties and potentialities," Kharpertian's book grapples with the complex interrelations of labor, class, and space while providing a tour of some of western literature's more down-and-out corners (xxii). In doing so, Kharpertian analyzes the West's "deep scars of repeated and lasting displacements, deterritorializations, and dispossessions," from California to Texas (xxii). She argues that class-steeped stories of a purportedly authentic West reflect the contradictions—not just regional but national—that emerge as space and identity are differentially shaped by labor. In readings of well over a dozen novels, Kharpertian offers case studies that trace dramatically shifting literary representations of these components of identity and politics over the last century and more. Beginning with the deterministic naturalism of Frank Norris's McTeague, Kharpertian shows how labor—when it becomes a defining feature of identity and space—cuts both ways. It provides McTeague with a living and a sense of self but ties him inextricably to a violent state of nature that Norris imagines as inherent in his working-class identity. Such class identity in turn defines spaces abandoned to transgressive violence: rough parts of town and isolated deserts. Maria Ruiz de Burton's The Squatter and the Don (1885), meanwhile, highlights the noncontiguous overlap of nationality, ethnicity, class, and space through the post-annexation category affiliations wrapped up in the label "Californio," which Kharpertian reads as an emergent Chicano civic ethos. The labor migrations and erosions of the dustbowl are examined (in contrast to Steinbeck's triumphal Grapes of Wrath) through a quintet of novels by Sanora Babb, Frank Waters, and John Fante, which highlight the reality and prevalence of failure and collapse. Kharpertian observes in each of these Depression novels a particularly western evaporation of "rootedness" that [End Page 193] haunts the stories and space. Of course, no study of work in the West would be complete without considering the cowboy, and in one of the book's strongest chapters Kharpertian draws her exemplars from the novels of Larry McMurtry, Elmer Kelton, and Cormac McCarthy. Focusing on post-WWII-era Texas, she reads these fictional cowboys as economic refugees whose work-based worlds crumble around them—yet they remain mythic figures of authenticity through the performative labor of rodeos. As her reading draws out the contradictions within this myth of labor in the context of ascendant capitalism, she also offers a model to our era of enduring peons, the purportedly authentic (masculine) labor of coalminers, roughnecks, and farmers. Read in conjunction with her commentary on cowboys, Kharpertian's analysis of the narratively obscured labor in Native American novels is also insightful. Building on the work of Chadwick Allen, Gerald Vizenor, and Philip Deloria, she argues that the particular varieties of alienated labor and space in the fiction of Linda Hogan, Sherman Alexie, and Stephen Graham Jones expose the pernicious binary of modernization and tradition so ingrained in representations of western Indian Country. The final chapter takes up Philip Meyer's 2013 novel The Son to demonstrate that in a culture that disdains labor and tries to ignore space, belonging may never be more than provisional and contingent. Readers of Western American Literature may already know another tragic fact about this book: Kiara Kharpertian died in 2016 after years of struggle with breast cancer. Most book reviews do not acknowledge the fact that books will outlive their authors, though in some vague sense we all know this to be true. In so doing, Kharpertian's book not only contributes importantly to scholarship but acts as a monument to "her impassioned mind, her heroic work ethic, and her determined courage" (ix). It will be of interest not only to those studying labor or western American literature, but to Kiara's friends and...

COVID-19 Outbreak, Impact on Sri Lankan Economy

We all have been affected by the current COVID-19 pandemic. COVID-19 is the ongoing menace to the all over the World, labeled as pandemic and worst economic shock in recent history. The Corona virus pandemic is the defining global health crisis of our time. The pandemic is moving like a wave. But COVID-19 is much more than a health crisis, by stressing every one of countries it touches, it has the potential to create devastating social, economic and political crisis that will leave deep scars. COVID-19 initial impact on Chinas economy and Chinas consequent slowdown may have adverse economic impact on the rest of the world as well. Sri Lankan economy mainly depends on the foreign trade. China is the one of the major country linked with Sri Lankan tourism, investment and many agreements. It is the second largest source market for Sri Lanka in terms of tourism and imports and the main supplier of raw materials for textiles also. Therefore COVID-19 in China has been caused a significant impact on Sri Lankan economy. This article examines the impact of COVID-19 on the Sri Lankan economy, tourism, Apparel and Textiles, Poverty and Financial Market.Apparels, Sri Lanka major merchandise export, faced disruptions with earnings from textiles and garments falling by 27.6% in 2020. The tourism industry has collapsed, business are finding it more difficult to operate due to the impacts of the curfew. Demand for the tourism is dropped now. There is a real risk that COVID-19 will set back the Sri Lankan economy and cause higher unemployment, poverty and deprivation. There is considerable amount of Sri Lankan employers have been terminated in Middle East countries. The events and activities related to production and employment of most of small and medium enterprises are significantly hit by the COVID-19 pandemic. The outbreak of COVID-19 and the impact on the wider economy has placed unprecedented pressure on Sri Lanka business. Therefore, proactive policy measures should be undertaken to mitigate the economic slowdown in Sri Lanka.