Chance Of Healing Research Articles

A Network Meta-Analysis of Randomized Controlled Trials on the Comparative Efficacy of Stem Cells Therapy for Diabetic Foot Ulcer Healing

Stem cell therapy in diabetic foot ulcer has emerged as a promising treatment option to promote ulcer healing. This network meta-analysis was undertaken to evaluate how they compete with each other and their ranking with respect to chances of ulcer healing. A systematic search strategy to retrieve data from five databases, were used to identify potential studies. Randomized controlled trial or clinical controlled trial, published in English, using any type of stem cells as intervention in individuals aged over 18 years diagnosed with diabetic foot ulcers were included. This network meta-analysis was performed using frequentist method using R version 4.2.1. Eighteen clinical trials were included in the study which included 13 interventions. The study found that most of the stem cells were significantly promoting ulcer healing chances with human viable wound matrix (hVWM) [RR 2.91; CI: 1.28, 6.64], peripheral blood mononuclear cells (PBMNC) [RR 2.35; CI: 1.21, 4.55], bone marrow mesenchymal stem cells (BMMSCs) [RR 2.20; CI: 1.34, 3.60], were top three stem cell options among all. P score also suggested the same. Risk of bias study suggested that there was “some concern or “high risk’’ among majority of studies. It is evident from this study that bone marrow mononuclear cells were found to be most effective in wound healing in cases of diabetic foot ulcer in that order. Though there was no significant difference between these and more studies were required to ascertain whether they differ in term of efficacy for the clinical outcome of ulcer healing.

Colorectal cancer screening in Tuzla canton: Project and strategy for patients with average cancer risk

Background: Screening for colorectal cancer (CRC) can identify premalignant lesions and detect asymptomatic malignant tumors at an early stage that have a better chance of healing, but also longer-term better treatment outcomes. Screening has been shown to reduce mortality from CRC. The aim of this paper is comprehensive education of health care professionals in the Tuzla Canton about this disease, adoption of new guidelines and simpler route from diagnosis to surgical treatment,which ultimately leads to reduced mortality and better outcomes in treatment. Material and methods:The project included family medicine specialists, surgeons and gastroenterologists, 100 of them. The education project was led by two surgeons, who implemented the guidelines ofthe American College of Gastroenterology (ACG) 2021, when it comes to screening CRC. Results: None of the participants offered all correct answers in tests, prior to the training, in both groups of doctors. For a post-educational test, data suggest that there has been a noticeable improvement in the results. In a group of doctors with over 10 years of service, 71 (98.61%) answered correctly all the questions offered and only 1 (1.39%) between 5 and 9 correct answers. For a group of doctors with less than 10 years of service, 26 (92.86%) provided all correct answers and only 2 (7, 14%) between 5 and 9 correct answers.Conclusion: This project pointed to the necessary education of healthcare professionals in this area, who are involved in early detection programmes for CRC, especially family medicine specialists, surgeons and gastroenterologists.

Influences on the Decision to Euthanize a Compromised Pig.

The decision to euthanize a compromised pig can be challenging for pig farmers and veterinarians. To understand more about the challenges in Germany, a cross-sectional online survey was conducted. Based on a hybrid design, the responses of 39 veterinarians and 62 pig farmers were analyzed to generate a list of common clinical signs associated with the euthanasia of sows, fatteners, and piglets. Moreover, a set of influences on the farm, due to economic and personal considerations, were found to shape the decision-making process. The two most salient reasons outlined for the delay of timely euthanasia were uncertainty and misinterpretation of the chance for healing. The lack of valid clinical signs or a sound justification was most frequently mentioned as a challenge to the general decision-making process. In summation, this study highlights the need to generate a valid taxonomy for clinical signs that includes their development in a compromised pig over time. Future studies should elaborate on the justification of euthanasia decisions to facilitate the resolution of ethical dilemmas among the involved pig farmers and veterinarians. Lastly, the results suggest that clinical reasoning and consultation skills should be included when decision-making behavior is to be trained.

Hydrocele

The hydrocele is overall arare condition in urology. A differentiation between primary and secondary hydrocele is essential for further treatment. A primary hydrocele with apatent vaginal process tends to spontaneously regress in the first 2 years of life in newborns. If treatment is necessary, open as well as laparoscopic methods are available with good results. The treatment of scrotal pathologies, especially secondary hydrocele, often poses achallenge in the clinical practice. Despite the benign nature, supposedly simple surgical techniques and good chances of healing, postoperative complications are frequent. In comparison to open surgery, sclerotherapy provides agood alternative for the treatment of secondary hydrocele.

Effect of Platelet-Rich Plasma Dosing for Healing after Arthroscopic Cuff Repair Compared with Surgery Alone: A Systematic Review and Meta-Analysis.

Platelet-rich plasma (PRP) has been used for arthroscopic rotator cuff repairs (aRCR), but no studies have addressed the impact of platelet concentration. The primary aim was to evaluate whether the PRP cell concentration has an effect on tendon healing after aRCR compared with surgery alone. The secondary aim was to assess the functional and pain outcomes. A systematic review was performed with searches in the MEDLINE (PubMed), Scopus, Web of Science, and Cochrane (Central) databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Metanalytic procedures were performed for randomized controlled trials (RCTs), and a subgroup analysis was used for studies with target (approximately 10 6 cells·μL -1 ) or below-target PRP cellular concentrations (app. 5 × 10 5 cells·μL -1 ) regarding the primary outcome of tendon healing. This review included 10 studies (8 RCTs) with 342 patients in the aRCR + PRP group and 344 patients with isolated aRCR. The risk of bias was low to intermediate (6/4, respectively). Meta-analysis of the RCT revealed that the aRCR + high-concentration PRP group had an approximately 3.9-fold higher chance of healing than the non-PRP group (odds ratio, 3.89; 95% confidence interval, 1.78-8.44; P = 0.0007). No significant difference in healing was found between the aRCR + low-concentration PRP and non-PRP groups (odds ratio, 2.21; 95% confidence interval, 0.66-7.45; P = 0.2). The Constant-Murley score and University of California Los Angeles scores were significantly improved in the aRCR + PRP groups with more than 12 months of follow-up, and no significant differences were found consistently for the American Shoulder and Elbow Society and visual analog scale scores. This study highlights that a PRP cell concentration close to the target (10 6 cells·μL -1 ) of patients with aRCR may improve their healing and functional outcomes and that dosing may be potentially useful in therapy.

Effect of a multidisciplinary team approach in patients with diabetic foot ulcers on major adverse limb events (MALEs): systematic review and meta-analysis for the development of the Italian guidelines for the treatment of diabetic foot syndrome.

The treatment of patients with diabetic foot ulcers (DFUs) is extremely complex, requiring a comprehensive approach that involves a variety of different healthcare professionals. Several studies have shown that a multidisciplinary team (MDT) approach is useful to achieve good clinical outcomes, reducing major and minor amputation and increasing the chance of healing. Despite this, the multidisciplinary approach is not always a recognized treatment strategy. The aim of this meta-analysis was to assess the effects of an MDT approach on major adverse limb events, healing, time-to-heal, all-cause mortality, and other clinical outcomes in patients with active DFUs. The present meta-analysis was performed for the purpose of developing Italian guidelines for the treatment of diabetic foot with the support of the Italian Society of Diabetology (Società Italiana di Diabetologia, SID) and the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD). The study was performed using the Grading of Recommendations Assessment, Development, and Evaluation approach. All randomized clinical trials and observational studies, with a duration of at least 26weeks, which compared the MDT approach with any other organizational strategy in the management of patients with DFUs were considered. Animal studies were excluded. A search of Medline and Embase databases was performed up until the May 1st, 2023. Patients managed by an MDT were reported to have better outcomes in terms of healing, minor and major amputation, and survival in comparison with those managed using other approaches. No data were found on quality of life, returning-to-walking, and emergency admission. Authors concluded that the MDT may be effective in improving outcomes in patients with DFUs.

The Incidence of Devitalization of Vital Teeth Associated with Pathologies of the Jaws Following Surgical Intervention: A Mixed-case Study.

The purpose of this mixed-case study is to explore the incidence of pulp necrosis of vital teeth after surgical treatment of adjacent lesions of the jaws. The records of 341 biopsies submitted to the institute's histopathology laboratory were reviewed to include cases that met the inclusion criteria. About 84 biopsies collected from patients during surgical enucleation of lesions in proximity to healthy vital teeth were included of which 22 patients were recalled. Adjacent teeth were examined clinically and radiographically to assess their pulpal and periapical status after at least 8 months of follow-up. There were 7 different pathological lesions diagnosed histologically. The follow-up period ranged between 8 and 72 months; 12 cases (54.6%) have developed pulpal necrosis for at least one tooth after surgical enucleation of the lesion. The other 10 cases (45.4%) showed normal responses to sensibility testing for all the teeth adjacent to the lesion. Ten out of the 12 cases (83%) that underwent pulpal necrosis were associated with odontogenic cysts, whereas the remaining 2 were associated with periapical granuloma and fibrous dysplasia. Pulp necrosis is high in vital teeth associated with lesions without pulpal involvement. These teeth may benefit from root canal treatment prior to surgical enucleation of the lesion, which may prevent impaired healing or recurrence of infection. Careful treatment planning and thorough discussion should take place between the surgeons, endodontists, and patients prior to executing the treatment. The patient should be aware that there is a possibility that they may need root canal treatment as a preventative measure to enhance the chances of healing following the surgical procedures and in case the patients opted not to perform root canal treatment beforehand, close follow-up in the future should take place to monitor the vitality of the teeth in the follow-up visits.

In blood we trust: anemia as a negative healing prognostic factor in diabetic foot patients.

Anemia has been associated with severity of diabetic foot (DF) disease. Our study aimed to evaluate whether the presence of anemia could decrease the healing chances in DF. We retrospectively analyzed all patients admitted in our department in 2021 for DF, dividing them according to presence (Group A) or absence (Group B) of anemia. Groups were compared for clinical and demographic characteristics, procedures and outcomes: healing rate (HR) at 6 months, healing time (HT) and recurrence rate (RR) at 12 months. We sorted out data from 196 consecutive patients: 114 (58%) in Group A and 82 (42%) in B. Group A had a higher male prevalence and a longer duration of disease. Group A showed lower hemoglobin concentration (10.3 ± 1.3g/dL vs 13.1 ± 1.4g/dL, p < 0.002) and red blood cells count (3.4 ± 0.5 × 106/mL vs 4.8 ± 0.6 × 106/mL, p = 0.004). Group A presented a lower HR (55.2% vs 76.8%, p = 0.0028), no differences in HT and a higher RR (23.6% vs 17.1%, p < 0.02). Cox's logistic regression on healing confirmed the negative impact of anemia: hazard ratio 2.8 (CI 95% 1.4-5.4, p = 0.0037). Anemia is frequent in DF and associates to a reduction in healing chances and an increase in recurrences representing an independent predictor of healing failure.

509-P: There Is No Blood for Improvement—Anemia Cuts Down Healing Chances in Diabetic Foot Patients

Aim: Anemia is considered a marker of severity of diabetes and diabetic foot syndrome (DFS) but is still controversial if it can be taken as a predictor of negative outcomes in these patients. Our study aimed to evaluate if anemia could be associated with a reduction of healing chances in patients admitted for DFS. Methods: We retrospectively analysed all patients admitted in our Department in 2021 for DFS, dividing them in two groups according to presence (Group A) or absence (Group B) of anemia, diagnosed on levels of total Hemoglobin (HB) and red blood cells (RBC) below normal values (HB 13 g/dl for men and 12 g/dl for women and RBC 4.5×106/mm3 for men and 4.2×106/mm3 for women). We compared the groups for clinical and demographic characteristics, blood chemistry, procedures and clinical outcomes: healing rate (HR) and recurrences rate (RR). Among anemic patients we compared clinical outcomes according to the reduction of HB or RBC alone or both. Results: We derived data from 196 patients: 114 patients in Group A [58.1%; age 70.9±10.6 yrs; male/female 75.4/24.6%; DM1/DM2 7.0/93.0%; Hba1c 57.5±18.6 mmol/mol; diabetes duration (DD) 20.1±11.9 yrs] and 82 in Group B (41.8%; age 68.4±10.9 yrs; male/female 61.0/39.0%; DM1/DM2 9.8/90.2%; Hba1c 60.6±16.2 mmol/mol; DD 16.8±11.9 yrs). Group A presented higher (p&amp;lt;0.05) male prevalence and shorter disease duration but no differences in comorbidities, and surgical or vascular procedures. Group A showed a lower HR (55.2% vs 76.8%, p=0.0028) and a higher RR (23.6% vs 17.1%, p&amp;lt;0.002). No difference in terms of HR, HT or R according to the different diagnostic criteria for anemia. In Cox’s logistic regression analysis only anemia negatively affected healing (HR 2.8, CI 95% 1.4-5.4, p=0.0037). Conclusions: Anemia is associated to a reduction in healing chances in DFS patients and represents an independent predictor of healing failure. Disclosure F.Giangreco: None. E.Iacopi: None. V.Malquori: None. L.Pieruzzi: None. C.Goretti: None. A.Piaggesi: None.

Medical Astrology in Hippocrates and Galen's Medical Works

In the pre-modern period, astrology has been the practice of relating celestial bodies to lives and events on earth and the resulting tradition. One aspect of astrology was based on the knowledge of astronomy and mathematical calculations, and the other aspect dealt with soothsaying. We can talk about two types of astrology: natural astrology and judicial astrology. Natural astrology has admitted the idea of celestial influences of a general nature, such as would affect the weather or the environment of a patient, and thus his chances of healing. Judicial astrology aims to determine the particular effects of the stellar influences on a specific person, with a view toward forecasting the future.&#x0D; But it is noteworthy that many sciences in the pre-modern period used astronomical results. Thus, understanding the knowledge related to climate, agriculture and medicine in the pre-modern era is not complete without understanding astrology. In this article, in the first part, we try to briefly describe astrology and its types and enumerate some features of medical astrology as part of natural astrology. In the second part, we will examine how astrology influenced the medical theories of Hippocrates and Galen in ancient Greece. And we show that medical astrology for them has been part of the natural process of explaining diseases and methods of prognosis and treatment and prevention.&#x0D; Our method in this article is the hermeneutic-based author understanding method. In other words, in this article, we do not use modern ideas about astrology, but try to examine medical astrology based on the natural and judicial astrology, which were expressed in the same pre-modern era. Thus, we show that astrology was not only an important science in its time, but was also related to the various sciences of its time, so that the understanding of knowledge related to medicine in the pre-modern would be incomplete without understanding astronomy.

Artificial Intelligence for Cancer Detection-A Bibliometric Analysis and Avenues for Future Research.

After cardiovascular diseases, cancer is responsible for the most deaths worldwide. Detecting a cancer disease early improves the chances for healing significantly. One group of technologies that is increasingly applied for detecting cancer is artificial intelligence. Artificial intelligence has great potential to support clinicians and medical practitioners as it allows for the early detection of carcinomas. During recent years, research on artificial intelligence for cancer detection grew a lot. Within this article, we conducted a bibliometric study of the existing research dealing with the application of artificial intelligence in cancer detection. We analyzed 6450 articles on that topic that were published between 1986 and 2022. By doing so, we were able to give an overview of this research field, including its key topics, relevant outlets, institutions, and articles. Based on our findings, we developed a future research agenda that can help to advance research on artificial intelligence for cancer detection. In summary, our study is intended to serve as a platform and foundation for researchers that are interested in the potential of artificial intelligence for detecting cancer.

Prevalence, Management and Outcomes of Enterocutaneous Fistulas in Buea Regional Hospital and Laquintinie Hospital of Douala. A Five Years Retrospective Study

Background: An Enterocutaneous fistula (ECF) is an abnormal connection between the intestinal tracts or stomach and the skin. They are a major catastrophe to the patient and surgeons and still have a high incidence of morbidity and mortality which varies between 6% - 33%; their management remains a big challenge. These patients frequently face complications, and a well-organized multidisciplinary approach must be implemented in their management to improve outcomes. Objectives: Our study aims to assess the prevalence, management and outcomes of enterocutaneous fistulas in Buea regional hospital and Laquintinie hospital of Douala over the past 5 years. Methods: This was a hospital-based retrospective study in Buea regional hospital and Laquintinie hospital of Douala. Records of patients who had enterocutaneous fistulas within the period of 1st January 2017 to 31st December 2020 in the surgical departments. Data included demographics, pre-operative diagnosis, comorbidities, type of fistula, management modality and means, the indication of operative treatment, length of stay in the hospital and outcomes. Data was analysed using SPSSv26. Results: The study constituted 1343 medical records of which 83 medical records of patients with enterocutaneous fistulas, giving a prevalence of 6.2%, female predominance at 59% (n = 49), 42.2% (n = 35) were referred cases from the periphery for better management. A vast majority (96.4%) occurred as post-operative complications with appendectomy the most common indication (18.8%). High output fistulas were predominant (43.4%). 59% (n = 47) were managed medically, 6% (n = 5) received both conservative and surgical modalities while 35% (n = 5) were managed surgically. 64.1% (n = 50) were placed on enteral nutrition while 35.9% (n = 28) were placed on parenteral nutrition. Peritonitis/infection 50% (n = 18) was the commonest indication of surgical treatment, followed by failure of medical treatment 25% (n = 9) then high output fistulas 16.7% (n = 6). Resection with end-to-end anastomosis was the preferred repaired work at 61% (n = 22). The mortality rate was 38.5% (n = 32), 29% (n = 24) healed after conservative treatment, 21.7% (n = 18) healed after surgery, 7.2% (n = 6) persisted after surgery while 3.6% (n = 3) persisted after conservative treatment. Anaemia, sepsis, electrolyte imbalance, dehydration and malnutrition were the commonest complications. Conclusion: The prevalence of enterocutaneous fistulas was high, with a female predominance and a mean age of 38 years. Most cases were seen as a referral from the periphery for better management. The greatest majority of fistulas occurred as a postoperative complications. Conservative management with enteral feedings was preferred, they had better outcomes and gave more chances of healing. The commonest indication of surgical treatment was an infection. Resection with end-to-end anastomosis was the preferred repaired work. The mortality rate was high, and anaemia, sepsis and electrolyte imbalance were the commonest complications.

Exploring the living experience of shame; protector or persecutor?

PurposeThe purpose of this opinion piece is to give voice to the living experience of shame within myself as the author, both psychologically and physically. This is in the hope to increase awareness among others who experience shame and mental health professionals tasked with supporting people in emotional distress.Design/methodology/approachThe author has written a biographical piece outlining her experiences of living with shame and used rich, provocative and metaphorical language in describing the events which led to this and the impact this has had on my quality of life. The author has positioned shame as a character playing a role in her life.FindingsThis piece reveals the inner turmoil experienced when living alongside shame and the resilience and fortitude needed to understand the role of shame and how it developed. With this knowledge and awareness, the author has found it is possible to move forward in life.Research limitations/implicationsThe author has lived through adverse and challenging early life experiences within a difficult family environment. The author has shown that it is possible to undertake a healing journey and to come to an acceptance of shame within my own life and still move forward to create supportive relationships with others and a life worth living. These are often the stories of those people who survive great difficulty and still go on to help and support other people.Practical implicationsThe author has found and experienced that loving and supportive relationships give the best chance of healing from early life adversities. The author has also found that shame plays an interesting role as both necessary and painful. Moving forward from the distress often associated with shame is a long journey but one that is possible.Social implicationsThe author has aimed to make clear that exploration and education about the lived experience of shame is both helpful for those who suffer and those who intend to help within the mental health professions. Listening to the stories of people with living experiences is vital and plays as important a role as academic theory and learning.Originality/valueThis is a subjective living experience of shame and, in that way, adds to the helpful canon of stories that can inform our understanding of distress and the ability to help. The author has described shame as a character playing a role in her life and belief that this is an interesting way to view this. This piece also contains stories regarding the genesis of shame which are unique to her. The author understands and makes clear that his experience does not necessarily translate or relate to anyone else but stands on its own merit. The author hopes to have much more to contribute in terms of others’ understanding of emotional distress and shame, especially considering its transdiagnostic nature.

The role of peripheral arterial occlusive disease in the healing of venous ulcers

Background: The biggest challenge in patients with chronic venous insufficiency is venous ulcers that occur in stage 6 of the CEAP classification. In general, acute ulcers have a 71–80% chance of healing, while chronic ulcers only have a 22% chance of healing. Our clinical practice has shown that patients diagnosed with peripheral arterial occlusive disease have a much longer duration of the disease and a more difficult treatment of venous ulcers than patients with normal arterial circulation. Materials and Methods: The study included 105 patients with CVI and a developed leg ulcer. Among these, twenty patients were diagnosed with peripheral arterial occlusive disease. All patients were followed for more than twelve weeks. Results: Peripheral arterial occlusive disease was significantly more common in patients with delayed healing than in patients with normal venous ulcer healing: 18 (30%) vs. 2 (4.4%). for twelve weeks or longer, and it was statistically significant for p = 0.00097. Conclusion: Peripheral arterial occlusive disease has been shown to be an important indicator of venous epithelial wound healing. The establishment of good arterial circulation is closely related to the course of treatment of chronic venous ulcers.

Present status and future directions of intracanal medicaments

Two fundamental goals of endodontic treatment are to prevent or treat apical periodontitis. From a predictive perspective, several variables can affect the outcome of root canal treatment. Some of these variables depend on intraoperative factors, which include irrigation technique, size of the apical preparation, use of intracanal medicaments or the number of appointments necessary to complete the treatment. However, the outcome may also be affected by host and microbial factors. The intensity of periradicular bone loss or tissue damage, the presence of preoperative pain and associated conditions such as mechanical allodynia and central sensitization, the anatomical complexity of the apical portion of the canal, and the virulence and longevity of the bacterial infection can all have a profound influence on the outcome. Furthermore, numerous medical conditions have been reported to decrease the capability of the immune system to heal the periapical tissues. It is the clinician's responsibility to analyse these variables and incorporate them into the disinfection strategy to maximize the chances of healing. This narrative review will focus on the present status of intracanal medicaments, the clinical indications for their use and future directions for research.

729 "Feets" of Strength: How Glabrous Skin Defied the Odds

Introduction58 year old female with past medical history notable for IDDM with peripheral neuropathy presented to ER after stepping barefoot onto asphalt in August 2020. Patient initially presented to community ER who performed bedside debridement and referred patient to wound clinic for management. After presenting to wound clinic, patient was referred to Burn center. She arrived 10 days after burn and was found to have full thickness burns to the soles of bilateral feet, 3% TBSA. The majority of the soles of both feet were injured. The patient had little residual glabrous skin which was uninjured. Glabrous skin is highly specialized skin and grafting non glabrous skin to the soles of the feet does not have optimal functional outcomes.MethodsThe patient was extremely compliant and willing to do whatever was necessary to maintain function. The patient underwent one debridement, two debridements with allografting, and one debridement with wound vacuum application. Wounds were initially treated with daily silvadene dressings and transitioned to daily damp to dry and finally to daily xeroform dressings. Wounds were measured at each follow up appointment, plan was made to intervene only when wounds stopped showing progress, however this plateau was never reached, and wounds were allowed to heal without any further intervention.ResultsOne year post burn, the right sole is fully healed while the left sole remains with small open area. The patient does have significant alterations to her gait pattern. However, the patient has managed to heal her wounds and is functioning independently.ConclusionsGiven patient’s IDDM, her perceived chances of healing a graft was low. Furthermore, her risk of infection and eventual amputation was high. Given a very compliant patient and diligent wound care, the patient was able to achieve significant healing of wounds without the need for amputation. Glabrous skin is specialized skin and grafting non glabrous skin to the soles of the feet does not have optimal functional outcomes. Allowing the patient’s own glabrous skin to pull across the bed and heal has provided for optimal functional outcomes.

A Bibliometric Approach to Track Research Trends in Computer-Aided Early Detection of Cancer Using Biomedical Imaging Techniques

The paper’s primary goal is to conduct a comprehensive bibliometric analysis of scholarly publications related to computer-aided early detection of cancer using biomedical imaging techniques. Among many diseases, cancer is the second major cause of death in the world. Nevertheless, with advancements in cancer screening, the survival rate for many types of cancer is enhancing. If cancer is noticed in its early stage, it sets out the best chances for healing. Screening involves a physical examination, laboratory tests, imaging tests, and biopsy. According to research, imaging tests are the most accurate cancer diagnosis methods. This work seeks to acquire results from scholarly articles extracted from the Scopus database for the last two decades by analyzing growth in publications and sources, author’s endowment, keyword analysis, article citation frequencies, etc. To exhibit the bibliometric study, open-source tools, namely BiblioShiny, VOSviewer, Word Cloud, are utilized. The analysis indicates, 78.52% of publications are of article and review type. Breast cancer, segmentation, melanoma, and deep learning are often used keywords in scholarly articles. Substantial work has been done in China, followed by Germany and the USA under the Computer Science area; also, it shows the elevation in several publications since 2019. Our study will furnish a broad range of perceptions for upcoming researchers by tracking the research study trends. This bibliometric analysis will be worthwhile for an apprentice to survey ongoing research under cancer detection using biomedical images.

THE BENEFITS OF COMMUNICATION IN HEALTH SERVICES IN INDONESIA: A LEGAL STUDY

In the principle of informed consent, doctors were obliged to establish communication with patients before carrying out medical treatments. Information from the doctor became a guideline or consideration for patients in making a choice (freedom to choose) and gave approval to the doctor to carry out medical action to them. The obligation of doctors to effectively communicate has been regulated in Article 35 and Article 45 of Law No. 29 of 2004 concerning Medical Practice and further strengthened by Regulation of the Minister of Health of the Republic of Indonesia No. 290/ Menkes/ Per/ III/ 2008 concerning Approval of Medical Measures. The effectiveness of communication in health services was an act of caution in medical treatments. Before the medical treatment was carried out, the patient should already knew about the disease, the chances of healing, the risk of medical treatment and the patients were also given alternative methods of other treatments so that the patients has information about the illness and therapy that doctors would do. If communication between patients and doctors is effective, it could prevent medical malpractice.

Comparative Assessment of Topical Glucantime® Injection Plus Cryotherapy and Cryotherapy Alone for Treatment of Anthroponotic Cutaneous Leishmaniasis

Background: Cutaneous leishmaniasis is a worldwide health problem due to the complications in the transmission cycle, treatment failure, and post-healing problems. Objectives: Infected humans are the parasite reservoirs in the transmission cycle of anthroponotic cutaneous leishmaniasis (ACL); thus, the lack of efficient treatment increases the risk of the disease outbreak. The gold standard treatment for CL is mainly the topical or systematic use of antimonial compounds. Much research has been done on the development of topical therapy alone or in combination with cryotherapy. Therefore, this study was conducted to comparatively evaluate the current treatment protocol, cryotherapy, versus combined cryotherapy (Cryo) and intralesional Glucantime® (IG). Methods: This quasi-experimental study was performed on 476 patients with cutaneous leishmaniasis lesions referred to the health centers of a CL endemic area in southern Iran (Bam County, Kerman Province) during 2013 - 2019. A total of 200 cases with 301 lesions received Cryo using liquid nitrogen once every two weeks, and 276 cases with 406 lesions received weekly IG combined with Cryo, once every two weeks. The lesion size was recorded before and after the treatment. At seven and 12 weeks after the treatment, the lesion healing rate was monitored. Healing was defined as complete re-epithelialization. The obtained data were assessed using logistic regression to calculate the relative risk and therapeutic effects. Results: Out of 476 CL patients with 709 lesions, 200 cases with 221 lesions received Cryo, and 276 patients with 292 lesions received Cryo plus IG. At the seventh week after the treatment, complete healing was observed in 100 out of 221 cases (50%) in the group that received biweekly Cryo only and 225 out of 276 cases (81.5%) in the group that received biweekly Cryo plus weekly IG (P = 0.001). Conclusions: This study found that the use of cryotherapy plus intralesional Glucantime® increases the chance of healing for patients by 4.4 times compared to the use of cryotherapy alone.

Tumor Diagnosis by Genetic Markers Protein P-53, p16, C-MYC, N-MYC, Protein K-Ras, and Gene Her-2 Neu is this possible? Tumor Diagnosis by Genetic Markers C-MYC, N-MYC, Protein P-53, p16

Currently, cancer is among the leading causes of death in the world. It is the correct diagnosis that gives the patient a better chance of healing. The detection of genetic markers, macromolecules that are produced directly by the tumor or by the host, has the potential to be one of the diagnostic tests. This paper is a review article, with the objective of addressing tumor markers c-MYC, n-MYC, protein p-53, protein Kras, and the gene HER-2 neu regarding the diagnosis and prognosis of patients with cancer, studies demonstrated that c-MYC is expressed in several malignant tumors because it affects proliferation and cellular metabolism, P-53 in breast and lung tumors is overexpressed, Regarding p16 it has been suggested that cytoplasmic also overexpression as kind of cancer predictor. K-ras is used to determine survival time and free time for neoplasm. It is an effective marker for monoclonal antibody therapy. The marker HER-2 neu and N-MYC are indicative of poor prognosis, conclusions: application of these markers is being increasingly used for expressing specificity and sensitivity in different areas of tumor characterization, in addition to being related to the therapeutic conduct to be followed in tumor treatment. Keywords: genetic marker; p16; Tumor marker; cancer diagnosis;p53