Grade Of Satisfaction Research Articles

The role of telemedicine in the postoperative home monitoring after robotic colo-rectal cancer surgery: a preliminary single center experience.

The telemedicine studies, takes care and prevents diseases at distance basing on the interaction among physicians and patients remotely. Few data are available on its application to early postoperative after surgery. The endpoints of our preliminary experience were the detection, as primary, of feasibility and safety of home telemonitoring after robotic colo-rectal resection and, as secondary, perception and satisfaction of the patients. From December 2019 to March 2020, at the Division of Robotic Surgery of San Giovanni Hospital of Rome, 20 of 29 colorectal cancer patients, submitted to Robotic resection, were prospectively included in a program of postoperative home telemonitoring. Telemonitoring was considered feasible if at least 75% of data were available and safe if morbidity ≤ II by Clavien-Dindo classification. Perception and patients' satisfaction were evaluated through a dedicated questionnaire. Out of 20 patients, the median age was 68 years, overall postoperative morbidity was 30%, all events classified Clavien-Dindo Grade I or II. Only 2 patients were corresponded to surgical consult without readmission during home telemonitoring. Compliance of patients was > 80%, overall grade of satisfaction was very high: 4.2 as median (range 0-5). In this preliminary study, the procedures of postoperative home telemonitoring were feasible and safe and high rate of patients' satisfaction was observed. The telemedicine could enhance the role of robotic technique in decrease the hospital stay and improving postoperative recovery after surgery. Further structured prospective trial are needed to validate the routine application of telemedicine in healthcare.

Uro-oncologic patient management during theCOVID-19 pandemic: survey findings froman Italian oncologic hub.

Aim: Patient and worker satisfaction at an oncologic hub during the COVID-19 pandemic has never been reported. We addressed this topic. Methods: We conducted a survey to test the views of patients (n = 64) and healthcare professionals (n = 52) involved with our operative protocol. Results: A moderate/severe grade of concern due to the COVID-19 emergency was recorded in 63% of patients versus 75% of hospital staff. High/very high versus low satisfaction grade about preventive strategies to reduce the risk of SARS-CoV-2 contagion was identified in the patients compared with the hospital staff group. Conclusion: Surgical treatment at a hub center of uro-oncologic patients coming from spoke centers is well accepted and should, therefore, be recommended. Preventive strategies to reduce the risk of SARS-CoV-2 contagion in hospital staff members should be implemented.

Cosmetic results of autologous bone cranioplasty after decompressive craniectomy for traumatic brain injury based on a patient questionnaire

BackgroundDecompressive craniectomy (DC) after traumatic brain injury (TBI) is a common surgical procedure. Cranioplasty (CP) is undertaken as a routine secondary operation following DC. In neurosurgical trauma centers, patients who require CPs compete with other patients who require emergency neurosurgical intervention and they are not given enough priority. MethodsA retrospective study was conducted of patients who had undergone autologous bone CP after DC for TBI over three years in a 3rd level trauma center in Mexico. All families were administered a questionnaire to assess how the patient judged the cosmetic result of CP. ResultsA total of 29 patients agreed to participate in this study. 25 patients (86.2%) were satisfied with the aesthetic result and 4 patients (13.8%) were no satisfied with their CP. 4 cases (13.8%) reported medical complications related to CP. Unsatisfied patients complained most likely about the dented aesthetic look, with a moderate negative correlation between this and cosmetic outcome (ρ = −0.483, P = 0.001). Patient age (ρ = 0.194, P = 0.314) and defect size (ρ = 0.156, P = 0.419) was not related to the assessment of the aesthetic result. A strong negative correlation between postoperative infection and the grade of satisfaction (ρ = −0.710, P = 0.001) was also observed. ConclusionsBased on our results, overall most of the patients were satisfied with their CP with an acceptable complication rate.

A COMPARISON OF LEFT UTERINE DISPLACEMENT USING CLINOMETER GUIDED TABLE TILT VS CONVENTIONAL CRAWFORD WEDGE DURING SPINAL ANAESTHESIA IN CESAREAN SECTION- A PROSPECTIVE RANDOMIZED STUDY

INTRODUCTION: Enlarged gravid uterus causing aortocaval compression may decrease the venous return and cause maternal hypotension. Maternal position after neuraxial blockade may exacerbate the impact of aortocaval compression and consequences on cardiovascular instability. Left uterine displacement (LUD) after spinal anaesthesia in lower segment cesarean section is essential in preventing supine hypotension syndrome. Decreased cardiac output secondary to vena cava obstruction by the gravid uterus can be prevented by lateral tilt position. AIM OF THE STUDY: This study is therefore designed to evaluate the role of leftward uterine displacement by table tilt using clinometer software or by using crawford wedge tilt and compare the effects on hemodynamics in parturient undergoing lower segment cesarean section (LSCS) under subarachnoid block MATERIALS AND METHODS: The study was carried out in the Department of Anaesthesiology involving Department of Obstetrics and gynecology in Kanyakumari Government Medical College from January 2018 to June 2019. Patients were allocated into two groups by randomization. After spinal anaesthesia parturient in Group T: Lateral Table Tilt by using clinometer -15 degree- (40 parturient). Parturient in Group W: Crawford wedge Tilt- (40 parturient). Patients, age, body weight, BMI and baseline vital parameters were recorded. Incidence of hypotension after spinal anaesthesia in a cesarean section, Total dose Vasopressor required, Level of blockade, APGAR Score, Surgeon satisfaction grading. RESULTS: The demographic parameters like age, height, weight, BMI and the indication for surgery were similar in both groups. There were no difference in mean height level of block between both groups. In comparison of hypotensive incidence in both groups, the high incidence noted in the GROUP W (wedge group) (35%) is higher than the incidence in GROUP T (table tilt) nd th th (7.5%). The incidence of hypotension is signicantly noted at 2 , 4 , 5 minute after the subarachnoid block in wedge group compared to the table tilt group. The dose of vasopressor requirements and average ephedrine dose used is less in GROUP T (table tilt) (0.6±2.3mg) compared to GROUP W (wedge) (3.9±5.7 mg). In comparison of surgeon satisfaction between both groups, surgeons are much satised with the wedge group patient and found difcult, disturbing and sometimes unbearable st th while perform the surgery for the patient in table tilt. The APGAR Scores in GROUP W at 1 minute and 5 minute is (7.3±0.5 and st th 8.7 ±0.5) respectively which are relatively satisfactory compared to the GROUP T (6.8±0.6 and 8.3±0.6) at 1 and 5 minute. CONCLUSION: Table tilt provide a good relief from inferior vena cava and aortocaval compression when compared to the wedge placed under the right hip during cesarean section done under subarachnoid block. Using the wedge is easier and 0 surgeons at our institute found it more comfortable than the table tilt to 15 but anesthetists feel better with table tilt because there is little incidence of hemodynamic variation. We conclude that all the parturient posted for caesarean section should be 0 given a table tilt of 15 placed with angle measured exactly by clinometer to decrease incidence of hypotension occurring due to aortocaval compression

Treatment of grossly dislocated supracondylar humerus fractures after failed closed reduction: a retrospective analysis of different surgical approaches.

The supracondylar humerus fracture (SCHF) is one of the most common pediatric injuries. Highly displaced fractures can be very challenging. If closed reduction fails, the therapy algorithm remains controversial. In total, 41 patients (21 boys and 20 girls) with irreducible Gartland type III SCHF, treated with open reduction through three different approaches and cross-pin fixation, were retrospectively evaluated. The mean follow-up was 46 months (min.: 12, max.: 83, SD: 23.9). The Mayo elbow performance score (MEPS) as well as the quick disabilities of arm, shoulder and hand (qDASH) score were used to assess the functional outcome. Baumann's angle and the anterior humeral line (AHL, Roger's line) were obtained from follow-up radiographs. Time to surgery, postoperative nerve-palsy, rate of revision surgery, and complication rate were examined. Two revision surgeries were reported. One due to inadequate reduction and one due to secondary loss of reduction. In this context, the AHL was a sufficient tool to detect unsatisfactory reduction. According to the MEPS the functional outcome was excellent (> 90) in 37/41 patients and good (75-89) in 4/41 at the final visit. Fair or poor results were not documented. The qDASH score was 1.8 (min.: 0, max.: 13.6, SD: 3.4). There were no significant differences between the utilized surgical approaches. An iatrogenic injury of the ulnar nerve was not reported in any case. Overall, one heterotopic ossification without impairment of the range of motion and one preliminary affection of the radial nerve were documented. In the rare case of an irreducible SCHF, an anatomical reduction can be achieved by open approaches with excellent functional outcome and a high grade of patient satisfaction. All described open approaches can be utilized with a high safety-level.

Heads-up 3D eye surgery: Safety outcomes and technological review after 2 years of day-to-day use.

3D heads-up visualization systems are aimed to improve the surgical experience by providing high-resolution imaging. Objective of our study is to analyze, over a long-time span, the grade of satisfaction and safety of day-to-day 3D surgery compared to standard surgery and to investigate the technical distinctiveness between the heads-up systems currently in use. In this retrospective observational case series. we reviewed all surgical records of our ophthalmology-dedicated operatory rooms since the arrival of 3D heads-up viewing system, in November 2017. In particular, we compared the procedural complications of 3D-equipped operatory room (3DR) with the standard microscope operatory room (2DR). Moreover, a satisfaction questionnaire was administered to those surgeons shifting on both rooms to test their preferences on seven specific parameters (comfort, visibility, image quality, depth perception, simplicity of use, maneuverability and teaching potential). 5483 eye surgeries were considered. 2777 (50.6%) were performed in 3DR and 2706 (49.3%) in 2DR. Procedural complication rate was comparable in 3DR and 2DR, also when considering different subtypes of surgery. Twelve surgeons (100% of our surgery team) participated in our satisfaction survey, expressing highest satisfaction score for 3D when applied in retina surgery. For cataract surgery, 3D scored best in all the parameters except for facility in use and depth of field perception. Long-term day-to-day use of 3D heads-up visualization systems showed its safety and its outstanding teaching potential in all ophthalmic surgical subtypes, with higher surgeons confidence for retina and cataract surgery.

IOERT versus external beam electrons for boost radiotherapy in stage I/II breast cancer: 10-year results of a phase III randomized study

BackgroundIntraoperative radiotherapy with electrons (IOERT) boost could be not inferior to external beam radiotherapy (EBRT) boost in terms of local control and tissue tolerance. The aim of the study is to present the long-term follow-up results on local control, esthetic evaluation, and toxicity of a prospective study on early-stage breast cancer patients treated with breast-conserving surgery with an IOERT boost of 10 Gy (experimental group) versus 5 × 2 Gy EBRT boost (standard arm). Both arms received whole-breast irradiation (WBI) with 50 Gy (2 Gy single dose).MethodsA single-institution phase III randomized study to compare IOERT versus EBRT boost in early-stage breast cancer was conducted as a non-inferiority trial. Primary endpoints were the evaluation of in-breast true recurrences (IBTR) and out-field local recurrences (LR) as well as toxicity and cosmetic results. Secondary endpoints were overall survival (OS), disease-free survival (DFS), and patient’s grade of satisfaction with cosmetic outcomes.ResultsBetween 1999 and 2004, 245 patients were randomized: 133 for IOERT and 112 for EBRT. The median follow-up was 12 years (range 10–16 years). The cumulative risk of IBTR at 5–10 years was 0.8% and 4.3% after IOERT, compared to 4.2% and 5.3% after EBRT boost (p = 0.709). The cumulative risk of out-field LR at 5–10 years was 4.7% and 7.9% for IOERT versus 5.2% and 10.3% for EBRT (p = 0.762). All of the IOERT arm recurrences were observed at > 100 months’ follow-up, whereas the mean time to recurrence in the EBRT group was earlier (55.2 months) (p < 0.05). No late complications associated with IOERT were observed. The overall cosmetic results were scored as good or excellent in physician and patient evaluations for both IOERT and EBRT. There were significantly better scores for IOERT at all time points in physician and patient evaluations with the greatest difference at the end of EBRT (p = 0.006 objective and p = 0.0004 subjective) and most narrow difference at 12 months after the end of EBRT (p = 0.08 objective and p = 0.04 subjective analysis).ConclusionA 10-Gy IOERT boost during breast-conserving surgery provides high local control rates without significant morbidity. Although not significantly superior to external beam boosts, the median time to local recurrences after IOERT is prolonged by more than 4 years.

Outcomes of Breast Free Flap Reconstruction in the Middle East

Objectives: Reviewing patient satisfaction and quality of life following post mastectomy breast reconstruction in breast cancer patients of Middle East. Methods: Retrospective study of 68 patients of post mastectomy who underwent free flap-based breast reconstruction with a mean follow up of 6 months were studied over a period of 5½ years. Specific preoperative investigation included CT angiography of the abdominal wall for perforator assessment. All of breasts were reconstructed by microsurgical free flap breast reconstruction. A questionnaire was developed for the postoperative patients in order to assess their satisfaction grades. Results: A total of 67 patients of post mastectomy females attended to our clinic for breast reconstruction. Most of the patients (97.3%) were in the age group of 29-53 years. Majority of patients (68%) underwent delayed reconstruction. Average BMI at reconstruction in most females was 30.1. CT angio demonstrated two ideal perforators in 59% of cases. Majority underwent reconstruction by free DIEP flap. Complications occurred in 6.4% of patients. Overall satisfaction rates of 92% was noted. At the completion of the study 30% has completed nipple reconstruction. Conclusion: With the availability of “state of the art” microsurgical breast reconstruction, in properly selected patients, the quality of life and satisfaction rates are high and free flap breast reconstruction has proven to be the standard of care in post mastectomy patient population.

Grade of satisfaction and tolerability of a medical device based on P. acnes in adults waiting for destructive treatments for genital warts

Grade of satisfaction and tolerability of a medical device based on P. acnes in adults waiting for destructive treatments for genital warts

Fractional CO2laser versus fractional CO2laser with subcision in management of atrophic postacne scar

ObjectiveTo evaluate efficacy and safety of fractional CO2 laser treatment versus fractional CO2 with subcision in the management of atrophic postacne scars.BackgroundAtrophic postacne scarring has always been a challenge to treat. Fractional CO2 resurfacing in combination with subcision is effective and well tolerated.Patients and methodsThis prospective study includes 50 patients with atrophic acne scars from Outpatient Clinic of Dermatology, Andrology and STDs Department. An informed consent was obtained. Patients from both sex at least 18 years with any types and any grade of atrophic postacne scars, and not receiving any treatment in the past 6 months for their scars were included. All patients were subjected to history taking, general examination, and qualitative grading of acne. Patients were divided into two groups: group A included 25 patients who were subjected to fractional CO2 laser, and group B included 25 patients who were subjected to subcision and fractional laser on the second day of subcision.ResultsExcellent satisfaction was 100% with grade 1 scar, and good satisfaction was more common with grade 2 scar (60%) in group A. There were highly statistically significant differences found between grade of scar and patient satisfaction in group A (P = 0.001). Excellent satisfaction was 90.91% with grade 1 scar, and good satisfaction was more common with grade 1 scar (57.14%) in group B. There were statistically significant differences found between grade of scar and patient satisfaction in group B (P = 0.028).ConclusionThe combination of fractional carbon dioxide laser and subcision is safe and effective modality for the treatment of atrophic acne scars. Moreover, there were improvements in patient satisfaction, without considerable complication.

Comparison of intraarticular injection versus radiofrequency neurotomy in knee osteoarthritis.

Background: Multiple modalities are existing for pain management in knee osteoarthritis cases. This study was conducted to compare between the efficacy of genicular nerves radiofrequency ablation versus intraarticular steroid injection in pain management in knee osteoarthritis.Patients and methods: A total of 58 cases with knee osteoarthritis were included and they were divided into 2 equal groups; RF group who underwent radiofrequency for the genicular nerves, and IA group who underwent intraarticular steroid injection. Follow up visits were scheduled after 1week, 2 weeks, 1,2, 3, and 6 months. Both visual analogue score and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were assessed in each visit. Furthermore, patient satisfaction was also recorded.Results: Patient characteristics did not differ significantly between the two groups (p > 0.05). Both VAS and total WOMAC scores were improved in both groups. However, the RF showed better scores at 2-, 3-, and 6- month visits. Satisfaction grade did not differ between the two groups.Conclusion: Both genicular nerve RF and intraarticular steroid injection are safe and efficacious in pain management in knee osteoarthritis cases. Nevertheless, the effect is more prolonged after RF.

Development of the professional role of diabetes nurses in specialised diabetes and primary care in Catalonia

ObjectivesThe aim of this study was to describe therapeutic education programmes in diabetes in Catalonia and the differences according to the healthcare setting in which the patients are attended (primary care [PC] and specialised diabetes care [SDC]). MethodWe performed a descriptive, cross-sectional, comparative study of diabetes nurses (DN) in SDC and PC in Catalonia. The sample was obtained from all the DN in SDC and a randomised cluster sample of DN in PC. The questionnaire of the Study of European Nurses in Diabetes (SEND) validated in Spanish was used. ResultsA total of 287 questionnaires were analysed (24.3% SDC and 75.6% PC). More training in diabetes through masters, postgraduate courses and continuing education was observed in SDC (p<0.001) as well as structured, written, education programmes and the combination of individual and group education strategies (p<0.05). The roles of educator, consultant, researcher, manager, liaison or collaborator and innovator and the telematic follow-up of patients was also more developed in SDC (p<0.05). The grade of work satisfaction was elevated in both groups. Conclusions(1) Nursing professionals in SDC assume more roles of specialised clinical nursing and also have more training in diabetes and therapeutic education than PC professionals. (2) Professionals in SDC work with a greater proportion of structured diabetes therapeutic education programmes although this should improve in both settings. According to the results obtained and the scientific evidence currently available, the training of DN working in the care of people with diabetes should be accredited in order to increase the use of structured programmes and investigation by DNs in both healthcare settings.

Research and Practice of PAD Class Based on WeChat Platform in Medical Universities English Teaching

Objective: To explore the impact of the PAD Class teaching mode on students’ learning satisfaction and final comprehensive grades; Methods: Our students in higher vocational colleges from Class 1 of nursing profession enrolled in 2020 and 2019 were selected as the research objects, which were respectively experimental class and control class. PAD Class mode is given in the experimental class, while the traditional teaching mode in control class. After the course, the students were surveyed on questionnaires of their learning satisfaction in nine aspects, including acquisition of knowledge, and their final comprehensive grades were compared. Results: The learning satisfaction with PAD Class of the experimental class students is significantly higher than that of the control class. 86.27% of the students in the experimental class and 57.91% in the control class are satisfied. The final comprehensive grades of the experimental class are also significantly higher than that of the control class (t = 6.301, P < 0.001). Conclusion: As a teaching mode worthy of recognition and promotion, PAD Class can help to improve students’ learning satisfaction and academic performance, tap students’ ability of independent learning and acquiring knowledge, and lay a good foundation for the future lifelong learning.

Impact of COVID-19 Quarantine on Advanced Hemorrhoidal Disease and the Role of Telemedicine in Patient Management.

The aims of this population study were to assess the lockdown impact on patients waiting for hemorrhoidal surgery, and the role of telemedicine in patient management. All patients on our waiting list for hemorrhoidal surgery were considered. Eligible patients were contacted by phone. Rørvik score was evaluated and compared to the baseline score. Univariate and multivariate analyses were performed. A numeric rating scale was used to estimate patient satisfaction regarding telemedicine. One-hundred and ten patients were found to be eligible. Finally, 103 patients were included in the study of whom 16 (15.3%) were already considered for priority surgery. Patients waiting for a longer time showed significantly worse scores (p < 0.001). After telemedicine evaluation the priority waiting list increased by 43.8% (plus 23 patients). Weight loss of at least 3 kg and physical activity were found to be protective factors (p = 0.02 and p = 0.002 respectively). A high grade of satisfaction (almost 80%) towards telemedicine was registered. COVID-19-related delays are linked to a deterioration of hemorrhoidal symptoms and patients’ well-being. Weight and lifestyle changes were deemed key factors in determining disease severity. Telemedicine was a valuable tool to evaluate and re-evaluate patients waiting for hemorrhoidal surgery and was considered satisfactory by patients.

Efficacy and Patient Tolerability Profiles of Probiotic Solution with Bisacodyl Versus Conventional Cleansing Solution for Bowel Preparation: A Prospective, Randomized, Controlled Trial.

Although adequate bowel preparation is essential in screening colonoscopy, patient intolerability to bowel cleansing agents is problematic. Recently, a probiotic mixture solution with bisacodyl emerged to improve patient tolerability. We investigated the efficacy, safety, and patient tolerability profiles of probiotics with bisacodyl versus conventional polyethylene glycol (PEG) solution for bowel preparation for screening colonoscopies in healthy patients in this prospective, randomized, case-control study. In total, 385 volunteers were randomly assigned to receive 2 L of water + 200 mL of probiotic solution (case group, n = 195) or 4 L of PEG solution (control group, n = 190). The efficacy of the bowel cleansing was evaluated using the Ottawa scale system, polyp detection rate, and adenoma detection rate, and the patient tolerability profiles were assessed using a questionnaire. The demographics were not significantly different between groups. When the Ottawa score for each bowel segment was stratified into an adequate vs. inadequate level (Ottawa score ≤ 3 vs. >3), there were no statistical differences between groups in each segment of the colon. There were no significant differences in the polyp and adenoma detection rates between groups (38.42% vs. 32.42, p = 0.30; 25.79% vs. 18.97%, p = 0.11). The case group showed significantly fewer events than the control group, especially nausea, vomiting, and abdominal bloating events. Regarding the overall satisfaction grade, the case group reported significantly more “average” scores (95% vs. 44%, p < 0.001) and were more willing to use the same agents again (90.26% vs. 61.85%, p < 0.001). As patient compliance with bowel preparation agents is associated with an adequate level of bowel cleansing, a probiotic solution with bisacodyl might be a new bowel preparation candidate, especially in patients who show a poor compliance with conventional bowel preparation agents.

Ileal Neoappendicostomy in the Treatment of Fecal Incontinence in Children.

An antegrade colonic enema (ACE) via an appendicostomy has been shown to be effective in the management of functional bowel problems. In cases with a missing appendix, a neoappendicostomy may be considered. A retrospective review of clinical outcomes in children who underwent ileal neoappendicostomy for ACE. Medical records were reviewed for data on demography, intra- and postoperative complications. A follow-up questionnaire on stoma problems, ACE-related problems, bowel function, patient satisfaction, well-being, and effect on daily activities was performed. Ten patients were included at an average age of 10.6 years at surgery. In half of the patients, minor postoperative complications (Clavien-Dindo grade 2 or less) were found. Nine patients answered the questionnaire with a mean follow-up of 57 months. Despite complaints of stomal leakage, difficulties with catheterization, and pain during irrigation, they reported a high grade of satisfaction, improvements in well-being, and bowel function and the achievement of continence. Ileal neoappendicostomy may be an alternative to ACE in children with severe and medically intractable constipation and or/and fecal incontinence where the appendix is missing or not available.

A comparative evaluation of students' insight of face to face classroom lectures and virtual online lectures

Background: Online virtual lectures have the advantages of mass communication from any location and can be recorded and repeated as long as computers and internet access are available. The medical students here had never been offered online virtual lectures until now. Taking the advantages of online virtual teaching and the need of the hour, the present study was conducted with the following aims and objectives. Aims and Objectives: To study, evaluate and compare the effectiveness and satisfaction of students in two modalities of teaching-learning (T-L) technique – (1) face to face classroom lectures versus (2) virtual online lectures. Material and Methods: The present observational study was conducted in 93 undergraduate medical students of the second year. A series of 10 face to face classroom lectures and then a series of 10 virtual online lectures were conducted on different topics of forensic medicine and toxicology at a frequency of 1 lecture/week. A well-designed and -structured questionnaire was forwarded to the students through “Google form.” The students could fill in the form and submit only if willing. The statistical analysis of the descriptive variables was expressed as mean ± SD and percentage separately. The comparison of the variables for both modalities of T-L technique was done by unpaired - t test. Results: The attendance of the students was highly significantly increased in online virtual lectures as compared to face to face classroom lectures. The impact of online virtual lectures on knowledge, the connectivity with the teacher, attentiveness, and satisfaction grades as experienced by students and rated on a 5 point Likert scale was statistically significantly low as compared to face to face classroom lectures. The online virtual lectures were experienced as significantly more monotonous as compared to face to face classroom lectures. Conclusion: After so many years of pedagogical nature of medical education, the students will require time to adapt to the self-directed learning protocol. It is the role of the educator to keep the students motivated and use multimedia and social media to make the online virtual lectures more interesting, informative, interactive, and hence more effective.

Micro Needling with Platelet Rich Plasma Versus Fractional CO2 Laser with Platelet Rich Plasma in Patients with Post Acne Scars

Background: Facial scaring has always been challenged to treat and there are many treatments available to decrease the appearance of scars like topical retinoids, chemical peeling, microneedling, dermabrasion, soft tissue fillers, botulinum toxoid injection and laser resurfacing The aim of this study was to evaluate and compare the efficacy of microneedling and fractional CO2 laser in the treatment of post acne scars. A comparative studyOf thirty patients (12 males and 18 females) aged 19 – 36 years with atrophic acne scars were devided into Group (A): treated with Fractional Co2 laser combined with topical platelet rich plasma. Group (B): treated with skin microneedling combined with topical platelet rich plasma. Platelet rich plasma can improve the quality of atrophic acne scars treated with ablative fractional CO2 laser or microneedling and decrease the duration of related side effects including oedema and erythema. Regarding patient’s satisfaction grades there was an improvement after both treatment modalities with insignificant differences between both treatment modalities. PRP can improve the quality of atrophic acne scars treated with ablative fractional CO2 laser or microneedling and decrease the duration of laser-related side effects including oedema and erythema.

Comparative study between Intranasal Injection of Botulinum Toxin-A and Combined Intranasal Medical Treatment for Allergic Rhinitis

Background: Allergic rhinitis is one of the most common diseases, with no consensus on its ideal treatment. Botulinum Toxin-A was proposed to be an effective treatment. Aim of the work: To estimate the outcome of intranasal injection of Botulinum Toxin-A [BTX-A] as a sole therapy for allergic rhinitis. Patients and Methods:Ninty patients with classic symptoms of allergic rhinitis were clinically evaluated and asked to complete the score for allergic rhinitis [SFAR] questionnaire using cutoff at >8 as diagnostic AR. Two blood samples [venous] and nasal smears were obtained at the beginning of the study and at the end of 12-weeks after initiation of therapy for estimation of human immunoglobulin E [IgE] and eosinophilia grading. Control group included patients who chose to receive combined medical treatment. BTX-A, 2.5 units were injected intranasally, under 0o rigid telescope guidance. Study outcome was the treatment success rate at the end of 12-w follow-up period. Results: Intranasal BTX-A injection provided significantly maintained relieve of allergic rhinitis manifestations especially for running nose than combination therapy. The treatment success rate of 1.9 versus 0.7 item/patient in study versus control group with significant difference in favor of BTX-A injection. Serum IgE levels and eosinophilia grades were significantly lower in control patients. Patients' satisfaction grading was significantly more with BTX-A injection. Conclusion: Intranasal BTX injection could be a safe and effective sole therapeutic modality for patients with long-lasting AR

Surgical wound closure by staples or sutures?: Systematic review.

To compare the effects of sutures and staples for skin closure of surgical wounds. We included published and unpublished randomized controlled trials (RCTs) and cluster-randomized trials comparing staples with sutures. Patients were adults (aged 18 years or over) who had undergone any type of surgery. The primary outcomes were risk of overall and severe wound infection. Secondary outcomes included length of hospital stay, readmission rate, adverse events, patient satisfaction with cosmetic results, postoperative pain. Forty-two very low to low quality RCTs with a total of 11,067 patients were included. Sutures resulted in slightly fewer overall wound infections (4.90%) compared to staples (6.75%) but it is uncertain whether there is a difference between the groups (risk ratio [RR] 1.20, 95% confidence intervals [CI] 0.80-1.79; patients = 9864; studies = 34; I = 70%). The evidence was also insufficient to state a difference in terms of severe wound infection (staples 1.4% vs sutures 1.3%; RR 1.08, 95% CI 0.61-1.89; patients = 3036; studies = 17; I = 0%), grade of satisfaction (RR 0.99, 95% CI 0.91-1.07; patients = 3243; studies = 14; I = 67%) and hospital stay. Staples may increase the risk of adverse events (7.3% for staples vs 3.5% for sutures; RR 2.00, 95% CI 1.44-2.79; patients = 6246; studies = 21; I = 33%), readmission rate (RR 1.28, 95% CI 0.18-9.05; patients = 2466; studies = 5; I = 66%) and postoperative pain (standardized mean difference [SMD] 0.41,95%CI -0.35 to 1.16; I = 88%, patients = 390 patients, studies = 5). Due to the lack of high quality evidence, we could not state if sutures are better than staples in terms of wound infection, readmission rate, adverse events, and postoperative pain. With a low quality of evidence, sutures reduce postoperative pain and improve grade of satisfaction with the cosmetic outcome.