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Health and Human Rights Dec 2019Through focusing on the neoliberal "Health Transformation Programme" launched in 2003 in Turkey, I show how reproductive law can be modified by neoliberal mechanisms...
Through focusing on the neoliberal "Health Transformation Programme" launched in 2003 in Turkey, I show how reproductive law can be modified by neoliberal mechanisms that are implemented with neoconservative policies and pressures. The paper builds on original data collected in 2014 and 2015 through focus groups and interviews with health practitioners in family health centers and women receiving reproductive care in Izmir, Diyarbakir, Van, and Gaziantep. The data analysis informed by writings on the debt economy by Maurizio Lazzarato and Bifo Berardi and transnational feminist theory demonstrate that neoliberal mechanisms of "dismantling the public" interact with pronatalist policies and pressures to erode women's reproductive rights in Turkey. This has resulted in (1) indebtedness of women through out-of-pocket payments for contraception and abortion, (2) indebtedness of providers through performance measures, (3) reduction in the quality of reproductive care, and (4) reduction in access to reproductive care itself (contraception, counseling, and abortion). There is a need to pay attention to neoliberal mechanisms and the legal framings of reproductive rights to fully understand the limitations of law and counter the neoliberal and conservative assaults on women's sexual and reproductive rights.
Topics: Abortion, Induced; Adult; Contraception; Female; Focus Groups; Health Expenditures; Health Services Accessibility; Health Surveys; Humans; Interviews as Topic; Politics; Pregnancy; Reproductive Rights; Turkey; Women's Rights
PubMed: 31885436
DOI: No ID Found -
Indian Journal of Otolaryngology and... Dec 2019The tympanic membrane retraction pocket is a pathological invagination of tympanic membrane into the middle ear space. The most common sites for formation of retraction...
The tympanic membrane retraction pocket is a pathological invagination of tympanic membrane into the middle ear space. The most common sites for formation of retraction pocket are pars flaccida and postero-superior parts. Decision about the procedure and the timing of the treatment of retraction pockets is debatable and depends on the functional and anatomic condition of the ear. To evaluate the results of the technique of two handed endoscopic management of retraction pockets with sliced tragal cartilage. Prospective Non Randomized Clinical Study. The study included 41 ears operated with the technique of two handed endoscopic cartilage tympanoplasty for retraction pockets with endoscope holders from November 2013 to May 2016 with a follow up period ranging from 22 to 53 months. Cases of cholesteatoma and tympanic membrane perforation were excluded from the study. Pre and postoperative symptoms and air-bone gaps were recorded. The average preoperative air-bone gap in the study group was 24.53 ± 4.326 dB. 28 ears were of pars tensa retractions (stage II-4, stage III-15, and stage IV-9) and 13 were pars flaccida retractions (stage III-8 and stage IV-5). 24 ears had ossicular erosion. The follow up revealed that, the results of two handed endoscopic sliced cartilage tympanoplasty for retraction pockets were stable and there was no recurrence of the retraction and the post-operative air-bone-gap closure was achieved to 13.62 ± 4.78, 14.13 ± 5.91 dB, 14.32 ± 3.46 and 14.57 ± 3.88 dB at 6 months, 1 year, 2 years, 3 years respectively. Though, indications for surgery are based mostly on anatomic status and observation of behaviour of retraction pocket over time, we recommend early management of retraction pockets by the technique of endoscopic sliced tragal cartilage tympanoplasty with tragal cartilage of 0.5 mm thickness using endoscope holder. : Level 4.
PubMed: 31750111
DOI: 10.1007/s12070-019-01682-2 -
Veterinary Ophthalmology Mar 2020To evaluate the results obtained using Morgan pocket technique and chondrectomy (MPTC) alone, or combined with a wedge conjunctivectomy (MPTC + WC) for the treatment...
Treatment of prolapsed gland and cartilage deformity of the nictitating membrane with pocket technique and chondrectomy alone, or combined with a wedge conjunctivectomy: 132 dogs (1998-2018).
OBJECTIVE
To evaluate the results obtained using Morgan pocket technique and chondrectomy (MPTC) alone, or combined with a wedge conjunctivectomy (MPTC + WC) for the treatment of prolapsed gland associated with cartilage deformity of the nictitating membrane (PGCD) in dogs.
PROCEDURE
Medical records of dogs diagnosed with PGCD that received a MPTC or MPTC + WC were reviewed between 1998 and 2018. Success rate was defined by lack of recurrence of the prolapsed gland with a minimum of 6 months follow-up. Histological examination of the excised cartilage was performed in 13 eyes.
RESULTS
A total of 132 dogs (181 eyes) met the inclusion criteria. Median follow-up time was 25 months (range, 6-166 months). MPTC was used in 131 eyes with 91.6% success rate. MPTC + WC was used in 50 eyes with 100% success rate. Postoperative complications occurred in 6.9% and 4%, respectively, for MPTC and MPTC + WC, including lacrimal cysts (8 eyes) or corneal erosion (3 eyes). Recurrence and complications rates were significantly lower using MPTC + WC compared with MPTC in the giant breed dogs (P = .019 and P = .002, respectively), but not in the overall study population (P = .328 and P = .290, respectively). Histological cartilage anomalies were noted in 2/13 specimens from chronic PGCD.
CONCLUSIONS
MPTC + WC offers a good therapeutic option for giant breed dogs with PGCD. The combined technique provides a good apposition and mobility of the nictitating membrane onto the ocular surface and potentially reduces the risk of recurrence in these giant canine breeds.
Topics: Animals; Cartilage; Dog Diseases; Dogs; Eyelid Diseases; Female; Male; Nictitating Membrane; Ophthalmologic Surgical Procedures; Prolapse; Treatment Outcome
PubMed: 31746106
DOI: 10.1111/vop.12727 -
The Laryngoscope Aug 2020Although attic retractions have previously been classified into Grades 0 through IV, it is often not possible to assign attic retraction pockets into a single specific...
INTRODUCTION
Although attic retractions have previously been classified into Grades 0 through IV, it is often not possible to assign attic retraction pockets into a single specific category. The present study describes an improved classification system based on otoscopic and endoscopic visualization of the retraction pocket fundus, the ossicular status in the attic, degree of scutal erosion, and the presence or absence of cholesteatoma.
MATERIALS AND METHODS
One hundred and fifty-four patients (200 ears) with different grades of attic retraction pockets who were seen by a tertiary referral otology center between August 2015 and July 2018 were selected for this study.
OBSERVATIONS
The new classification system (Grades I, IIa, IIb, IIIa, IIIb, IIIc, IVa, IVb, IVc, and V) was applied to these retraction pockets. Pure tone audiometry was obtained.
RESULTS
All attic retraction pockets could be classified precisely using the new classification system. Forty-four of 200 (22%) of ears showed Grade I Attic retraction, 18 ears showed Grade IIa (9%), 14 showed Grade IIb (7%), 28 showed Grade IIIa (14%), 12 showed IIIb (6%), 20 showed Grade IIIc (10%), 16 showed grade IVa (8%), 12 showed grade IVb (6%), 28 showed grade IVc (14%), and eight showed grade V (4%) attic retraction pockets. Grades I, IIa, IIb, IIIa, and IVa had no significant hearing loss. Average hearing loss was 42 dB and 52 dB in Grades IIIb and IIIc, 44 dB and 58 dB in Grades IVb and IVc, and 61 dB in Grade V.
LEVEL OF EVIDENCE
5 Laryngoscope, 130: 2034-2039, 2020.
Topics: Cholesteatoma, Middle Ear; Ear Diseases; Ear, Middle; Humans; Otitis Media
PubMed: 31693167
DOI: 10.1002/lary.28368 -
British Dental Journal Oct 2019Aims To determine patient awareness of periodontal health, dentine hypersensitivity and tooth wear, and their impact on oral health quality of life in patients attending...
Aims To determine patient awareness of periodontal health, dentine hypersensitivity and tooth wear, and their impact on oral health quality of life in patients attending NHS practices in South West England.Method In this cross-sectional, multi-centre epidemiological study 814 adult NHS patients completed an oral health questionnaire and then underwent a clinical examination. Pocket probing depths (mm), gingival recession (mm), gingival bleeding (yes/no), dentine hypersensitivity (Schiff score, and yes/no) and tooth wear (basic erosive wear examination score) were measured.Results Participants were regular dental attenders, with good oral hygiene practices and a low prevalence of periodontal disease (probing depth of 4 mm or more) (25%). For all conditions assessed, self-reported data and clinical indices were significantly positively associated, with the strongest associations being seen for dentine hypersensitivity and the weakest for tooth wear. Periodontal disease and dentine hypersensitivity were significantly associated with all four patient-reported measures of oral health quality of life studied.Conclusion This NHS patient population is well cared for and educated with respect to their oral health. The findings confirm the negative impact of periodontal disease and dentine hypersensitivity, and identifies the need to increase awareness of the signs and symptoms of tooth wear.
Topics: Adult; Cross-Sectional Studies; Dentin Sensitivity; England; Humans; Quality of Life; State Medicine
PubMed: 31605067
DOI: 10.1038/s41415-019-0721-9 -
Polymers Sep 2018The objective of this study was to develop the metronidazole loaded high and low methoxyl pectin films (HM-G-MZ and LM-G-MZ) for the treatment of periodontal disease....
The objective of this study was to develop the metronidazole loaded high and low methoxyl pectin films (HM-G-MZ and LM-G-MZ) for the treatment of periodontal disease. The films were prepared by pectin 3% /, glycerin 40% /, and metronidazole 5% / The developed films were characterized by scanning electron microscope and evaluated for thickness, weight variation, and elasticity. The developed films showing optimal mechanical properties were selected to evaluate radial swelling properties, in vitro release of metronidazole and the antimicrobial activity against and by the disc diffusion method. The results demonstrated that LM-MZ and HM-G-MZ films were colorless and yellowish color, respectively, with the film thickness around 0.36⁻0.38 mm. Furthermore, both films exhibited good elasticity with low puncture strength (1.63 ± 0.37 and 0.84 ± 0.03 N/mm², respectively) and also showed slight increase in radial swelling, so that they could be easily inserted and fitted into the periodontal pocket during a clinical use. However, HM-G-MZ showed a decrease in radial swelling after 1 h due to the film erosion. The in vitro release study of LM-G-MZ showed a burst release that was initially followed by a slow release rate profile, capable to maintain the therapeutic level in periodontal pocket for seven days, whereas HM-G-MZ showed an immediate release profile. The cumulative percentage of metronidazole release from HM-G-MZ was less than LM-G-MZ during the first 5 min as metronidazole was in a crystalline form inside HM-G-MZ film. For antimicrobial activity test, both films showed the inhibitory effect against and , and there was no difference in the inhibition zone between LM-G-MZ and HM-G-MZ. The present study showed, for the first time, that low methoxyl pectin film containing glycerin and metronidazole could be potentially considered as a promising clinical tool for the drug delivery via intra-periodontal pocket to target an oral disease that is associated with polymicrobial infection.
PubMed: 30960947
DOI: 10.3390/polym10091021 -
International Journal of Paleopathology Jun 2019To evaluate and differentially diagnose erosive skeletal lesions located on multiple joints of an individual archaeologically recovered in 2017.
OBJECTIVE
To evaluate and differentially diagnose erosive skeletal lesions located on multiple joints of an individual archaeologically recovered in 2017.
MATERIALS
Skeletal remains of a well-preserved skeleton dating to the 12th-13th centuries from the medieval church of San Biagio in Cittiglio (Varese, northern Italy).
METHODS
Macroscopic and radiographic imaging.
RESULTS
Erosive marginal symmetrical lesions are present on the metatarsophalangeal, metacarpophalangeal and interphalangeal joints of an adult male, aged 55-75 years. Osteolytic changes, in the form of pocket erosions, surface resorptions and pseudocyst formations, are also macroscopically observed on some carpal and tarsal bones and on several large peripheral joints.
CONCLUSIONS
A careful differential diagnosis of the lesions and their macroscopic and radiological appearance is suggestive of a case of rheumatoid arthritis-like polyarthropathy.
SIGNIFICANCE
This case contributes to the debate regarding the antiquity of erosive polyarthropathies, providing additional evidence for the existence of these diseases in the Old World prior to the European discovery of the Americas.
LIMITATIONS
Small sample size limits discussion of the scope of the disease in antiquity.
SUGGESTIONS FOR FURTHER RESEARCH
This case highlights the need for further macroscopic, radiographic, and biomolecular studies of pre-modern European skeletal samples to investigate the hypothesized pre-existence of these pathological conditions in Europe prior to 1492.
Topics: Aged; Arthritis, Rheumatoid; Carpal Bones; History, Medieval; Humans; Italy; Male; Middle Aged; Osteoarthritis; Radiography; Skeleton; Tarsal Bones
PubMed: 30927654
DOI: 10.1016/j.ijpp.2019.03.002 -
Journal of Investigative Surgery : the... Jul 2020Vascular access ports (VAPs) are an essential tool for long-term vascular access in preclinical studies and disease modeling in non-human primates (NHPs). We...
Vascular access ports (VAPs) are an essential tool for long-term vascular access in preclinical studies and disease modeling in non-human primates (NHPs). We retrospectively reviewed central (inferior vena cava, IVC) and portal VAP implantation with the maintenance at our center from 15 January 2010 to 31 January 2018. In total, 209 VAPs were implanted for long-term drug administration and sampling. Patency was >95% at 6 months and >80% at 1 year for IVC VAPs and >90% at 6 months and >85% at 1 year for portal VAPs. The majority of animals had no complications and access was generally durable with device use ranging up to 7 years. In IVC, VAPs loss of patency occurred in 13% (0.035/100 d), surgical site infection in 2.9% (0.097/100 d), port pocket infection in 2.2% (0.004/100 d), erosion in 2.9%, 0.008/100 d), and mechanical failure in 4.3% (0.012/100 d). In portal, VAPs loss of patency occurred in 11.3% (0.028/100 d) and port pocket infection in 1.4% (0.003/100 d). About 12% of VAPs were removed as a result of complications.This study confirms VAP implant and maintenance is a beneficial and safe practice in NHPs resulting in favorable outcomes. High patency rates and low complication rates are comparable to the clinical setting. In addition to enabling comprehensive data collection, VAPs increase satisfaction and well-being by minimizing interference with daily routines and fostering cooperation. VAP implantation, together with an effective maintenance regimen and co-operative handling, is a reliable and convenient refined method for drug administration and blood sampling. Vascular access port; nonhuman primates; refinement; central vascular access; portal vascular access; surgical technique; experimental surgery; animal model.
Topics: Animal Welfare; Animals; Catheter-Related Infections; Catheters, Indwelling; Disease Models, Animal; Drug Evaluation, Preclinical; Endovascular Procedures; Female; Macaca fascicularis; Macaca mulatta; Male; Postoperative Complications; Retrospective Studies; Vascular Access Devices; Vascular Patency
PubMed: 30543131
DOI: 10.1080/08941939.2018.1536178 -
Journal of Cardiology Cases Aug 2018The number of implantations of cardiac implantable electrophysiological devices (CIEDs) has increased over the past several years. However, the aging population and...
The number of implantations of cardiac implantable electrophysiological devices (CIEDs) has increased over the past several years. However, the aging population and expansion of indications for CIEDs have led to an increase in associated infections. We experienced a case of a 99-year-old man presenting with skin erosion at the pocket site, where a 6-month-old implantable pacemaker was replaced. He was referred for pacemaker pocket infection and presented with fever accompanied by pain and swelling around pacemaker generator. We could not explant 7-year-old pacemaker leads and the patient refused to undergo either laser lead extraction or surgical removal. We planned to re-implant in the contralateral chest. However, the patient was emaciated with low body-mass-index (15.2 kg/m), thus concerns arose about the possibility of tissue disruption and re-infection owing to thin skin and absence of sufficient subcutaneous tissue in contralateral subclavian region. Axillary placement of CIEDs has been adopted in patients with limited venous access. We applied a mid-axillary pacemaker implant procedure to this elderly and emaciated patient. Postoperative clinical course was uneventful. After discharge, no history of unexplained fever or illness was recorded. Mid-axillary pacemaker pocket could be an alternative approach for re-implantation in patients with emaciated, cachexic, or limited pocket preparation. < We apply the mid-axillary pacemaker implant procedure to a nonagenarian with contralateral pacemaker infection to minimize the risk of skin disruption after implantation. This implies that implantation is possible in patients with emaciated or cachexic or infection of the contralateral subclavian pocket. Mid-axillary pacemaker pocket could be an alternative approach for re-implantation in patients with emaciated, cachexic, or limited pocket preparation.> .
PubMed: 30279914
DOI: 10.1016/j.jccase.2018.04.008 -
European Journal of Nuclear Medicine... Jan 2019F-FDG PET/CT is an emerging technique for diagnosis of cardiac implantable electronic devices infection (CIEDI). Despite the improvements in transvenous lead extraction... (Observational Study)
Observational Study
PURPOSE
F-FDG PET/CT is an emerging technique for diagnosis of cardiac implantable electronic devices infection (CIEDI). Despite the improvements in transvenous lead extraction (TLE), long-term survival in patients with CIEDI is poor. The aim of the present study was to evaluate whether the extension of CIEDI at F-FDG PET/CT can improve prediction of survival after TLE.
METHODS
Prospective, monocentric observational study enrolling consecutive candidates to TLE for a diagnosis of CIEDI. F-FDG PET/CT was performed in all patients prior TLE.
RESULTS
There were 105 consecutive patients with confirmed CIEDI enrolled. An increased F-FDG uptake was limited to cardiac implantable electrical device (CIED) pocket in 56 patients, 40 patients had a systemic involvement. We had nine negative PET in patients undergoing prolonged antimicrobial therapy (22.5 ± 14.0 days vs. 8.6 ± 13.0 days; p = 0.005). Implementation of F-FDG PET/CT in modified Duke Criteria lead to reclassification of 23.8% of the patients. After a mean follow-up of 25.0 ± 9.0 months, 31 patients died (29.5%). Patients with CIED pocket involvement at F-FDG PET/CT presented a better survival independently of presence/absence of systemic involvement (HR 0.493, 95%CI 0.240-0.984; p = 0.048). After integration of F-FDG PET/CT data, absence of overt/hidden pocket involvement in CIEDI and a (glomerular filtration rate) GFR < 60 ml/min were the only independent predictors of mortality at long term.
CONCLUSIONS
Patient with CIEDI and a Cold Closed Pocket (i.e., a CIED pocket without skin erosion/perforation nor increased capitation at F-FDG PET/CT) present worse long-term survival. Patient management can benefit by systematic adoption of pre-TLE F-FDG PET/CT through improved identification of CIED related endocarditis (CIEDIE) and hidden involvement of CIED pocket.
Topics: Aged; Defibrillators, Implantable; Endocarditis, Bacterial; Female; Fluorodeoxyglucose F18; Humans; Male; Mortality; Pacemaker, Artificial; Positron Emission Tomography Computed Tomography; Prosthesis-Related Infections; Radiopharmaceuticals
PubMed: 30196365
DOI: 10.1007/s00259-018-4142-9