Obesity correlates with a higher risk of fractures in some sites as vertebras, upper arm, and legs. This is a narrative mini-review focused on several key points that link obesity with osteoporosis. Waist circumference may a better predictor of fractures than body mass index (BMI) in obese females. Even obese menopausal women have an extra source of estrogens in fat tissue this actually is not enough to offer a complete protection against osteoporotic fractures. Low levels of testosterone in males induce a higher risk of fall dependent or independent of sarcopenia (which is more evident in elderly). High BMI is correlated with vitamin D deficiency. Obesity is a contributor to muscle damage and decline due to fat accumulation and inefficient fuel utilisation by the muscle, namely sarcopenic obesity, regardless the age. Associated type 2 diabetes mellitus involves bone damage and fracture risk due to glycated proteins of the matrix, the changes of adipokines, increased cortical porosity, high risk of fall because of blood pressure and glycaemia anomalies, visual disturbances, renal and peripheral nerves diabetes-associated conditions etc. The fracture risk is also augmented via fat derived cytokines and chronic inflammation. Even it seems logical that the weight correction though bariatric surgery reduces the fracture risk in obesity, actually data from longitudinal studies pointed that, despite the procedure is life saving, it does not actually protect against osteoporosis which is regarded as a potential long-term complication. A high fracture burden in obesity should increase the level of awareness for practitioners of different medical areas due to multiple levels of complications and to the epidemiological impact of obesity.
Purpose: Cancers are one of the main causes of mortality in the world. The incidence of cancers in the world and mainly in developing countries is increasing. Due to the importance of this issue, the purpose of the current study was to assess the trend of incidence and death of Bladder Cancer among Iranian Military Community (MC) from 2007 to 2019. Methods: This is a cross-sectional study using time series data. All registered bladder cancer in Iranian Military community from March 2007 to February 2017 entered in this study. The future trend predicted using ARIMA (p,d,q) model. All analyzes were performed using ITSM and Excel (2010) software. Results: According to ARIMA (2, 2, 1) model, the bladder cancer among the Iranian military community had an increasing trend. The AR (12, 2, 0) model showed an increasing trend of this cancer among males but it seems the trend of bladder cancer among females will have a constant trend AR (12, 2, 1). The death due to bladder cancer was showed a decreasing trend using AR (14, 2, 1) model. Conclusion: In spite of decreasing trend in death due to bladder cancer, the trend of incidence of the Bladder cancer among the Iranian Military Community was increasing. However, it is necessary to adjust the effect of many factors that may have an important role in this trend.
The treatment of diseases is based on pharmacological and non-pharmacological means, but adequate devices are needed for their application. Medicine uses a wide range of medical devices. Currently, many medical devices are used, many of them being disposable. As recognition of the importance of medical devices, the national authority of the drug is the ANMDM (National Agency for Medicines and Medical Devices). Medical devices are indispensable for therapy, and their evolution has led to an extraordinary diversification of the field and the emergence of industry related to the pharmaceutical industry, with specific laws and regulations.
Background and Aim: Information on patients' experiences with and evaluations of health care is considered an essential outcome indicator to assess the quality of health care. This study aims to evaluate patient satisfaction with primary health care in a military setting. Methods: This cross-sectional study was conducted at the primary health care center located in a military setting, in Ankara, Turkey. A total of 3080 military personnel who received primary care in the last 12 months formed the population of the study. Turkish version of the European task force on patient evaluations of general practice care (EUROPEP) questionnaire was administered to the participants. Results: In the study, 2677 participants were reached with a response rate of 86.9%. The mean satisfaction rate (MSR) of clinical behaviour (69.3%) was higher than the MSR of the organization of care (58.4%). The MSR of the overall questionnaire was 67.1%. Significant differences were observed in the mean satisfaction scores of patients according to their descriptive characteristics including gender, age level, troop type, and the doctor providing the care. Conclusions: This study highlights the low patient satisfaction levels, which may have resulted from the fact that the study population was young and relatively healthy, and that there was no possibility of choosing the general practitioner. The EUROPEP questionnaire, which is an internationally validated and standardized instrument, can also be used to improve primary health care in military settings.
The pandemic called COVID-19 disease has an exponential course since the first cases were reported showing in 9th of May, 2020, more than 4 million cases of COVID-19. United States and European Council (EC), together with other European Union institutions, were closely monitoring the situation in order to take quick action. Objective: The aim of this article is to analyze the response to COVID 19 pandemic outbreak in term of strategy and money flow of Romanian health system in order to identify the strength and weakness and prepare for other similar provocative challenges. Global and national strategy: United States Government is delivering a comprehensive package of services to support international partners around the world in combatting this disease adding American expertise for global benefit, saving lives by improving international partners abilities to respond to the COVID-19, and reducing secondary impacts. Meanwhile European Union is focused on 6 major coordinates limit the spread of the virus, ensure and provide medical supplies, decrease negative economic impact, support jobs, promoting research and help European citizens to repatriate. Despite all negative elements a proper and relatively quick response of Romanian Public Health System was noticed and the taken measures were harmonized and synchronized with the European coordinates, prioritize initiatives, build an action plan, establish a communication plan, workforce optimization and management strategy. Conclusion: Global shock needs global response, with little or no government interventions, economic costs will be huge.
Background and Aim: Digital skills of healthcare professionals are recognized as critical for the successful digital transformation of healthcare. The present study aims to examine the relationship between the digital skills of healthcare professionals and the organizational structures of hospitals. Methods: In this cross-sectional study, using the convenience sampling method, 857 healthcare professionals, working in Greek military and civilian hospitals, voluntarily participated. Data were collected between July and November 2021 through a structured questionnaire, based on the Digital Competence framework. Digital skills were categorized into five subscales: information, communication, content creation, problem solving, and safety skills. Statistical analysis was performed with SPSS 26.0, with p-values 0.8, indicating high reliability. Younger participants showed higher scores (p<0.001). The mean scores for information, communication, content creation, problem solving and safety skills in military hospitals were calculated as 52.1 (SD=32.3), 50.6 (SD=31.8), 48.4 (SD=33.3), 49.8 (SD =30.8) and 52.8 (SD=34.1) respectively, while in civilian hospitals they were calculated as 45.1 (SD=32.2), 44.5 (SD=29.5), 41.8 (SD=32.4), 41.5 (SD=30.8) and 47.1 (SD=34.5) respectively. Conclusions: Healthcare professionals in military hospitals exhibit higher digital competence compared to their counterparts in civilian hospitals. Identifying the organizational factors that promote greater digital competence among healthcare professionals provides essential information to policymakers and healthcare managers for implementing targeted organizational improvements.
Background: Nonmelanoma skin cancers (NMSCs), including basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), often occur in high-risk areas like the face, ears, and scalp. Surgical excision is standard, but achieving tumor-free margins while preserving function and appearance is challenging. This study evaluates the adequacy of arbitrary surgical margins versus histopathological clearance. Methods: A retrospective analysis was conducted on 147 patients with BCC or cSCC in high-risk areas treated at Elias Emergency University Hospital (2020–2024). Data included demographics, tumor type, size, location, excision margins, and histological clearance. Margins were grouped from 0 mm to >10 mm. Results: Most patients were male (59.2%) with a mean age of 70.6 years. BCC accounted for 70.7% of cases. Arbitrary margins averaged 5.4 mm; mean histological margins were ~2.5 mm. Complete excision was achieved in 91.2%; positive margins were most common on the nose and scalp. Discussion: Arbitrary margins in high-risk areas are often narrower than guidelines recommend, especially where tissue is limited, increasing the risk of incomplete excision. Conclusion: While aesthetic and functional considerations often necessitate smaller margins, improved intraoperative margin assessment could enhance oncological outcomes in high-risk NMSC.
In this study, symptoms, functions, and outcomes of patients who underwent surgery with the diagnosis of Elastofibroma dorsi between 2007-2019 in our clinic were discussed retrospectively. A total of 19 patients were operated on with the diagnosis of Elastofibroma dorsi in our clinic. The demographic characteristics of patients such as age and gender, symptoms, clinical findings, diagnostic and radiological features, surgical procedures, results of surgical treatments, and postoperative follow-up results were evaluated based on the records. The mean age of patients who underwent surgery was 55.7 and there were 13 females and 6 males. The most common clinical complaint was swelling (61%). Seven of ED were located on the right side, 3 of them were located on the left side and 7 of ED were located bilaterally. The mass in all cases was over 5 cm in diameter, complete surgical excision was done via muscle-sparing technique. All patients were followed up postoperatively and there was no recurrence. ED should be considered in terms of differential diagnosis when middle-aged patients present with a mass in the scapular region and shoulder pain. Total excision is surgically sufficient in symptomatic patients.
All large armies (EU and/or NATO) have pharmaceutical production facilities to provide the necessary antidotes for the troops and the population: The French Army Medical Directorate produces many military-specific pharmaceutical products in its own laboratory, the Turkish Army owns its own medicines factory, including CBRN antidotes, the US Army, in addition to a sustained drug purchase program in the pharmaceutical industry has launched a new concept: Pharmacy on demand. Providing the armed forces with antidotes is a necessity, the concept for their endowement in this sense can be based on imports (sometimes impossible to achieve) or on the national development of a specialized production structure. The design or construction of a specific production capacity for antidotes can be accomplished on multiple variants, with a complexity proportional to the identified need. The total costs are high, but the objective and implementation of effective antidote supply mechanisms is a security guarantee for the armed forces and the civilian population (through commercialization to allied forces), given the risks of terrorist threats and hybrid warfare.
Peptide Nucleic Acids (PNAs) are nanostructures similar to nucleic acid molecules (synthetic DNA/RNA analogs) wherein the negatively charged backbone (sugar-phosphate) present in DNA/RNA molecules is replaced by a backbone without polyamide or peptide charge. Later, it was found that PNAs containing both purine and pyrimidine bases form highly stable duplexes with DNA and RNA. Although it is not as stable as 2PNA/DNA triplexes containing a homopyrimidine strand, it is still more stable than DNA/DNA and/or DNA/RNA duplexes. The unique characteristics of PNAs add new aspects to these nanostructures relative to conventional analogs to make them appropriate for molecular biology studies. The most important applications include the use of these nanostructures in the detection and treatment of diseases caused by threatening biological agents using the antisense/antigen technology and as genetic regulator drugs.
