Introduction: The prognosis of patients with Zenker`s diverticulum is dependent mainly on the type of procedure performed, either surgical or rigid/flexible endoscopy. Purpose - evaluation of the redo procedure by reviewing correlations in patients with iterative procedures. Material and Methods: We included in the study 36 patients with cervicomediastinal Zenker diverticula treated from 2010 to 2017 at two university hospitals: Clinic of General and Esophageal Surgery. Mary Clinical Hospital Bucharest and Department of Diagnostic and Interventional Digestive Endoscopy of the Regional Institute of Hepatology and Gastroenterology Prof. Dr. Octavian Fodor, Cluj-Napoca. For the patients included in the study we studied correlations of patients with symptoms persistence and to those with reintervention with epidemiological, clinical and the treatment criteria. Results: Postprocedural symptoms we observed in 5 patients of the 29 treated endoscopically and 6 of the seven treated surgically. Statistical correlations were noted in patients with persistent symptoms after surgical treatment (p <0.01) with patients with diverticulectomy (54.5%) (p <0.01), grade III diverticula (36.4%) (p <0.01) statistical association was noticed in patients who have required reoperation and those with persistent symptoms (63.6%) (p <0.01) and with remaining dysphagia (100%) (p <0.01) and those with grade 2 dysphagia persistence (71.4%) (p <0.01), grade 3 diverticula (42.9%) (p <0.03) and the high number of comorbidities. (p <0.04) Conclusion: Undoubtedly, endoscopic treatment is being used more and more even for those cases that require further treatment. Reoperation has been necessary for patients with persistent dysphagia with voluminous diverticula and a high number of comorbidities.
Introduction: Given fast grow and competition in the healthcare industry, managers and health activists in this sector need to adopt strategies for branding. The purpose of the study was to develop a conceptual model for branding in the healthcare industry to build brand advocacy and positive brand image. Methods: The study includes patients referred to a military hospital in May 2018. Data gathered by questionnaire, and 162 surveys were collected by simple random sampling method. To test the hypotheses, the conceptual model was analysed by structural equation modeling with SmartPLS® software. Results: The affective commitment and brand trust could predict brand advocacy. CSR significantly impacts brand image and affective commitment, furthermore brand attitude and COB significantly impact brand trust. There was no significant relationship between brand trust and affective commitment with brand image. Conclusion Organizations can improve brand image and establish brand support through investing resources on branding. This study contributes insights for marketing managers in developing successful branding strategies for health care organizations.
Fever of unknown origin (FUO) is a diagnosis that describes a prolonged febrile illness without an established cause, despite investigations. From the first definition of the medical condition (given by Petersdorf and Beeson in 1961) the diagnostic criteria have changed over time, intending to improve the management and outcome of these patients. The main causes of FUO fall into 4 categories: infectious, non-infectious (inflammatory), neoplastic and diverse causes. The etiology of FUO has changed over time, due to ever-changing disease patterns and the development of diagnostic techniques. A significant percentage of patients with FUO remain without an etiologic diagnosis, despite advanced diagnostic tests. Gathering potentially diagnostic clues through history, physical examination and nonspecific key paraclinical abnormalities is the basis for the diagnosis of FUO.
Background and Aim: Efficient manpower is the most important of military capital, and many studies have shown the relationship between personal health and organizational performance. The preparation of military cadet volunteers to enter aeronautical training and the provision of optimal services in the form of well-trained pilots requires many material spiritual resources that disabilities, make them waste. Methods: This is a descriptive, cross-sectional, retrospective study with target population of Iranian air force cadets with early and permanent medical disqualification from 1986 to 2016. Results: 80 cases were detected, including 25 kills and 55 early and permanent medical disqualification. The main causes were ear, nose and throat, psychiatry and cardiac, respectively. Common diseases include motion sickness, generalized anxiety disorder, adjustment disorder and epilepsy, respectively. The total number of lost service years was 1412 person years and the average of lost service years was 25.67 person years. Most of the lost service years were related to medical causes included ear, nose and throat, psychiatric and cardiac, and diseases included motion sickness, generalized anxiety disorder and adjustment disorder, respectively. Neurologic causes resulted in highest average of lost service years and high blood pressure was the major diseases, respectively. Conclusions: Due to the lack of similar studies, the results of this study were compared with the data, which extracted from previous studies in the pilot’s population. Because of occupational similarity between pilots and cadets, It was expected that the most common causes in pilots and cadets should be the same, but we found that the results are very different.
One of the most obvious trends in current prosthetic dentistry is the introduction of digital techniques. Of these, the techniques that offer the possibility of aesthetic prefiguration of the final prosthetic result are of particular interest to the dentist. The aim of this paper was to verify the applicability of the Digital Smile Design application, which is the most commonly, used aesthetic prefiguration application, an application designed for the dentate patient, to full edentulism. Two groups of full edentulous patients were formed: the first group, complete denture carriers, dissatisfied with the aesthetic aspects, that they wanted to improve in the new denture, and, the second group, newly bimaxillary full edentulous patients with high aesthetic expectations. Thus, on the first group, the tests were performed on the existing denture, and the second one with the maxillary occlusion template. However, the view of the final result offered the patients the chance to have a realistic picture of their desires regarding the shape, color, size of the teeth, which were inadequate in relation to age and facial typology. The use of this application also improves communication with the dental laboratory. In full edentulism, the current DSD technique can be used with some limitations and the use of it in this field needs more complex studies on larger groups of patients.
The pneumatization of all nasal turbinates is an extremely rare finding. Several previous reports have presented the bilateral superior, middle, and inferior conchæbullosæ. We report the bilateral pneumatization of middle and superior nasal turbinates. The variant was documented in cone beam computed tomography (CBCT) in all three dimensions. The inferior concha bullosa was a bilaterally moderate subtype of lamellar pneumatization that presented as a conchal recess of the maxillary sinus. The concha bullosa media was bilaterally of the extensive or true type and associated unilaterally with an uncinate bulla. The concha bullosa superior was asymmetrical bilaterally, narrower on the right side, and larger on the left where it was also septated and tri-cameral. The supreme conchæ were rudimentary, as were their pneumatizations. For an accurate anatomic diagnosis of conchæbullosæ in computed tomography, sagittal, coronal, and axial cuts, as well as three-dimensional reconstructions, should be used to ensure adequate planning of functional endoscopic sinus surgery.
Laparoscopic sleeve gastrectomy (LSG) is becoming popular between the bariatric procedures. There are few studies available in the literature about LSG impact on esophageal motility, with debatable results. Technically, it modifies the anatomy of the esophago-gastric junction; it can damage the phreno-esophageal ligament and decrease the lower esophageal sphincter pressure that will predispose to reflux. Gastroesophageal reflux disease (GERD) is already common in obese patients due to frequent hiatal hernia, high intraabdominal pressure, increased transient lower esophageal sphincter relaxations (TLESR), altered esophageal motility and poor esophageal clearance. LSG can worsen gastroesophageal reflux disease, but also the weight loss achieved after it and the decrease of acid production in the small gastric pouch will probably reduce the GERD symptoms. Dysphagia and odynophagia were reported after sleeve gastrectomy, but usually associated with anatomical narrowing of the gastric sleeve, caused by esophageal dismotility or secondary to diabetes mellitus, low tiamine level, the use of opioids and non-steroidal anti-inflammatory drugs, even hypothyroidism. In addition to upper GI tract endoscopy, high-resolution esophageal manometry (HRM) should be required for all patients planning to undergo a LSG, and in the follow-up period according to the contractility pattern.
Non‑melanoma skin cancer (NMSC) comprises squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and severalrare skin tumors (i.e., Extramammary Paget’s disease), being the most common malignancy-affecting people worldwide. Itrepresents the majority of skin cancers and a significant percentage of all malignancies. Despite increasing public awarenessand scientific interest, the incidence of NMSC is constantly increasing. Even though most NMSC`s are associated with lessaggressive behavior, they can still be invasive locally and cause extensive damage to neighboring structures, inducingsignificant morbidity. In addition, different types and subtypes of NMSC tend to have frequent recurrences and may have significantmetastatic potential. As a direct consequence, NMSC has become an important issue for healthcare systems with a significantsocio‑economic impact.
The “volatile” international context requires the strengthening of the national security measures, including in the field of CBRN and public health. The medical countermeasures for the defense are based ultimately on the prophylactic treatment (pre-exposure, intra-exposure and post-exposure) and on the curative treatment (of emergency, maintenance and recovery) of the contaminated and the sick. Depending on the rapid and correct etiological diagnosis, the appropriate treatment is immediately applied. Although in times of peace this scenario is almost non-existent, during war or terrorist attack it can be a mass pathology, like an explosive epidemic, that requires specific therapeutic means. Military medicine had and has the conceptual capacity to make antidotes for CBRN medical protection; some have been patented and/or produced as experimental models, but it has no manufacturing capacity anymore.
Background and Aim: This study aimed to investigate the expression level of Sine oculis homeobox homolog 1(SIX1) in normal and cancerous cervical tissues. Methods: Real-time PCR was used to evaluate SIX1 expression level in fresh surgically obtained cervical biopsies. Also, cervical specimens were tested for HPV DNA detection by MY09/11, GP5+/6+ nested PCR method. Results: The expression level of SIX1 mRNA in Cervical cancer was markedly higher than in normal cervical tissue (p<0.0001). Moreover, HPV DNA was detected in 100% of cases and 21.05% of controls (P<0.0001). Conclusions: This finding indicates that increased SIX1 expression might be of relevance to the pathogenesis of cervical cancer. Perhaps, studies to find agents that specifically target SIX1, develop novel anti-cancer and anti-metastasis drugs. This idea has to be investigated in future clinical studies.
