Journal of Surgery and Trauma
Volume:7 Issue: 4, Winter 2019

"Beauty has so many forms, and I think the most beautiful thing is confidence and loving yourself" Kiesza Beauty has classically been considered amongst the definitive values, goodness, justice, integrity, and loyalty. Beauty, cutaneous body image, quality of life, self-esteem, and self-confidence are intertwined together (1-2). Life quality consists of a feeling of joyance and satisfaction with life. However, life quality, self-esteem, and self-confidence in patients with dermatoses have not adequately been attended to so far. As regards, dermatoses affect general health, well-being, and social adaptation of the individual (3-5). In a study, the majority of the female patients who were candidates for Bariatric Surgery declared high body image concerns (6). Modern cognitive approaches to Body Dysmorphic Disorder suppose that appearance-related intrusive cognitions and their functional outcomes determine the disorder (1). The Body Dysmorphic Disorder is a common debilitating disease worldwide. Patients manifest a disabling preoccupation with a few perceived defects, frequently well-marked by poor insight or delusional thoughts (2-7). According to the results of a study, rhinoplasty candidates reported high body image concern (8). Accurate interviewing of the patients who are candidates for rhinoplasty is very important to evaluate their level of body image concern in order to diagnose any available disease and prescribe required treatments (8). More and more people worldwide are using hyaluronic acid injections for skin rejuvenation and better cutaneous body image and self-esteem (5- 7). Cosmetic injectable treatments are progressively common. However, a few studies have investigated modifications in psychosocial functioning following these procedures (9). Some studies were performed to evaluate changes in cutaneous body image, self-esteem, and life quality following cosmetic injectable procedures with neuromodulators and soft tissue fillers (9). Cosmetic injectable treatments associated with an increase in body image satisfaction. Further investigation using modern cosmetic surgery-specific devices can supply new insights into the psychosocial advantages of cosmetic injectable treatments (9). Millions of cosmetic and surgical procedures of the face are administrated each year; however, objective clinical criteria that assess surgical procedures, such as complication rates, have limited efficiency when applied to cosmetic procedures. While there might be subjective improvements in cutaneous body image, it is very important to assess if these procedures have an effect on patients in other domains, such as psychosocial functioning (10).

Goal directed therapy (GDT) is a method aiming at optimizing doses and timing of fluids, inotropes and vasopressors, through monitoring of cardiac output and other basic hemodynamic parameters. Several meta-analyses confirm that GDT can reduce postoperative complications in high risk patients, and a recent trial suggests its significant effect also in low-moderate risk patients. The aim of the present meta-analysis is to investigate the effect of GDT on postoperative complications, in both high and low risk patients. Moreover, we stratified the effect of GDT in different kind of surgical procedures.

Randomized controlled trials (RCTs) on perioperative GDT in adult surgical patients were included. The primary outcome measure was complications, defined as number of patients with a least one postoperative complication. A subgroup-analysis was also performed including RCTs with a mortality rate in control group <10%, and considering the kind of surgery: major abdominal (including also major vascular), only vascular, only orthopedic surgery and so on. Meta-analytic techniques (analysis software RevMan, version 5.3.5, Cochrane Collaboration, Oxford, England, UK) were used to combine studies using odds ratios (ORs) and 95% confidence intervals (CIs).

In 47 RCTs, 2329 patients developed at least one complication: 1030 out of 2781 (37%) were randomized to perioperative GDT, and 1299 out of 2772 (47%) were randomized to control. Pooled OR was 0.58 and 95% CI was 0.47-0.70. The sensitivity analysis confirmed main result. The subgroup analysis including only studies in which the mortality rate in the control group was higher than 10% showed significant results (OR 0.51, 95% CI 0.35-0.74, p=0.004, 10 RCTs), as well as a statistical significant effect was observed in those RCTs with a mortality rate in control group <10% (OR 0.59, 95% CI 0.47-0.74, p<0.0001, 37 RCTs). The subgroup analysis enrolling major abdominal patients showed a significant result (OR 0.69, 95% CI 0.57-0.83,p <0.0001, 29 RCTs, 3881 patients) as well as a significant effect was observed in those RCTs enrolling exclusively orthopedic (OR 0.48, 95% CI 0.30-0.79,p=0.004, 6 RCTs, 501 patients) and neurosurgical procedures (OR 0.40, 95% CI 0.21-0.78, p=0.008, 2 RCTs, 208 patients).

The present meta-analysis suggests that GDT can reduce postoperative complication rate in high risk as well as in low risk patients. Moreover, the beneficial effect of GDT on postoperative morbidity is significant on major abdominal, orthopedic and neurosurgical procedures. However, heterogeneity was found in some subgroups, reducing the strength of the results. Several well-designed RCTs are needed to further explore the effect of GDT in low risk patient and in different kind of surgeries.

Hemorrhoids can be managed by means of several therapeutic options. Regarding this, it is of fundamental importance to identify the hemorrhoidectomy method with fewer complications (e.g., bleeding, pain, and postoperative infections) or beneficial outcomes (e.g., accelerated speed of wound healing and resumption of normal life activities). Such knowledge can play a significant role in the advancement of medical and educational goals. Therefore, the present study was conducted to compare the clinical results of Milligan-Morgan surgery and hemorapy device in the treatment of patients with hemorrhoids.

This prospective study was conducted on 60 patients aged over 20 years with hemorrhoids referring to Bahonar and Afzalipour hospitals of Kerman, Iran, and diagnosed to need surgery by a surgical specialist. The study population was selected using a simple randomization method and then allocated into two groups of A and B, regardless of gender. Group A was operated by open or Milligan-Morgan technique, while group B was subjected to the hemorapy method. After the surgery, the patients’ data were recorded in specific forms and analyzed by SPSS software (version 21).

Out of 60 patients with hemorrhoids, 37 (64%) cases were male. Regarding the severity of hemorrhoids, 19 (32%) and 41 (68%) patients had fourth-degree and third-degree hemorrhoids, respectively. The mean age of the patients was 35.86±12.84 years. Four weeks after the surgery, the mean pain scores of the patients in the Milligan-Morgan and hemorapy groups were 3.67±1.84 and 1.67±1.35, respectively, showing a statistically significant difference (P=0.001). However, 8 weeks post-surgery, no pain, bleeding events, urinary retention, or incontinence were observed in the patients, except for anal stenosis in two patients treated with the Milligan-Morgan method.

According to the results, the hemorapy method resulted in lower postoperative pain than the Milligan-Morgan method. In addition, the hemorapy technique was accompanied by considerably fewer complications, such as bleeding, urinary retention, gas incontinence, and stenosis, compared to the Milligan-Morgan method. Consequently, the hemorapy method can be recommended for hemorrhoidectomy.

Amputation operations are rare in children and are often performed in emergencies as lifesaving procedures or in elective cases resulting from congenital limb deficiencies. This study aimed to retrospectively examine the pattern of trauma-related amputations among children in Ghana.

Hospital records of the children aged 16 years and younger who underwent trauma-related amputations during May 2015-September 2018 were assessed retrospectively. The data were analyzed using the SPSS software version 24 (IBM, Chicago, USA). Descriptive statistics were used to report the means and frequencies.

A total of 34 children had amputation surgeries during the study period. Our findings showed that 5.9% (n=2) of the subjects were female and 94.1% (n=32) were male. Falls as the leading cause accounted for 50% (n=17) of the injuries, followed by personal or interpersonal violence 23.5% (n=8), road traffic accidents 14.7% (n=5), machinery 5.9% (n=2), and birth injuries mainly related to the accidents during child delivery 5.9% (n=2). At the onset of injury, 61.8% (n=21) of the children were taken to hospitals as the first point of call, while 38.2% of the cases (n=13) first referred to bonesetters. According to the records, upper limb amputation 70.6% (n=24) was more frequent than lower limb 29.4% (n=10).

A record of thirty-four trauma-related amputations among children over a period of 3.5 years in a single treatment center is remarkable. The living environment of children could predispose them to catastrophic incidents leading to amputations. Therefore, strategies for injury prevention should be developed taking into consideration the contextual factors.

Root canal treatment, including pulp removal, mechanical and chemical cleaning, and canal filling is an important part of a dentist's job. This study aimed to evaluate the quality and success rate of root canal therapy performed by dentistry students in the Department of Endodontics, School of Dentistry, Birjand University of Medical Sciences, Birjand, Iran.

This retrospective study was conducted from 2014 to 2017. In total, 62 students were randomly divided into two equal groups of males and females. For each tooth, four radiographs, including the periapical images of the initial radiograph, master apical file, master cone, and final obturation radiographs, were reviewed under the supervision of an endodontist. The investigated technical errors included transport, ledge, perforation, underfilling, overfilling, and presence of void and broken instrument. Data were analyzed in SPSS software (Version 22). A P-value less than 0.05 was considered statistically significant.

According to the results, only 79.3% of the students committed at least one type of root healing error, and there was no significant difference between males and females regarding the overall prevalence of error (P=0.12). However, errors, such as underfill, broken instrument, and transport were more common among males; moreover, void and perforation errors were slightly more prevalent among females. It should be noted that this difference was not statistically significant.

The results of the present study can help identify the weaknesses of treatment in order to improve the quality of root canal treatment, especially regarding student gender in the School of Dentistry affiliated to Birjand University of Medical Sciences, Birjand, Iran.

The reform in medical records processes is recognized as one of the effective measures implemented for reducing insurance deductions. The present study aimed to evaluate the effect of outsourcing the medical records unit on the insurance deductions in Qazvin Trauma Center within 2013-2018.

The present study was a descriptive and analytical study which was conducted in Qazvin Trauma Center. The intervention variable was the performance of the outsourcing plan in the medical records unit. Changes in the level and trend of basic insurance deductions before and after outsourcing were at the significance level of 0.05 using the independent t-test and segmented regression model in Stata software (version15).

The percentages of deductions before and after performing the outsourcing contract were measured at 0.038±0.112 and 0.194±0.068 for the health insurance (P <0.001), respectively. These values were reported as 0.077±0.028 and 0.031±0.126 for the social security insurance (P<0.001), respectively, and they were obtained at 0.105±0.060 and 0.124±0.087 for the armed forces insurance (P=0.369), respectively. Finally, for the relief committee insurance, these percentages were reported as 0.154±0.078 and 0.183±0.080 (P=0.209), respectively.

As evidenced by the obtained results, the level of y-intercept increased in all observations after outsourcing. Therefore, it can be concluded that outsourcing the services of the records unit did not directly affect the insurance deductions and the insurance deductions can be attributed to some other reasons, apart from the outsourced tasks.

Car accidents are the most common accidents and one of the major health problems endangering the health of society. In fact, they are predictable and preventable events that can cost lives and money. The identification of the factors that influence these events can help control and reduce them. The present study aimed to identify the effective factors in the occurrence of road accidents in West Azerbaijan, Iran, during 2010-2016.

All the traffic accident data recorded by the traffic police of West Azerbaijan during 2010-2016 were used in this cross-sectional study. The data were analyzed descriptively by the Chi-square test and analytically using SPSS software (version 16) and time series using Minitab (version 17).

The data of 79,296 registered accidents were included in the study. Most accidents were reported among males (93.9%) and high school education holders (56%), during 12-18 p.m. (39%) and the day (62%), by light vehicle (65%), disregarding longitudinal and transverse distance (63%), and resulting in damage (53%).

There was a higher frequency of traffic accidents among male drivers holding a diploma. Further investigations are required to determine the contribution of each of the risk factors and plan for the prevention of accidents.

The Dentigerous cyst which is the most common developmental cyst of the jaw forms around the crown of an unerupted or supernumerary tooth. This case report demonstrates the treatment of a large inflammatory dentigerous cyst caused by an abnormal supernumerary tooth and the subsequent irreversible pulpitis affecting the four maxillary teeth.