Articles

From my desk I could be watching the wind blow or the horses running. Practicing Medicine in a rural setting has these advantages: from time to time you can take the time to admire the beauty that surrounds you in the form of an obligatory pause within a marathon working day, and rest helps refresh your mind of prejudices to continue with the inescapable task that awaits us after a few minutes, the only ones allowed to order our thoughts.

Basic control theory equations are developed showing conventional exponential system response of refraction vs. time R (t) with a characteristic system time constant, in response to a step change of near work environmental conditions. Details from preliminary experimental design using reading glasses at the U.S. Naval Academy at Annapolis are discussed. The conclusion is that (+) add lenses, used as reading glasses during study, can prevent the development of myopia for college students in pilot training.

Introduction: Serology (antibody) tests for the SARS-CoV-2 have been proposed as an instrument to inform health authorities about immunization during the COVID-19 pandemic. As there is a significant part of the population that may have some degree of immunity, it is of great interest to communicate the immunization results obtained in the first 500 healthcare workers (HCW), patients and relatives tested in a community-based Oncological Center. Materials and methods: Between April 9th, 2020 and May 8th, 2020, a group of healthcare workers (HCW), their families, and general public who had had the COVID-19 or had been in close contact with confirmed cases of COVID-19 were screened for IgG SARS-CoV-2 antibodies. The tests were carried out in a rigorous manner, strictly following the guidelines approved by the Spanish Ministry of Health (Ministerio de Sanidad). Results: The major objective of this study was to determine the proportion of asymptomatic infected individuals and those who had already secreted IgG against SARS-CoV-2 in our cancer treatment center or in the community of Barcelona. Patients were tested with PCR, Rapid diagnostic test (RDT) or enzyme-linked immunoabsorbent assay (ELISA). A total of 521 participants were tested, 206 with RDT and 315 with ELISA, 59 (11,32%) resulted positive to SARS-CoV-2. Conclusion: RDT and ELISA proved to be effective and sensible enough to determine the extent of SARS-CoV-2 immunization in a community-based oncological center. The degree of immunization reached is nowadays far away from what can be considered desirable for a herd immunization.

Aim: To compare the anatomical and functional outcomes of cataract surgery with manual small incision cataract surgery (MSICS) to those of extracapsular cataract extraction (ECCE) in Lome. Patients and Methods: A prospective study involved two groups of patients who underwent ECCE (group 1) and MSICS (group 2) by the same surgeon in the same conditions in different periods. Complications and visual results to the 45th postoperative day were compared. Results: At the 45th postoperative day, 60% of operated eyes of the ECCE group (G1) and 83.9% in the group of MSICS (G2) had uncorrected visual acuity greater than or equal to 3/10. Through the pinhole, these proportions increased to 73.3% for G1 and 92.2% for G2. Visual acuity was less than 1/10 in 4.4% for G1 and 1.1% for G2. The vitreous loss was observed in proportions of 3.8% for G1 and 3.3% for G2. During follow-up, the three main early postoperative complications were inflammation (13.9%), corneal edema (13.3%), and the pigment dispersion (7.2%) in G1 and corneal edema (9.4%), pigment dispersion (8.3%) and hypertonia (6.6%) in G 2. Conclusion: Two cataract extraction techniques offer the same level of safety in intraoperative period. However, MSICS has certain advantages over the ECCE and would be an alternative technique in developing countries.

Rhabdomyosarcomas are the most common soft tissue tumors of childhood. They are characterized by their poor prognosis. Vaginal location is very rare after puberty and exceptional in the post menopause. Treatment is based on several therapeutic measures combining neoadjuvant chemotherapy followed by surgery and/or external beam radiation therapy. We report herein the case of a 25 years-old woman, presented with vaginal embryonal RMS revealed by metrorrhagia and pelvic pain. The diagnosis was confirmed by biopsy and histopathological study. Pre-treatment workup was negative for metastatic disease. She has received chemotherapy based on vincristine, doxorubicin, and cyclophosphamide. The clinical evolution was marked by improvement of symptoms, unfortunately the patient died following febrile neutropenia after the third cycle of chemotherapy.

Inferior vena cava (IVC) involvement by intraluminal extension of tumor is infrequent, occuring in 4% to 10% of patients with renal cell carcinoma (RCC) [1-5]. Based on the cephalic extension of the thrombus, Mayo [6] described a classification of inferior vena cava thrombi in 4 categories, which has implications on surgical complexity, estimated blood loss (EBL) and peri-operative complications, but not cancer-specific survival [2,7]. Level III IVC thrombus is classified as being located in the retro-hepatic IVC below the diaphragm. Total resection of this tumor is the best chance of cure when no distant metastases are present [4,8]. Actually, open radical nephrectomy with concomitant thrombectomy is still the standard treatment. This procedure is technically challenging and involves a large incision and prolonged convalescence [9]. Recently, the feasibility of robotic IVC thrombectomy has been demonstrated, with potential lower EBL and shorter hospitalization and convalescence [7,10-14]. This surgery requires thorough knowledge of surgical anatomy, detailed pre-operative preparation and meticulous robotic technique [7]. The key point in the surgical management is the correct assessment of the extension of the endocaval thrombus, what is mainly based on radiological examinations [8]. Although Ultrasonography (US) and computerized tomography (CT) are useful in demonstrating the extent of the thrombus, CT is not always accurate in delineating the superior margin of the tumor in the IVC. More precisely, magnetic resonance imaging (MRI) can demonstrate a tumor thrombus and its extension, besides signs of wall invasion, being extremely useful to surgical procedure planning [8,15]. Vena cavography is not additive to US, CT, and MRI, and it increases the risk of contrast-associated renal injury [4,8]. However, new modern image technologies has emerged to help surgical planning, as three-dimensional visualization technique (3DVT) based on routine CT or MRI processed image data [16-20]. Recently, a comparative study showed advantage of 3DVT in management of complex renal tumor during laparoscopic partial nephrectomy [20]. This modality is able to demonstrate anatomy relations, allowing the surgeon to observe the relationship between targeted tumor and peripheral structure before surgery and perform virtual manipulation. This kind of preoperative accurate assessment can enhance surgeons confidence of surgical procedure and decrease surgical risk and incidence of complications [20]. There is no report in the literature of the use of this type of technology in cases of IVC tumor thrombus. We present the use of 3D holographic interactive reconstruction in a single case of robotic radical nephrectomy with level III IVC thrombectomy.

The study attempted to answer several questions: Does the cultural and social background of immigrant youth from the Former Soviet Union (FSU) affect their use of addictive substances? Do these youth show distinctive patterns of drug and alcohol abuse? Do the addictive substances used by these teenagers share similar characteristics? Are the patterns of drug abuse and alcohol abuse different? Do students in different educational frameworks demonstrate different consumption patterns? Can “critical moments” explain the presence or absence of alcohol and drug abuse?

The surgical treatment of prostate cancer (PCa) had as its initial milestone the first prostatectomy, performed by H.H. Young at the Johns Hopkins Hospital, in 1904 [1], however, the procedure only reached a fundamental role after 1982, based on a better understanding and description of the male pelvic anatomy, by Walsh [2-6] and other [7-11]. Subsequently, minimally invasive approaches emerged: laparoscopic prostatectomy (1992) [12] and robot- assisted laparoscopic prostatectomy (RALP) (2000) [13], which modified and optimized the execution of key surgical steps of this procedure, such as bladder neck preservation, nerve-sparing dissection, and prostate apex management [14].

Global drug use has reached epidemic levels, with approximately 269 million drug users worldwide [1]. Problematic drug use may lead to serious physical, social, and mental health problems. An estimated 167,000 deaths attributed to drug-related disorders worldwide in 2017 [2]. The rising global drug use and its severe adverse consequences make the drug treatment/rehabilitation a top priority for policymakers. In modern China, illicit drug use has raised great concern from both the academia and the public. Nearly 2.15 million Chinese were registered as drug users in 2019 [28]. Drug-related crimes and deaths are also increasing [29]. The current drug treatment programs in China are mainly compulsory, addressing coercion and discipline. However, the effectiveness was found to be low [3]. Situated in the fields of social work, public health, and psychology, Chinese scholars and practitioners have conducted some empirical tests for these drug treatment/rehabilitation programs and already found several effective preventive factors in the programs. However, the existing research on the design and evaluation of Chinese drug treatment/rehabilitation programs rarely investigate the theoretical rationales behind these programs. This study would address three criminological theories that have been applied to explain drug treatment and rehabilitation in Western societies: Differential Association Theory, Social Bonding Theory, and Labeling Theory. Similar theoretical rationales could be learnt and adopted by Chinese programs. 

Background: Epidemiological studies in smokers indicate a dose-response relationship between the number of cigarettes smoked per day and the risk of developing certain smoking related diseases. The alkaloid nicotine is the major pharmacologically active substance in tobacco. Objective: To estimate the cotinine level excretion in urine among smoked and smokeless tobacco users and nonsmokers among the Indian population. Materials and methods: The study sample consisted of 250 subjects who were apparently healthy, asymptomatic and not using any drug. The study sample was divided into smoked tobacco users (bidi and cigarette), smokeless tobacco users, both smoked and smokeless tobacco users and controls (non-users of tobacco in the past or present). Results: The mean Cotinine level in urine was significantly (p – value < 0.05) more among smoked tobacco users in comparison to smokeless tobacco users and non-users of tobacco. Whereas, the mean Cotinine level in urine was significantly (p – value < 0.05) more among smokeless tobacco users in comparison to non-users of tobacco.