A prospective interventional study of intra-caesarean copper intrauterine contraceptive devices insertion in a teaching hospital in a rural medical college in Telangana, India

Background: Providing quality contraceptive services to women is essential for achieving maternal and child health. Objective of this study was to evaluate the efficacy of intra-caesarean insertion of copper IUCDs as postpartum contraception. To study the side effects of intra caesarean copper device. To study the continuation rates of intra-caesarean copper IUCDs. To study the acceptability of intra-caesarean copper IUCD as immediate postpartum contraceptive.Methods: The prospective study was undertaken at Bhaskar medical college and general hospital, Yenkepally, Moinabad, Telangana, between January 2016 and March 2018 after ethical committee clearance. About 60 pregnant women were enrolled into the study after an informed written consent regarding the procedure, benefits and complications and the need for follow up for at least one year. Copper T 380A/multiload copper 375 was inserted into the uterine cavity after delivery of the placenta and membranes during caesarean section. Patients were followed up at 6 weeks, 6 months and one-year intervals for any complaints, visibility of threads and for ultrasound examination for position of copper IUCDs in the uterus. Data analysis was done using Microsoft excel 2016.Results: Nearly 48.33% continued intra-caesarean copper IUCDs for more than 1 year. 70% did not have any complaints. 86.67% came for more than one follow-up visit. 47% had copper IUD threads visible by one year. No case of perforation either during insertion or during continuation was noted. None conceived with copper IUCD in situ. Removal of copper IUCD was also easy and none required hysteroscopic removal.Conclusions: Intra-caesarean copper IUCD insertion is a safe and effective long acting reversible contraceptive method in the postpartum period.

Comparison Of The Force Deterioration Of Different Orthodontic Elastomeric Materials In Artificial Saliva: An In Vitro Study

The orthodontist must be able to choose an elastic band with force-extension characteristics that are most suitable for the particular tooth movement required. From a clinician view it would be mandatory not only to know the clinical aspect of these elastics but also their basic properties, in order to extract the most out of these polymers. Stretching of elastics are thought to be the primary cause of force degradation of orthodontic elastics but there is evidence of in-creased force degradation of elastics when exposed to various types of substances like artificial saliva, phosphoric acid and citric acid. Orthodontic elastics have received mixed reactions of practitioners as reported by the vendors of ortho-dontic supplies. The present study is designed to compare the force deterioration of different orthodontic elastomeric materials in artificial saliva medium. There was a force deterioration over time in all materials, being greatest on the seventh day of the experiment, especially more in the chains; From the third to the fourth week there was no noticea-ble force degradation in either group; By the end of the experiment, modules showed less deterioration of the force compared to the chains and threads.

Uso exclusivo de fios absorvíveis em fendas labiopalatais / Exclusive use of absorbable suture threads in cleft lip and palate

INTRODUÇÃO: O tratamento de fendas labiopalatais tem etapas que podem trazer traumas psicológicos consideráveis aos pacientes e familiares. O uso de fios absorvíveis pode eliminar um destes momentos desconfortáveis. Contudo, a utilização exclusiva deste tipo de material de síntese ainda não é a preferência de todos os cirurgiões, principalmente em planos musculares. MÉTODOS: Levantados os dados dos pacientes operados no Hospital Universitário da Universidade Federal do Rio de Janeiro, submetidos à correção de fendas labiais ou palatais, nas quais foram utilizados somente fios absorvíveis (poliglecaprona 25 - Monocryl® ou poliglactina 910 - Vicryl Rapide®) em todos os panos de sutura (mucosa, músculo, pele). O período avaliado foi de 2007 a 2014. RESULTADOS: Encontramos 360 pacientes que se enquadraram no estudo. Não observamos diferenças quanto ao aspecto local das feridas durante o processo de absorção dos fios. A incidência de deiscências ou fístulas se manteve abaixo de 1% e não houve complicações relacionadas ao objetivo do estudo. As cicatrizes não se mostraram, a longo prazo, diferentes das obtidas com o uso de fios inabsorvíveis, utilizados em outros tipos de cirurgias. CONCLUSÕES: O uso exclusivo destes fios absorvíveis se mostrou uma opção eficaz e segura. Proporcionou cicatrizes de boa qualidade, força tênsil adequada (mesmo em planos musculares) e não observamos complicações relacionadas ao processo de absorção dos materiais empregados.

INTRODUCTION: The treatment of orofacial clefts comprises steps that may result in considerable psychological trauma for patients and their caregivers. The use of absorbable sutures may help to eliminate these uncomfortable situations. However, the exclusive use of this synthetic material is still not preferred by surgeons, particularly in the muscle planes. METHODS: Data from patients who underwent surgery at the University Hospital of the Federal University of Rio de Janeiro from 2007 to 2014 were used. The patients underwent correction of cleft lip or palate, using only absorbable sutures (poliglecaprone 25 - Monocryl® or polyglactin 910 - Vicryl Rapide®) in all suture planes (mucosa, muscle, skin). RESULTS: We found 360 patients who met the inclusion criteria for this study. We did not observe differences in terms of the local appearance of the wounds during the suture absorption process. The incidence of dehiscence or fistula cases was below 1%, and there were no complications regarding the objectives of the study. In the long term, the scars did not differ from those obtained with non-absorbable sutures used in other types of surgeries. CONCLUSIONS: The exclusive use of absorbable sutures was shown to be an efficient and safe option. These resulted in good quality scars and adequate tensile strength (even in muscle planes), and we did not observe complications related to the absorption process of the material used.

Wandering intrauterine contraceptive device: An unusual travel to the sigmoid colon

Intrauterine contraceptive device (IUCD) is common choice for contraception. Migration of IUCD is one of the complications that are encountered. Here we report a case of IUCD migration to the sigmoid colon. A 39-year-old Malay lady carrying a copper T type of IUCD presented with missing thread then underwent examination under anaesthesia, proceeded to hysteroscopy but failed removal. Abdominal ultrasound detected it in the left lower quadrant of abdomen. She then underwent diagnostic laparoscopy where the device was found to be embedded in the sigmoid colon. Technical difficulty necessitated conversion to mini laparotomy and sigmoidotomy to remove the IUCD and the bowel closed primarily. IUCD is a relatively simple and safe contraceptive procedure but possible complications are bleeding and pain that usually co-exist, pelvic infection, expulsion and perforation. Investigations should be based on clinical suspicion and migrated IUCD in symptomatic patients should be surgically removed whereas, asymptomatic patients can be managed conservatively under certain circumstances. However in the presence of a concurrent pathology that requires exploration then retrieval of the migrated IUCD should be undertaken.

Análisis de los procesos centrados al paciente en el área de radiología: Un enfoque orientado al modelado de procesos de negocio / Analysis of processes centered to the patient in the radiology area: An approach oriented to modeling business processes

En los últimos años se han desarrollado herramientas para el modelado de procesos que fueron diseñadas en un principio para el ámbito industrial y que hoy en día aún no han sido ampliamente aplicadas en el medio hospitalario. En este trabajo se presenta el análisis de los procesos de atención a pacientes ambulatorios y hospitalizados atendidos en el servicio de radiología del Instituto Nacional de Rehabilitación de la Ciudad de México, mediante la aplicación del modelado de procesos de negocio BPMN el cual mostró a través de índices de flujo de trabajo que la duración de los procesos a los pacientes de urgencias (7.87±4.50 min/estudio) fue menor en comparación a la atención a los pacientes de estudios especiales (53.69±13.12 min/estudio); así mismo se calcularon los tiempos de utilización de la tecnología médica radiológica y se mostró la secuencia de actividades del personal involucrado en los procesos. Además, fue posible identificar las variables que influyen en la realización de estudios radiológicos (edad y condición física) siendo la edad la más estadísticamente significativa en la realización de estudios de urgencias (p = 0.004). La aplicación de BPMN en los procesos de salud brinda una herramienta de apoyo a la mejora continua, a la optimización de los recursos e identificación de los elementos limitadores en los procesos de atención a los servicios médicos.

In recent years, a set of tools for processes modeling have been developed, that was originally designed for the industrial environment, and that up to date has not been widely applied in healthcare environment. This paper presents the implementation of the processes analysis of outpatients and inpatients care attended in the radiology department of the National Institute of Rehabilitation in Mexico City, applying the business processes modeling notation (BPMN), which showed through the use of workflow indexes, that the attention processes duration for emergency patients (7.87±4.50 min/study) was lower when compared to the special studies patients (53.96±13.12 min/study), as well as the using time of medical radiological technology and the sequence of activities of the personnel involved in the processes. In addition, it was possible to identify the variables that influence the realization time of radiological studies (age and physical condition), being age the one with the greatest statistical significance for the realization time of emergency studies (p = 0.004). The application of BPMN in health processes provides a supporting tool for continuous improvement, resources optimization and identification limiting factors in the processes of care medical services.

Materiales de sutura quirúrgico / Surgical suture materials

Se realizó una revisión bibliográfica sobre el tema Materiales de sutura quirúrgica, tanto nacional como internacionalmente, tratando de encontrar la información más actualizada posible, tomando como base un trabajo publicado en una revista nacional en el año 1990 y una revisión bibliográfica nuestra presentada en el hospital Amalia Simoni en 1995. Se revisaron los materiales informativos de algunas casas comerciales y a partir de aquí, se expusieron las clasificaciones conocidas con los productos que la conforman y se ofrecieron las características del producto comercial y del fabricante. Se señalaron las ventajas de los materiales de sutura de origen sintético sobre los naturales que van siendo desplazados en su utilización y preferencia. Existe el interés de ayudar a mejorar el conocimiento sobre este tema a los profesionales de la salud, personal paramédico y en formación al igual que a médicos veterinarios.

A bibliographical review on the topic of surgical suture material, so much national as internationally, trying to find the most up-to-date possible information, taking as base a work published in a national magazine in the year 1990 and a bibliographical review of ours presented in Amalia Simoni hospital in 1995. The informative materials of some business houses are reviewed and starting from here, the well-known classifications are exposed with the products that compose it and offering the characteristics of the commercial product and the manufacturer. The advantages of the suture materials of synthetic origin are pointed out on the natural ones that are displaced in their use and preference. It encourages us the interest of helping to improve the knowledge on this topic to the health professionals and in formation, paramedic personnel as well as to veterinary doctors.

Clinical, histologic, and histometric evaluation of implants with microthreaded crest module and SLA surface / 대한치주과학회지

BACKGROUND: Crestal bone loss known as saucerization is a frequently observed phenomenon. Recent studies have shown that implants with micothreaded crest module reduced the force concentration in the crestal region thus resulting in no or reduced crestal bone loss. This study presents a clinical, histologic, and histometric evaluation of implants with microthreaded crest module and SLA surface. METHODS: The implants were placed in the mandible of 5 beagle dogs weighing 10-15kg. Four premolars were bilaterally extracted 8 weeks prior to implant placement. Mucoperiosteal flap was elevated and drilling with increasing diameter was performed under saline irrigation. After countersinking 2 implants were placed in each side resulting in 4 implants per dog. Healing period of 8 weeks was allowed before sacrificing the animals. Histologic preparation was performed for histologic and histometric analysis. Bone to implant contact as well as percentage of bone area inside threads were measured. T-test was used for statistical analysis with pvalue p<0.05. RESULTS: 1. Healing was uneventful without any cover screw exposure. New bone formation around the implants was observed without any inflammatory infiltration. 2. Bone to implant contact in the microthread and thread were 43.90 +/- 20.30 %, and 53.19 +/- 20.97 % respectively. The overall bone to implant contact was 48.54 +/- 20.95 %. 3. Percentage of bone area inside threads were 54.43 +/- 10.39 %, and 38.44 +/- 16.44 % for the microthread and thread respectively. There was statistically significant difference(p<0.05). The overall percentage of bone area inside threads was 46.67 +/- 15.68 %.

Removal Torque and Histometric Evaluations of Implants with Various Area of Hydroxyapatite Coating Placed in the Rabbit Tibia / 대한치주과학회지

BACKGROUND: This study presents a biomechanical and histometric comparison of bone response to implants with various area of hydroxyapatite(HA) coating. METHODS: The implants were placed in the tibia of 10 rabbits weighing 2.5-3.5kg. The control group had a machined surface, the experimental group 1 had 50micrometer thick HA coated in a band form, and the experimental group 2 had 50micrometer thick HA coated on the entire surface. 8 weeks after implantation, the animals were sacrificed. Removal torque was measured and histologic preparation was also performed for histologic and histometric analysis. Bone to implant contact as well as percentage of bone area inside threads were measured. ANOVA post hoc, and t-test were used for statistical analysis with p-value p<0.05. RESULTS: 1. The removal torques were 9.36 +/- 5.64 Ncm, 48.40 +/- 16.66 Ncm, and 82.37 +/- 22.56 Ncm for the control, exp. 1, and exp. 2 group respectively. Statistically significant difference were found among all the groups(p<0.05). 2. Bone to implant contact in the cortical bone were 38.94 +/- 10.9 %, 66.90 +/- 14.1 %, 73.00 +/- 19.4 %, in the marrow bone, 8.30 +/- 5.4 %, 14.59 +/- 5.9 %, 18.54 +/- 11.8 %, and in total, 22.40 +/- 10.1 %, 31.19 +/- 7.5 %, 41.41 +/- 12.2 % for the control, exp.1, and exp. 2 group respectively . In the cortical bone, exp. 1, and exp. 2 group showed statistically significantly higher contact compared to control group. Total contact and in the marrow bone, only exp. 2 group showed statistically significantly higher contact compared to control group(p<0.05). In all the groups significantly higher contact were observed in the cortical bone compared to the marrow bone(p<0.05). 3. Percentage of bone area inside threads in the cortical bone were 55.68 +/- 7.25 %, 55.19 +/- 13.19 %, 57.04 +/- 13.33 %, in the marrow bone, 12.34 +/- 14.61 %, 17.56 +/- 20.04 %, 20.26 +/- 12.83 %, and in total, 30.30 +/- 12.46 %, 31.57 +/- 15.15 %, 34.25 +/- 12.56 % for the control, exp.1, and exp. 2 group respectively. There was no statistical difference among the groups. In all the groups significantly higher bone area were observed in the cortical bone compared to the marrow bone(p<0.05)

Os fios de sutura cirúrgica e a enfermeira de Centro Cirúrgico: critérios de previsão e provisão segundo a natureza pública ou privada das instituições hospitalares / The sutures and the operation room nurse: criteria in forecasting the need for sutures threads provisioning according to the public or private nature of the hospital institution

Este estudo teve como propósito identificar e analisar os critérios adotados pelas enfermeiras na previsão de fios de sutura cirúrgica para a provisão da Unidade de Centro Cirúrgico, segundo a natureza pública ou privada das instituições hospitalares. As enfermeiras são responsáveis pela previsão, provisão, organização e controle dos materiais em suas unidades de trabalho. Os fios de sutura cirúrgica são considerados insumos duráveis, não reutilizáveis, consumidos durante cirurgias e fazem parte da lógica de programação das instituições hospitalares. A enfermeira da Unidade de Centro Cirúrgico interage com a administração, que efetua a compra do material e com o cirurgião que é seu usuário final. Para tanto, ela necessita conhecer suas aplicações e também os processos internos aos quais está submetido, de acordo com as normas e características da instituição. Observamos que fio de sutura cirúrgica é um tema pouco abordado em eventos de enfermagem, além da bibliografia ser escassa. Os dados foram coletados por meio de entrevista estruturada em 74 hospitais do município de São Paulo. Dentre eles, a maioria (68%) é privada, de porte médio, com Unidades de Centro Cirúrgico geral, movimento de até 500 procedimentos anestésico-cirúrgicos por mês e os fios são adquiridos por contrato direto com fornecedores. Das enfermeiras, a maioria (84%) tem mais de 5 anos de formada, curso de pós-graduação senso lato (78%), estão entre 2 a 5 anos como responsáveis pela Unidade de Centro Cirúrgico (51%) e aproximadamente metade é sócia de sociedade de especialista com predomínio absoluto da Sociedade Brasileira de Enfermeiros e Centro Cirúrgico (SOBECC). Sobre os fios de sutura cirúrgica, os aspectos que mais interessam às enfermeiras estão relacionadas à aplicação/indicação, características de cada um e critérios de substituição. Quase a totalidade das enfermeiras (96%) declarou ter adquirido a maior parte dos conhecimentos ) sobre fios na prática diária, isoladamente ou acrescido de outros meios. Com relação aos fios propriamente, 64% deles são padronizados por solicitação do cirurgião. Quanto a provisão na sala de operações, 40% dos fios são escolhidos no momento da cirurgia, enquanto 32% são disponibilizados em kits por especialidade. No hospital, 46% são adquiridos do fornecedor - hospitais privados - 32% através de concorrência pública - hospitais públicos. O estoque é reposto segundo cota estabelecida, em 58% dos hospitais, o que mantém relação com a natureza privada da instituição. Nos hospitais públicos predomina a provisão por meio de contagem de estoque com tempo pré-estabelecido, seguido de reposição (38%). A variedade dos fios também está relacionada à natureza, havendo maior variedade de fios em hospitais privados e uma inconstância no públicos. Tendo descrito os principais conceitos que envolvem fios de sutura cirúrgica e as características dos processos de previsão e provisão que envolvem esse material, esperamos contribuir para a tarefa de disponibilizar fios de sutura cirúrgica, uma das várias atribuições das enfermeiras de Centro Cirúrgico.

The present study aims at the indentification and analysis of the criteria adopted by nurses in forecasting the need for suture threads in Surgical Center Unit provisioning, according to the public or private nature of the hospital institution. Nurses are the responsible for the forecast, provision, organization and control of the materials in their work units. Surgical suture threads are considered as permanently needed non-reusable materials, daily consumed in surgeries and therefore part and parcel of the hospital programming logic. The Surgical Center Unit nurse interacts with the administration and with the surgeon, the former purchases the material and the later is its final user. Thus, nurses need to be acquainted with the materials in view, their applications and also the processes to which they are submitted in the institution. Notwithstanding, we have observed that surgical suture threads are rarely approached to, as a theme in nursing events, and that the bibliography concerning them is scarce. The data analyzed were collected by means of structured interviews in 74 São Paulo city hospitals which agreed to participate and filled out certain requirements. Most of them (68%) are middle-sized private institutions, counting with a general Surgical Center Unit that realizes up to 500 anesthetic-surgical procedures a mounth, the threads being acquired by direct contract with suppliers. The majority of the nurses that participated in this research have been graduated for 5 years (84%) and have concluded a post-graduation course (78%), 51% of them are in charge of the respective Unit of Surgical Center for 2 to 5 years and approximately half of them are members of specialist's society, such as the SOBECC (Sociedade Brasileira de Enfermeiros em Centro Cirúrgico, Brazilian Surgical Center Nursing Society). The most interesting aspects for nurses are those related to the application / indication of the threads, characteristics of each thread type and substitution criteria. Almost all the nurses (96%) declared to have acquired knowledge on threads in daily practice. Regarding the threads properly, 64% of them are standardized by surgeon's request, 40% are chosen in the moment of the surgery, while 32% are made available in kits divided by specialty. In the hospital, 46% are acquired from the supplier - private hospitals - 32% through public bid - public hospitals. The stock is restored by established quotes in 58% of the hospitals, a fact related to the private nature of the institutions. In the public hospitals the provision prevails through counting the stock at pre-established times, followed by replacement (38%). The variety of threads differs with the nature of the institution, with a larger variety in the private and an inconstant one in the public hospitals, significant at the level of 5%. By describing the main concepts related with surgical suture threads as well as the forecasting and provisioning characteristics involved, we hope to contribute toward making surgical suture threads available, one of the Surgical Center nurses several attributions.

Infantile Primary Enuresis Treated by~Spotted--moxi-bustion with Zhuang Medicated Threads / 中医杂志

33 cases were treated by spotted—moxibustionwith Zhuang medicated threads,the effective rate be-ing 84.6～85.0%.The longterm effect was also satis-factory.This therapy can also markedly raised the in-filtration pressure of nocturnal urination.There wasno obvious relation between the therapeutic effect andsyndrome typing.