Transcutaneous oximetry values in chronic ulcer patients during Hyperbaric treatment at 1.4 ATA compared to 2 ATA.

Chronic wounds have a significant impact on a patient's quality of life. Different pathologies, such as poor blood supply and tissue breakdown, may lead to inadequate oxygenation of the wound. Hyperbaric oxygen (HBO2) is a widely used treatment for an increasing number of medical practices. A new so-called "hyperbaric treatment" trend has emerged. The use of low-pressure, soft-sided, or inflatable chambers represents a growing trend in hyperbaric medicine. Used in professional settings as well as directly marketed to individuals for home use, they are promoted as equivalent to clinical hyperbaric treatments provided in medical centers. However, these chambers are pressurized to 1.3 atmospheres absolute (ATA) on either air or with an oxygen concentrator, both generate oxygen partial pressures well below those used in approved hyperbaric centers for UHMS-approved indications. A total of 130 consecutive patients with chronic ulcers where tested. TcPO2 was measured near the ulcer area while the patient was breathing 100% O2 at 1.4 ATA for five and 10 minutes. The average TcPO2 at 1.4 ATA after 10 minutes of O2 breathing was 161 mmHg (1-601 mmHg, standard deviation 137.91), compared to 333 mmHg in 2 ATA (1-914±232.56), p < 0.001. Each electrode tested was also statistically significant, both after five minutes of O2 breathing and after 10 minutes. We have not found evidence supporting the claim that 1.4 ATA treatment can benefit a chronic ulcer patient. The field of HBO2 is constantly evolving. We have discovered new ways to treat previously incurable ailments. Nevertheless, it is important to note that new horizons must be examined scientifically, supported by evidence-based data. The actual effect of 1.4 ATA on many ailments is yet to be determined.

Broken Dermal Filler Cannula in Post-Radiated Décolleté.

We present a case of 72-year-old that arrived at our emergency department following breaking of a dermal cannula used to inject a poly-L-lactic acid (PLLA) to the décolleté by an aesthetic practitioner. She had a history of previous radiation to the breast after a lumpectomy. The cannula was removed using fluoroscopy guidance. This case emphasizes several key messages. First is the extreme caution needed when using a cannula to inject dermal fillers in a previously radiated area. Second, the importance of properly trained practitioners. Last, one should consider the use of bio-stimulants in a previously cancerous area. Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [Yoav Yechezkel] Last name [Pikkel], Author 1 Given name: [Assaf Aviram] Last name [Zeltzer] Also, kindly confirm the details in the metadata are correct.confirmedPlease check and confirm the organization division and organization name is correctly identified for the affiliation 2.yesLevel of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Characterization of Meningitis and Meningoencephalitis in the Israeli Defense Forces From 2004 to 2015: A Population-Based Study.

Background: Meningitis and meningoencephalitis (MME) are potential medical emergencies. Mandatory reporting of all MME cases in the Israel Defense Force (IDF) allows accurate characterization of MME incidence and course. In the present study, we described the epidemiology of MME in soldiers. Methods: Medical charts of 860,000 combat and non-combat soldiers serving during the years 2004-2015, accounting for 2,256,060 patient years, were retrospectively evaluated. The diagnosis of MME was based on signs of meningeal irritation and a count of > 5 white blood cells (WBC) in the cerebrospinal fluid (CSF). Data on the diagnosis of bacterial or aseptic MME, significant sequelae, and associated mortality were collected. Results: Approximately 273 cases of MME were diagnosed. Overall, MME incidence was 12.1/100,000 patient-years. Bacterial and viral pathogens were identified in 31/273 (11.4%) and 52/273 (19%) cases, respectively. Combat soldiers had higher incidence of bacterial meningitis [14/40 (35%) vs. 31/212 (14.6%); p = 0.002] and meningoencephalitis [13/40 (32.5%) vs. 33/212 (15.6%); p = 0.023] compared to non-combat soldiers. Their clinical presentation was more severe, including confusion [10/40 (25%) vs. 22/212 (10.4%); p = 0.018], focal neurological deficits [12/40 (30%) vs. 11/212 (5.2%); p < 0.0001], and status epilepticus [3/40 (7.5%) vs. 0/212 (0.0%); p < 0.01]. Mortality among combat soldiers was higher [5/40 (15%) vs. 1/212 (0.5%); p < 0.001]. N. meningitidis was the most frequently isolated bacteria, despite universal preventative vaccination. Conclusion: The incidence of bacterial MME in the IDF is higher than in the civilian population. Combat soldiers present with higher incidence of meningoencephalitis and bacterial meningitis.

Hidden in plain sight: the (other) danger of COVID-19.

The Novel Coronavirus disease (COVID-19) first emerged in Wuhan province, China, in late November 2019 and changed public healthcare perception. It has caused a significant decline in attendance to outpatient clinics. However, other diseases have not stopped, including malignant melanoma. Survey of the number of visits to plastic surgery outpatient clinic during the first lockdown in Israel concerning malignant melanoma was compared to the same months in the previous years. We assessed the number of visits to the oncology department during 2020 compared to the number of visits and treatment protocols for malignant melanoma. During the first lockdown, the attendance at the plastic surgery outpatient clinic and ambulatory surgery decreased significantly (P = 0.002), both in excisions of suspected malignant melanoma and malignant melanoma follow-ups (P = 0.019 and P = 0.035, respectively). The last third of 2020 (from September to December) had shown a significant rise in new protocols commenced (P < 0.001). This rise in the final third of the year was not noted in 2018 or 2019. These data clearly show the rise in advanced and metastatic malignant melanoma cases due to refraining from medical follow-ups and treatments during the COVID-19 pandemic. Diseases other than COVID-19 have not vanished, and continue to treat those diseases. Ignoring malignant melanoma treatment because of COVID-19 and vice-versa will not benefit our patients.

Analysis of Popular Social Media Addressing Breast Augmentation, Implants, and Anaplastic Large Cell Lymphoma.

BACKGROUND: Social media is part of modern life, for better or worse. Patients seek counsel on treatments, their side-effects, and the surgeon performing the surgery. Previous study has found several "dos" and "don'ts" regarding social media. The aim of this study was to specifically look for social media posts addressing breast augmentation, breast implants, and breast implant associated anaplastic large cell lymphoma (BIA-ALCL).The aims of this study were to examine social media posting regarding BIA-ALCL and to analyze the ways general public receive information regarding this disease. METHODS: A prospective analysis of 3 popular, global social media networks was performed, using the key phrase in English "anaplastic large cell lymphoma" or "ALCL" or "#ALCL." Three hundred posts related to breast cancer published on Instagram, YouTube, and Facebook in June 2018 were assessed by the following parameters: author identity, subject, "social media currency" (likes, shares, comments), presence of special effects (videos, photographs, research, etc.). RESULTS: Most posts were posted by professional entity (ie, plastic surgeon, company, or general practitioner), with YouTube being the social media least used by patients (P < 0.001). Facebook was the only social network that had more posts authored by non-professional authors (P < 0.001). Social currency did not change between the professional and non-professional authors. The highest return for investment was seen on Instagram (P < 0.001, "likes" only). YouTube, having the most posts published by professionals, was more positive toward breast augmentation and the use of implants (P < 0.001). CONCLUSIONS: Social media is here to stay and not a trend. It is a tool for the patient when searching for treatment and surgeon. It would be wise to invest and understand these communication platforms, since this is where our patients are, and the way they are researching.

Corneal Cross-Linking as a Treatment for Fungal Keratitis Associated with Corneal Melting.

We present the case of a young male that suffered from fungal corneal abscess and corneal melting. The patient was treated successfully by corneal cross-linking. Taking into account our experience from this case, we offer to consider corneal cross-linking as a therapeutic option in cases of fungal keratitis.

Acute bilateral glaucoma and panuveitis as a side effect of topiramate for weight loss treatment.

A 54-year-old male patient presented to our clinic with acute angle-closure glaucoma and panuveitis in both eyes after being treated with topiramate for binge eating and obesity. This case report emphasises the hazardous side effects of treatment with topiramate with unusual indication and the precaution a caretaker must take when treating a patient.

Acute shortening and angulation for limb salvage in a paediatric patient with a high-energy blast injury.

We present the case of an 8-year-old girl casualty of the Syrian conflict who arrived with open fractures of the right tibia and fibula with extensive bone and soft tissue loss as well as an open fracture of the left calcaneus as the result of a high-energy blast injury. She was successfully treated with repeated debridement procedures, external fixation with acute temporary shortening and angulation of the right leg and skin grafting to both lower limbs.