Health System in Zimbabwe and Delay in Seeking Health Care of Breast Cancer Among Women

Breast cancer, the most prevailing and only cancer considered universal among women worldwide. The rate of breast cancer per 100,000 women is higher in high income countries than in low income countries. However, mortality rates are high in low income countries due to the delay in seeking health care. A systematic literature review was carried out to document the health system implemented in Zimbabwe and its challenges that could be contributing to the delay in seeking health care of breast cancer among women in Zimbabwe. A content analysis was used to analyze articles, searching was done using the Boolean search strategy, articles from 2005 to 2021, which met the inclusion criteria were considered. Factors such as centralized services due to shortage of cancer specialists, lack of financial allocations on breast cancer health programs, shortage of screening and surgical equipment, lack of accurate data due to weak registration system and health management information system as well as poor governance and leadership have also been found to be challenges in the health system of Zimbabwe that may contribute to delay in seeking health care of breast cancer among women in Zimbabwe. Keywords: breast cancer, health system, health care, Zimbabwe

Piezosurgery – A novel tool in modern dentistry

Dentistry has undergone significant improvement with a lot of changing concepts involving novel surgical tools over the past two decades. Piezoelectric surgery, also popularly called as piezosurgery (PS), is a rapidly evolving technique of bone surgery which is gaining importance because of its ability to place osteotomy cuts with absolute precision and confidence, especially near the vital structures. Piezosurgical device functions with an ultrasonic frequency (25–29 KHz) resulting in microvibrations in the range of 60–200 µm/s enabling bone cutting that is secured and accurate preserving the underlying neurovascular elements along with improved visibility through bloodless surgical site and thorough debridement using internal irrigation system. Till date, PS has seen wide applications in various disciplines of medicine. In the field of dentistry, PS has emerged as a promising technical modality in bone graft harvesting, alveolar ridge expansion, sinus lift procedures, osteogenic distraction, and endodontic and periodontal surgeries. The present review addresses the efficiency of PS comparing it with the traditional dental surgical equipment. The advantages, limitations, and biological effects of PS as well its various applications in dentistry have also been discussed.

Corneal Surgery in the Cat: Diseases, considerations and techniques

Practical relevance: The ability to recognize, diagnose and treat corneal disease is essential for maintaining vision and comfort in feline patients. Being able to correctly identify appropriate techniques for surgical cases is of particular importance for success when performing corneal surgery. Clinical challenges: Many different corneal diseases present with similar clinical signs, and it can be hard to determine the appropriate treatment for individual patients. It is essential for the clinician to understand the indications for corneal surgery, instrumentation needed and microsurgical principles prior to attempting these procedures. The prognosis following surgery and potential complications should be discussed with the client. Audience: This review article aims to assist in decision-making and to provide detailed guidance for primary care clinicians considering referral of cats for corneal surgery. The review outlines common feline corneal diseases and associated surgical therapies performed by veterinary ophthalmologists, highlighting appropriate instrumentation and case selection. Some surgeries are explained in depth for ophthalmologists and residents in training. Equipment: Although some procedures may be performed with common surgical equipment and supplies, most require specialized ophthalmic instrumentation and expertise, which entails significant microsurgical training and practice, as well as financial investment. Most of the procedures require an operating microscope for the best surgical outcomes; however, surgical loupes may be sufficient in some cases. Evidence base: This review article compiles information from many published references on feline corneal diseases and surgeries, complemented by the experience of the authors.

Comprehensive treatment of pathology of the ascending, arch and descending thoracic aorta by performing operations of the hybrid "elephant trunk"

The purpose of the study – study and demonstration of the possibilities of the technique of complete replacement of the ascending, arch, vessels of the arch and descending thoracic aorta "elephant trunk" surgery in patients with aortic arch aneurysms.Material and methods. The paper describes the technique and demonstrates the results of the first 29 operations of prosthetics of the ascending, arch, vessels of the arch and descending thoracic aorta, which were performed by the staff of the Department of Surgical Treatment of Aortic Pathology National M.Amosov ICVS of the NAMS of Ukraine" in 2016-2020. Results. Hospital mortality was 10.3%, three patients died. The causes of death were: the following acute cardiovascular failure, uncontrolled bleeding, and multiple organ failure in each case. In none of the operated patients the level of postoperative blood loss did not require rethoracotomies.Conclusions. The optimal way to correct aneurysms of the aortic arch is the operation of prosthetics of the ascending, arch and descending thoracic aorta - "elephant trunk". Improvement of preoperative diagnostics, surgical equipment, optimization of methods of protection of the brain, spinal cord and visceral organs, the possibility of using hybrid / endovascular techniques to treat patients with complex lesions of the aortic arch pool with hospital mortality within 10.3%.

FEM Based Elasto-Electric Analysis of Elastomers for Pharmaceutical Applications

Elastomer materials are very important due to weak intermolecular forces and very low Young's modulus and have high failure strain. Due to these properties, they are used in a large number of applications especially in pharmaceutical industry and medical / surgical equipment etc. Electrostatic discharge on such material is a potential hazard for the operator who is dealing with elastomers. In the research presented here, a detailed analysis on the elasto-electric analysis of 03x elastomers is analyzed in detail by using Finite Element Method (FEM). A CAD model is generated in accordance with an early research on elasto-electric study of Silicon material. Subsequently FEM based analysis is carried out to study vital electrostatics properties like Surface deformation and surface potential distribution developed on the application of external forces on 03x types of elastomers i.e. Silicon Rubber, Nitrile (NBR) and Poly Vinyl Chloride (PVC). The whole study is carried out in COMSOL multi-physics software. Analysis showed that the electric field developed on the surface of the elastomer is dependent on the deformation on non-linear nature and depends upon the material properties. FEM based results show that Silicon Rubber develops maximum deformation and electric potential of three chosen materials up to 50mm and 3150V respectively. Based on the conducted analysis, Silicon Rubber is widely recommended for its utilization in Pharmaceutical applications requiring electrostatics.

Service-Oriented Medical Device Connectivity: Particular Interoperability Standards for High Frequency Surgical Equipment and External Control Devices

Manufacturer-independent medical device interoperability has been strongly demanded by the clinicians and healthcare delivery organizations (HDOs), however has not been achieved in practice for decades. The ISO/IEEE 11073 Service-oriented Device Connectivity (SDC) family of standards constitutes a paradigm shift. This work supplements SDC with Device Specializations (DevSpecs) or Modular Specifications (ModSpecs): particular interoperability standards for high frequency (HF) surgical equipment and external control devices, such as foot or finger switches. They provide models to describe these devices in a service-oriented medical device system and modes of interaction with other network participants. Additionally, we contribute to the ISO/IEEE 11073-10101 nomenclature standard to provide semantic descriptions of the exchanged information. This is a key enabler for safe and effective medical device interoperability to support the caregivers and improve patient safety as well as clinical outcome.

Medical and economic justification of the use of micropercutaneous nephrolithotripsy in clinical practice

Introduction. Percutaneous nephrolithotripsy (PNL) is traditionally used in the surgical treatment of patients with kidney stones. The use of retrograde intrarenal surgery using a flexible endoscope (RIRS) and micropercutaneous nephrolithotripsy (micro PNL) in the treatment of kidney stones with a diameter of 10-15 mm allows minimizin renal bleeding and reducing the period of hospitalization of the patient. Despite the development of urolithiasis treatment methods, the results of a comparative study of the medical and economic aspects of various surgical options for kidney stones treatment were not described. Materials and methods. We carried out a retrospective analysis of 654 cases of PNL and RIRS for the period of 2015-2019. We analyzed the results of surgical and medical material costs in 15 patients whom micro PNL was done according to the standard protocol. All patients underwent an assessment of the blood hemoglobin level and the frequency of complications according to Clavien-Dindo classification, as well as a control examination to exclude residual stones was done. Results. According to the data of the planning and economic service of healthcare institutions, the costs under the mandatory medical insurance tariff for RIRS and PNL amounted to 47,743.10 rubles and 71,300.00 rubles, respectively, without differences in hardware. The cost of endoscopes used for RIRS and PNL differed significantly (1,045,185. 00 rubles and 886,203. 00 rubles, respectively). Taking into account labor costs and general anesthesia, the cost of surgical treatment of kidney stone in PNL increased by 7,429. 78 rubles (74.9%). For fragmentation of the stone with micro PNL, a thulium or YAG laser was used, without nephrostomic drainage. The duration of the PNL was longer-on average 113 minutes (62-186 minutes), than with micro PNL – on average 83 minutes (42-122 minutes,). After micro PNL, there was a slight decrease in the level of hemoglobin and a minimal degree of complications (I-II Grade Clavien-Dindo), compared with PNL. The transition to the RIRS was required in three cases: during the mobilization of the migration of the stone into the middle calyx and during the removal of residual fragments of the upper and lower calyx. The duration of hospitalization of patients decreased after micro PNL to 2 days. Conclusions. Micro PNL for small (up to 2 cm) kidney stones treatment is more advantageous compared to traditional PNL in a number of positions: less the duration of the operation, reduced blood loss, lack of drainage, reduced costs for hospital observation of the patient. From a medical and economic point of view, the RIRS is the most preferable, but it requires initially large costs for the purchase of flexible endoscopes with a small working resource and a relatively high cost. The development of surgical equipment and production capacities, as well as the accumulation of clinical experience of micro PNL will allow us fairly assess the feasibility of this technique with a personalized approach.

Decontamination of Surgical Instruments for Safe Wound Care Surgeries in Disasters: What are the Options? A Scoping Review

International guidelines stipulate that autoclavation is necessary to sterilize surgical equipment. World Health Organization (WHO) guidelines for decontamination of medical devices require four levels of decontamination: cleaning, low- and high-level disinfection, as well as sterilization. Following disasters, there is a substantial need for wound care surgery. This requires prompt availability of a significant volume of instruments that are adequately decontaminated. Ideally, they should be sterilized using an autoclave, but due to the resource-limited field context, this may be impossible. The aim of this study was therefore to identify whether there are portable and less resource-demanding techniques to decontaminate surgical instruments for safe wound care surgery in disasters. A scoping review was chosen, and searches were performed in three scientific databases, grey literature, and included data from organizations and journals. Articles were scanned for decontamination techniques feasible for use in the resource-scarce disaster setting given that: they achieved at least high-level disinfected instruments, were portable, and did not require electricity. A total of 401 articles were reviewed, yielding 13 articles for inclusion. The study identified three techniques: pressure cooking, boiling, and liquid chemical immersion, all achieving either sterilized or high-level disinfected instruments. It was concluded that besides autoclaves, there are less resource-demanding decontamination techniques available for safe wound surgery in disasters. This study provides systematic information to guide optimal standard setting for sterilization of surgical material in resource-limited disaster settings.

1695 Undergraduate Cardiothoracic Surgery: Pumping Up Knowledge and Inspiration with High-Fidelity Simulation

Introduction Alongside declining ST3 applications, cardiothoracic surgery (CTS) is underrepresented in the medical curriculum with 90% of medical students reporting no exposure to the specialty in medical school placements. This may result in clinicians having difficulties recognising emergency presentations, with subsequent referrals made inappropriately. Method A simulation course involving teaching around common CTS conditions and procedures was delivered by CTS trainees to undergraduate medical students (n = 50). This involved both theory and high-fidelity simulations of coronary anastomoses using cardiac surgical equipment on porcine hearts and ureters. Delegates were given pre and post-test questionnaires, and another at six-weeks to test knowledge retention. Results were statistically analysed using paired and independent sample t-tests. Results Delegates demonstrated significant improvements in post-test knowledge of 56% (p<0.01), and sustained improvement of 51% (p<0.01) six-weeks later compared to baseline. 64% of delegates reported an increased interest in pursuing CTS as a career; 40% reported improved confidence performing a coronary anastomosis. Conclusions Immediate and long-term knowledge retention of key CTS concepts and ability to assess common CTS pathological scenarios were demonstrated in this study. CTS simulation therefore represents an effective mechanism by which key concepts can be taught to undergraduate medical students, whilst enhancing interest in pursuing CTS as a career. As an educational adjunct, simulation can help bridge the gap between taught theory and applied practice, with the potential to empower future doctors to make more informed referrals and management decisions.

The Role of Biomaterials and Biocompatible Materials in Implant-Supported Dental Prosthesis

The dental implant is one of the appropriate instances of the different dental materials and their application, which is the combined procedure of technology and science in physics, biomechanics, and surface chemistry from macroscale to nanoscale surface engineering and manufactured technologies. In recent decades, biomaterials in implant therapy promote bone response and biomechanical ability, which is long-term from surgical equipment to final prosthetic restoration. Biomaterials have a crucial role in rehabilitating the damaged structure of the tooth and supplying acceptable outcomes correlated with clinical performance. There are some challenges in implantation such as bleeding, mobility, peri-implant infections, and the solution associated with modern strategies which are regarded to biomaterials. Various materials have been known as promising candidates for coatings of dental implants which contain polyhydroxyalkanoates, calcium phosphate, carbon, bisphosphonates, hydroxyapatite, bone stimulating factors, bioactive glass, bioactive ceramics, collagen, chitosan, metal and their alloys, fluoride, and titanium/titanium nitride. It is pivotal that biomaterials should be biodegradable; for example, polyhydroxyalkanoates are biodegradable; also, they do not have bad effects on tissues and cells. Despite this, biomaterials have important roles in prosthetic conditions such as dental pulp regeneration, the healing process, and antibacterial and anti-inflammatory effects. In this review study, the role of biocompatible materials in dental implants is investigated in in vitro and in vivo studies.