Journal of General Practice

Recently, our unit tackled a case of severe anemia in a surrogate mother during the third trimester of a twin pregnancy. Her hemoglobin was just 5 g/dl, whereas the normal range should ideally be within the range of 12 g/dl to 14 g/dl. Due to timely intervention, we managed to avoid complications. However, it is important to discuss this case, as it is found that in the Assisted Reproductive Technology (ART) centers worldwide, multiple embryo transfers is preferred over single embryo transfers, which often result in higher morbidity and mortality in mothers and infants.

It is observed in practice that most of the diabetes patients have cardiovascular disease. Researchers and medical practitioners try to locate the hidden association between the cardiovascular disease and diabetes mellitus. But both the characters are attribute. It is not easy to derive the association between two attribute characters when many other variables/attribute characters are simultaneously influencing on them. The current report have suggested some approaches to examine the association between the cardiovascular disease and diabetes mellitus. Based on the suggested approaches, the report has examined the association between the two diseases using a real data set. The report has concluded that these two diseases are correlated.

Objective: To compare the frequencies of chronic diseases in three cross-sectional investigations corresponding to 1985, 1995, and 2016, in order to detect the secular variations of chronic health problems.

Methodology: We compare the results of three cross-sectional studies previously published, conducted in the same Family Medicine office in Toledo, Spain, by the same principal investigator: in 1985 and 1995, on the total number of patients enrolled in the consultation, and a cross-sectional study, from a secondary analysis of an existing dataset, based on a random sample of patients from the same consultation, in 2016, with a similar methodology and identical or compatible classifications.

Results: We included 1356 patients in 1985 with 56% of female patients, 1677 patients in 1995, with 55% females in 1995, and 300 patients, with 57% in 2016 (χ2=0.575, p=0.750148, not significant at p<0.05). But in 2016 more patients older than 65 years were included: 11%>65 years in 1985, 12% in 1995, and 28% in 2016 (χ2=73.71, p<0.00001). Secular variation of the diseases in this series of 30 years shows an uneven behavior of the different groups: 1) A group with increase (Circulatory system, Endocrine, Mental, and Musculo-skeletal), but not of the expected magnitude if the trend until 1995 had continued; 2) A group with only small increase (Respiratory system and Neoplasms); 3) A group with stagnation of the prevalence (Genitourinary, Infectious and Nervous and senses); And 4) A group with decrease of the prevalence (Diseases of the skin, and Digestive system). There is also an increase in the number of chronic diseases per patient, from 0.9 in 1985, to 2.0 in 1995, and to 2.4 in 2016, but their variation is not uniform either, and in several age groups and sex there is a slight decrease in the last 20 years.

Conclusions: The comparison of consistent, comparable and stable series between 1985, 1995 and 2016 in our context shows that although not all disease groups behave the same, there is a general trend of secular variation of chronic diseases of increasing prevalence of chronic diseases from 1985 to 1995, and a reduction or slowdown in prevalence growth from that date to 2016: there is only a clear increase in Circulatory system, Endocrine, Mental, and Musculo-skeletal, but not of the expected magnitude, and in all other groups the increase is weak, or there is no or there is a decrease in prevalence. This knowledge can help to plan the needs of community health resources in our environment in the near future.

An all-composite Direct Adherence Bridge (Direct Adhesion Prosthesis) is a fixed dental replacement for one or multiple missing teeth that need replacing, relies on its adherence and strength, with superior composites, and its adherence with attachment components—bonding agents. It is the newest of the five currently available methods for replacing missing teeth. The four most commonly in use are the: 1) “flipper,” a removable prosthesis; 2) the orthodox fixed bridge with metal requiring tooth preparation; 3) the resin retained bridge with specific metal and design requirements; and, 4) the dental implant-all requiring multiple appointments and tissue alteration-the DAB does not. All previous methods are of an “indirect nature” having laboratory phases; the DAB is a “direct intervention.” A direct adherence prefabricated dental bridge has no metal framework and requires none. It is simply a prefabricated false tooth made of composite that may be altered to fit the space between two (or alongside one) natural teeth that is bonded in place once adjusted. The Direct Adherence Bridge (glue-in bridge) is only adhered, in most cases, to external structures of natural teeth or silicate porcelain veneer crowns over altered teeth; and, will not damage the surrounding teeth due to preparation (cutting hard structures) or placement and is well accepted and liked and preferred by patients. The average life span of a-glue in bridge is that of any other fixed bridge. The adherence material that holds the winged pontic to the natural structures is the same composite, which composes the pontic. The composite to tooth bond strength is approximately 4,800 lbs/in2, which far exceeds all resin, or conventional adhesion cements which range from 1,500 psi to 2,240 psi. The compressive strength of the composite is about 62,000 psi and its tensile strength about 22,000 psi.

Non-suicidal self-injury (NSSI) has its typical onset during adolescence and usually configures a maladaptive coping strategy that serves numerous functions. Adverse psychosocial situations are related with an increased risk for NSSI. The objective of this work was to identify the most prevalent psychosocial risk factors for NSSI during adolescence and statistically significant associations between them. A convenience sample of 50 adolescents with identified history of NSSI was used. Each case was searched for the Abnormal Psychosocial Situations (APS) contemplated in the psychosocial axis (Axis V) of the International Classification of Diseases (10th edition). The 10 more prevalent APS were present in at least 50% of the subjects. Several statistically significant associations between APS were identified, signalizing certain patterns of associations that suggest increased risk for NSSI. A proper assessment of the psychosocial contexts may allow identification of youth at risk for NSSI, and thus the institution of early intervention programs.

Objective: Severe trauma to the hand or forearm often results in the deep soft tissue defect with the exposure of tendon or bone, which needs to be repaired by skin flaps. In this study, we introduced the use of paraumbilical perforator flap in the repair of such defects, and discussed its advantages and disadvantages.

Methods: From Jan. 2006 to Dec. 2016, 14 patients with deep soft tissue defects in the hand and forearm were admitted into our clinic. The defects were caused by hot-crush injury (n=2), electrical injury (n=4), severe burn (n=2), crush injury (n=3), and avulsion injury (n=3). After admission, the patients underwent the debridement, vacuum suction, and skin graft to repair partial wound. The deep defects with the exposure of tendon and bone were repaired by paraumbilical perforator flap finally.

Methods: From Jan. 2006 to Dec. 2016, 14 patients with deep soft tissue defects in the hand and forearm were admitted into our clinic. The defects were caused by hot-crush injury (n=2), electrical injury (n=4), severe burn (n=2), crush injury (n=3), and avulsion injury (n=3). After admission, the patients underwent the debridement, vacuum suction, and skin graft to repair partial wound. The deep defects with the exposure of tendon and bone were repaired by paraumbilical perforator flap finally.

Conclusions: The paraumbilical perforator flap has reliable blood supply, good texture, sufficient area, and is convenient to transfer. It's an ideal choice for the repair of the deep soft tissue defect in the hand and forearm.

Background: Optimal dietary intake in alcohol rehabilitation is a pathway that reflects self-care, commitment to staying sober and is a vital adjunct in effective alcohol rehabilitation.

Objective: This qualitative study sought to elicit facilitators and barriers that influence the practice of optimal dietary intake during the three months of alcohol rehabilitation.

Methods: A question guide was utilized to solicit information through in-depth interviews from 15 alcoholics and 5 health professionals until saturation point. Constant comparative approach was used to analyze verbatim transcripts obtained from in-depth interviews. This analysis entailed three stages including open, axial and selective coding.

Results: Recuperating alcoholics’ appreciated the health benefits of practicing optimal dietary intake in restoring their health, with health professionals being significantly supportive which translated into increased self-efficacy to practice of optimal dietary intake during alcohol rehabilitation.

Conclusions: The rehabilitation centres should have nutritionists besides other health professionals who can offer individualized nutrition services needed by the recuperating alcoholics.

Objectives: We aimed to assess the status of anxiety and depression in newly diagnosed acute leukemia patients.

Material and method: In this prospective, observational, cross-sectional study, we aimed to assess the risks of anxiety and depression in newly diagnosed acute leukemia patients who were admitted to hematology clinic of Ministry of Health ?stanbul Training and Research Hospital in 2016.

Results: A total of 21 patients including 13 (61.9%) patients with Acute Myeloid Leukemia (AML) and 8 (38.1%) patients with Acute Lymphoblastic Leukemia (ALL) were evaluated in the study. The median age of the patients was 45 years (range: 21-69) and the number of female patients were 11 (52.4%). Only eight (38.1%) patients, who were diagnosed with AML in five (38.5%) patients and ALL in three (37.5%) patients, have revealed to have anxiety. The anxiety rates were 45.5% (n:5) in the female patients and only 30% (n:3) in the male patients. The difference was not statistically significant (p>0.05). Depression was recorded in 17 (81%) patients and the rates of depression were 84.6% (n:11) in AML patients, 75% (n:6) in ALL patients, 81.8% (n:9) in the female, and 80% (n:8) in the male patients.

Conclusion: The assessment of anxiety and depression in patients with acute leukemia from the admission to hospital is substantial for the adherence to treatment. Both are distinctively more common in those patients and trigger each other causing a vicious circle. A professional support to improve their psychological status should be provided during the treatment of these patients.