Does supervised exercise after deep venous thrombosis improve recanalization of occluded vein segments? A randomized study

OBJECTIVES: The aim of the present study was to evaluate weather early supervised exercise improves recanalization of acute deep vein thrombosis (DVT) and reduces symptoms. PATIENTS AND METHODS: From September 2001 to March 2004, of 381 patients, 72 eligible patients were included and with a mean age 54 +/- 14 years, 39 (52%) men with deep vein thrombosis (DVT) proven with phlebography were randomized to: an exercise group (n = 36) receiving routine anticoagulation, class II compression stockings and additionally supervised exercise and a control group (n = 36) receiving the same therapy but no exercise. Patients were followed-up during six months. Phlebography was scored initially and at six-months. RESULTS: There were at inclusion no differences between the two groups regarding age, body weight, body mass index (BMI), calf circumference of the affected leg, and overall quality of life estimated by visual analog scale (VAS)-scale. In both groups there were significant reductions regarding calf circumference in the affected leg compared to the inclusion time, both at one-month (P = 0.0012) and six month (P = 0.0002) follow-up. The degree of recanalization of the affected venous segments was high and did not differ between groups. There were no recurrent DVT or pulmonary emboli or other treatment complications in any individual during the six-month follow-up period. CONCLUSIONS: Early exercise did not acutely exacerbate the risk of complications in patients with DVT. No benefits of early exercise were seen regarding the degree of recanalization of the thrombi, or faster resolution of pain or swelling. Nevertheless, our study shows that early exercise/ambulation is safe in combination with anticoagulation and compression stockings for the majority of patients with DVT.     

Traumatic displacement of teeth into maxillary sinus cavity: an unusual dentoalveolar fracture

We present an unusual dentoalveolar fracture case who had displacement of teeth into maxillary sinus cavity. This patient was 15 years old. He had oral bleeding and lost teeth after falling from the top of a building. Examination of maxillofacial region showed that there were left maxillary teeth lost, alveolar fracture, gingival bleeding and laserations. Maxillofacial bones were found intact. Canine, both premolars and the first molar teeth on left maxilla were lost. Pantomographic evaluation viewed two teeth in the left maxillary sinus. In addition, computerized tomography clearly showed oroantral fistula, alveolar fracture and teeth into maxillary sinus. Extraction of teeth from sinus cavity was performed as well as repair of oroantral fistula and alveolar fracture. This patient is thought that dentoalveolar injury may be more serious than expected according to the oral examination and it requires careful evaluation, even if dentoalveolar trauma does not pose a significant morbid risk.     

Determinants of maternity health care utilization in Tajikistan: Learning from a national living standards survey

This study examines the demographic, economic, social, and geographic factors that help explain maternity health care utilization in Tajikistan, a low-income transitional country in Central Asia, based on a newly available nationally representative living standard survey. Two regression models, namely, a binomial logit model and a zero-inflated negative binomial (ZINB) model are estimated. The estimations of the two models show strikingly consistent results—the year of last childbirth, educational attainment, and the availability of public infrastructure are important predictors of maternity health care utilization. The results also signify an urgent need to overturn the current negative trend in maternity health care utilization. The findings also suggest that many determinants of maternity health care are outside the direct sphere of health care policies, indicating the need of cross-sectional policies in addressing maternity health care utilization, for example, policies and strategies that include contributions from other sectors.     

Osteomusculocutaneous flap for clavicular reconstruction: a case report

Radiotherapy for tumors can cause soft tissue necrosis, osteonecrosis, and pathologic fractures. A 47-year-old woman presented with a pathologic fracture of the left clavicle 10 years after radiotherapy following radical mastectomy for breast cancer. She was treated with a compound rib-latissimus dorsi osteomusculocutaneous flap with a 4-cm segment of the sixth rib. Fusion of the bones was achieved in three months. Donor site morbidity was cosmetically acceptable and function of the shoulder was improved. The Constant shoulder score which was 36 preoperatively increased to 88 after 38 months of follow-up.     

Third Early “Booster” Dose Strategy in France of bnt162b2 SARS-CoV-2 Vaccine in Allogeneic Hematopoietic Stem Cell Transplant Recipients Enhances Neutralizing Antibody Responses

Immunocompromised individuals generally fail to mount efficacious immune humoral responses following vaccination. The emergence of SARS-CoV-2 variants of concern has raised the question as to whether levels of anti-spike protein antibodies achieved after two or three doses of the vaccine efficiently protect against breakthrough infection in the context of immune suppression. We used a fluorescence-based neutralization assay to test the sensitivity of SARS-CoV-2 variants (ancestral variant, Beta, Delta, and Omicron BA.1) to the neutralizing response induced by vaccination in highly immunosuppressed allogeneic HSCT recipients, tested after two and three doses of the BNT162b2 vaccine. We show that neutralizing antibody responses to the Beta and Delta variants in most immunocompromised HSCT recipients increased after three vaccine doses up to values similar to those observed in twice-vaccinated healthy adults and were significantly lower against Omicron BA.1. Overall, neutralization titers correlated with the amount of anti-S-RBD antibodies measured by means of enzyme immunoassay, indicating that commercially available assays can be used to quantify the anti-S-RBD antibody response as a reliable surrogate marker of humoral immune protection in both immunocompetent and immunocompromised individuals. Our findings support the recommendation of additional early vaccine doses as a booster of humoral neutralizing activity against emerging variants, in HSCT immunocompromised patients. In the context of Omicron circulation, it further emphasizes the need for reinforcement of preventive measures including the administration of monoclonal antibodies in this high-risk population.     

Lifetime direct healthcare costs of treating colorectal cancer: a systematic review

The European Journal of Health Economics - Colorectal cancer is a global public health issue and imposes a significant economic burden on populations and healthcare systems. This paper...