Objective: To evaluate bone regeneration in alveolar defects treated with human umbilical cord–derived mesenchymal stem cells (hUCMSCs), hydroxyapatite/chitosan/gelatin (HA/CS/Gel) scaffold, and bone morphogenic protein-2 (BMP-2) in Capra hircus models. Design: Randomized posttest-only control group design. Setting: Animal Hospital at Bogor Agricultural Institute. Participants: Healthy and equally treated 24 female Capra hircus/goats. Intervention: Animals were randomly assigned to 3 experimental group design (iliac crest alveolar bone graft/ICABG [control], HA/Cs/Gel+BMP-2 [ Novosys], and HA/Cs/Gel+BMP-2+UCMSCs). Graft materials were implanted in surgically made alveolar defects. Main Outcome Measures: Postoperative functional score and operating time were assessed. New bone growth, bone density, inflammatory cells recruitment, and neoangiogenesis were evaluated based on radiological and histological approach at 2 time points, week 4 and 12. Statistical analysis was done between treatment groups. Results: Operating time was 34% faster and functional score 94.5% more superior in HA/Cs/Gel+BMP-2+hUCMSC group. Bone growth capacity in HA/Cs/Gel+BMP-2+UCMSCs mimicked ICABG, but ICABG showed possibility of bone loss between week 4 and 12. The HA/Cs/Gel+BMP-2+UCMSCs showed early bone repopulation and unseen inflammatory cells and angiogenesis on week 12. Discussion and Conclusion: The HA/Cs/Gel+BMP-2+hUCMSCs were superior in enhancing new bone growth without donor site morbidity compared to ICABG. The presence of hUCMSCs in tissue-engineered alveolar bone graft (ABG), supported with paracrine activity of the resident stem cells, initiated earlier new bone repopulation, and completed faster bone regeneration. The HA/Cs/Gel scaffold seeded with UCMSCs+BMP-2 is a safe substitute of ICABG to close alveolar bone defects suitable for patients with cleft lip, alveolus, and palate.
Introduction Conjoined twins are a rare medical phenomenon that poses unique challenges for surgeons. Separation of conjoined twins involves multidisciplinary teamwork, complex medical management and surgical planning, and multi-stage operations and often still has a high mortality and morbidity rate. In the times of the COVID-19 pandemic, separation of conjoined twins pose even greater challenges. Aiming for the best outcome possible, while minimizing the risk of COVID transmission and ensuring the safety of the personnel, is paramount. This case report presents thoraco-omphalopagus twins who were successfully separated at 4 months of age. The preoperative planning, operative details, postoperative follow-ups, and outcomes are discussed. Methods The absence of a tissue expander and the inability to acquire it due to travel restrictions from COVID-19 further complicated the management on this patient. A Routine Polymerase Chain Reaction (PCR) swab test was performed on the patients and personnel. Standardized personnel protective equipment (PPE) was worn during ward and surgical care. After separation of the twins by cardiothoracic and pediatric surgeons, one twin underwent immediate skin closure using a double keystone perforator island flap and a lower abdominal perforator flap. Due to extensive defects, closure was delayed for the second twin. After a series of dressing changes, eventually local perforator flaps could be raised to close the defect using staged tension sutures and skin grafts for secondary defects. Results Both twins were discharged with no significant morbidity, and no personnel were exposed to COVID-19 infection during the management Conclusion Preoperative coordination and planning, multidisciplinary effort, adherence to screening protocols for COVID, and strict use of standardized PPE all contributed to the successful separation of thoraco-omphalopagus conjoined twins during the COVID-19 pandemic.
Hypospadias present with a wide array of meatal position and curvature. Choosing an operative technique for the different types of hypospadias has been challenging and controversial among the plastic, urologic, and pediatric surgeons. Regardless of the selected techniques, primary hypospadias repair still frequently results in complications requiring further surgery, such as fistula, residual chordee, and stricture. Owing to its practicality, the single stage urethroplasties are more-popular and widely used at present. However, our experience found higher rates of postoperative complications with the one-stage procedure compared to the two-stage for repair of non-glanular hypospadia. This article details the operative techniques of the two-stage Sidik-Chaula urethroplasty, a technique that we have implemented in our institution over two decades. It is applicable for the primary repair of any distal, middle, and proximal hypospadias. We also introduce the Manset Flap, a simple modification to the first stage of urethroplasty, which ease neourethra creation in the second stage. However, due to prior insufficient medical recordkeeping, we are yet unable to produce a quantified rate of success and complications by utilizing this technique. A study is currently being done to produce the numbers.
Condyloma acuminata in the external genitalia (genital warts) is a sexually transmitted disease that is often caused by human papillomavirus (HPV). We report a case of giant genital condyloma acuminata in a 35-year-old male patient with HIV comorbidity treated by wide surgical excision. Excision defect was covered with split thickness skin graft (STSG) and double keystone flaps. There was no complication after surgery. Ten months following surgery, there was no new condyloma lesion and the patient had normal voiding and erectile functions.
The coronavirus disease 2019 (COVID-19) pandemic has caused an international shortage of nasopharyngeal flocked swabs, which are one of the main supplies for diagnostic testing. In response to this issue, our institution developed locally made nasopharyngeal swabs. This report aims to provide a clinical evaluation by conducting a sterility test, reverse transcription polymerase chain reaction (RT-PCR) compatibility test, and a user-based survey test of two batches of locally made flocked swabs. Sterility and compatibility tests were conducted at our microbiology laboratory. Participants with clinical suspicion of COVID-19 were scheduled for swab tests using Flocked Swab HS-19 and samples obtained were tested using the RT-PCR method. The cycle threshold (Ct) value of the samples was recorded. A user-based survey was conducted to evaluate the swab stick and flocked-fiber tip performance. The sterility test showed no evidence of bacterial growth on both blood agar and thioglycolate medium. RT-PCR compatibility test from Ct value of 33 samples of the first batch and 30 samples of the second batch was recorded with a mean Ct of 27.17±2.96 and 23.99±2.18, respectively. Six parameters of the swab stick (comfortability, smoothness, flexibility, durability, applicability, and breakpoint performance) showed satisfactory scores with an average of 4.14 out of 5.0 for the first batch and 4.16 for the second batch, while 4 parameters of the flocked-fiber tip (fiber adherence, thickness, symmetricity, and sample collection sufficiency) revealed acceptable scores with an average of 3.6 out of 5.0 for the first batch and 3.75 for the second batch. This study indicates that locally made flocked swabs are satisfactory and clinically applicable for testing and diagnosing COVID-19. Furthermore, mass production and distribution across the country are expected. The development of these swabs, which involved multidisciplinary teamwork and various industrial partners, portrayed a valuable lesson on how to cope with the pandemic through innovation.
Background : A Surgeon should have good leadership. Leadership plays an important role in improving health services. Leadership can shape a better future. Method : A literature search was conducted in November 2019. Related keywords were applied to Pubmed, Medline, and SCOPUS for studies published in the last five years. Relevant research is taken to be used as the discussion material. Result : The key to surgical leadership is collaboration and cooperation, humanism and mentorship, and operational efficiency. Conclusion: Effective leadership in a surgical team has the following characteristics: (1) Defines the role of a leader clearly, especially in critical situations; (2) Leadership style that suits the clinical situation; (3) Clear directions to team members; (4) Consistently seeking input from team members; (5) Involving members in decision making.
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