Notes

Low-velocity, private pistol extremity injuries-review and update with regard to radiologists.
Leptospirosis, a bacterial infection attributed to the group leptospira, remains a globally emerging public-health issue in many endemic tropical, subtropical and temperate zones of the world. The burden is expected to inflate with population shifts related to violent storms and urban floods leading to poor housing and inadequate sanitation. Leptospirosis may mimic other illnesses such as influenza, dengue fever, typhoid and malaria due to its myriad presentation ranging from a mild, self-limiting febrile illness to hepatorenal dysfunction, myocarditis, pulmonary haemorrhage, meningitis, optic neuritis and rhabdomyolysis. The classical gastrointestinal manifestation of leptospirosis without hepatorenal dysfunction (Weil's disease) is a rare entity. We report a rare presentation of concurrent appendicitis and rectal perforation in a patient, whose jaundice and thrombocytopenia led to a suspicion of leptospirosis, confirmed by serology and fulfilment of parameters under the modified Faine's criteria. The patient was managed successfully and discharged in a stable condition.
With the increase and refinement of video assisted mitral valve surgery, cristalloïd cardioplegia started regaining popularity. The aim of our study was to evaluate the effectiveness of Celsior
, a crystalloid cardioplegic solution, on myocardial protection in elective surgical mitral valve repair in comparison to blood based hyperkalemic cardioplegia.

In this observational retrospective study, all consecutive elective isolated surgical mitral valve repair where Celsior
or normothermic hyperkalemic blood cardioplegia were used were included. Primary endpoint was any sign of myocardial protection failure (troponin levels, need for inotropic or mechanical support, rhythm disturbances, mortality). Secondary endpoint was Celsior
safety (allergic reactions, bleeding, organ toxicities).

From January 2009 to August 2016, 382 patients underwent elective isolated mitral valve repair in whom normothermic hyperkalemic blood cardioplegia (
 = 181) or Celsior
(
 = 201) were used. There were no statistically significant differences in baseline characteristics including Euroscore 2. Peak troponin (pg/ml) release and 30-days mortality were not statistically different. Need for cardioversion was significantly more frequent in the Celsior
group (47% vs 13%,
 < 0.001). There was no statistical difference in post-operative atrial fibrillation, permanent pacemaker implantation, reoperation for bleeding, transfusion, acute kidney injury, haemoglobin at discharge or length of stay. No allergic reaction to Celsior
occurred.

Effective myocardial protection was achieved with the Celsior
cardioplegic solution with no unexpected toxicity. Celsior
may be an efficacious and safe cardioprotective strategy in mitral valve repair.
Effective myocardial protection was achieved with the Celsior® cardioplegic solution with no unexpected toxicity. Celsior® may be an efficacious and safe cardioprotective strategy in mitral valve repair.The focus of this article is on how parents of children with "nonnormative" genitalia cope with the conflict between the genital socialization process and their children's genital autonomy in the Israeli medical-sociocultural context. Based on a qualitative narrative study that included 18 parents of children born with atypical genitalia and 23 parents who had chosen not to circumcise their sons, I compare parents' experiences and perceptions of genital autonomy and examine the challenges posed by the Israeli genital socialization process from their perspective. In this study, I aim to shed light on the stressful and powerful Israeli genital socialization process, in which the medical, familial, and religious forces reproduce gendered normative genital appearances. The parents' physical and emotional experiences include feelings of doubt and a critical stance toward genital socialization, changes in perceptions regarding genital appearance, and parental practices that challenge the meaning and outcomes of genital surgeries.This paper explores attitudes of staff, residents and family members towards sexually diverse persons based on data from the first national study of its kind in Aotearoa New Zealand. The study was a two-arm mixed-method cross-sectional study using a concurrent triangulation design. The quantitative arm included the results of 433 staff surveys related to knowledge, attitudes, behaviours and beliefs about sexuality, intimacy and ageing. The qualitative arm included interviews with 77 participants including staff, residents and family members. MDL-28170 molecular weight This paper focuses only on sexual diversity. A generational cultural effect was noted among all respondents; younger participants expressed the most open and accepting views of diversity. Residents were aware that they mostly held the views of their generation; nonetheless they also looked to staff to set the tone. Staff held varying views and felt that residents would be less accepting; some staff felt the issue of intimate relationships was not something they were willing to discuss at intake. Facilities will want to establish policies about sexuality and intimacy and communicate those policies and practices to staff, residents and family members. Facilities may also wish to consider specific educational events about sexual diversity for residents.
As a non-European Union member state, Albania is increasingly orienting itself on Western models regarding human rights, patient rights, and legal regulations for healthcare. Due to its limited fiscal and legal power, enforcing legal and ethical regulations poses a major problem.

The aim of this study is to investigate nurse's knowledge and experiences regarding ethical and legal issues in Albanian elder care in state-funded and privately run institutions.

The study was conducted using an inductive and qualitative design, utilizing a focused ethnographic approach, based on Roper and Shapira's framework.

Data were collected between June 2017 and September 2018 using participant observation, field notes, and semi-structured interviews with 15 nurses in seven different elder care institutions. In total, 100 h of observation and 15 interviews were performed. Data analysis was based on Mayring's qualitative content analysis.

The approval for the study was obtained from UMIT-The Health and Life Sciences University, Austria.
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