In Maya theology, everything from humans and crops to gods and the world itself passes through endless cycles of birth, maturation, dissolution, death, and rebirth. Traditional Maya believe that ...human beings perpetuate this cycle through ritual offerings and ceremonies that have the power to rebirth the world at critical points during the calendar year. The most elaborate ceremonies take place during Semana Santa (Holy Week), the days preceding Easter on the Christian calendar, during which traditionalist Maya replicate many of the most important world-renewing rituals that their ancient ancestors practiced at the end of the calendar year in anticipation of the New Year’s rites.Marshaling a wealth of evidence from Pre-Columbian texts, early colonial Spanish writings, and decades of fieldwork with present-day Maya, The Burden of the Ancients presents a masterfully detailed account of world-renewing ceremonies that spans the Pre-Columbian era through the crisis of the Conquest period and the subsequent colonial occupation all the way to the present. Allen J. Christenson focuses on Santiago Atitlán, a Tz’utujil Maya community in highland Guatemala, and offers the first systematic analysis of how the Maya preserved important elements of their ancient world renewal ceremonies by adopting similar elements of Roman Catholic observances and infusing them with traditional Maya meanings. His extensive description of Holy Week in Santiago Atitlán demonstrates that the community’s contemporary ritual practices and mythic stories bear a remarkable resemblance to similar cultural entities from its Pre-Columbian past.
The Resuscitation Outcomes Consortium (ROC)epidemiological registry (Epistry) provides opportunities to assess trends in out-of-hospital cardiac arrest treatment and outcomes.
Patient, event, system, ...treatment, and outcome data from adult (≥18 years) out-of-hospital cardiac arrest (OHCA) from 10 geographically diverse North American ROC sites over four 12-month epochs, from July 1, 2011 to June 30, 2015, were assessed. Descriptive statistics were used to characterize the sample and logistic regression assessed the association of study epoch and key covariates on survival.
Overall, 85,553 patients were assessed by Emergency Medical Services (EMS) and 45,516 (53.2%, site range 30.4%–69.9%) had resuscitation attempted by EMS. Patient and event characteristics were consistent except for increases in bystander CPR (41.3%–44.9%) and bystander AED application (3.9%–5.2%). EMS CPR depth and compression fraction increased while pre-shock pause interval decreased. Targeted temperature management was performed in 51.1% of admitted patients and early coronary angiography in 30.2%. Survival to hospital discharge improved (from 10.9% to 11.3% across epochs) with epoch significantly associated with survival (p < 0.001) showing an increasing trend in survival over time. (p = 0.02). Marked site variation in survival persisted within and across epochs (overall site range: 4.2%–19.8%). Patients with an initially shockable rhythm (VT/VF) had an overall survival of 32.2% (site range: 11.9%–47.1%) while survival in bystander witnessed VT/VF was 35.8% (site range: 12.9%–53.1%).
Survival from adult OHCA in multiple large geographically-separate sites improved over the study period. Marked site differences in survival persist and addressing this variation is essential to improve outcomes from OHCA across North America.
Abstract Objectives Surgery for varicose veins is still the method of choice worldwide. When varicose veins require bilateral surgery, a single procedure often is the preferred choice by the patient. ...Today, unilateral varicose vein surgery is frequently performed as an outpatient procedure, while in many institutions bilateral surgery is done as an in-hospital procedure. Design Retrospective comparative study. Methods Between 1 October 2004 and 31 October 2006, 433 patients underwent surgery for the great saphenous vein as in-patient procedure (303 unilateral and 130 bilateral), period 1. From 1 November 2006 until 31 December 2009, 825 patients had ambulatory great saphenous vein surgery (550 unilateral and 275 bilateral), period 2. We have compared unilateral and bilateral varicose vein surgery (high ligation and stripping of the great saphenous vein) and in-hospital procedures with ambulatory surgery, with regard to postoperative complications, postoperative pain and midterm follow-up. Results Operation time and total length of stay in the institution following varicose vein surgery were significantly shorter for period 2 compared with period 1 for both unilateral and bilateral surgery, without other differences between the groups. There were few postoperative complications without differences between periods, and between unilateral and bilateral surgery (wound infection 0.5%, haematoma requiring drainage 0.2%, transient paraesthesia 1.1%, superficial localised thrombophlebitis 0.6% and deep vein thrombosis in one unilaterally operated case only). Conclusions Bilateral varicose vein surgery can be safely performed as an outpatient procedure, without increased risk of postoperative complications, increased postoperative discomfort or midterm adverse effects compared with unilateral surgery.
The incidence of nonmelanoma skin cancer is increasing rapidly among elderly persons, but little is known about its incidence in the population younger than 40 years.
To estimate the sex- and ...age-specific incidences of basal cell carcinoma and squamous cell carcinoma in persons younger than 40 years in Olmsted County, Minnesota, and to evaluate change in incidence over time; to describe the clinical presentation, rate of recurrence and metastasis, and histologic characteristics of these tumors in this population-based sample.
Population-based retrospective incidence case review.
Residents of Olmsted County, Minnesota, a population with comprehensive medical records captured through the Rochester Epidemiology Project.
Patients younger than 40 years with basal cell carcinoma or squamous cell carcinoma diagnosed between 1976 and 2003.
Incident basal cell carcinomas and squamous cell carcinomas and change in incidence of these tumors over time.
During the study period, 451 incident basal cell carcinomas were diagnosed in 417 patients and 70 incident squamous cell carcinomas were diagnosed in 68 patients. Of these tumors, 328 were histologically confirmed basal cell carcinomas and 51 were histologically confirmed squamous cell carcinomas. Overall, the age-adjusted incidence of basal cell carcinoma per 100,000 persons was 25.9 (95% confidence interval CI, 22.6-29.2) for women and 20.9 (95% CI, 17.8-23.9) for men. The incidence of basal cell carcinoma increased significantly during the study period among women (P<.001) but not men (P = .19). Nodular basal cell carcinoma was the most common histologic subtype; 43.0% of tumors were solely nodular basal cell carcinoma and 11.0% had a mixed composition, including the nodular subtype. The incidence of squamous cell carcinoma was similar in men and women, with an average age- and sex-adjusted incidence per 100 000 persons of 3.9 (95% CI, 3.0-4.8); the incidence of squamous cell carcinoma increased significantly over the study period among both women (P = .01) and men (P = .04).
This population-based study demonstrated an increase in the incidence of nonmelanoma skin cancer among young women and men residing in Olmsted County, Minnesota. There was a disproportionate increase in basal cell carcinoma in young women. This increase may lead to an exponential increase in the overall occurrence of nonmelanoma skin cancers over time as this population ages, which emphasizes the need to focus on skin cancer prevention in young adults.
Scabies—An ancient itch that is still rampant today Thomas, J.; Christenson, J. K.; Walker, E. ...
Journal of clinical pharmacy and therapeutics,
December 2017, 2017-Dec, 2017-12-00, 20171201, Letnik:
42, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Summary
What is known and Objective
Scabies is recognized as a neglected tropical disease responsible for a substantial health and economic burden, especially in resource‐poor communities around the ...world.
Comment
There are relatively few current treatment options for scabies, and they possess important limitations. The treatments are ineffective in preventing relapse, inflammatory skin reactions and associated bacterial skin infections. There are also safety concerns, especially in children and pregnant women. Furthermore, there has been the emergence of resistance among scabies mites to the classical acaricides.
What is new and Conclusion
More research needs to be devoted to developing new treatments for scabies.
Summary
Background Reduction of immunosuppression is considered a reasonable adjuvant therapeutic strategy in solid‐organ transplant recipients experiencing multiple or high‐risk skin cancers. ...However, the literature provides no guidance about what threshold of cancer development would warrant initiation of reduction of immunosuppression.
Objectives To develop expert consensus guidelines for initiation of reduction of transplant‐associated immunosuppression for solid‐organ transplant recipients with severe skin cancer.
Methods An expert consensus panel was convened by the International Transplant Skin Cancer Collaborative and Skin Care for Organ Transplant Patients Europe Reduction of Immunosuppression Task Force. Thirteen hypothetical patient scenarios with graduated morbidity and mortality risks were presented and mean and mode expert opinions about appropriate level of reduction of systemic immunosuppression (mild, moderate, severe) were generated.
Results Mild reduction of transplant‐associated immunosuppression was considered warranted once multiple skin cancers per year developed or with individual high‐risk skin cancers. Moderate reduction was considered appropriate when patients experienced > 25 skin cancers per year or for skin cancers with a 10% 3‐year risk of mortality. Severe reduction was considered warranted only for life‐threatening skin cancers.
Conclusions Reduction of immunosuppression is considered a reasonable adjuvant management strategy for transplant recipients with numerous or life‐threatening skin cancers. Proposed guidelines are presented for the graduated reduction of immunosuppression coincident with the increasing skin cancer risks.
Melanoma in Solid Organ Transplant Recipients Zwald, F. O.; Christenson, L. J.; Billingsley, E. M. ...
American journal of transplantation,
20/May , Letnik:
10, Številka:
5
Journal Article
Recenzirano
This manuscript outlines estimated risk and clinical course of pretransplant MM, donor‐transmitted MM and de novo MM posttransplantation and includes an analysis of risk factors for metastasis, data ...from clinical studies and current and proposed management. MM in situ and thin melanoma (<1 mm) in the transplant population has similar recurrence and survival estimates to those in the general population. A minimum wait time of 2 years prior to transplantation is suggested for MM with a Breslow depth <1 mm and no clinical evidence of metastasis. More advanced MM may adopt a more aggressive course in transplant recipients. Sentinel lymph node biopsy may be of additional prognostic benefit. Revision of immunosuppression in the management of de novo melanoma in collaboration with the transplant team should be considered. Larger studies utilizing uniform staging criteria or at minimum Breslow depth, are required to assess true risk and outcome of MM in the immunosuppressed transplant population. Emphasis remains on patient education and regular screening to provide early detection of MM.
This collaborative review addresses the clinical course of transplant associated melanoma and outlines a proposed strategy for management.
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