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Priority Allocation in Medical Resources

According to the modifications, a team must evaluate the prioritization of patients and decide to whom the resources are given.
Patients who are more likely to survive with the help of critical medicine will have priority to receive ventilators and other supplies, whether or not they have COVID-19, according to the Bioethical Guide for the Allocation of Limited Resources for Critical Medicine in Emergency Situations.

The General Health Council made changes to the guide due to the controversy that originated an earlier version that prioritized the principle of “lives to be completed”, that is, that of the youngest over that of the elderly. Now the allocation of resources will be determined by a triage team, which will calculate the score of each patient considering their current infection situation, their past situation (pre-existing comorbidities) and the expectation of survival to treatment.

The objective of the guide is to protect the health of the population, that is, to save the greatest number of lives, which is why those who are more likely to survive with the help of critical medicine are prioritized over patients who are less likely.

The document indicates that saving the greatest number of lives requires evaluating the probability that a patient improves and survives and the time that said the patient would use the scarce resources that can be reused, which implies that sometimes it is necessary to select among patients with similar characteristics and Medical prognosis.

The principles of social justice –in which all people have the same value and the same rights–, human dignity, solidarity and equity should guide the Bioethics Guide and be decisive at the time of assignment.

Who Will Have Priority To Receive Resources?

The prioritization mechanism includes both the initial allocation of resources and the reallocation of resources that are already being used and must be applied to both COVID19 patients and patients who require critical care for other conditions.
Having COVID-19 does not make a patient a higher priority in accessing scarce critical medicine resources. “

The process is done in two steps; first, the initial prioritization score of each patient is calculated, according to a scale that indicates the probability of survival for both patients with COVID-19 and for patients without COVID-19, as soon as “ make clinically clear ”that a patient needs critical medicine, it should start as soon as possible.
However, the score of patients who are using the resources should be re-evaluated periodically, to assess whether it is appropriate to change the status.
This evaluation will only be carried out in patients who have already been stabilized and, if possible, they will be provided with temporary mechanical ventilation, in which the prioritization score is calculated, which should be informed to the relatives.
As a special case, it is established that priority of access to the scarce resources of critical medicine should be given to health personnel who combat the emergency of COVID-19, this means that health personnel who face the pandemic must pass at the top of the list for scarce critical medicine resources when required.
The only exception to this assignment is when the health personnel present such comorbidities, or their prognosis is such that it would be futile for them to access these resources.

What Should Not Be Considered For The Allocation Of Resources?

Political affiliation, religion, head of household, perceived social value, nationality or immigration status, age, gender, ethnic origin, orientation, sexuality, gender identity, disabilities, and legal or socioeconomic status.

Nor should the first-come-first-serve principle be considered during a health emergency, since it unfairly benefits people who live in urban populations and near hospital units, compared to those patients who are foreigners.

Applications Of Alloplastic Materials In Rhinoplasty

Rhinoplasty has shifted its focus in the last 10-15 years from an aggressive reductive surgery to one with a greater emphasis on nasal augmentation. As a consequence of this, the need has arisen to have in the nasal plastic with support materials, filling and camouflage. There are several types of grafts and alloplastics available for surgical use today, and their choice depends on multiple factors 1-3.

The grafts can be divided into two broad categories, the autografts, which are derived from the patient himself and include cartilage, bone, fascia and dermis; and homografts, which are derived from tissues donated by members of the same species, and include irradiated cartilage and acellular dermis. Autologous grafts have high blood compatibility and a low risk of infection and extrusion compared to homologous and alloplastic grafts. They remain by far preferred materials in rlnoplastía by most surgeons 45. However, its advantages must be compared with the consequent morbidity of the donor site, availability of the graft and its reabsorption. On the other hand, in malformed noses and, mainly, in secondary rhinoplasties, it is common to find a shortage of grafts necessary for adequate reconstruction 1-5. Some of these techniques are used by Florida rhinoplasty specialists.

Homolngrafts are materials obtained from members of the same species. They include Irradiated cartilage and cadaveric acellular dermis. Irradiated cartilage is obtained from cadaver donor ribs, who are screened for HIV, hepatitis B, venereal diseases, and tuberculosis. Being subsequently irradiated with gamma rays at doses of 30,000 to 60,000 Gy. Due to the absence of cellularity, they are non-immunogenic and well-tolerated by the host. However, one of its main disadvantages is reabsorption, close to 10%. Infection, graft displacement and extrusion rates are acceptable, generally less than 5%. The acellular dermis is obtained from a cadaveric donor and is later frozen dry. It lacks antigens of the major complex of histocompatibility type I and II, so it is highly biocompatible. It is used for the correction and camouflage of Irregularities of the nasal dorsum1.

Alloplastic materials are synthetic, block-compatible polymers developed for use in surgery. In recent years its use in rhinoplasty has been introduced, which is why we consider that its properties and applications should be known by professionals who are related to this surgery. The objective of this review is to show the different types of alloplastic materials currently used in rhinoplasty, analyzing their specific uses, properties, advantages and disadvantages.

Non-Surgical Nose Surgery: The Pros And Cons Of The Procedure

For some time now, cosmetologists have learned to use injectables (for example, hyaluronic acid gels) to correct the profile in less than 15 minutes. We learned from the experts all the intricacies of non-surgical rhinoplasty.

Most fillers have a temporary effect (from three months to two years, depending on the type of preparation chosen).

Many do not understand why injections are needed if the result is fleeting. For example, Volumema lasts for a year and a half. Once the drug dissolves, many switch to Bellafill (collagen-based injections commonly used to treat acne scars). The effect after its introduction lasts for years.

Correction methods

Botulinum toxin injections

In people with advanced nasal muscles, the tip of the nose usually drops downward (called a “drooping” nose). Botulinum toxin relaxes the mimic muscles and blocks the appearance of wrinkles. Modern formulations of the drug are practically safe, but there are individual contraindications.

If there is a drooping of the tip of the nose when smiling or talking, it would be better to inject botulinum toxin into the muscle that lifts the upper lip and the wing of the nose,

Pros: there is no rehabilitation after the procedure; there are practically no contraindications. As a result, the correction is very delicate.

Cons: it is impossible to radically correct the shape of the nose.
Filler injections

With a low bridge of the nose and bridge of the nose, filler injections are a more effective and simple way to correct the shape.

Pros: less traumatic, fast, effective with a low bridge of the nose and bridge of the nose.

Cons: they cannot be used to make the tip sharper, lift it, get rid of the hump and narrow the wide nose.

Rehabilitation

If there were a pain scale, then Botox would be at the very bottom (you barely feel the pricks), injections in the cheek would be located closer to the top. Lip injections are somewhere in between. And what about non-surgical nose surgery? All experts say it is almost painless. However, even ordinary ice helps.

Risks

The advantages of non-surgical plastic surgery are obvious: a “new” nose without anaesthesia and scalpel, quick rehabilitation and relatively low cost. But even the seemingly safe methods have disadvantages. All injections are a risk. Swelling, bruising, and bleeding may occur.