Prevention of COVID-19 can only be done by changing behavior. The recommended behavior change is 3Ms behavior. The Health Belief Model (HBM) theory can be used to predict the behavior of 3M people. The purpose of this study is to find out how 3M s behavior is viewed from the HBM theoretical framework.

BACKGROUND: Anaesthesia at bronchoscopy is a unique challenge for the anaesthesiologist as both the anaesthesiologist and operator work in the same airway. It is essential that administration of sedative agents must achieve the desired depth of sedation without risking airway patency, ventilation function and cardiovascular function. About 25% of bronchoscopy patients cite cough as the most unpleasant effect of this procedure. Fentanyl is widely chosen for a sedative agent because of their analgesic, sedative, and antitussive effects, however there has been no data regarding the optimal dose of fentanyl to suppress cough in bronchoscopy procedures. METHODS: We designed a research with 18 subjects received fentanyl in a dose of 1 µg / kgBW, 18 subjects received fentanyl in a dose of 1.5 µg / kgBW and 18 subjects received propofol in a dose of 2 mg / kgBW as a control group. We observed the depth of sedation using the Ramsay sedation score and duration of cough suppression in their bronchoscopy procedures. We also observed the alteration of blood pressure, pulse rate, respiratory rate and oxygen saturation. RESULTS: There was a significant difference in the depth of patient sedation between the control group and the treatment groups; as patients without fentanyl treatment were sedated deeper on the Ramsay 4 scale, patients in the treatment groups with either fentanyl of 1 µg / kgBW or 1.5 µg / kgBW had the depth of sedation on the Ramsay 2 scale and unable to reach moderate sedation as expected. Subjects with fentanyl treatments showed significantly better suppression effects against coughing compared to control group patients. As there also was a significance difference in suppression effects for coughing between the group receiving fentanyl treatment of 1 µg / kgBW and the group receiving fentanyl treatment of 1.5 µg / kgBW, we noticed a fentanyl treatment of 1 µg / kgBW was adequate to suppress cough although a dose of 1.5 µg / kgBW would show better cough suppression effect. Subjects in control group with 2 mg / kgBW of propofol experienced a more significant alteration in vital signs than the fentanyl group, either with a dose of 1 µg / kgBW or 1.5 µg / kgBW. Comparing and statistically analysing the two treatment groups of different dose of fentanyl, we found no significant difference in vital signs alteration between the two groups. DISCUSSION: Our study revealed that as fentanyl significantly suppressed cough reflex and larger dose would provide longer period of suppression. Subjects with fentanyl treatment showed more favourable altercation in systolic and diastolic blood pressure, pulse rate, respiratory rate and oxygen saturation compared to subjects in control group with 2 mg / kgBW of propofol, but comparing and statistically analysing the two groups of different dose of fentanyl, we found no significant difference in vital signs alteration.

Background: Appendicitis is an acute inflammation that occurs in the vermiform appendix. The incidence of appendicitis in Indonesia was reported at 5 per 1000 population with the number of cases reaching 10 million annually and was the highest incidence in ASEAN. The present study was conducted to assess the prevalence of Appendicitis in RST Tk.III Wijayakusuma Purwokerto. Method: This was a descriptive cross-sectional study that determine the prevalence of appendicitis at RST Tk.III Wijayakusuma Purwokerto during January 2020 – December 2020. Descriptive analysis was performed for age, sex, chief complaints, complications, laboratory tests of blood leucocytes, patient conditions on hospital discharge, and patient length of hospital stays (LOS). Result: The highest incidence in persons aged 10 – 19 (29.03%), that females had higher rates (51.61%), the most common presenting complain was pain in right lower abdomen with 93.54% , that 61.29% were developed the complications, the highest proportion were in the group of blood leucocytes =10.000/mm3 about 83.87%, patients were planned for continuing in outpatient care with 87.09%, and the highest proportion were belonged to the LOS group of 4 – 5 days that 35.48%. Conclusion: Our Study concluded that female were affected more by appendicitis, most common age for appendicitis was 10-19 years, the most presenting complain was pain in right lower abdomen that more developed in to complications with highest propotion were blood leucocytes =10.000/mm3 with patients were planned for continuing in outpatient care and the most LOS was 4-5 days.

Diabetes mellitus and depression are common comorbidities, a relationship that may indicate a shared autonomic and neurohormonal etiology, which affects the quality of life, including sleep quality. Objective: To determine the relationship between sleep quality and symptoms of depression in patients with type 2 diabetes mellitus in a family medicine unit. Material and method. Observational, analytical, cross-sectional study; patients diagnosed with diabetes mellitus, older than 18 years, indistinct sex were included, the clinimetric scale was applied to assess depressive symptoms and the Pittsburgh Sleep Quality Index, previously validated, descriptive statistics were used, chi-square (X2), Mann Whitney U and Kruskal-Wallis H. Results: 308 patients were included, 64% women, between 31 and 87 years, median 64 years, diabetes diagnosis time between 1 and 35 years, 41.9% (129) uncontrolled. According to the clinimetric scale for the diagnosis of depression, 26.3% have mild depression, 6.5% moderate depression, and 12.7% severe depression. 56.8% have poor sleep quality and 43.2% have good sleep quality according to the Pittsburgh Sleep Quality Index. Depression was not associated with age (p 3.26), occupation (p .677), education (p= .083), marital status (p = .475), body mass index (p= .083) or job quality. sleep (p= 0.065). Conclusions: Sleep quality is poor in more than half of the population, it is not associated with depression or glycemic control

The renal manifestations of multiple myeloma are devastating coupled with a disease as aggressive as the aforementioned. Its pathophysiological understanding has been clarified over time and has revealed the different mechanisms by which difficult-to-manage kidney damage occurs. However, the different therapies that have been developed have made this disease have an increasingly better prognosis. It is still a therapeutic challenge to treat myeloma together with a disease as complex as kidney disease.

Urinary tract infections are the most common infections in pregnant women. The most common are asymptomatic bacteriuria, cystitis and pyelonephritis, the latter presenting as a complication in 1 to 2% of women. Urolithiasis is also very common, complicating approximately 1 in every 2,000 pregnancies. These entities usually occur due to physiological changes that occur during pregnancy, such as enlargement of both kidneys, increased glomerular filtration rate, as well as dilatation of the renal pelvis and ureters. It is important to perform imaging studies to establish the diagnosis, being renal ultrasound the first line option in the pregnant patient with renal colic because it is harmless to the patient and fetus. Treatment can be conservative with hydration and pain management with analgesics.

Acne is an inflammatory disease that usually affects the pilosebaceous unit. It is a very common disease worldwide and its onset during puberty is common. Multiple studies have shown that up to 95% of adolescents will be affected to some degree during their lifetime, being the female sex the most affected. It is frequently associated with monogenic diseases such as Apert syndrome; comedonal nevus; Frank-ter Haar syndrome, among others. The pathogenesis is multifactorial, however, it has been demonstrated that there are four interrelated factors, being these the increase of sebum production, hyperkeratinization of the follicular infundibulum, inflammation and microbial infection. Some genes frequently involved in affected patients are SELL, DBB2 and TP53, whose function is the regulation of hemostasis and cutaneous inflammation; the regulation of apoptosis of damaged DNA and the formation of scars associated with severe acne, respectively. It is common to observe comedones, pustules, papules and cysts as characteristic lesions, face and thorax are the most frequent location. It has been shown that the incidence decreases between the fourth and fifth decades of life, also, generally in affected individuals the lesions resolve spontaneously leaving scars in severe cases.

Specialized nutrition support (SNS) is required when oral intake is either limited or not possible for a prolonged period of time. Common indications for SNS include patients in critical care, those with dysphagia, unconscious patients who cannot be fed, severely malnourished patients, and those with intestinal malabsorption. The two forms of SNS are enteral nutrition and parenteral nutrition. Enteral feeding is always preferred whenever possible, but parenteral feeding may be instituted if the patient has a nonfunctional GI tract (e.g., gastroschisis, short bowel syndromes), and/or if enteral feeding is contraindicated. Patients who are on SNS may develop several complications related to feeding tubes or intravenous catheters, as well as additional metabolic complications such as electrolyte imbalances, hyperglycemia, refeeding syndrome, gallstone disease, and nonalcoholic fatty liver disease

Peroral endoscopic myotomy (POEM) is a form of transluminal endoscopic natural orifice surgery (NOTES) that uses the beginnings of submucosal endoscopy to make the endoscopic equivalent of a surgical myotomy. POEM can be done in most patients who have primary idiopathic achalasia demonstrated manometrically symptomatic. Previous therapies for achalasia, such as pneumatic balloon dilation, botulinum toxin injection, or surgical myotomy, are not contraindications to POEM. Generally, POEM is done in 4 continuous steps: incision in the mucosa, construction of a submucosal tunnel, myotomy and closure of the incision in the mucosa. Endoscopic management has been revolutionary for the treatment of achalasia and other pathological entities, however, it must be performed in specialized centres and by endoscopist surgeons with extensive experience in the subject, to reduce the associated morbidity and mortality

Background: Fibroadenoma is the most common type of breast tumor diagnosed in young women, in children and adolescents it is called juvenile fibroadenoma. These tumors often result in emergence, self-confidence, and anxiety in adolescents. Case Report: A 21-year-old female patient came to the surgical clinic with lumps in the right and left breasts since about 4 years ago. History and physical examination showed the right and left breast tumors were suspiciously benign. Ultrasound results showed multiple hypoechoic (solid) lesions, on the right breast the largest size was 4 cm, with BIRADS 2, the left breast the largest size was 3.5 cm, with BIRADS 2. The patient then underwent surgical excision of the tumor and performed histopathological examination. The results of histopathological examination provide an overview of fibroadenoma. Conclusion: The presentation of the case report from the authors hopes to expand the literature and provide insight into multiple fibroadenoma and the need for anamnesis, comprehensive physical examination, accompanied by ultrasonography to FNA in a young female patient who has a lump in the breast.

Tetanus is caused by clostridium tetani bacteria through skin breach. The tetanus is characterized by tonic contraction and muscle spasm which can cause vertebral fracture in some patients. we are reporting a young male patient who after ring circumcision technique had tetanus complicated into thoracic vertebral fracture with severe kyphotic deformity and lower limb functional impairment. The surgical management was performed in two stages: First stage consisted of Shwab 2 osteotomy, pedicle screws and rod fixation with good result for deformity correction. The second stage of surgery involved left transpedicular T6 and T5 corpectomies (Shwab 3 osteotomy) plus interbody titanium cage fixation which provided good spinal cord decompression. Tetanus is still a major complication of circumcision, tetanus complication may be devastating Early surgical deformity correction and spinal cord decompression provide favorable neurological and functional outcome for patients with spine deformity post tetanus. The Patient was able to walk with crutches 3 months post-surgery.

Background: Platelet-rich plasma (PRP) is blood plasma containing an above baseline level of platelets and growth factors. Recently, Platelet-rich plasma (PRP) has come to the attention of aesthetic surgeons, with burgeoning new applications ranging from hair restoration to soft tissue augmentation. Injectable Poly-D,L-Lactic Acid (PDLLA) is a biostimulator rather than a traditional filler, which provides immediate volumetric improvement. Injectable PLA can produce a result comparable with Hyaluronic Acid fillers for the correction of wrinkles such as nasolabial folds, and can be a good choice for such a treatment. Methods: A Female 45 years Old with deep smile lines and fine wrinkles on cheeks. The patient was treated with injected of Poly(D,L Lactic Acid) and Platelet Rich Plasma. Poly-D,L-Lactic Acid was injected subdermal with retrograde linear thread technique and used 24-G cannula needle. After 3 weeks PDLLA Injection, PRP was injected intradermal into the whole face especially along the smile lines using a 32-G Needle at a dose of 0.05 ml at each injection site with a distance of about 0.5-1.0 cm. PRP was injected every 2 weeks for 3 months. Results: Wrinkle Severity Rating Scale was downgrading and skin quality like skin tone looks more brightening and fading hyperpigmentation. Conclusion: The combination of Poly-D,L-Lactic Acid and Platelet-Rich Plasma is effective for facial rejuvenation. Keywords: Platelet-rich plasma (PRP), Poly-D,L-Lactic Acid, Nasolabial Folds, Wrinkle Severity Rating Scale

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a hypersensitivity reaction. Therefore, the case of a 51-year-old woman with no history of drug allergies is presented. In empirical treatment with Ceftriaxone, presenting 15 days later pruritic maculopapular rash on the chest, abdomen and extremities accompanied by temperature rises of up to 39°C. Laboratories with leukocytes of 47.38/uL, with eosinophils of 27.07/uL, and skin biopsy report with inflammatory infiltrate in the dermis at the expense of eosinophils. regiSCAR and J-SCAR with results of 8 and 6 points respectively. Administering methylprednisolone 250 mg every 24 hours for 3 days, continuing with prednisone 50 mg per day. Improvement of skin lesions and laboratory abnormalities at 72 hours. DRESS induced by this antibiotic is rare. Appropriate assessment of the indications and diagnostic assumption of side effects is important because the manifestations are potentially reversible.of rash, fever, facial edema, lymphadenopathy, hematologic abnormalities, and visceral involvement.

COVID-19 is caused by the novel SARS-CoV-2 that has disseminated in a global pandemic. During this pandemic, the healthcare seeking of stroke patients faces relentlessly critical challenges, as doctors continue to struggle in uncharted territory because of There are increasing concerns regarding the impact of imposed health care and social restrictions in response to the corona virus disease 2019 (COVID-19) pandemic on the management and care of patients with stroke Several cohort studies suggest that COVID-19 itself may be a risk factor for developing a vascular event, while raising concerns about increased morbidity and morbidity. Our objective is to determine the effect of the corona virus on the epidemiological and clinical characteristics of stroke patients.

Congestive heart failure is a clinical condition in which the heart cannot send enough blood to meet the bodys metabolic needs due to pathological cardiac changes. In recent decades, a progressive increase in patients affected by this disease has been observed; this could be due to the increase in population age throughout the world, as it is a disease that mainly affects elderly individuals, a higher rate of general healing as a decrease in mortality results in a more significant number of patients affected by it, as well as more effective treatments for cardiac pathologies such as primary angioplasty in acute myocardial infarction, causing a more substantial number of patients with decreased cardiac function.

Snake bite is common condition that lead to great consequence in the rural area of tropical country. Although snakebite is treatable, WHO listed snakebite as Neglected Tropical Disease. Epidemiology data of snakebite not known exactly, the real data may be higher than data inscribed. Both venomous and non-venomous snake are can lead to fatal condition and make the victim consequences morbidity and mortality. Non-venomous snakebite also have potential risk of infection, coagulopathy, and traumatic feelings. Prognosis affected by many factors from snake venom, the victim, and environment that led to delayed medical treatment. Here, we report a case of neglected non-venomous snakebite wound that lead to severe infection of the limb.

Free bodies in the peritoneal cavity are solid, very rare and mostly asymptomatic tumors. We present the case of a finding of free body in the peritoneal cavity during appendectomy. Free bodies in the peritoneal cavity are very rare cases reported in the literature, described as giants greater than 5 cm in diameter, predominantly in men over 50 years, with an incidence of man / woman of 17: 3. There is no definite surgical treatment for foreign bodies in the cavity, as most are asymptomatic and mostly identified as a finding. Surgical treatment is reserved for symptomatic cases.

The Health Belief Model seeks an explanation for the lack of public participation in prevention programs; and as we get older, we are more exposed to different diseases, some of which, thanks to the development of vaccination schedules, can be prevented. However, due to the increase and dissemination of false beliefs, many people are against it. In March 2020, the WHO declares an emergency situation due to the number of COVID-19 cases, with high morbimortality rates affecting mainly the elderly, thus arising the need for a vaccine, generating beliefs towards it, either by ignorance, uncertainty and / or influence of third opinions, influencing its application. A total of 128 people were surveyed, of whom 50% were vaccinated and 50% were not; of those not vaccinated, they did not want to be vaccinated (45.7%) because of fear of adverse effects (32.7%), because they did not trust (26.5%), and because of lack of information (38.8%). On the other hand, of those vaccinated, 71.2% felt safer, 19.7% felt the same, and 9.1% felt less safe. The lack of information about vaccines as well as the yellowing of the adverse effects has increased the population that refuses to be vaccinated, increasing morbidity and mortality.

Endometriosis is a pathology that commonly prevails in more than 50% of women as a cause of dysmenorrhea and infertility and we can define it as the presence of endometrial glands and stroma outside of it, that is, ectopic endometrial tissue that is mostly located in the ovaries, Douglas pouch, uterosacral ligaments and other anatomical sites. Infertility associated with endometriosis is a multifactorial disease and there is no certainty about the mechanisms by which it is developed, however there are several theories that could provide an explanation. Oxidative stress is one of the factors that contribute to infertility where a chain of events is created that culminates in the alteration of the number of oocyte recovery and the number of mature oocytes. Dysregulation of aromatase P450 production in steroidogenesis causes a decrease in estrogen production altering follicular and oocyte development. There are also interleukins associated with infertility of which TNF-a, interleukin-1ß, IL-6, IL-8, IL-10 and others stand out. On the other hand, there are several biological explanations that are related to the causal link between endometriosis and infertility, some of them include factors of the pelvic cavity, ovarian and genetic factors.

Pancoast tumors are an interesting pathological entity when it comes to talking about mediastinal tumors, the alterations they cause are deeply rooted in their location. The development of surgical techniques as well as new antitumor therapies have created a pillar on which therapy that generates high survival in these patients could be based. However, these treatments also carry their risks.

Aspirin and other nonsteroidal anti-inflammatory medicines (NSAIDs) have been shown in a large body of research to be protective against the growth of adenomas and colon cancer. the possible benefit of NSAIDs like aspirin in preventing CRC. Other protective factors have also been found, mostly through observational research, but the potency of some of these correlations is not clear. Dietary regimens of a certain kind may lower the risk of CRC

The site-specific modification of an existing gene is known as gene editing. A section of DNA must be cut with an endonuclease (such as the CRISPR-Cas9 system) before the two severed ends are brought together, frequently with a new or improved sequence inserted between them. Somatic cell gene editing can be helpful in a variety of clinical contexts, and some preliminary preclinical and clinical trials have been carried out. Extremely high levels of precision are required for DNA recognition, excision, and repair; issues with publishing integrity must be resolved. Germline editing utilizing eggs, sperm, or embryos raises ethical concerns.

Malignant hyperthermia is a subclinical myopathy in which general anesthesia triggers an uncontrollable contraction of skeletal muscle that leads to a life-threatening hypercatabolic state and an increase in body temperature. The disease is primarily autosomal dominant; mutations in receptors (especially ryanodine receptor type 1) predispose to volatile anesthetic agents or succinylcholine causing an accumulation of intracellular calcium in skeletal muscle that leads to its overactivation and hypermetabolism. In the acute setting, diagnosis is based mainly on clinical presentation and end-tidal capnography, which reveals an increase in end-tidal CO2. Initial treatment measures include discontinuation of the agent causing the reaction and administration of dantrolene. In non-acute settings, there are specific diagnostic tools such as the caffeine-halothane contracture test to confirm suspected cases. MH is a lethal disease and has a high mortality rate if not treated early.

INTRODUCTION: Prevalence estimates for developmental delay are scarce for eastern India. The main objective of the study was to estimate the prevalence of developmental delay amongst apparently neurologically normal children admitted to the general paediatrics ward. We also aimed to ascertain associations between developmental delay and known or suspected precedents and risk factors for developmental delay. METHODS: A prospective, cross-sectional and observational study was conducted on in-patients in the general paediatrics ward. A pretested and predesigned questionnaire was administered to the attendant on the day of the discharge. Information was gathered regarding patients’ demographics, parent’s socio-economic and educational status, relevant history that is known or suspected to cause developmental delay. Achievement of developmental milestones was assessed as per the Trivandrum Development Screening Chart (TDSC) for 0-3 years. Chi-square tests were done and p<0.05 was considered statistically significant. RESULT: The prevalence of developmental delay was 23.13% amongst 134 children. Developmental delay had a significant association with child’s age (p-value:0.0007), preterm delivery (p-value:0.0012), histories of birth asphyxia (p-value:0.0066) and neonatal seizure (p-value:0.0093). CONCLUSION: A significant proportion of apparently normal children have developmental delay. Measures to detect these cases can help to institute early intervention and prevent long-term sequelae.

Human face is the front side of a head which functions most of all for individual identity. Global culture agrees that scarring on the face reduces attractiveness to the opposite sex; and it drives everyone with a wound or a proposed wound on his/her face to ask for a favorable scar. Clinical management of incisional scars begins with a thorough discussion of surgical pre-measures. The main modifiable factor of scar formation is the design of the skin incision that bears the least tension in the healing period. During surgical procedures, doctors must pay attention to skin tension lines and vascularization to the wound edge tissues. After the surgical procedure, sutures with non-absorbable materials must be taken off, and skin tape must be applied perpendicularly to the wound axis to reduce tensions during the remodeling phase of healing. The patients’ active participation in wound management, even long after the wound appears to heal, support good outcomes. Post-surgical evaluation visits must be conducted and focus on the prevention, early detection, and proper management of the healing wound, especially ones with hypertrophic potential. Hypertrophic scars which do not improve after six months is no longer considered hypertrophic scars but it is considered keloids which require proactive and more intensive management.

Purple urine bag syndrome is a rare but dangerous entity that indicates an important colonization of the urinary tract by multiple multiresistant bacteria in most cases. The low incidence means that this entity is not only underdiagnosed but also treated erroneously. The culture, as well as a general urine test, are key to its correct diagnosis and treatment.

The purpose of this paper was to investigate the findings of the available literature regarding the role of psychosocial support in the organic and psychosocial management of the disease for the family as a whole. To fulfill this goal, the method of reviewing the existing literature has been implemented and all the relevant necessary data were collected with the aid of two databases, namely Google Scholar and PubMed. The main criteria for selecting the appropriate scientific investigation tools were the necessary research among minors and the time of publication, especially from 2000 onwards. The later was taken into serious consideration, with a specific focus on the articles published after 2015. Psychosocial support at the stage of diagnosis can contribute to a more effective psychosocial adaptation and social work becomes of major importance. The crisis intervention method can be very helpful, but it needs to be empirically substantiated through a qualitative research study

In the article, iron deficiency associated with Helicobacter pylori is associated with a number of external factors and bad habits in the development of anemia. Helicobacter pylori should be tested in all patients with chronic iron deficiency anemia and gastrointestinal complaints. In patients diagnosed with Helicobacter pylori-associated iron-deficiency anemia, it has been shown to have a highly reliable effect of first carrying out antibacterial eradication therapy and then prescribing an iron supplement according to the severity of the disease.

Background: Community Health Center carrying out the authority task to implement the stages of management functions. The application of management requires good knowledge to be able to implement planning, mobilizing implementation, monitoring, and controlling assessments optimally. Materials/Methods: The research was conducted using a quantitative method with a cross-sectional approach. The research population is the Head in charge of health efforts at Public Health Center throughout Bengkulu Province. The data was collected using a questionnaire and analyzed using the Chi-Square Test with the help of the SPSS 22 application. Result: The research affects planning knowledge, Organizing Actuating, monitoring, and linearly controlling the assessment. Knowledge of supervision control appraisal has less effect on the implementation of management functions simultaneously. Conclusion: Applying knowledge management in health services will improve service quality for targeted and sustainable services. Knowledge management in health services can be improved to help improve the quality, efficiency, and effectiveness of services. Mobilizing the implementation of health programs must pay attention to available resources to optimize their respective roles and functions. Resource based mobilization is useful in adding perspective to knowledge mobilization in healthcare organization

De Garengeots hernia was described in 1731, referring to it as the presence of the appendix in a femoral hernia. It occurs in between 0.5% and 5% of cases. It is believed to perform simple hernia surgery and avoid using mesh if there is infection or inflammation. Laparoscopic surgery should be considered in patients who are clinically stable and have a preoperative diagnosis. In this case, we are dealing with a patient who has a hernia caused by Garengeots syndrome

Prostate cancer is an affectation acquired in old age, men who develop it may have genetic factors, other predisposing diseases such as benign prostatic hyperplasia and bad habits such as alcoholism and smoking that may be the cause of developing the affectation. The identification of risk factors as well as their early treatment can significantly reduce morbidity and mortality

Background The quality of laboratory services is a very important tool for patient care. Medical decisions in diagnosing disease and providing appropriate treatment mainly depends on the results of laboratory tests jointly with the clinical examination and interview. So this study was conducted to assess the confidence of internists in laboratory services and to analyze the strengths and limitations imposed on these services.

Patients with systemic sclerosis (SSc, scleroderma) offer challenges inherent in surgical interventions involving the hands, including poor circulation, compromised and inelastic dermis, constantly ulceration, and immunocompromised systemic status, constantly aggravated by immunosuppressive drugs. Despite these challenges, certain drawbacks that are affecting the hands of patients with CSS are best treated by surgery. Surgical methods in the hands of patients with SSc mainly aim to address the next complications: Digital ischemia, deformities of the interphalangeal (IP) and metacarpophalangeal joints (MCP), and Calcinosis cutis.