Central Hospital Research Articles

Global and Community Health: Neurologic Care and a Case Study for Immigrants and Refugees in West Philadelphia.

Philadelphia is a diverse city that has experienced an increasing immigrant and refugee population in recent decades. Although many academic medical centers also call Philadelphia their home, lack of accessibility and difficulty with insurance limit access to health care for many of its newest residents. The Social Health and Medical Services (SHAMS) Free Health Clinic was started to help address some of these disparities, especially for immigrant and refugee populations. Despite initial setbacks, the clinic has thrived and even moved locations to accommodate increasing patient demand. While many patients initially presented for primary care, there was a growing need for specialist care and coordinated multidisciplinary management. We present an example of a partnership between an academic center (Hospital of the University of Pennsylvania) and a community health center (SHAMS clinic), whereby patients have access to a dedicated neurology clinic that is run by residents and staffed by neurology attendings. This has allowed patients to have access to outpatient neurologic care, has facilitated referral to inpatient care when needed for serious conditions such as status epilepticus (as in the case study discussed), and has allowed for continuity of care between the hospital and the outpatient setting. Although this clinic is an endeavor to create an academic-community partnership, there is still much work to do to improve medical access in the immigrant and refugee communities.

Study of bone mineral disorders in hemodialysis patients at Hue Central Hospital

Study of bone mineral disorders in hemodialysis patients at Hue Central Hospital

Effect of Intensive Nursing Management on Quality of Life and Mental Health in Elderly Gastric Cancer Patients Undergoing Chemotherapy: A Retrospective Study

Aims/Background Implementing effective nursing management is particularly critical in the case of elderly gastric cancer (GC) patients receiving chemotherapy, who are more vulnerable to risk events. Therefore, this study explored the effect of intensive nursing management on quality of life (QoL) and mental health in elderly GC patients receiving chemotherapy. Methods A total of 155 elderly patients with GC undergoing chemotherapy in Central Hospital Affiliated to Shandong First Medical University from July 2021 to July 2023 were selected as the study subjects. The sample was divided into two groups according to different nursing methods: 74 patients who received intensive nursing management were classified in the observation group, while 81 patients treated with routine nursing management were classified under the reference group. The QoL, mental health and adverse reactions to chemotherapy were compared between the two groups. Results Before nursing management was implemented, there was no significant difference in the scores of the quality of life questionnaire-core 30 (QLQ-C30), patient health questionnaire-9 items (PHQ-9), and the Chinese version of the M.D. Anderson Symptom Inventory (MDASI-C) (p > 0.05). After management, in comparison with the reference group, the observation group showed significantly higher scores in each dimension of QLQ-C30, as well as significantly lower scores in PHQ-9 and MDASI-C (p < 0.001). The incidences of gastrointestinal reaction, myelosuppression, neurotoxicity, and hepatorenal damage were lower in the observation group than in the reference group (45.95% vs 70.37%, 40.54% vs 65.43%, 35.14% vs 53.09%, and 33.78% vs 51.25%, respectively; p < 0.05). Conclusion The application of intensive nursing management in treating elderly GC patients during chemotherapy effectively improves their physical and mental states, ameliorates clinical symptoms and enhances the QoL, showing certain clinical application value.

Sexually transmitted infections in sexually abused children: an audit project to implement PCR tests in a child advocacy center in Türkiye

Background. Sexual abuse in children can sometimes result in sexually transmitted infections (STIs), which can serve as crucial forensic evidence. Although PCR methods are now accepted as the gold standard for STI screening, they have not yet widely replaced traditional culture methods in Türkiye. This study aims to assess the necessity of implementing PCR-based STI testing at Child Advocacy Centers in Türkiye, where such testing is not routinely available. Methods. Conducted between February and November 2023, this study included children who presented to the Child Advocacy Center of Marmara University Pendik Training and Research Hospital. High-risk victims were identified based on criteria including a history of penetrative sexual abuse and factors such as multiple perpetrators or significant age disparity. Serological tests and genital swabs were collected and analyzed using both bacterial culture methods and a comprehensive STI PCR panel. Results. The study included 20 victims, with a median age of 16 years. STI PCR testing detected pathogens in 19 out of 21 samples, including Chlamydia trachomatis (20%) and Neisseria gonorrhoeae (5%). In contrast, culture methods identified no sexually transmitted pathogens. Conclusion. PCR testing demonstrated significantly higher sensitivity for detecting STIs compared to traditional bacterial culture methods, as expected. Implementing PCR-based STI testing in Child Advocacy Centers is an urgent and essential need for providing an accurate diagnosis and robust forensic evidence, enhancing the care and legal protection of sexually abused children.

A Longitudinal Study of the Association of Awareness of Disease Incurability with Patient-Reported Outcomes in Heart Failure.

To examine awareness of disease incurability among patients with heart failure over 24 mo and its associations with patient characteristics and patient-reported outcomes (distress, emotional, and spiritual well-being). This study analyzed 24-mo data from a prospective cohort study of 251 patients with heart failure (New York Heart Association class III/IV) recruited from inpatient wards in Singapore General Hospital and National Heart Centre Singapore. Patients were asked to report if their doctor told them they were receiving treatment to cure their condition. "No" responses were categorized as being aware of disease incurability, while "Yes" and "Uncertain" were categorized as being unaware and being uncertain about disease incurability, respectively. We used mixed-effects multinomial logistic regression to investigate the associations between awareness of disease incurability and patient characteristics and mixed-effects linear regressions to investigate associations with patient outcomes. The percentage of patients who were aware of disease incurability increased from 51.6% at baseline to 76.4% at 24-mo follow-up (P < 0.001). Compared with being unaware of disease incurability, being aware was associated with older age (relative risk ratio [RRR] = 1.04; P = 0.005), adequate self-care confidence (RRR = 5.06; P < 0.001), participation in treatment decision making (RRR = 2.13; P = 0.006), higher education (RRR = 2.00; P = 0.033), financial difficulty (RRR = 1.18; P = 0.020), symptom burden (RRR = 1.08; P = 0.001), and ethnicity (P < 0.05). Compared with being unaware of disease incurability, being aware was associated with higher emotional well-being (β = 0.76; P = 0.024), while being uncertain about disease incurability was associated with poorer spiritual well-being (β = -3.16; P = 0.006). Our findings support the importance of being aware of disease incurability, addressing uncertainty around disease incurability among patients with heart failure, and helping patients make informed medical decisions. The findings are important to Asian and other cultures where the prognosis disclosure to terminally ill patients is generally low with an intention to "protect" patients. Our 24-mo study with heart failure patients showed an increase from 52% to 76% in patients being aware of disease incurability.Compared with being unaware of disease incurability, being aware was associated with higher emotional well-being, while uncertainty about disease incurability was associated with poorer spiritual well-being.

A pedicled anterolateral thigh flap decreased the risk of empty pelvis syndrome following total pelvic exenteration.

Total pelvic exenteration (TPE) can be complicated by empty pelvis syndrome (EPS), and none of the currently available procedures completely mitigate this problem. The aim of this study was to evaluate the feasibility and effectiveness of a pedicled anterolateral thigh (p-ALT) flap for preventing EPS. All cases of TPE at the National Cancer Center Hospital in Tokyo between 2008 and 2022 were retrospectively reviewed. The main indication for TPE was colorectal cancer, with some other malignancies. Background factors, surgical outcomes and postoperative complications were compared between patients who underwent primary suture closure (the PC group) and those who underwent p-ALT flap reconstruction (the flap group). A total of 114 patients underwent TPE during the study period. Twenty patients in whom a different procedure was performed or a different flap was used for reconstruction were excluded, leaving 94 for analysis (PC group, n = 54; flap group, n = 40). There was no significant between-group difference in patient characteristics. Severe pelvic abscess developed in 12 patients (22.2%) in the PC group and 2 (5%) in the flap group. Multivariable analysis identified a significantly lower risk of severe pelvic abscess in the p-ALT flap reconstruction (OR 0.07, 95% CI 0.01-0.58, p = 0.01). EPS-related readmissions were more common in the PC group [37.0% (20/54) vs. 25% (10/40)]. The risk of severe pelvic abscesses and readmission for EPS was significantly lower after perineal reconstruction with a p-ALT flap. Perineal reconstruction with this flap is a feasible and effective method in TPE.

A Cardiac Tumor and Liver Masses on Point of Care Ultrasound (POCUS): Implications in a Resource-Limited Setting

Malignant cardiac tumors are quite rare, but portend a poor prognosis [1,2]. Early identification and classification are essential given their aggressive nature, particularly when metastases are present [3,4]. Clinical presentations are varied, and detection relies primarily on echocardiography. Thus, cardiac tumors may go undiagnosed in areas where echocardiography is not routinely available [1,5]. In this case, point of care ultrasound (POCUS) rapidly detected a cardiac mass and liver lesions, prompting referral to a central hospital in Malawi for further evaluation. This case highlighted the potential role of POCUS as a readily available tool in a resource-limited setting, serving as a triage point for more definitive diagnosis and management [6-8].

Intracytoplasmic sperm injection compared with in vitro fertilisation in patients with non-male factor infertility with low oocyte retrieval: a single-centre, retrospective cohort study

ObjectiveTo investigate the effects of in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) on the clinical outcomes of non-male factor patients aged >35 with three or fewer oocytes retrieved.DesignRetrospective...

Analysis of wrong blood in tube events at a hospital-based blood centre in a tertiary care referral hospital: A perspective from a lower middle-income country.

Wrong blood in tube (WBIT) continues to be a preventable cause of unintended harm to the patient. The literature describing extent of the problem, its consequences and factors leading to WBIT from the perspective of lower middle-income countries (LMICs) is limited. The present study describes WBIT and its outcome in a hospital-based blood centre from an LMIC. WBIT events occurring during the study period were analysed to identify the root cause. In addition, they were analysed according to discipline, department and time of sample draw. Root causes were divided and compared with standard operating procedure (SOP) for sample collection for blood requests. All WBIT events were followed and their outcomes analysed. WBIT events occurred at a rate of 4.8/10,000 blood requests, with a higher rate in urgent requests (5.2/10,000 requests). The average rate of WBIT was higher in surgical disciplines compared to medical and acute care services (6.58 vs. 4.43 vs. 3/10,000 requests). The highest rate of WBIT was observed when requests were received during 8:00 PM-2:00 AM (p = 0.02). Deviations from SOP with contribution from human and organizational elements were identified as the root cause. The consequences ranged from delay in providing blood to acute haemolytic transfusion reactions. We found that WBITs occurred at a rate comparable to that reported from developed countries. Use of software and automation may reduce the rate of WBIT but not eliminate it completely. Strict adherence to SOPs and continuous training of phlebotomy staff would help reduce it to a minimum. Blood centres need to develop specific strategies with respect to their root causes.

REMEMBER: 30 YEARS SINCE CONSTANTIN ARSENI PASSED AWAY - THE FONDATOR OF ROMANIAN NEUROSURGERY

Introduction The authors will present one of the great personalities of Romanian neurosurgery, Dr Constantin Arseni, who created it in Bucharest, creating the largest university centre of neurosurgery in Europe at that time. Material After the tragic loss of his mentor Prof. Dr Dumitru Bagdasar in 1946, Dr Constantin Arseni, took over the management of the neurosurgery service at the Central Hospital for Mental, Nervous and Endocrinologic Diseases, the only department of this kind in this country; He was able to have the first Clinic of Neurosurgery from Romania. For his merits, Dr Constantin Arseni, became an Associate Professor in 1952 and University Professor in 1963. His neurosurgical activity was complex, but mainly focused on tumoral pathology, cerebral and spinal, and also on spinal degenerative disease. Under Professor C. Arseni, the Neurosurgical Clinic of Bucharest is transformed in 1975 into the “Prof. Dr D. Bagdasar” Clinical Hospital of Neurosurgery, the largest hospital of Neurosurgery in the Europe, with 550 beds and, subsequently, 650 beds. Also, he developed the departments of neurosurgery in each of the biggest university centres in the country; while being the first President of the Romanian Society of Neurosurgery. Scientific Activity Scientific activity of Prof. Dr Constantin Arseni includes the numerous publications (54 treaties and monographies), together with all his collaborators, encompassing all domains of neurosurgery: Tumoral, Neuropathological, Vascular, Paediatric, Spinal Degenerative Pathology, Central Nervous System Malformations, History, etc. with high international visibility. An editorial board under C. Arseni published, with the substantial contribution of the Bucharest Medical Publishing House of the Clinic, the “Treatise of Neurology” in 8 volumes (1979-1981). Conclusions Professor Constantin Arseni was a dedicated surgeon, he practiced his job asking from those around him as much as he offered - the maximum. He was a schoolmaster and a teacher in the true sense of word. Professor Constantin Arseni, Member of the Romanian Academy, was an exemplary professional, a model of conduct, which will forever remain in our memory, of the neurosurgeons, and of the Romanian neurosurgery, leaving behind a legacy hard to match for those who followed him.

Cerebral venous sinus thrombosis and exploration of prognostic factors: a case series

BackgroundThis study examined the etiology, treatment response, and prognosis of patients with cerebral venous sinus thrombosis (CVST) at a single institution.MethodsThis retrospective study included patients diagnosed with CVST between January 2016 and December 2020 at Baotou Central Hospital. The data were collected from patient charts, including sex, age, comorbidities, pregnancy, smoking, alcohol drinking, symptoms at onset, radiological location, examinations, Glasgow coma scale (GCS) at admission, National Institutes of Health stroke scale (NIHSS) at admission, modified Rankin scale (mRS) at admission, and treatments.ResultsThe study included 31 patients (13 males and 18 females) aged 39.0 (interquartile range, 30.0–53.0) years. Three (9.7%) patients had a history of hypertension, one (3.2%) had a history of stroke, four (12.9%) had thrombotic disorders, six (19.4%) were pregnant (including three who delivered), four (12.9%) were smoking, and four (12.9%) were drinking alcohol. The GCS at admission was 15.0 (IQR, 15.0–15.0), the NIHSS at admission was 0.0 (IQR, 0.0–2.0), and the mRS at admission was 0.0 (IQR, 0.0–0.0). The patients were grouped according to their mRS (&amp;gt;0 vs. 0); there were no significant differences between the two groups regarding the patient characteristics (all p &amp;gt; 0.05). Only an NIHSS of &amp;gt;0 at follow-up was associated with a 3-month mRS &amp;gt;0 (p &amp;lt; 0.001).ConclusionThe median age of the patients with CVST was 39 years. The majority were female (58%), 13% had thrombotic disorders, and 19% were or were recently pregnant. Only a NIHSS of &amp;gt;0 at follow-up was associated with a 3-month mRS &amp;gt;0.

Efficacy and safety of remimazolam tosylate for patients undergoing off-pump coronary artery bypass grafting: a study protocol for a non-inferiority randomised controlled trial in China

IntroductionMaintaining haemodynamic stability is crucial but challenging during the induction and maintenance of general anaesthesia (GA) in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Remimazolam tosylate is a novel...

MS O02 - OGC An audit of waiting times of the oesophagogastric cancer diagnostic pathway at a high-volume, tertiary centre

Abstract Background The oesophagogastric cancer (OGC) staging pathway is extensive, contributing to prolonged waiting times from referral to treatment. NHS England guidance details the ideal timeframe from referral to finalisation of the patient’s treatment plan and stipulates a time of 21 days from OGD to communication of the treatment plan to the patient. This audit aims to compare pathway times at a tertiary cancer centre, which accepts referrals from seven different hospitals, to the current NHS target and further stratify pathway times according to patient characteristics and referring hospitals. Method Data was collected using a prospectively collected database of OGC patients who underwent staging investigations at the tertiary centre between October 2022 and October 2023. The primary outcome was OGD to communication of the treatment plan. Secondary outcomes included time from OGD to first staging investigation and the proportion of patients that had a next-day computed tomography (CT) scan. Outcomes were stratified to investigate inter-hospital variation and the effect of curative status and tumour location. Data was expressed as median and interquartile range (IQR) for continuous data or n (%) if categorical. Results 263 patients were included in this audit with a median age of 69.0 (IQR 61.5-77.0). 13.8% of patients satisfied the target time of 21 days from OGD to communication of treatment plan. Curative patients had a longer median pathway time than palliative patients (49.0 vs 35.0 days), whereas oesophageal and gastric cancer patients had similar pathway times (44.0 vs 44.5 days). Patients diagnosed at the tertiary centre had a faster time from OGD to first staging investigation than patients diagnosed at non-specialist centres. Only 13.3% of patients had a next-day CT scan following their OGD (median time 5.0 days). Conclusion The OGC staging pathway is considerably slower than the target. Faster pathway times in palliative patients can be attributed to many of these patients not requiring further staging post-CT. Potentially, targets should be re-evaluated to distinguish between palliative and curative patients. The faster staging process at the central hospital may be explained by more regular clinics run by specialist clinicians and the prompt requesting of staging investigations without awaiting MDT discussions. Alongside increasing the proportion of next-day CT scans, these factors must be addressed to streamline the entire pathway.

Genomic sequencing and neutralizing serological profiles during acute dengue infection: A 2017 cohort study in Nepal.

Dengue virus (DENV) is a mosquito-borne flavivirus that poses a threat to nearly 50% of the global population. DENV has been endemic in Nepal since 2006; however, little is known about how DENV is evolving or the prevalence of anti-DENV immunity within the Nepalese population. To begin to address these gaps, we performed a serologic and genetic study of 49 patients from across Nepal who presented at central hospitals during the 2017 dengue season with suspected DENV infection. Of the 49 subjects assessed, 21 (43%) were positive for DENV NS1 antigen; of these; 5 were also anti-DENV IgM+ IgG+; 7 were DENV IgM+ IgG-, 2 were IgM- IgG+, and 7 were IgM-IgG- by specific ELISAs. Seven of the 21 NS1 positive sera were RNA positive by RT-PCR (six DENV2, one DENV3), suggesting that DENV2 was the dominant serotype in our cohort. Whole-genome sequencing of two DENV2 isolates showed similarity with strains circulating in Singapore in 2016, and the envelope genes were also similar to strains circulating in India in 2017. DENV-neutralizing antibodies (nAbs) were present in 31 of 47 sera tested (66%); among these, 20, 24, 26, and 12 sera contained nAbs against DENV1, 2, 3, and 4 serotypes, respectively. Additionally, 27 (58%) samples had nAbs against multiple serotypes (2 or more). Serology analysis suggested that 12 (26%) and 19 (40%) of the 47 subjects were experiencing primary and secondary DENV infections, respectively. Collectively, our results provide evidence for current and/or past exposure to multiple DENV serotypes in our cohort. These data suggest that expanded local surveillance of circulating DENV genotypes and population immunity will be important to effectively manage and mitigate future dengue outbreaks in Nepal.

Data managers and clinical research coordinators: a tool to collect the hourly activity

Background and Aims: the main purpose of this paper is analyzing the hourly activities performed by Data Managers (DMs) and Clinical Research Coordinators (CRCs) in a Clinical Trial Center (CTC) of an Italian Public Hospital in order to define and monitor the relevant job descriptions of these professionals Materials and Methods: the CTC of the Research and Innovation Departments (DAIRI) has created a tool to collect the hourly activity of DMs and CRCs. In the period between January 1 and December 31, 2022; the activities were collected and grouped in 24 macro areas. Results: the main activities conducted by staff are found in the macro areas "Study Management" (15.78%); "Briefing/Planning" (12.86%) and “Data Management/Data Entry” (12.42%). A difference was found between the activities carried out by CRCs and those conducted by DMs. Conclusions: the results of this monitoring, compared with data obtained at the national level, confirm the heterogeneity of the tasks performed by these professional figures. These differences increasingly underscore the need to obtain recognition of the figure by the National Health System (NHS) with the definition of a precise “job description”.

Assessment of patient knowledge and perceptions towards orthodontic treatment in the Aljouf Region, Saudi Arabia: a cross-sectional study

Background In orthodontic treatment, it is most important to assess the patient’s perspective of malocclusion because these perceptions are fundamental to determining the patient’s demands and level of treatment satisfaction. This study was done to assess the knowledge and perception of residents of the Aljouf Region of Saudi Arabia seeking orthodontic treatment. Furthermore, we determined the factors associated with the patients’ knowledge and perception of orthodontic treatment. Methods This cross-sectional study was conducted using a pre-tested and validated questionnaire among patients seeking orthodontic treatment who were registered at King Abdulaziz Hospital, Sakaka, and primary health centers. We identified the associated factors using binomial logistic regression analysis. Finally, we applied Spearman’s correlation test to identify the correlation between knowledge and perception. Results A total of 282 individuals participated in the current study, of which 53.3% were female and 46.1% were male. About one-third (36.9%) of patients had a low level of knowledge, 35.5% had a medium level of knowledge, and 27.7% had a high level of knowledge regarding orthodontic treatment. A total of 20.6% had low perceptions, 42.9% had medium perceptions, and 36.5% had high perceptions of orthodontic care. A significant correlation was found between age and gender, knowledge (p = 0.001), and perception (p = 0.040). Moreover, we observed a positive correlation between knowledge and perception (Spearman’s rho = 0.297, p = 0.001). Conclusion People in Aljouf have poor knowledge and medium perception regarding orthodontic treatment. We recommend that the concerned authorities make a health educational plan for the patients seeking orthodontic treatment.

The effect of interhospital transfer on pediatric burn injury mortality in a resource-limited setting.

The World Health Organization's burn mortality estimate is 180,000 annually. Ninety-five percent of all mortality caused by fire-related burns worldwide occurs in low- and middle-income countries (LMICs). Prior studies have shown that transfer status (direct transfer from an injury scene to a trauma center vs. indirect transfer from another health facility) affects patient outcomes. We evaluated the effect of interhospital transfer on burn mortality. We analyzed a burn database of pediatric patients admitted to the Kamuzu Central Hospital (KCH) burn unit in Lilongwe, Malawi. We performed a bivariate analysis based on their transfer status and mortality and a logistic regression analysis to determine the effect of transfer status on mortality after burn injury. A total of 2301 patients were analyzed, with 1095 (47.6%) being in the transfer cohort from referring hospitals. The median age was 3years (IQR 1-4). The transfer cohort had more patients presenting to the hospital more than 48h after injury. Upon multivariate logistic regression, controlling for pertinent variables, including time to presentation, burn-injured patients in the transfer cohort had increased odds of mortality (OR 2.26, 95% CI 1.22-4.19, and p=0.01) compared to patients who were not transferred. The predictive probabilities of burn mortality by TBSA showed significant differences in mortality based on transfer status at TBSA between 20% and 80%. Ensuring district hospitals and other primary health care centers in resource-limited settings are sufficiently equipped to provide initial burn resuscitation and care may decrease mortality rates associated with transferred patients.

Evaluation of the effect of full-process blood glucose management on T2DM cataract patients based on visual electrophysiology and OCTA.

To investigate the difference in preoperative retinal function in patients with type 2 diabetes cataract (DC) without obvious retinopathy and to explore the clinical application of full blood glucose management for improving the postoperative vision in DC patients. This was a retrospective analysis in which we estimated the changes in visual electrophysiology (N75, P100, photopic flash electroretinogram(FERG), and scotopic FERG, paraoptic retinal nerve fibre layer thickness (pRNFL) and paraoptic radial capillary network blood flow density (ppVD) of type 2 diabetes (T2DM) patients at different phases of disease progression along with fasting blood glucose (FBG) and glycosylated haemoglobin (HbAlC) levels before and after DC surgery at Ziyang Central Hospital from January 2020 to December 2022. Additionally, trends in the above data throughout the entire process of glucose management intervention were examined. As the course of T2DM progressed, FBG and HbA1c increased, the N75 and P100 latency periods of patients gradually increased, and the values of photopic FERG, scotopic FERG, pRNFL, and ppVD gradually decreased at each postoperative time point. Moreover, the best corrected visual acuity(BCVA) of patients after surgery gradually decreased (P < 0.05). The BCVA of Group B (with full process blood glucose management) gradually stabilized at 1 month after surgery, and the BCVA of Group B was better than that of Group A at all time points after surgery. The results revealed that N75 and P100 in Group A were greater than those in Group B, whereas the photopic and scotopic FERG, pRNFL, and ppVD (%) values in Group A were lower than those in Group B. In addition, N75 and P100 in Group A gradually increased at various time points after surgery, whereas the photopic FERG, scotopic FERG, pRNFL, and ppVD (%) values gradually decreased. In the state of full blood glucose management, although N75 and P100 both reached their longest durations at one week after surgery, N75, the P100, photopic FERG, scotopic FERG, and pRNFL showed a gradually decreasing trend at 1 month and 3 months after surgery, whereas ppVD (%) gradually increased (P < 0.05). According to the results of the quantitative analysis of visual electrophysiology and OCTA, with the aggravation of diabetes, the retinal function of DC patients without obvious retinopathy tends to decrease, but full-process blood glucose management can effectively recover the retinal function of DC patients and improve visual quality after surgery.

BN SO54 - Complex Management of a Gastrocutaneous Fistula Following Pancreatic Necrosectomy: A Case Report

Abstract Background Gastrocutaneous fistulas are rare but serious complications that can arise following the surgical treatment of necrotizing pancreatitis. This post-operatory complication can be refractory to conservative management and may be further aggravated by severe skin injuries and malnutrition. This case report describes the comprehensive and multidisciplinary approach of a challenging case of gastrocutaneous fistula, ultimately requiring re-intervention. Method A 78-year-old female with a history of severe necrotizing pancreatitis underwent pancreatic necrosectomy by laparotomy. Postoperatively, she developed a gastric fistula, initially repaired with a double-layered suture. Recurrence led to a gastrocutaneous fistula with continuous gastric drainage and chemical burn of the surrounding skin. Initial conservative management included insertion of a nasogastric tube for gastric decompression, followed by placement of a PEG tube to redirect the drainage and prevent further skin damage and an esophagojejunal feeding tube to bypass the fistula and maintain nutrition. Nevertheless, the fistula persisted, resulting in significant skin erosion and deterioration of the patient’s condition. Results Given the failure of conservative measures and a concurrent diagnosis of a pancreatic fistula, a surgical approach was deemed necessary. The patient was transferred to a specialized hospital center, where she underwent fistulectomy with partial gastrectomy and wound closure. Negative pressure wound therapy (NPWT) was applied to the ulcerated skin to promote healing. This approach led to the successful closure of the gastrocutaneous fistula and healing of the skin wound. The patient showed marked clinical recovery, with no signs of infection or fistula recurrence and the nutritional status was successfully managed through enteral feeding leading to a notable functional recovery. Conclusion This case underlines the complexity of managing gastrocutaneous fistulas, demonstrating the efficacy of combining surgical and supportive therapies, serving as a reference for similar future cases and emphasizing the need for comprehensive management strategies for complex postoperative complications.

Correlation Between Vitamin D Deficiency and Calcium, Phosphorus, Alkaline Phosphatase in Preterm Libyan Infants: Case-Control study

Vitamin D plays a vital role in regulating calcium and phosphorus levels and in bone mineralization. Vitamin D deficiency is a widespread issue contributing to metabolic bone disease in preterm infants. This study aimed to evaluate the biochemical parameters associated with varying levels of vitamin D deficiency. Serum samples were collected from preterm infants at the Neonatal Intensive Care Unit of Althawra Hospital Center, Al Beyda, Libya, from Feb-July 2019. The study included two groups: 62 preterm infants and a control group of 34 full-term infants. Serum levels of calcium, phosphorus, alkaline phosphatase, and 25OH-Vitamin D were measured using enzyme immunoassays and standard method. The study involved 62 preterm neonates, with a median gestational age of 32 weeks (range 28-36) and median birth weight of 1960 gm (range 900-2800 gm). The median levels recorded were calcium at 8.7 mg/dl (p=0.000), phosphorus at 4.1 mg/dl (p=0.584), ALP at 458 U/L (p=0.008), and vitamin D at 13.6 ng/ml. The prevalence of varying degrees of vitamin D deficiency was noted: very severe (9.7% &lt; 5 ng/ml), severe (19.4% 5-10 ng/ml), and overall deficiency (45% 10-20 ng/ml), and suboptimal (25.8% 20-30 ng/ml). Comparing preterm infants to the control group revealed statistically significant differences across all parameters (Vitamin D p=0.000, Ca p=0.007, PO4 p=0.036, and ALP p=0.000). All preterm infants exhibited inadequate vitamin D levels, and there was an inverse relationship between the biochemical parameters and vitamin D deficiency. Notably, the elevated ALP level could serve as a crucial marker for diagnosing vitamin D deficiency in clinical settings.