Early Detection Of Complications Research Articles

Lowering of the Patella — prevention and treatment of a rare complication during leg lengthening: a case report

Background. Changes in the level of the patella position are a well-known complication of knee replacement, reconstruction of the anterior cruciate ligament, high tibial osteotomy and consequences of injuries. However, this problem has not been disclosed in the literature in relation to distraction osteogenesis using the Ilizarov method. The aim of the study is to describe such a rare iatrogenic complication as patella baja during limb lengthening by the Ilizarov method using a clinical case as an example. Case description. In 2017, a 17-year-old teenager was injured in a head-on collision of cars at high speed. The patient was diagnosed with an open fracture of the left femur and fibula and tibia of the left leg. He was treated in another clinic using the Ilizarov apparatus for osteosynthesis of the femur, tibia and proximal osteotomy of the tibia to move the bone to fill the distal bone defect. At the end of the treatment, the patient had a moderate limitation of the knee flexion (180-80°). In 2018, the patient was admitted to our clinic due to osteomyelitis at the level of the consolidated fracture. A new resection of the osteomyelitis lesion and proximal osteotomy for bifocal osteogenesis were performed. During the treatment, limitation of knee flexion (180-120°) was developed and radiographic signs of low position of the patella were obtained. Given the progression of patella baja (the Caton-Deschamps index = 0.51), we were forced to return the patient to the operating room to restore the correct height of the patella. Conclusions. The presented clinical case emphasizes the need for a more thorough assessment of the patella height after surgical treatment on the proximal tibia using the Ilizarov method. It is also noted that it is important to conduct a control MRI, which allows for a more detailed study of the initial position of the anterior tibial tubercle. In our case, early detection of complications allowed us to achieve complete recovery without any consequences.

The Role of Artificial Intelligence in Clinical Decision Support Systems

Clinical Decision Support Systems (CDSS) are integral tools in modern healthcare, designed to assist clinicians by providing patient-specific recommendations based on vast medical data and knowledge. The advent of Artificial Intelligence (AI) has significantly enhanced CDSS, enabling sophisticated predictive analytics, early detection of complications, and personalized interventions. AI techniques like machine learning, natural language processing, and deep learning play crucial roles in refining CDSS functionality. However, challenges such as data quality, AI transparency, and clinician trust hinder widespread adoption. Future trends focus on improving AI integration in CDSS through better data representation, automation, and ethical considerations. This paper investigates the fundamental aspects of CDSS, the applications of AI in healthcare, and the challenges and future directions for AI-driven CDSS. Keywords: Clinical Decision Support Systems (CDSS), Artificial Intelligence (AI), Machine Learning, Healthcare Technology, Predictive Analytics.

ADVANCING CARDIOVASCULAR CARE: A COMPREHENSIVE REVIEW OF PORTABLE AND CONTINUOUS MONITORING DEVICES IN CARDIOVASCULAR RADIOLOGY

Cardiovascular radiology has witnessed significant advancements with the introduction and widespread adoption of portable and continuous monitoring devices. These technologies have revolutionized patient care by providing real-time, comprehensive cardiovascular health assessments. This narrative review explores the current landscape of portable and continuous monitoring devices in cardiovascular radiology. It examines their applications, impact on early detection of complications, influence on mortality rates, and potential side effects associated with prolonged use. By synthesizing recent research and clinical guidelines, this review aims to thoroughly understand these devices' role in modern cardiovascular care and their potential to shape future diagnostic and treatment paradigms.

Postoperative monitoring of ovariohysterectomy carried out with two types of surgical sutures in shelter cats and differences in selected blood parameters between shelter and pet cats

BackgroundReduction of inflammation and early detection of complications after surgical procedures are important objectives for proper veterinary practice. This study aimed to evaluate the differences between shelter and pet female cats in selected acute-phase parameters scheduled to ovariohysterectomy. Postoperative monitoring after ovariohysterectomy with the same laboratory parameters was performed in shelter cats, in which two different types of surgical sutures were used for the entire procedure. The experimental group comprised 40 female cats from animal shelters (‘shelter cats,’ n = 40). These cats were divided into two subgroups: group A (n = 20) operated on with absorbable sutures and group NA (n = 20) operated on with non-absorbable sutures. In addition, the same parameters were evaluated in pet female cats (n = 19). Blood was collected from shelter cats immediately before surgery (term 0), at 24 and 72 h (terms 1 and 3, respectively), and at 7 and 14 days (terms 7 and 14, respectively) after ovariohysterectomy. Blood samples from the pet cat group were collected only once.ResultThe mean haptoglobin concentration before ovariohysterectomy in pet cats was significantly lower than that in shelter cats. Fibrinogen concentration was significantly lower in pet cats than in cats from group A. Serum albumin, beta-1, beta-2, and gamma-globulin concentrations were significantly higher in the shelter cats than in the pet cats. Subcutaneous tissue thickening at the site of the postoperative wound was observed in five patients cats (25%) in group A, and two (10%) cats in the NA group.ConclusionThese results indicate that ovariohysterectomy leads to local and general inflammatory responses. The majority of cats from animal shelters suffered from subclinical inflammation.

Advancements in health informatics for monitoring perioperative patient data

Advancements in health informatics are revolutionizing perioperative care by enhancing patient monitoring, improving clinical decision-making, and promoting patient safety. The integration of electronic health records (EHR) facilitates seamless information flow across all perioperative stages, ensuring up-to-date patient data is accessible to the entire healthcare team. This accessibility reduces errors, improves coordination, and enhances overall patient outcomes. EHR systems also support standardized documentation, reducing variability in record-keeping and ensuring comprehensive patient information is consistently captured. Real-time data analytics and predictive modeling are powerful tools in perioperative settings, enabling clinicians to anticipate and manage potential complications proactively. By analyzing vast datasets, predictive models identify patterns and risk factors associated with adverse outcomes, allowing for targeted interventions and personalized care plans. Real-time analytics provide continuous monitoring of patient status during surgery, offering immediate feedback and enabling prompt adjustments to ensure patient stability. Wearable devices and remote monitoring systems further augment real-time data analytics by continuously tracking physiological parameters throughout the surgical process and into the postoperative period. This continuous data stream allows for ongoing assessment of patient status and early detection of complications, enhancing patient safety and outcomes. Health informatics solutions, including automated alerts and decision support tools, minimize human error and ensure adherence to clinical guidelines. Automated reminders for critical actions, such as timely antibiotic administration, significantly reduce the incidence of surgical site infections. Decision support tools provide real-time, evidence-based recommendations at the point of care, supporting clinicians in making informed decisions and improving patient outcomes. Additionally, health informatics facilitates continuous quality improvement by enabling the collection and analysis of performance data, informing targeted interventions and process improvements. Overall, advancements in health informatics are transforming perioperative care, offering numerous benefits in terms of efficiency, accuracy, and patient safety, ultimately leading to better patient outcomes and higher quality of care. Continued innovation in this field will be essential for maintaining and improving the standards of perioperative care.

Determinants of feto-maternal outcomes of antepartum hemorrhage among women who gave birth in Awi zone public hospitals, Ethiopia. A case-control study.

Antepartum hemorrhage continues to be a major cause of maternal and perinatal morbidity and mortality in developing countries including Ethiopia and it complicates 2-5% of all pregnancies with an increased rate of maternal and perinatal morbidity and even mortality. Despite many activities, still, poor fetomaternal outcomes of antepartum hemorrhage are still there. Moreover, studies around the current study area emphasize the magnitude and associated factors for antepartum hemorrhage rather than its feto-maternal outcomes. Thus, there is a need to identify the determinants associated with the fetomaternal outcomes of antepartum hemorrhage to guide midwives and obstetricians in the early diagnosis and treatment. An institution-based case-control study was conducted in four-year delivery charts diagnosed with antepartum hemorrhage from April 2, 2022, to May 12, 2022, at Awi Zone public hospitals. To see the association between dependent and independent variables logistic regression model along with a 95% confidence interval (CI) and a p-value of <0.05 were used. No antenatal care follow-up (AOR: 2.5, 95% CI 1.49-4.2), rural residence (AOR: 1.706, 95%CI 1.09-2.66), delay to seek care >12 hours (AOR: 2.57, 95% CI: 1.57-4.23) and advanced maternal age (AOR: 3.43, 95% CI 1.784-6.59) were significant factors associated with feto-maternal outcomes of antepartum Hemorrhage. This study revealed that rural residence, delay in seeking the care of more than 12 hours, not having antenatal care follow up and advanced maternal age were significant factors associated with feto-maternal outcomes of Antepartum hemorrhage. The findings of our study suggest the need for health education about the importance of antenatal care follow-up which is the ideal entry point for health promotion and early detection of complications, especially for rural residents.

Awake VA-ECMO in cardiogenic shock, single centre experiences

Abstract Funding Acknowledgements None. Background/Introduction "Awake" V-A ECMO when the patient is fully awake, breathing spontaneously, without deep sedation. Advantages of awake VA-ECMO include reduced sedative side effects, early active movements, reduced muscle mass loss, increased interaction with the family and medical staff, description of their symptoms, and more exact information than sedative patients so that early detection of complications. Purpose and Methods Present a series of 15 patients with cardiac support by awake VA-ECMO, techniques, parameters, complications, and treatment results. Results Enrolled in this study, including 15 patients: 04 NSTEMI (very high-risk PCI), 09 Myocarditis, 02 electrical storm; Age 53,2 ± 19,5. The local anesthesia, mild sedation when the patient is anxious; performed vascular access with DSA system. The duration from the patient's admission to ECMO was 3,8 ± 2,9 (day) and awake VA-ECMO 3,1 ± 2,5 (day) (min to max: 1 – 6). The CO of ECMO: 1,6 ± 1,2 (l/ph); 03 patients with continuous renal replacement therapy. A patient with acute thrombosis of the lower extremity had successful percutaneous thrombectomy; fifteen patients were successfully weaned from ECMO (100%), no patient death in 7 days, and 02 patient deaths in 30 days. Conclusion Awake VA-ECMO can be performed safety on the cardiac patient when waiting for recovery or management.

ASSOCIATION OF SERUM URIC ACID WITH DIABETES MELLITUS TYPE-2: A NARRATIVE REVIEW

Diabetes mellitus type 2 (T2DM) is a disease which imposes a great burden on the health resources of the emerging and developing world. It is a global pandemic which leads to chronic complications. Serum uric acid (SUA) is a biomarker that could be of value in detection of early complications and better prognosis in diabetic patients. SUA serves both as a causal factor and disease progression marker in DM, having a causal relationship with diabetic complications. This narrative review aims to determine the association between SUA and T2DM. Research articles from the year 2005 to 2023 were selected for this review. Literature search was conducted from PubMed and Google Scholar which resulted in short listing of 15 articles. It also reflects upon the diabetic complications associated with Hyperuricemia (HUA) and focuses on the health implications of HUA in T2DM patients. SUA and T2DM were negatively associated in 8 research studies and positively associated in 6 studies in which one revealed a partial association, one was prevalent in the female gender only, and one was negatively associated in uncontrolled DM. Another study was associated with both hypouricemia and HUA. Pak J Physiol 2024;20(1):52-7

Artificial intelligence in intensive care medicine

The integration of artificial intelligence (AI) into intensive care medicine has made considerable progress in recent studies, particularly in the areas of predictive analytics, early detection of complications, and the development of decision support systems. The main challenges remain availability and quality of data, reduction of bias and the need for explainable results from algorithms and models. Methods to explain these systems are essential to increase trust, understanding, and ethical considerations among healthcare professionals and patients. Proper training of healthcare professionals in AI principles, terminology, ethical considerations, and practical application is crucial for the successful use of AI. Careful assessment of the impact of AI on patient autonomy and data protection is essential for its responsible use in intensive care medicine. A balance between ethical and practical considerations must be maintained to ensure patient-centered care while complying with data protection regulations. Synergistic collaboration between clinicians, AI engineers, and regulators is critical to realizing the full potential of AI in intensive care medicine and maximizing its positive impact on patient care. Future research and development efforts should focus on improving AI models for real-time predictions, increasing the accuracy and utility of AI-based closed-loop systems, and overcoming ethical, technical, and regulatory challenges, especially in generative AI systems.

‘To Drain or Not’ in Abdominal Surgery

The use of drains in abdominal surgeries is a matter of debate, especially the prophylactic use of a drain. In present times, the prophylactic use of drain is reducing due to some studies not supporting it. We are, in this study, discussing the pros and cons of using drains in abdominal operations. We are stressing through this study that drain helps in prevention and early detection of complications like bleeding, collection (pus, blood, bile, infected fluids) and anastomotic leaks. It also helps in early detection of the kind of fluid, which would be otherwise difficult even by radiological investigations, if drain has not been placed. Total of 50 cases of various abdominal surgeries, open and laparoscopic, are included in this study where drains were used. Informed written consent was taken. None of the patients had residual collections. Drains helped in prevention of post operative fluid collection. We advise placing a drain routinely, in cases of acute or chronic inflammation, or in cases with extensive dissection, in cases with risk of post op collection is high, cases with pus present in cavity, perforation peritonitis, trauma. Drains can always be removed early if they have a low output. But not placing a drain when it should have been placed, can result in preventable complications and add to the morbidity of the patient, sometimes significant.

Long-term continuous instrumented insole-based gait analyses in daily life have advantages over longitudinal gait analyses in the lab to monitor healing of tibial fractures.

Introduction: Monitoring changes in gait during rehabilitation allows early detection of complications. Laboratory-based gait analyses proved valuable for longitudinal monitoring of lower leg fracture healing. However, continuous gait data recorded in the daily life may be superior due to a higher temporal resolution and differences in behavior. In this study, ground reaction force-based gait data of instrumented insoles from longitudinal intermittent laboratory assessments were compared to monitoring in daily life. Methods: Straight walking data of patients were collected during clinical visits and in between those visits the instrumented insoles recorded all stepping activities of the patients during daily life. Results: Out of 16 patients, due to technical and compliance issues, only six delivered sufficient datasets of about 12weeks. Stance duration was longer (p = 0.004) and gait was more asymmetric during daily life (asymmetry of maximal force p < 0.001, loading slope p = 0.001, unloading slope p < 0.001, stance duration p < 0.001). Discussion: The differences between the laboratory assessments and the daily-life monitoring could be caused by a different and more diverse behavior during daily life. The daily life gait parameters significantly improved over time with union. One of the patients developed an infected non-union and showed worsening of force-related gait parameters, which was earlier detectable in the continuous daily life gait data compared to the lab data. Therefore, continuous gait monitoring in the daily life has potential to detect healing problems early on. Continuous monitoring with instrumented insoles has advantages once technical and compliance problems are solved.

CORRELATION ANALYSIS OF ECONOMIC FACTORS AND HUSBAND SUPPORT TO PREGNANT WOMEN'S COMPLIANCE IN ANTENATAL CARE (ANC)

Midwifery care services in pregnancy are carried out to prepare optimal health for pregnant women and their babies, both physical, social and mental health. Antenatal care plays an important role in providing quality midwifery services, including several important service components such as health promotion, early detection of complications, diagnosis and prevention of disease. There was an increase in K4 coverage in Indonesia from 84.6% in 2020 to 88.8% in 2021. Based on the results of reporting data from Local Area Monitoring (PWS) Maternal and Child Health (KIA) in South Sumatra in 2021, the number of first visits K4 pregnancies reached 90.1%, decreasing from the K4 achievement in 2020, which was 90.9%, while for K6 coverage in South Sumatra in 2021 it reached 72.9% above the Indonesian K6 average of 63%. The purpose of this study was to find out whether economic factors, and husband's support factors correlated with obedience of pregnant women in carrying out Antenatal Care (ANC) at Lismarini Palembang's Independent Midwife Practice (PMB). This type of research is a quantitative research using an analytic survey method with a cross sectional approach. The population of this study was all 3rd trimester pregnant women who had ANC visits at BPM Lismarini Palembang, while the sample was a portion of 3rd trimester pregnant women who had ANC visits at BPM Lismarini Palembang. The sampling technique in this study was carried out by accidental sampling technique. The data analysis used was univariate analysis followed by bivariate analysis. The results of statistical tests showed that there was a relationship between economic factors and husband's support with p values of 0.029 and 0.035. From the results of the study it can be concluded that economic variables and husband's support are related to respondents' adherence to antenatal care visits at BPM Lismarini Palembang.

Screening for diabetes complications and associated factors in primary care in Galle, Sri Lanka

Introduction: Diabetes (DM) and its complications show an increasing trend and pose a huge burden on the health system. Thus, early detection of complications is essential. Primary care institutions treat and follow up patients with diabetes in their territories. The aim of the study was to assess awareness, practices, and service-related factors associated with screening for diabetes complications among patients attending the medical clinics of primary care level hospitals in the Galle district.Methods: A descriptive cross-sectional study was conducted at three Divisional Hospitals in Galle District, among patients attending medical clinics. Data was collected through an interviewer-administered questionnaire designed to assess awareness and screening practices for diabetes complications, screening done for diabetes complications, and associated factors were analyzed.Results: Four hundred patients with diabetes participated in the study. The majority (more than 95%) were aware of common organs affected by DM and were aware of investigations and their availability at primary care institutions (more than 85.0%). Adherence to recommended screening tests and frequency was very low (ranging from 3% to 16%) and nearly half of the patients never had any form of screening. Older age was associated with better retinopathy screening {OR = 0.61 95% CI (0.41-0.91)} while having co-morbidities was associated with better screening for retinopathy {OR = 1.67 95% CI (1.02-2.71)} and ischemic heart disease.{OR = 2.03 95% CI (1.22-3.40)}. A better awareness was associated with better screening for DM complications.Conclusions: In conclusion, awareness about screening for diabetes complications was satisfactory among the study sample. However, the screening practices were sub-optimal as the recommended screening protocols have not been followed. Better screening was associated with better awareness, older age, having comorbidities, and being employed.

Intracardiac echocardiography is a promising strategy for guiding closure of the left atrial appendage.

Percutaneous transcatheter left atrial appendage (LAA) closure (LAAC) is an effective approach for preventing ischemic stroke in nonvalvular atrial fibrillation patients. Intracardiac echocardiography (ICE), a new imaging modality, is a promising strategy for guiding LAAC. This review highlights the various strategies for ICE-guided-LAAC as an option for clinical policy. A comprehensive literature search was conducted of PubMed, ScienceDirect, Ovid Web of Science, SpringerLink, and other notable databases to identify recent peer-reviewed clinical trials, reviews, and research articles related to ICE and its application in the guidance of LAAC. Various methods are used to evaluate the spatial structure and dimensions of the LAA. The main techniques for guiding LAAC are transesophageal echocardiography (TEE), cardiac computed tomography (CTA), and ICE. Among these techniques, the advantages of ICE typically include (1) multiangle and real-time assessment of intracardiac structure, (2) a reduction in procedural fluoroscopy, (3) reduced operation time and improved workflow in the catheterization laboratory, and (4) the avoidance of general anesthesia and the early detection of complications. ICE is a promising strategy for the guidance of LAAC. Among the most advanced and recent technological innovations in cardiovascular imaging in general and volume imaging in particular, ICE offers greater efficacy and safety.

OP72 Innovating To Decrease Mortality And Resource Use In Surgical Inpatients: The ZERO Project

IntroductionInterest in early detection of complications in hospitals has increased recently. Complications after elective or urgent surgery are frequent and are associated with higher mortality rates, longer hospital stays, and more resource utilization. The ZERO project implemented an educational nursing program and developed an innovative algorithm that assesses a patient’s complication risk based on clinical parameters to prevent complications and reduce hospital burden. Our aim was to present the results from one year of implementing ZERO at the Clinic Barcelona University Hospital.MethodsA comparative effectiveness and cost study was conducted. Data from patients admitted after elective or urgent surgery were collected for one year retrospectively (n=8,844 from January 2019 to December 2019) and prospectively (ZERO) (n=8,163 from October 2021 to October 2022). Effectiveness was measured in terms of mortality, complications, and life-years gained (LYG). Length of stay (LoS) at conventional, intermediate, and intensive care units and rates of readmissions were collected for resource use. The chi-square test was used to compare categorical variables. The t-test and Wilcoxon test were used for normally and non-normally distributed continuous variables, respectively.ResultsThere was a significant decrease in the rate of complications (7.8%, 95% confidence interval [CI]: -8.46, -7.19; p&lt;0.001) with ZERO. Moreover, there were statistically significant reductions in mean LoS for readmissions to conventional wards (-5.04 days, 95%CI: -9.9, -0.18; p=0.04) and to the intensive care ward within the same episode (-4.68 days, 95%CI: -9.26, -0.14; p=0.02). The mean cost per patient was EUR2,772.92 and EUR2,591.57 before and after ZERO implementation, respectively. After accounting for the cost of implementing ZERO, there was a cost saving of EUR147.76 per patient (p=0.048), which yielded a yearly impact of EUR1,206,165 for the hospital budget.ConclusionsThis one-year analysis of the effect of ZERO on surgical patients shows that it decreases complication rates and all types of LoS, leading to overall cost savings for the hospital.

Lessons Learned from Nanbar Health: Developing a Multi-System Software Suite for Predictive Algorithms and Remote Monitoring for People Living with Sickle Cell Disease

Background: Sickle cell disease (SCD) is a genetic disorder that alters the shape of red blood cells, leading to significant complications and requiring highly complex care. Efforts often focus on prevention and early diagnosis of pain to improve outcomes for those with SCD. Remote monitoring (RPM) and predictive algorithms has grown exponentially in the last decade as a support tool for managing chronic diseases like heart failure and diabetes. Implementing similar technology for SCD care could improve patient outcomes through early detection of complications and providing physicians with longitudinal data to support clinical decisions. Our team previously used mobile health (mHealth) as RPM in this population and developed a machine learning algorithm to predict pain scores with 86% accuracy. Here, we describe the development process for the Nanbar Health software alongside the lessons learned from its development. Objectives: Describe the methods necessary to build a comprehensive mHealth remote monitoring system (Nanbar Health) that facilitates SCD health management. Develop a set of lessons for other developers when building a remote monitoring software suite. Methods: Nanbar Health's development process has taken 2 years. First, our team reviewed feedback and “bug” reports from patients and providers of other mobile applications our team built at Duke University. Using the feedback collected an user-interface (UI) interface (mock-ups) was created for the Nanbar Health mobile app using Figma. These mock-ups were then shown to healthcare providers with expertise in caring for individuals with SCD for feedback. Upon approval of mock-ups, our team developed the mobile application using Swift and Apple HealthKit. The team also built a physician-facing dashboard using React, NodeJS, and Python. The backend software for this system utilized Docker containers mounted on AWS EC2 instances, a Parse server, MongoDB and PostgreSQL databases, and Nginx for deployment and load balancing. Next, the dashboard was reviewed by medical providers for feedback. The analytics portion of the dashboard processed data in Python backend scripts and interactive visualizations were built using the Plotly library in NodeJS. The analytics portion of the tool is currently being reviewed for feedback. Throughout the process of developing and piloting the Nanbar Health Software, our team identified several challenges. These challenges were collected into a comprehensive index named, “Lessons Learned”. Results: The lessons learned include: 1. Overall Gain user feedback and place yourself in the shoes of the user: At every step of your software's development ensure you are continuously getting feedback from your users. 2. Mobile Application Engagement is key to acquiring good data: Ensure your team uses a variety of methods methods to engage your users.No mobile app is one size fits all, but one app can customize to all: The development team should create re-usable, dynamic components wherever possible. 3. Provider Dashboard Testing to build: Developers should build a user interface that is easy to run and test as a “pseudo-user” while they are building it, making it easier for the developer to understand the user experience and build a user-friendly application.Building to test: Plan for beta testers from the beginning and ensure that they have access to continuously-updated and fake but realistic data. 4. Network Analysis Complex analytics are computationally demanding - Advanced analytical tools incur more complications when incorporated into a High-Usage SystemFor heavy data processing, go serverless - Isolating heavy data processing from the rest of the application saves tremendous time and money. 5. Research and Operations Don't cry over spilt code: Mistakes and bugs are part of the process when developing any software, and part of the research process.Lack of engagement is not a reason for disappointment, but rather an opportunity for growth and improvement: Our tool has continuously experienced changes and improvements to increase patient engagement. Conclusion: Our team was successfully able to create and deploy a SCD care-focused Nanbar Health. These tools show promise of improving care for people living with SCD through the usage of RPM and predictive models. Further research should be conducted to determine methods to increase user engagement, and maintain large predictive models in cloud-based systems.

The Role of Midwives in the Education of Labor and Childbirth Readiness

Background: Efforts to reduce maternal mortality ratio can be done promotively, preventively, curatively, and rehabilitatively. One of the promotive efforts is to provide education during pregnancy, especially in the third trimester or before the estimated delivery. Childbirth preparation education is essential for pregnant women, husbands and families to improve knowledge and skills, one of which is the prevention and early detection of complications. The World Health Organization strongly recommends strengthening preparedness programs for childbirth and complications to increase utilization of quality care at delivery and to increase the use of health services for obstetric and newborn complications. Purpose: This study aims to identify the implementation of childbirth readiness education to prevent complications of childbirth in independent midwife practices in the DKI Jakarta area. Methods: Qualitative research design was used in this study with an explanatory descriptive design. Informants for this research were 15 midwives in the DKI Jakarta area. Selection of informants using purposive sampling technique. Analysis was done by means of data reduction, data presentation, and conclusion verification. Results: The implementation of labor and childbirth readiness education to prevent labor complications was quite good. Education on physical, psychological, and financial preparation has been carried out adequately, but there were several aspects of education related to cultural preparation related to pregnancy and childbirth that was still not optimal. Conclusion: It is expected that midwives can maintain the education that has been given to pregnant women. Midwives actively participate in monitoring and educating pregnant women so that they can carry out early detection of complications and appropriate treatment if emergencies occur.

Clinical Significance of Pneumocephalus in Pediatric Mild Traumatic Brain Injury.

Mild traumatic brain injury (mTBI) comprises most (70%-90%) of all pediatric head trauma cases seeking emergency care. Although most mTBI cases have normal initial head computed tomography scan, a considerable portion of the cases have intracranial imaging abnormalities on computed tomography scan. Whereas other intracranial pathological findings have been extensively studied, little is known about the clinical significance of pneumocephalus in pediatric mTBI. We retrospectively identified pediatric mTBI patients with pneumocephalus using the institutional database of a large regional trauma referral center. Outcome measures were defined as clinically important TBI (ciTBI), hospitalization, intensive care unit (ICU) admission, and neurosurgical intervention. Comparisons were made between pneumocephalus and control (isolated linear fracture) groups as well as between isolated (only linear fracture and pneumocephalus) and nonisolated pneumocephalus (pneumocephalus and TBI) groups. Among 3524 pediatric mTBI cases, 43 cases had pneumocephalus (1.2%). Twenty-one cases (48.8%) had isolated pneumocephalus. The pneumocephalus group had higher rates of ciTBI, hospital admission, ICU admission, and neurosurgery when compared with the isolated linear fracture (control) group. The isolated pneumocephalus group had fewer ciTBI (21.1% vs 70%, P = 0.002), fewer hospitalization (23.8% vs 81.8%, P < 0.001), but similar ICU admission rates (4.8% vs 22.7%, P = 0.089) and length of hospital stay (4.0 ± 2.7 vs 3.6 ± 2.4 days, P = 0.798) in comparison to the nonisolated pneumocephalus group. None of the patients in the isolated group had neurosurgery whereas 2 patients in the nonisolated pneumocephalus group underwent surgery. Multivariable analysis revealed pneumocephalus as an independent predictor of ciTBI and hospital admission, but not ICU admission or neurosurgical intervention. Pneumocephalus is associated with increased rates of hospitalization and ciTBI, but not ICU admission, unfavorable outcome, or neurosurgical intervention in pediatric mTBI. Although usually spontaneously resolving pathology, it may occasionally be linked with complications such as cerebrospinal fluid leakage, meningitis, and tension pneumocephalus. Therefore, careful evaluation, close observation, and early detection of complications may prevent adverse outcomes.

Fat embolism as a complication of lower extremity long-bone surgery

Introduction Fat embolism syndrome (FES) is a formidable complication that occurs with extremity long-bone fractures. Overall, the mortality of FES is estimated to be 10–36 % depending on the severity of the injury. Early detection of complications, selection of optimal methods for fracture fixation and for anesthesia that would prevent FES are essential.The objective was to assess the incidence of clinical manifestations of FES in patients with lower extremity long-bone fractures, determine the optimal methods of prevention, methods of anesthesia and surgical intervention in the management of the patients.Material and methods The study included 355 patients with lower extremity long-bone fractures treated between 2020 and 2021 at the Trauma Department, State Budgetary Healthcare Clinical N.I. Pirogov Hospital No. 1. Patients were grouped according to different parameters including frequency of occurrence of FES depending on the length of the preoperative period: patients with a long and short preoperative period; treatment strategy: patients treated surgically or conservatively; preoperative use of prophylaxis: patients receiving and not receiving "Essentiale"; anesthetic aidused: general or spinal anesthesia.Results Of the 355 patients examined, FES was detected in 8 patients with fractures of the lower extremities, one patient died. FES developed mainly in the first 72 hours of injury. FES occurred in less than 12 hours (n = 1), in 12-24 hours (n = 2), in 24-48 hours (n = 2), in 48-72 hours (n = 3).Discussion FES developed in patients with a delayed operative period and in patients treated conservatively. The prophylaxis policy suggests timely diagnosis using Schonfeld's scoring system for FES and taking "Essentiale" early post trauma. Patients who underwent surgery with spinal anesthesia showed a decreased incidence of FES as compared with patients operated on using general anesthesia.Conclusion There is a high incidence of FES. Hepatoprotectors can be used on the first days after injury to prevent FES. Osteosynthesis under spinal anesthesia is the preferred method of treatment.

WTP3.13 Management of early complications of liver transplantation from a living related donor

Abstract Aim The aim of this study is to highlight the importance of the development of adequate surgical technique, the proper selection of donors, the preparation of recipients and the introduction of new molecules of Immunosuppressants in improving liver transplant (LT) outcomes. The study also shows that early complications, occurring within the first 3 months, are responsible for two-thirds of deaths. Methods All LT candidates were assessed for contraindications to immunosuppressants, social and psychiatric assessment, and operative and infectious risk assessment. Patients who received LT were followed according to a rigorous pre-established protocol that allowed the detection of early postoperative complications and surgical revision in some cases. Results Post-operative surgical complications occurred in 04 patients who required immediaterevision surgery for hemoperitoneum, portal thrombosis that required unblockage of the TP, thrombosis of the hepatic artery requiring new arterial anastomosis and liver resection, and one patient developed an infectious complication (MAT). Three patients experienced complications related to immunosuppressants. One patient required renal dialysis. Two patients developed biliary stenosis; treated endoscopically in one patient, and biliary repair after failure of endoscopic treatment in another. Conclusion Hemorrhage, primary graft non-function, multiple organ failure and infection, acute rejection and surgical complications dominate post-LT follow-up. Immunosuppressive treatments are responsible for a significant morbidity rate. Early detection of complications and their immediate management reducing morbidity and mortality. The living related donor LT program remains an option in our country due to the impossibility of LT as part of an ODB.