Emergency Cases Research Articles

Emergency shelter materials under a complex non-linear diophantine fuzzy decision support system

AbstractThe distribution of emergency shelter materials in emergency cases around the world is a hard task, the goal of this research is to offer a Complex Non-linear Diophantine Fuzzy (C-NLDF) decision-making model for earthquake shelter construction. Essentially, the article is divided into three sections to acquire acceptable and precise measures in emergency decision-making situations. First, we present the Complex Non-Linear Diophantine Fuzzy Set (CN-LDFS), a new generalization of the complex linear Diophantine fuzzy set (CLDFS) and q-linear Diophantine fuzzy set (q-LDFS), as well as explore its key aspects. Furthermore, aggregation operators are useful for aggregating uncertainty in decision-making issues. As a result, algebraic norms for CN-LDFSs are produced based on certain operational laws. In the second section of the work, we offer a series of averaging and geometric aggregation operators under CN-LDFS that are based on defined operating laws. In the final section of the work, under complex Non-linear Diophantine fuzzy information, the ranking algorithms based on suggested aggregation operators are present to address the case study regarding emergency situation of earthquakes. In comparison section, results of existing and proposed operators explore the effectiveness of proposed methodologies and provide accurate emergency measures to address the global uncertainty about the construction of emergency shelters in earthquakes.

Low-flow extra-intracranial bypass in acute carotid and vertebrobasilar ischemic stroke (literature review)

Introduction. The effectiveness of the method of revascularization of the brain using extra‑intracranial bypass in chronic insufficiency of blood supply to the brain has been studied in several randomized multicenter studies. The analysis of available publications devoted to this technique for 10 years with acute strokes in the carotid basin and for 20 years with ischemic strokes in the vertebrobasilar basin was carried out.Aim. To improve the results of treatment of ischemic strokes with the help of emergency extra‑intracranial low‑flow bypasses in the acute and acute period. In 12 publications over the past 10 years, selected from the PubMed search engine, 194 cases of the use of emergency extra‑intracranial microbypasses in the acute and acute period of ischemic stroke in the carotid basin were identified, 127 cases of emergency extra‑intracranial bypass were found in 6 articles during the last 20 years in the acute phase of vertebra‑basilar area stroke. Middle patient age in carotid group was 61.9 years, and 65 years in vertebral patient’s group. The male / female ratio was 3 / 1. The main indications for the bypass creation were: worsening of neurologic deficit from 4 and more according to the Stroke Severity Scale of the US National Institutes of Health, mini mal or not significant computed tomography (CT) or diffusion‑weighted magnetic resonance imaging (DW‑MRI) ischemia brain changes (not lower than 8 points on the scale of assessment of initial changes in the computed tomographic (CT) examination for stroke Alberta Stroke Program Early CT Score, ASPECTS), signs of significant brachiocephalic arteries atherosclerotic stenosis. In 83 carotid group cases perfusion‑diffusion mismatch was distinguished before bypass creation. In 111 carotid cases and in priority of vertebra‑basilar cases clinic‑diffusion mismatch was the only indication for emergency extra‑intracranial bypass creation. During the first 24 hours 65 % of carotid group bypass were performed, in other 35 % of cases bypasses were performed during 1 week after the stroke onset. There were 78 % of good results (<2 on the Rankin outcome scale, mRS) and 22 % of poor (mRS >2) in carotid stroke group. Mortality was 3 %. In vertebral group, coma was not contraindication for emergence extra‑intracranial bypass creation. In most cases, 70 % of bypass were performed between superficial temporal artery and superior cerebellar artery. Mortality in vertebral stroke group was 5 %, mostly because of somatic pathology worsening. Good results were achieved in76 % of cases.Conclusion. In some cases of atherosclerotic carotid and vertebrobasilar ischemic stroke, results of recovery can be approved greatly with use of emergency low‑flow extra‑intracranial bypass, if intravenous thrombolysis and endovascular tromboextraction were failed.

Penilaian Hasil Pelatihan Pemeliharaan Kesehatan Gigi dan Mulut di Era Pandemi COVID-19 pada Karyawan Yvonne’s Catering, Cipinang Muara

Since early March 2020 until today, COVID-19 case in Indonesia is still a problem, requiring comprehensive efforts to manage and break the chain of transmission. Employees of Yvonne's Catering located in Cipinang Muara, possess oral health problems such as cavities, swollen gums, bad breath, and significant number of tooth loss. These problems affect employees' day-to-day performance – bad breath gets in the way of employees talking to customers, and toothaches affect employees while working in the kitchen. During the COVID-19 pandemic, people were afraid to have their teeth checked by dentists because dental treatment was considered a high risk of transmission of COVID-19 infection. Based on the problems above, Yvonne's Catering employees need training and education about the importance of maintaining oral health to prevent cavities which are closely related to overall health, and providing an understanding of emergency cases that need to be treated immediately to prevent the conditions from worsening that can be life-threatening. Information regarding the importance of implementing the 5M health protocol (wearing mask, washing hands, keeping distance, staying away from crowds, and reducing mobility) to protect oneself from exposure to the COVID-19 virus was also provided, including when visiting dentists. The main purpose of this community service is to increase the knowledge and skills of the community in maintaining maximum oral hygiene. Other goals in this community service include providing alternatives as an effort to maintain oral hygiene and health by making their own mouthwash using natural ingredients from their surroundings, such as Ocimum basilicum.

Practices and educational needs of Hellenic Police Officers in providing first aid/cardiopulmonary resuscitation: A cross-sectional survey.

It is well known that police officers (POs) are expected to be the first responders in emergency cases requiring First Aid (FA) such as cardiac arrest. Description of practices and educational needs of Hellenic POs in providing FA/Cardiopulmonary Resuscitation (CPR) in case of medical emergencies and description of the equipment of professional FA kit. An anonymous cross-sectional survey was conducted from January 1, 2016, to December 31, 2017, using a self-administered questionnaire designed to serve the purposes of this particular survey. The instrument consisted of 53 questions (multiple choice and open-ended questions) administered in a convenience sample of 700 POs of the Attica prefecture. A sample of 520 POs (constables and lieutenants) completed the questionnaire (response rate = 74.28%). Among the participants, 248 (47.7 %) declared that they had provided FA/CPR in the past, while among those declaring that they had never provided FA/PCR (n = 248), 153 (61.7%) said that they had experienced FA/CPR needs, but did not know what they had to do. Moreover, only 18.1% (94/520) of the POs answered that they have FA equipment in their professional equipment, which mainly includes bandages (54/94, 57.4%), while 29.7% of POs provided answers about their educational needs (313 in total) declared that they would like to be educated in bleeding control. There is a need to educate and train Greek POs in first aid and CPR in an organized and mandatory way in order to meet emergency needs.

Automated Detection of Intracranial Hemorrhage from Head CT Scans Applying Deep Learning Techniques in Traumatic Brain Injuries: A Comparative Review

AbstractTraumatic brain injury (TBI) is not only an acute condition but also a chronic disease with long-term consequences. Intracranial hematomas are considered the primary consequences that occur in TBI and may have devastating effects that may lead to mass effect on the brain and eventually cause secondary brain injury. Emergent detection of hematoma in computed tomography (CT) scans and assessment of three major determinants, namely, location, volume, and size, is crucial for prognosis and decision-making, and artificial intelligence (AI) using deep learning techniques, such as convolutional neural networks (CNN) has received extended attention after demonstrations that it could perform at least as well as humans in imaging classification tasks. This article conducts a comparative review of medical and technological literature to update and establish evidence as to how technology can be utilized rightly for increasing the efficiency of the clinical workflow in emergency cases. A systematic and comprehensive literature search was conducted in the electronic database of PubMed and Google Scholar from 2013 to 2023 to identify studies related to the automated detection of intracranial hemorrhage (ICH). Inclusion and exclusion criteria were set to filter out the most relevant articles. We identified 15 studies on the development and validation of computer-assisted screening and analysis algorithms that used head CT scans. Our review shows that AI algorithms can prioritize radiology worklists to reduce time to screen for ICH in the head scans sufficiently and may also identify subtle ICH overlooked by radiologists, and that automated ICH detection tool holds promise for introduction into routine clinical practice.

Development of a Peak Flow Meter to Remotely Monitor Asthmatic Patients in Emergency Cases

Development of a Peak Flow Meter to Remotely Monitor Asthmatic Patients in Emergency Cases

Increased mucosal eosinophils in colonic diverticulosis and diverticular disease.

Eosinophils contribute to tissue homeostasis, damage, and repair. The mucosa of colonic diverticula has not been evaluated for eosinophils by quantitative histology. We aimed to investigate whether mucosal eosinophils and other immune cells are increased in colonic diverticula. Hematoxylin and eosin stained sections from colonic surgical resections (n=82) containing diverticula were examined. Eosinophils, neutrophils, and lymphocytes, in five high power fields in the lamina propria were counted at the base, neck, and ostia of the diverticulum and counts compared to non-diverticula mucosa. The cohort was further subgrouped by elective and emergency surgical indications. Following an initial review of 10 surgical resections from patients with diverticulosis, a total of 82 patients with colonic resections containing diverticula from the descending colon were evaluated (median age 71.5, 42M/40F). Eosinophil counts for the entire cohort were increased in the base and neck (median 99 and 42, both P=<0.001) compared with the control location (median 16). Eosinophil counts remained significantly increased in the diverticula base (both P=<0.001) and neck (P=0.01 and <0.001, respectively) in both elective and emergency cases. Lymphocytes were also significantly increased at the diverticula base compared to controls in both elective and emergency subgroups. Eosinophils are significantly and most strikingly increased within the diverticulum in resected colonic diverticula. While these observations are novel, the role of eosinophil and chronic inflammation is as yet unclear in the pathophysiology of colonic diverticulosis and diverticular disease.

Predictors of anesthesia ready time: Analysis and benchmark data

ObjectivePatients undergoing congenital cardiac surgery require induction of anesthesia. Our objective was to identify the median anesthesia ready time and the predictors of this time. MethodsBy using the Society of Thoracic Surgeons Congenital Heart Surgery Database, we identified patients who underwent cardiopulmonary bypass procedures from 2017 to 2021. Univariate and multivariable regression modeling to predict the anesthesia ready time was performed using mixed-effects linear regression. ResultsAfter exclusion of outliers, 44,418 cases were analyzed. The median anesthesia ready time was 51 minutes (interquartile range, 38-66). On multivariable analysis, independent predictors of a longer anesthesia ready time included decreasing weight (0.3 min/10 kg, 95% CI, 0.1-0.6; P = .011), prematurity (1.5 minutes, 95% CI, 0.8-2.2; P < .001), and presence of chromosomal abnormality (3.4 minutes, 95% CI, 1.5-5.2; P < .001). An increase in the duration in anesthesia ready time was seen with increasing Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery mortality category with an additional 7.8 minutes (95% CI, 5.2-10.4; P < .001) for a Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery 5 procedure compared with Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery 1. Emergency versus elective case designation was associated with an anesthesia ready time reduction of 3.6 minutes (95% CI, 1.1-6.1; P = .005), and an afternoon case start was associated with an anesthesia ready time reduction of 4.2 minutes (95% CI, 2.8-5.6; P < .001). The presence of an anesthesia trainee increased the anesthesia ready time by 3.8 minutes (95% CI, 2.6-5.0; P < .001). The presence of an airway in situ decreased the anesthesia ready time by 3.6 minutes (95% CI, 1.6-5.5; P < .001), whereas an in situ arterial line decreased the anesthesia ready time by 7.4 minutes (95% CI, 4.6-10.2; P < .001). Placement of a central venous line increased the anesthesia ready time by 8.5 minutes (95% CI, 5.9-11.1; P < .001). ConclusionsThe median anesthesia ready time was 51 minutes. For patients with characteristics associated with prolonged anesthesia ready time, consideration should be given to allocation of additional anesthesia staffing to improve efficiency.

Association of the classification of intraoperative adverse events (ClassIntra) with complications and neurological outcome after neurosurgical procedures: a prospective cohort study

PurposeTo analyze the reliability of the classification of intraoperative adverse events (ClassIntra) to reflect intraoperative complications of neurosurgical procedures and the potential to predict the postoperative outcome including the neurological performance. The ClassIntra classification was recently introduced and found to be reliable for assessing intraoperative adverse events and predicting postoperative complications across different surgical disciplines. Nevertheless, its potential role for neurosurgical procedures remains elusive.MethodsThis is a prospective, monocentric cohort study assessing the ClassIntra in 422 adult patients who underwent a neurosurgical procedure and were hospitalized between July 1, 2021, to December 31, 2021. The primary outcome was the occurrence of intraoperative complications graded according to ClassIntra and the association with postoperative outcome reflected by the Clavien-Dindo classification and comprehensive complication index (CCI). The ClassIntra is defined as intraoperative adverse events as any deviation from the ideal course on a grading scale from grade 0 (no deviation) to grade V (intraoperative death) and was set at sign-out in agreement between neurosurgeon and anesthesiologist. Secondary outcomes were the neurological outcome after surgery as defined by Glasgow Coma Scale (GCS), modified Rankin scale (mRS), Neurologic Assessment in Neuro-Oncology (NANO) scale, National Institute Health of Strokes Scale (NIHSS), and Karnofsky Performance Score (KPS), and need for unscheduled brain scan.ResultsOf 442 patients (mean [SD] age, 56.1 [16.2]; 235 [55.7%] women and 187 [44.3%] men) who underwent a neurosurgical procedure, 169 (40.0%) patients had an intraoperative adverse event (iAE) classified as ClassIntra I or higher. The NIHSS score at admission (OR, 1.29; 95% CI, 1.03–1.63, female gender (OR, 0.44; 95% CI, 0.23–0.84), extracranial procedures (OR, 0.17; 95% CI, 0.08–0.61), and emergency cases (OR, 2.84; 95% CI, 1.53–3.78) were independent risk factors for a more severe iAE. A ClassIntra ≥ II was associated with increased odds of postoperative complications classified as Clavien-Dindo (p < 0.01), neurological deterioration at discharge (p < 0.01), prolonged hospital (p < 0.01), and ICU stay (p < 0.01). For elective craniotomies, severity of ClassIntra was associated with the CCI (p < 0.01) and need for unscheduled CT or MRI scan (p < 0.01). The proportion of a ClassIntra ≥ II was significantly higher for emergent craniotomies (56.2%) and associated with in-hospital mortality, and an unfavorable neurological outcome (p < 0.01).ConclusionFindings of this study suggest that the ClassIntra is sensitive for assessing intraoperative adverse events and sufficient to identify patients with a higher risk for developing postoperative complications after a neurosurgical procedure.

Hypertensive Crisis

Hypertension in global burden disease and is expected to increase by 29% in 2025. one of the emergency condition that can arise from hypertension is hypertensive crisis. Hypertensive crisis is an increase of systolic blood pressure &gt;179 mmHg and diastolic blood pressure &gt; 109 mmHg. By the present of target organ damage, hypertensive crisis is classified as hypertensive urgency and hypertensive emergency.Hypertensive crisis occurs based on several mechanisms, failure of the autoregulation system, activation of renin-angiotensin-aldosterone system, and prothrombotic state. This mechanisms cause ischemia and induces a hypertensive crisis. Management of hypertensive crisis is to restore systolic blood pressure in range 100-110 mmHg. In hypertensive emergency case, blood pressure should be reduced slowly to 20-25% in first hour and 160/100 mmHg in the next 2 to 6 hours, except in hypertensive emergency case that cause aortic dissection. Therapy of hypertensive crisis including arterial and venous vasodilators, ACE inhibitor, calcium antagonists, and diuretics.

Comparison of Velocity and Reynolds Stress Distributions in a Straight Rectangular Channel with Submerged and Emergent Vegetation

Vegetation in rivers and streams plays an important role in preventing erosion and improving bank stability. Comparison between emergent vegetation (bank vegetation) and submerged vegetation, in terms of velocity and Reynolds stress distributions, for the same aspect ratio and flow discharge, has received limited attention in the literature. This study investigates the velocity and Reynolds stress, as well as the log law for submerged and emergent vegetation in a laboratory flume and compares the results for a different set up with different sediment size and aspect ratio but the same discharge. The results indicate that the influence of submerged vegetation on the secondary currents generation is less than emergent vegetation. In addition, the log law application is valid for both submerged and emergent vegetation cases, however, it is valid up to y/h = 0.75 for emergent vegetation (in which the vegetation cover in banks is partly out of the water) but up to y/h = 0.25 for vegetation bank. For both submerged and emergent vegetation, Reynolds stress distribution presents a convex form but with a different turning point. Comparison of the results with those in an artificial pool over submerged vegetation and low aspect ratio (&lt;5) keeps almost the same form for velocity and Reynolds stress distributions but decreases the turning point in Reynolds stress distribution. For the submerged vegetation cover, the location of zero shear stress superposes that of maximum velocity, but for the emergent vegetation approaching the bank vegetation and shifting the maximum velocity towards the bed, the location of zero shear stress approaches the bed.

Vacuum assisted closure with mesh mediated fascial traction of open abdominal wounds and acute fascial dehiscence, a single institution experience.

Laparostomy is a common means of managing surgical catastrophes, but often results in large ventral hernias which prove difficult to repair. It is also associated with high rates of enteric fistula formation. Dynamic methods of managing the open abdomen have been shown to result in higher rates of fascial closure and fewer complications. Recent publications have suggested the addition of chemical components relaxation with botulinum toxin has an added advantage over prior methods. We report on a series of emergent cases managed by the combination of Botulinum toxin A (BTA) mediated chemical relaxation with a modified method of mesh-mediated fascial traction (MMFT) and negative pressure wound therapy (NPWT). Thirteen cases (nine laparostomies and four fascial dehiscence) were successfully closed in a median of 12 days, using a median of 4 'tightenings', with no clinical herniation detected at follow up so far (median 183 days, IQR 123-292). There were no procedure-related complications, but one death from the underling pathology. We report further cases of vacuum assisted mesh-mediated fascial traction (VA-MMFT) utilizing BTA in successfully managing laparostomy and abdominal wound dehiscence and continues the known high rate of successful fascial closure seen when applied in treating the open abdomen.

PEMENUHAN KEBUTUHAN OKSIGENASI DENGAN PEMBERIAN POSISI HEAD UP 30˚ PADA PASIEN STROKE

Stroke as cerebrovascular damage, is a loss of brain function caused by cessation or reduced blood supply to an area of the brain, resulting in local or global neurological dysfunction. Substandard blood flow in stroke patients can lead to hemodynamic abnormalities, where hemodynamic conditions affect the distribution of oxygen throughout the body, affect heart function and reduce oxygen saturation so that stroke is an emergency case and requires fast and appropriate help. Purpose: of this study was to determine how to fulfill the need for oxygenation by giving a 30˚ head up position in stroke patients. Method: used is a literature study or literature review using articles/journals in the form of fulfilling oxygen needs by giving a 30˚ head up position in stroke patients. Results: showed that there was a significant increase in oxygen saturation levels after the 30˚ head up position in stroke patients. Conclusion :of this study is that one of the interventions that can be carried out in fulfilling oxygenation in stroke patients is giving a 30 head up position with a head elevation or 30˚ head up position that can facilitate increased cerebral blood flow and maximize cerebral tissue oxygenation

Non-Traumatic Abdominal Surgical Emergencies in the Field of HIV: A Series of 22 Cases in the Visceral and Digestive Surgery Department of the Siguiri Prefectural Hospital

Introduction: This study aimed to describe the epidemiological-clinical and therapeutic aspects of abdominal surgical emergencies on the ground of HIV in the department of visceral and digestive surgery of the prefectural hospital of Siguiri. Method: This was a descriptive prospective study which concerned patients operated on for abdominal surgical emergencies in the field of HIV, carried out in the visceral and digestive surgery department of the Siguiri prefectural hospital. Results: Out of a total of 88 cases of abdominal surgical emergencies operated on during our study, we collected 22 cases on HIV ground, i.e. 25%. The female sex dominated, including 14 women against 8 men, i.e. a sex ratio of 0.6 with an average age of 35 years. Miners were the most affected socio-professional layer, i.e. 31.80%, followed by traders and housewives, i.e. 27.30% each. HIV type I affected 77.27% against 22.73%. There were 41% of our patients who knew their serological status among which 66.66% were on ARV treatment and 33.33% were not on ARV treatment. The symptomatology was dominated by abdominal pain in 100% followed by fever in 77.27%. Appendicitis accounted for 40.09% followed by generalized acute peritonitis in 31.82%. The management was medico-surgical with pre-operative, intra-operative and post-operative resuscitation. The average length of hospitalization was 7 days. The postoperative course was favorable in 45.45%, we recorded 36.36% parietal suppuration and the mortality rate was 13.64%. Conclusion: Abdominal surgical emergencies in the field of HIV remain a major health problem in terms of care. The clinical pictures are dominated by acute appendicitis and generalized acute peritonitis.

Telemedical support for prehospital emergency medical service in severe emergencies: an open-label randomised non-inferiority clinical trial

BackgroundA tele-emergency medical service with a remote emergency physician for severe prehospital emergencies may overcome the increasing number of emergency calls and shortage of emergency medical service providers. We analysed whether routine use of a tele-emergency medical service is non-inferior to a conventional physician-based one in the occurrence of intervention-related adverse events.MethodsThis open-label, randomised, controlled, parallel-group, non-inferiority trial included all routine severe emergency patients aged ≥ 18 years within the ground-based ambulance service of Aachen, Germany. Patients were randomised in a 1:1 allocation ratio to receive either tele-emergency medical service (n = 1764) or conventional physician-based emergency medical service (n = 1767). The primary outcome was the occurrence of intervention-related adverse events with suspected causality to the group assignment. The trial was registered with ClinicalTrials.gov (NCT02617875) on 30 November 2015 and is reported in accordance with the CONSORT statement for non-inferiority trials.ResultsAmong 3531 randomised patients, 3220 were included in the primary analysis (mean age, 61.3 years; 53.8% female); 1676 were randomised to the conventional physician-based emergency medical service (control) group and 1544 to the tele-emergency medical service group. A physician was not deemed necessary in 108 of 1676 cases (6.4%) and 893 of 1544 cases (57.8%) in the control and tele-emergency medical service groups, respectively. The primary endpoint occurred only once in the tele-emergency medical service group. The Newcombe hybrid score method confirmed the non-inferiority of the tele-emergency medical service, as the non-inferiority margin of − 0.015 was not covered by the 97.5% confidence interval of − 0.0046 to 0.0025.ConclusionsAmong severe emergency cases, tele-emergency medical service was non-inferior to conventional physician-based emergency medical service in terms of the occurrence of adverse events.

2010'dan 2019'a Lagos Devletindeki Acil Durumlarin Coğrafi Analizi

Emergency management is a complex system that involves an intergovernmental, multi-phased effort. A lot of emergencies are largely unreported in developing nations due to perceived inadequacy of government infrastructure to address these challenges. More so, the population of Lagos is increasing significantly, and the rate of urbanization is reputed to be one of the fastest in the world. The study aimed at geographically analyzing reported emergency cases in Lagos State from 2010 to 2019. Specifically, it mapped the distribution of reported emergency incidents in Lagos state from 2010-2019; assessed the relationship between population, distribution of health centers, and the distribution of reported emergency incidents in the state during the study period. Secondary data from Lagos State Emergency Agency (LASEMA), Lagos state government, and GRID3 were used for the study. From these, data on reported emergency cases, population and distribution of health facilities were acquired respectively. The total number of reported emergency cases was 4,586 with a concentration around Ikeja LGA, the lowest from Epe and Badagry local government areas. A correlation of 0.056 between reported emergency cases and the population showed a weak or non-existent relationship. A correlation of 0.439 between reported emergency incidents and the number of available health care facilities however showed a strong relationship. Vigorous enlightenment campaign by LASEMA and other supporting agencies on the emergency reporting number 767/112 and improvement in emergency service delivery were recommended along with further studies to determine the awareness of residents about emergency reporting systems available to them in the state.

A review on computational studies and bioinformatics analysis of potential drugs against monkeypox virus

Monkeypox, a viral disease that is caused by monkeypox virus and occurs mainly in central and western Africa. However, recently it is spreading worldwide and took the focus of the scientific world towards it. Therefore, we made an attempt to cluster all the related information that may make it easy for the researchers to get the information easily and carry out their research smoothly to find prophylaxis against this emerging virus. There are very few researches found available on monkeypox. Almost all the studies were focused on smallpox virus and the recommended vaccines and therapeutics for monkeypox virus were originally developed for smallpox virus. Though these are recommended for emergency cases, they are not fully effective and specific against monkeypox. For this, here we also took the help of bioinformatics tools to screen potential drug candidates against this growing burden. Some potential antiviral plant metabolites, inhibitors and available drugs were scrutinized that can block the essential survival proteins of this virus. All the compounds Amentoflavone, Pseudohypericin, Adefovirdipiboxil, Fialuridin, Novobiocin and Ofloxacin showed elite binding efficiency with suitable ADME properties and Amentoflavone and Pseudohypericin showed stability in MD simulation study indicating their potency as probable drugs against this emerging virus. Communicated by Ramaswamy H. Sarma

Out-of-pocket costs and catastrophic healthcare expenditure for families of children requiring surgery in sub-Saharan Africa

BackgroundOut-of-pocket healthcare costs leading to catastrophic healthcare expenditure pose a financial threat for families of children undergoing surgery in Sub-Saharan African countries, where universal healthcare coverage is often insufficient. MethodsA prospective clinical and socioeconomic data collection tool was used in African hospitals with dedicated pediatric operating rooms installed philanthropically. Clinical data were collected via chart review and socioeconomic data from families. The primary indicator of economic burden was the proportion of families with catastrophic healthcare expenditures. Secondary indicators included the percentage who borrowed money, sold possessions, forfeited wages, and lost a job secondary to their child’s surgery. Descriptive statistics and multivariate logistic regression were performed to identify predictors of catastrophic healthcare expenditure. ResultsIn all, 2,296 families of pediatric surgical patients from 6 countries were included. The median annual income was $1,000 (interquartile range 308–2,563), whereas the median out-of-pocket cost was $60 (interquartile range 26–174). Overall, 39.9% (n = 915) families incurred catastrophic healthcare expenditure, 23.3% (n = 533) borrowed money, 3.8% (n = 88%) sold possessions, 26.4% (n = 604) forfeited wages, and 2.3% (n = 52) lost a job because of the child’s surgery. Catastrophic healthcare expenditure was associated with older age, emergency cases, need for transfusion, reoperation, antibiotics, and longer length of stay, whereas the subgroup analysis found insurance to be protective (odds ratio 0.22, P = .002). ConclusionA full 40% of families of children in sub-Saharan Africa who undergo surgery incur catastrophic healthcare expenditure, shouldering economic consequences such as forfeited wages and debt. Intensive resource utilization and reduced insurance coverage in older children may contribute to a higher likelihood of catastrophic healthcare expenditure and can be insurance targets for policymakers.

Відеолапароскопія при закритій травмі живота з пошкодженням печінки та селезінки

Open and closed abdominal trauma is the structure of traumatic injuries makes up from 1.5% to 36.5% of all injuries, accompanied in 26.7-40.8% of cases by liver and spleen damage. Damage to parenchymal organs of the abdominal cavity most often leads to the development of intra-abdominal bleeding, which is the basis of unsatisfactory results of treatment and death of patients. Among the diagnostic methods, video laparoscopy is becoming more and more important in finding the extent of damage to the internal organs of the abdominal cavity. In emergency cases as a minimally invasive but sufficiently informative research method, which in 20-60% of cases allows to supplement, clarify or change the diagnosis. The sensitivity of diagnostic laparoscopy in the case of damage to the organs of the abdominal cavity is 99-100%. Purpose - to study the role and place of video laparoscopy in the diagnosis and treatment of closed abdominal trauma with damage to the liver and spleen. Materials and methods. The results of using video laparoscopy in the diagnosis and treatment of closed abdominal trauma with isolated liver and spleen damage in 131 patients were retrospectively analyzed. The diagnostic search program included clinical, laboratory-biochemical, radiographic studies, ultrasound examination of the abdominal organs according to the FAST protocol, computed tomography, laparocentesis using a search catheter, diagnostic peritoneal lavage, laparoscopy, which were performed in a comprehensive examination according to indications. The obtained data are presented in the form of absolute (number of cases) and relative (%) values. The validity of laparoscopy was considered statistically significant at p˂0.05. Results. Video laparoscopy of the abdominal cavity in the case of a closed injury with isolated damage to parenchymal organs allows to diagnose the nature of the damage in the shortest possible time and to determine the treatment tactics. This method in the diagnosis of hemoperitoneum and injuries of the liver and spleen is informative (100%), sensitivity - 92.8%, specificity - 94.6%, at p&lt;0.05. All laparoscopic operations for injuries of the liver and spleen were ended with a thorough revision, sanitation and drainage of the abdominal cavity. We did not observe complications related to endo-video surgery in this group of patients. There were no fatal consequences. This indicates that the use of minimally invasive laparoscopic methods of treatment in this group of patients helps to reduce the severity of surgical trauma and the frequency of various postoperative complications. Conclusions. Laparoscopy is a highly informative method of diagnosing intra-abdominal damage to the liver and spleen in case of closed abdominal trauma with the possibility of carrying out medical measures. It allows you to prevent and significantly reduce the frequency of postoperative complications, improve the results of treatment, and shorten the hospitalization period of the patients. In compliance of the above criteria, laparoscopy is a safe and adequate replacement for laparotomy as both a diagnostic and treatment intervention. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Laparoscopic Treatment of Morgagni-Larrey Diaphragmatic Hernia with Reposition of the Transverse Colon in Patients with Cardiac Comorbidity. Clinical Observation

Morgagni-Larrey hernia is a rare form of diaphragmatic hernia (2-5% of cases) usually diagnosed in children; in adults, it is often detected in emergency cases or accidentally, during examinations or during surgery. The symptoms of the disease are non-specific, so the diagnosis is made using imaging methods (computed tomography is the gold standard). Currently, there is no single method of treating Morgagni-Larrey hernias. Closure of the defect is performed with or without the use of various mesh prostheses through the abdominal or thoracic route; open or minimally invasive access.&#x0D; The aim. To conduct a retrospective analysis of the treatment of adult patients with a Morgagni-Larrey diaphragmatic hernia, including those with cardiovascular comorbidity, with a comparison of symptoms, contents of the hernial sac, with the use of laparoscopic techniques and composite mesh prostheses.&#x0D; Materials and methods. The results of the treatment of three patients with a Morgagni-Larrey hernia in the period from 2020 to 2022 at the Shalimov National Institute of Surgery and Transplantation are shown. In two patients, the content of the hernial sac was a loop of the transverse colon, in one, the content of the hernial sac was a greater omentum. Taking into account the accompanying cardiovascular pathology, an interdisciplinary council consisting of a surgeon, anesthesiologist, and cardiologist recommended laparoscopic surgical intervention. Laparoscopic allogeneoplasty with composite prosthesis implantation was performed in three patients.&#x0D; Conclusions. The laparoscopic method of treating diaphragmatic hernias is safe and effective. The use of composite prostheses in combination with tension closure of the defect allows to reduce the risk of recurrence of the disease in the distant postoperative period.