Regional Hospital Research Articles

The role of communication in the successful implementation of the Slovenian NCCP

Abstract Issue Cancer remains a significant global public health challenge, necessitating comprehensive strategies for effective control and management. Slovenian National Cancer Control Programme (NCCP) addresses this challenge by prioritizing proactive communication with various stakeholders engaged in cancer care planning, delivery and advocacy. The communication strategy within this programme plays a pivotal role in its successful implementation. Description of the problem Active engagement and collaboration among stakeholders is crucial for achieving the programme’s objectives. NCCP seeks to address this challenge through various communication activities by fostering dialogue, sharing best practices, and facilitating networking opportunities among oncology professionals throughout Slovenia. Additionally, it seeks to strengthen partnerships with sectors beyond health and prioritizes engagement with cancer patient advocacy groups. Results The programme has devised a long-term communication strategy, guiding annual communication plans to engage stakeholders and foster support for its objectives. Notable communication activities in the period 2022-2024 include: organizing annual meetings for different oncology stakeholders including cancer patient associations, hosting impactful professional events, conducting visits to regional cancer hospitals, distributing e-newsletters and managing a NCCP website. Initial outcomes indicate strengthened communication and collaboration among professionals and institutions in the field of oncology nationwide. Engagement with patient advocacy groups has facilitated discussions on topics important to patients. Lessons Effective communication with diverse stakeholders is crucial for comprehensive cancer control. Collaborating across sectors enhances the impact of cancer control initiatives. Enhanced networking fosters innovation and synergy among oncology professionals, positioning Slovenia for greater success in cancer control. Key messages • Slovenia’s NCCP prioritizes proactive communication, fostering collaboration among stakeholders. Annual events, newsletter, and partnerships strengthen awareness and drive comprehensive cancer control. • Long-term communication strategy of Slovenia’s NCCP drives stakeholder engagement, and supports strategic objectives. This proactive approach strengthens comprehensive cancer control efforts.

Development of rapid methods to monitor nutritional standards in sustainable healthy public catering

Abstract Background The WHO and FAO in the Second International Conference on Nutrition stress the role of nutrition standards for public facilities catering services (CS) and in the Sustainable Healthy Diet guiding principles (SHD) underline synergies among foods, nutrients present in dietary patterns and their bioavailability, degree of food processing, and subsequent health impact. In Italy almost one in 10 people eat a meal in CS every day. In accordance with SHD, the Italian Ministry of Health (MH) in the national guidelines for CS indicate activating procedures for the conservation of nutritional qualities (NQ) of micronutrients and bioactive substances. The central purchasing body of the Region of Friuli Venezia Giulia have applied these criteria, introducing the process of critical control points of nutrient analysis (NACCP) in the Public Procurement for the school catering of 69 municipalities and for all 18 regional hospital with more than 3 million meals per year served. The aim of the project was to develop rapid and cheap methods for monitoring the NQ of meals by applying the NACCP process. Methods 150 samples of pasta, milk and also vegetables, meat, fish with different degrees of processing, were taken from the CS and analysed both with chemical techniques and with optical rapid techniques (1300 analyses). Results The samples were subjected to conventional analyses to determine the oxidation state and the content of characterizing molecules such as polyphenols, histamine, and total compounds of Maillard. The same samples were then analyzed by color measurements. The results showed a good correlation between the two analytical systems, in particular the color measurements and the Maillard compounds and the color measurements and the oxidation state. Conclusions Project findings can be applied in the NACCP process to rapidly cost-effectively monitor the nutritional quality of CS meals, and adhere to WHO and FAO the SHD guiding principles and MH guidelines for CS. Key messages • The development of rapid methods of monitoring the nutritional standards of public catering can implement sustainable food systems thereby promoting the healthy diets recommended by the FAO and WHO. • Rapid methods of monitoring nutritional standards represent an innovative component in improving the culture of food and nutritional security in public catering.

The Relationship Between Age, Gender, Workload, and Complaints of Low Back Pain (LBP) among Emergency Room Nurses

Low Back Pain (LBP) is Pain felt in the lower back area, can be local pain or radicular pain or both. Risk factors for low back pain (LBP) include age, gender and workload. This study aims to determine the relationship between age, gender and workload with complaints of Low Back Pain (LBP) in nurses in the emergency department of RSUD Banten in 2022. This type of correlation research uses a cross-sectional study approach. The population in this study were all ER nurses at Banten Regional Hospital as many as 65 nurses. The number of samples was determined by a total sampling technique of 65 respondents. The results showed 33 (50.8%) nurses had mild LBP complaints, 35 (53.8%) nurses aged < 30 years, 40 (61.5%) female nurses and 38 (58.5%) nurses had a light workload. The results of the analysis showed that there was a relationship between age and complaints of LBP (P value 0.004), gender with complaints of LBP (P value 0.002) and workload with complaints of LBP (P value 0.000). It is expected that the Banten Regional Hospital will observe and treat nurses who have LBP complaints.

Context and practices of health advocacy role by nurses in Ghana: A qualitative study

Background & Aim: Nurses play a crucial role in health advocacy, which is both morally obligatory and has significant consequences for the clinician. However, there is a paucity of empirical evidence regarding its context and practices. The location, method, and rationale behind nurses fulfilling their health advocacy duties are crucial in hospital settings. This study explored and described where and under what circumstances nurses fulfill their health advocacy responsibilities in Ghana. Methods & Materials: The study employed an inductive qualitative exploratory descriptive design to gather and analyze data from 24 nurses and midwives. Using a semi-structured interview guide, participants were selected from three regional hospitals in the upper, middle, and southern zones of Ghana, and qualitative content analysis was performed. Results: Nurses and midwives carried out their health advocacy roles both inside and outside of healthcare institutions, using both proactive and reactive advocacy practices to initiate their role performance. Although reactive advocacy roles were reported more, the nurses and midwives identified unfair client treatment, health professionals' errors or omissions of procedure, and social injustice as the driving forces behind their advocacy. Conclusion: Although health advocacy is performed by both nurses and midwives in hospitals and outside the hospitals, they are mostly reacting to situations. Teaching biopsychosocial assessment techniques to students during training and providing them with coaching and mentoring during clinical practice may enhance their ability to assess clients for unmet advocacy needs, enabling them to be proactive in their role performance.

Healthcare-Associated Infections in patients with Covid-19: Assessment of commorbidities and risk of mortality

Healthcare-associated infections are a known factor that is especially difficult to control within healthcare institutions. They are responsible for increased mortality, as well as increased length of stay and costs. This is a retrospective observational cross-sectional study that aims to elucidate information about infections acquired in the hospital environment by patients with a confirmed diagnosis of COVID-19, who are more susceptible to this condition; it was conducted from March 2020 to March 2022 at a hospital in the southern region of Brazil. Data were collected from electronic medical records, and the profile of these infections was defined; the frequencies of the main comorbidities and main infections were analyzed, with site and etiological agent being discriminated, and the antimicrobials that were used being specified. The mortality rate of patients with obesity was 2.3 times higher, while that of pregnant and postpartum women was 11.3 times higher.

Metabolic acidosis in patients with diabetes 2 undergoing cardiac surgery: The impact of SGLT2 inhibitor use: a retrospective cohort study.

Sodium-glucose cotransporter 2 inhibitors (SGLT2-i) lower blood sugar and reduce cardiovascular events and kidney failure. However, there have been increasing reports of euglycaemic diabetic ketoacidosis (eDKA) linked to SGLT2-i medicines. Investigating the association between SGLT2-i use and the incidence of metabolic acidosis in patients with type 2 diabetes undergoing cardiac surgery. A retrospective observational cohort study comprising 121 patients, with 38 in the SGLT2-i group and 83 in the control group. A 2-year period at Haukeland University Hospital, a tertiary regional hospital in Western Norway. Patients with type 2 diabetes undergoing cardiac surgery. Collection of clinical and laboratory data, including acid/base balance parameters, surgery details and SGLT2-i use. Base excess and anion gap measurements as indicators of ketosis development. A subgroup analysis in patients without renal failure (glomerular filtration rate > 60 ml min-1 m-2). Lower base excess levels and increased anion gaps were observed in the SGLT2-i group compared with controls at various time points postoperatively, with no significant differences in serum lactate levels.Twelve hours postoperatively, 41% of SGLT2-i patients without renal failure had a base excess -3 mmol l-1 or less after correction for serum lactate (indicating ketosis) compared with only 8% in the control group (P < 0.001). The anion gap was elevated in the SGLT2-i group compared to the control group at 12 h postoperatively (P = 0.018).Multivariable regression analysis identified SGLT2-i use as an independent factor associated with a lower base excess after correction for lactate levels (P < 0.001). Cessation of SGLT2-i medication did not correlate with the degree of acidosis. While taking SGLT2 inhibitors, diabetic patients undergoing heart surgery are at an increased risk of ketosis and possibly metabolic acidosis. This emphasises the importance of careful observation and effective treatment strategies within this group.

Embryotomy for head last retention: A case report from Thiès, Senegal

Introduction: Hydrocephalus is a pathology of heterogeneous nature and complex pathogenesis. It corresponds to an active distension of the ventricular system. Faced with hydrocephalus with retained head in a dead child, embryotomy by craniotomy is indicated. Case Report: We report a case of intrapartum fetal death with head-last retention due to hydrocephalus treated with craniotomy performed at the regional hospital of Thiès (CHRT). This was a 21-year-old primigravida patient seen for premature delivery in a pregnancy of 33 weeks 5 days. The ultrasound concluded that the pregnancy had stopped at 33 weeks 5 days with major hydrocephalus. A craniotomy followed by gradual evacuation of the cerebrospinal fluid allowed easy delivery of a fresh stillborn weighing 1950 grams. The afterbirth was simple. Conclusion: Embryotomy by craniotomy constitutes a good option to complete delivery by natural means in the face of head retention due to hydrocephalus with intrapartum death. It is therefore necessary to master this simple and less morbid technique than a cesarean section in such a situation.

The Use of Mobile Health Care Among Medical Professionals in the Sichuan-Chongqing Region: Cross-Sectional Survey Study.

The emergence and integration of mobile health care technology have fundamentally transformed the health care industry, providing unprecedented opportunities to improve health care services and professional practice. Despite its immense potential, the adoption of mobile health care technology among health care professionals remains uneven, particularly in resource-limited regions. This study aims to explore the use and influencing factors of mobile health care among health care professionals in the Sichuan-Chongqing region of China and make recommendations. Convenience sampling was used in a cross-sectional study conducted from November 8 to November 14, 2023, to survey frontline clinical health care professionals at 5 district-level secondary public hospitals in the Sichuan-Chongqing region. A web-based questionnaire was used to investigate the use of mobile health care and its influencing factors among the participants. Descriptive analysis and logistic regression analysis were used in the study. A total of 550 valid questionnaires were completed. Among the surveyed health care professionals, only 18.7% (103/550) used mobile health care, with a satisfaction rate of only 50.5% (52/103). Around 81.3% (447/550) did not use any form of mobile health care. The age group of 30-39 years was found to be a significant factor influencing the use of mobile health care by health care professionals (P=.03). The main reasons for not using mobile health care among health care professionals were lack of appropriate technical training and support (266/447, 59.5%), lack of suitable management-specific apps (204/447, 45.6%), and concerns about increased workload (180/447, 40.3%). There were significant differences in the single-factor analysis of the reasons for the nonuse of mobile health care among health care professionals from different specialties (P=.04). Logistic regression analysis indicated that age was the only significant factor influencing the use of mobile health care by health care professionals (P=.04). The utilization rate of mobile health care among health care professionals in the Sichuan-Chongqing region is low. Age is a significant factor that influences whether health care professionals use mobile health care. Providing appropriate technical training and support may help improve the enthusiasm of health care professionals in using mobile health care.

51 Feasibility of paediatric postoperative telemedicine in Nunavik

Abstract Background To access surgical care, Inuit children from Nunavik are relocated by plane to an urban tertiary hospital. Current processes that require an in-person follow-up appointment extend their stay away from home despite an overall low rate of postoperative complications. Telemedicine presents the opportunity to reduce this delay, but little is known about its feasibility for paediatric postoperative care in Nunavik. Objectives To determine the feasibility of paediatric postoperative telemedicine in Nunavik. Design/Methods In this mixed methods study using a convergent parallel design (August 2022 – May 2023), we recruited eleven healthcare providers who regularly interact with Inuit families of Nunavik. We conducted individual semi-structured in-depth interviews about postoperative care in this setting and analyzed the data thematically. In parallel, we conducted a narrative synthesis of the literature and gathered input from collaborators to assess the potential resources needed to enable postoperative telemedicine in the region. We then determined the capability for telemedicine in each of the fourteen villages of Nunavik using data provided by the regional health board. A meeting with specialists responsible for telemedicine in the region was held to discuss findings and future steps. We analyzed and compared qualitative and quantitative results to determine the degree of postoperative telemedicine readiness in the region. Results The main themes influencing the feasibility of telemedicine were general considerations for telemedicine use as a follow-up modality, patient characteristics most suitable for postoperative telemedicine, resources needed for telemedicine use as a follow-up modality, and the feasibility of postoperative telemedicine as determined by healthcare providers. All interviewees deemed paediatric postoperative telemedicine in this region feasible but highlighted conditions for its success. The narrative review uncovered limited literature on telemedicine use in Nunavik. As of January 2023, the two regional hospitals and three health centers had full capabilities for postoperative telemedicine. The nine other health centers had partial capabilities, mainly due to limited access to stable high-speed Internet and Internet bandwidth. Only regional hospitals had access to hospitalization, imaging, readaptation, and laboratory departments. The participating specialists deemed telemedicine feasible if patient load and burden of administrative work are manageable. Conclusion Postoperative paediatric telemedicine in Nunavik is feasible from a resource, healthcare providers and specialists standpoint. Leveraging centers with appropriate capacity would allow the increase in telemedicine usage in Nunavik. Next steps in this research program include interviews with families to evaluate their needs, preferences and attitudes toward postoperative paediatric telemedicine.

Determinants of unsuccessful tuberculosis treatment outcome in Southwest Ethiopia regional state public hospitals, 2022: a multi-center case control study.

Tuberculosis is the major cause of morbidity, and it is one of the top ten causes of death globally. In Africa, the overall pooled estimate of unsuccessful tuberculosis treatment outcome was reported to be 21.1%, which is above the World Health Organization defined threshold of 15%. Unsuccessful treatment outcomes result in drug resistance, prolonged periods of infection, and increased morbidity and mortality. Therefore, this study aimed to assess determinants of unsuccessful treatment outcomes among tuberculosis patients in Southwest Ethiopia regional state public hospitals, in 2022. A retrospective unmatched case-control study was employed by recruiting 570 study units (190 cases and 380 controls) in three randomly selected public hospitals from 1 August 2022 to 21 August 2022. Data were collected by using a data extraction checklist adapted from tuberculosis registration logbook. Bivariate and multivariate logistic regression models were employed. A predictor variable with a p-value of less than 0.05 in the multivariate logistic regression model was taken as statistically significant. The odds ratio and 95% confidence level were used to measure the strength of the association. A total of 561 records (187 cases and 374 controls) were included from tuberculosis registers. In this study, the factors independently associated with unsuccessful tuberculosis treatment outcome were older age (AOR = 1.68, 95% CI: 1.142, 2.472), rural residence (AOR = 1.548, 95% CI: 1.055, 2.272), retreatment category (AOR = 2.12, 95% CI: 1.339, 3.357), underweight (BMI < 18.5 kg/m2) (AOR = 1.952, 95% CI: 1.240, 3.071), being HIV positive (AOR = 2.144, 95% CI: 1.372, 3.349) and having no treatment adherence support (AOR = 2.016, 95% CI: 1.270, 3.201). In this study, socio-demographic, clinical, and treatment-related factors contributed to the risk of unsuccessful treatment outcomes. Targeted interventions should be taken into consideration to diminish poor tuberculosis treatment outcomes among high-risk groups throughout the whole tuberculosis treatment course.

Current status analysis of the prevalence and regional disparities of robot-assisted laparoscopic prostatectomy in Japan using diagnosis procedure combination data

The introduction of the “da Vinci S HD Surgical System” marked a significant shift towards robotic surgeries in Japan. However, initial high costs and lack of efficacy data posed barriers to its widespread adoption. By 2023, more than 570 da Vinci units were operational in Japan, highlighting the growing acceptance of robotic surgery despite these challenges. This study aimed to investigate the prevalence and regional disparities in the adoption of robot-assisted laparoscopic prostatectomy (RALP) across Japan using diagnosis procedure combination data. This retrospective observational study analyzed data from 2857 urban and 4184 regional hospitals across 47 prefectures in Japan. The study focused on the number of RALP procedures, da Vinci systems, and certified urological surgery proctors. Multiple regression analysis was performed to identify significant factors influencing RALP adoption. Urban areas demonstrated a higher prevalence of RALP procedures and more da Vinci systems compared to regional areas, with urban hospitals performing an average of 937 RALP procedures compared to 195.5 in regional hospitals. The number of certified urological surgeons also showed significant urban-regional disparities, contributing to the overall imbalance. Our findings highlight substantial regional disparities in access to robot-assisted surgery in Japan, with urban areas benefiting from better access to advanced medical technologies and specialist training. Addressing these disparities will require targeted policies to improve the dissemination of robotic surgery systems and enhance training opportunities in regional cities.

A qualitative study of older adults: The difficulties and needs of returning home after hip fractures

BackgroundFalls and consequent fractures are an increasing problem among older adults, with low rates of return to previous functional condition and a substantial risk of subsequent falls. This scenario points to the need for an improved response to this population's needs. ObjectiveTo define the difficulties and needs felt by older adults with hip fractures when returning home. MethodsThis was a descriptive and exploratory qualitative study. Semi-structured interviews were conducted with hip fracture patients who had been submitted to surgery and who were treated at a hospital in the central region of Portugal. Bardin's content analysis was used to analyze the data. Content analysis was carried out with the support of MAXQDA® Analytic pro 2022 software. ResultsThe analysis of the results of the 15 interviews yielded three categories related to the difficulties perceived by hip fracture patients on returning home: functional limitations; pain; and emotional management. Regarding the needs felt, the following categories emerged: resources/help with activities of daily living; capacity-building for the return home; and information. ConclusionsThe needs and difficulties of older adults with hip fractures on returning home are multiple and variable. Knowledge of these aspects can significantly enhance the standardized actions of nurses in this area of intervention, contributing to the improvement of continuity of care and ensuring a safe transition.

Plasma pesticide residues-serum 8-OHdG among farmers/non-farmers diagnosed with lymphoma, leukaemia and breast cancers: A case-control study.

A hospital-based cross-sectional case-control study was conducted to investigate the association between exposure through various pesticide residues detected in the plasma and serum 8-OHdG levels among farmers and non-farmers diagnosed with leukaemia, lymphoma and breast cancers and compare the same with healthy controls with no cancer and no exposure. The present study was conducted among the farmers and non-farmers visiting a regional tertiary cancer care hospital in Hyderabad, Telangana State, India. Data were collected by administering a pre-tested questionnaire through an interview followed by the collection of blood samples which were analyzed for pesticide residues using LC-MS/MS while the serum levels of 8-OHdG were measured using ELISA. Data were analyzed using SPSS 24. The pesticide residues detected were chlorpyrifos, dimethoate, malathion, phosalone, and quinalphos which were approved and recommended for their use on the crops that were cultivated by the farmers in their plasma samples along with banned pesticide residues like monocrotophos, diazinon, and dichlorvos among farmers diagnosed with all three types of cancers while the non-farmers and healthy controls were not detected with any such residues. In addition, farmers diagnosed with leukemia had higher levels of all the pesticide residues in their plasma than those diagnosed with lymphoma and breast cancers. Further, a significant difference was also observed between profenofos residues in plasma and serum 8-OHdG levels. In the present study, though the farmers diagnosed with three types of cancers were detected with various types of pesticide residues analysed, only residues of profenofos showed a significant difference with serum levels of 8-OHdG suggesting the need for an in-depth follow up molecular studies in a larger cohort to assess the possible association between 8-OHdG levels with the pesticide residues among the exposed.

Crimean-Congo hemorrhagic fever in Herat province of Afghanistan, 2007-2021

Crimean-Congo hemorrhagic fever (CCHF) is a geographically widespread tick-borne hemorrhagic diseasecaused by the Crimean-Congo hemorrhagic fever virus (CCHFV). In Afghanistan, the first case of CCHF wasdetected in Takhar province in 1998, after which no additional cases were reported for ten years. The aim ofthis study is to report the analyses of the clinical and epidemiological features of confirmed CCHF cases thatwere recorded in Herat province between 2007 and 2021. This prospective case series study was conducted atHerat Regional Hospital between January 2007 and December 2021. Demographic and clinical data werecollected for each patient; all patients were hospitalized. Biochemical and hematological laboratoryexamination, and the detection of CCHV IgM and viral RNA was performed for all patients. Statistical analyseswere performed in IBM SPSS Statistics (version 26). A total of 252 confirmed CCHF cases including 160(63.5%) males and 91 (36.5%) females, with a mean age of 33.37±14.1 years were included in the study. Themajority of patients were in 11-50 age category, 32.9% were housewife, 38.4% were farmers, shephard, andbutchers. The most prevalent clinical presentations were fever (100%), headache (98.8%), body pain (96.4%),Ecchymosis (48.0%), epistaxis (44.8%) and gum bleeding (33.3%). The majority of cases occurred betweenApril and October. The case fatality rate of CCHF in this study was 2.8%. Considering the significant social,economic and health burden CCHF places on the community, enhanced public health measures are necessaryto control CCHF in Herat province and neighboring regions.

PENGARUH KOMPETENSI TERHADAP KINERJA PERAWAT BANGSAL RAWAT INAP DI RSUD dr. SOEHADI PRIJONEGORO SRAGEN

Introduction: Human resources are the most important determining factor in achieving the strategic goals of an organization, especially in the healthcare industry. Based on the results of a preliminary study, inpatient ward nurses have education ranging from third diploma to bachelor's degree to postgraduate degree, and inpatient indicators meet the ten standards set by the Indonesian Ministry of Health. The competence of nurses in terms of knowledge and skills in nursing is very important to know how good the performance of nurses is in achieving good health goals in accordance with the duties and authority, code of ethics and applicable standard operating procedures. Objectives: The purpose of this study was to determine the effect of competence on the performance of inpatient ward nurses at RSUD Dr. Soehadi Prijonegoro Sragen Methods: This study used a quantitative paradigm with a cross-sectional design to test the hypothesis. The study population consisted of all nurses (N = 158) in 11 inpatient wards. The study sample consisted of 121 nurses selected using proportional random sampling technique. The predictor variable was competence and the criterion variable was nursing performance. The analysis used univariate and bivariate analysis (simple linear regression analysis). Results: Based on univariate analysis, competence and performance are in the "good" category, with the percentage of competence of 95.87% and nurse performance of 92.56%. Based on bivariate analysis, the significance value is 0.000 &lt;0.05 and t count is 8.796&gt; t table 1.980. The results of the study indicate that competence has a positive influence on the performance of nursing staff. Conclusions: The conclusion is that competence has a positive effect on the performance of the inpatient ward hospital Dr. Soehadi Prijonegoro Sragen Regional Hospital.

Public Services in the Field of Basic Health for Mothers and Children in Talawaan District, North Minahasa Regency, North Sulawesi Province

Maternal mortality rate and infant mortality rate are an indication of the low level of population welfare. Likewise, the high disparity in socio-economic levels - rich and poor, between regions and between urban and rural areas. Therefore, health services for mothers and children are the main priority in health development. The government at all levels of government has established and implemented health programs for mothers and children. However, it has not provided a good impact on the aspect of basic public services. Health services for mothers and children through integrated service posts are more visible at the village level and require serious attention from the government because they are very far from health service centers such as regional hospitals. Therefore, this study was conducted to describe and explain basic public health services for mothers and children in Talawaan District, North Minahasa Regency. This study is considered important from the aspect of public health and related to strengthening social capital in the superior fields of social humanities, arts and culture as well as the development and strengthening of institutional systems, health policies, and community empowerment in the superior fields of health and medicine in the Sam Ratulangi University research strategy plan. Data were collected through interviews with the Head of the Health Service and Health Center, Posyandu officers and pregnant mothers and those with toddlers. Observations were made by looking directly at basic health services in Talawaan District. Secondary data were collected during health service activities and conducting electronic searches on Google Scholar and ResearchGate. The analysis was carried out based on the stages of reduction, interpretation, drawing conclusions and verification/triangulation. The research findings that public services in the field of basic health are accessible, acceptable, fair and safe for mothers and children but are not yet fully efficient and effective in their implementation. The concept found from this study is that the community needs basic health services for mothers and children that are easy to access and accept, fair to all levels of society and medically safe. While the principles of efficiency and effectiveness are more about the interests of the organization in the use of resources and achieving goals.

SUCCESSFUL CONCEPTION AND FIRST PREGNANCY IN A 28-YEAR-OLD WOMAN WITH CERVICAL UTERINE MYOMA AND TOTAL PLACENTA PREVIA: A CASE REPORT

Background: Placenta previa is a major pregnancy complication associated with life-threatening hemorrhage. Cervical Uterine Myomas, benign smooth muscle tumors, increase the risk of placenta previa by two to three times, contributing to adverse pregnancy outcomes such as infection, urinary retention, preterm labor, and bleeding. Understanding the interaction between Cervical Uterine Myomas and placenta previa is crucial for optimizing care in high-risk pregnancies and improving maternal and fetal outcomes. Case Description: A 28-year-old primigravida (G1P0A0) patient was diagnosed with a breech presentation, Cervical Uterine Myoma, and total placenta previa at Klungkung Regional Hospital. The patient had a regular menstrual cycle and no history of comorbid conditions. The patient's management includes hospitalization with strict bed rest, followed by a scheduled elective cesarean section (CS). Fluid therapy will be administered using Ringer's lactate, and preoperative prophylactic antibiotics will be provided. Discussion: Cervical Uterine Myoma, particularly cervical myomas, can significantly impact pregnancy outcomes, with a prevalence of 1.6% to 10.7%. These fibroids, particularly large ones, increase the risk of placenta previa, a condition where the placenta partially or completely covers the cervix. The combination presents significant risks for both the obstetrician and the patient, including urinary retention, myoma degeneration, preterm labor, obstructed labor, and postpartum hemorrhage. Careful surgical planning and management strategies are crucial. Conclusion: A 28-year-old primigravida with breech presentation, Cervical Uterine Myoma, and total placenta previa was admitted after three days of abdominal pain and scheduled for an elective cesarean section at 36 weeks. The cesarean successfully delivered a healthy male infant, and a 10 x 10 cm cervical myoma was identified without complications. Postoperatively, the patient had a normal recovery with well-healing surgical wounds and was discharged in stable condition with appropriate medications.

Gestational Diabetes : A Cross-Section of Factors and Complications in Mothers and Newborns in Southern Morocco

By way of introduction, the prevalence of gestational diabetes varies between 1% and 14%, in Morocco, a single study conducted in Dakhla in southern Morocco in 2019, estimates that the prevalence of GD is 7.7% in accordance with the recommendations of the American Diabetes Association, hence the need to explore the epidemiological profile in southern Morocco.  Methodology:- A cross-sectional descriptive analytical correlational epidemiological survey of 202 pregnant women during the period 2021-2022, conducted at the Dakhla regional hospital centre, which attempts to describe the individual, biological and gynecological-obstetric risk factors in pregnant women with gestational diabetes. As well as maternal and neonatal complications. The study also analyses the effect of hospital performance on the management of parturients.  Results:- The prevalence of GD is high in the age group [35,41] and over 42 years, mainly among illiterate. Several risk factors have been identified for GD : age, high preconceptional BMI, low level of education, polycystic syndrome, history of urinary infection, positive vaginal swab for Streptococcus B, and complications for mothers and newborns revolving around Dystocic delivery, macrosomia and hypoglycaemia in newborns. There is also retinopathy in premature babies due to candida albicans and early bacterial infection due to GSB in full- term newborns.

Machine Learning Algorithm-Aided Determination of Predictors of Mortality from Diabetic Foot Sepsis at a Regional Hospital in South Africa During the COVID-19 Pandemic.

Background and Objectives: Diabetic foot sepsis (DFS) accounts for approximately 60% of hospital admissions in patients with diabetes mellitus (DM). Individuals with DM are at risk of severe COVID-19. This study investigated factors associated with major amputation and mortality in patients admitted with DFS during the COVID-19 pandemic. Materials and Methods: Demographic information, COVID-19 and HIV status, clinical findings, laboratory results, treatment and outcome from records of patients with diabetic foot sepsis, were collected and analysed. Supervised machine learning algorithms were used to compare their ability to predict mortality due to diabetic foot sepsis. Results: Overall, 114 records were found and 57.9% (66/114) were of male patients. The mean age of the patients was 55.7 (14) years and 47.4% (54/114) and 36% (41/114) tested positive for COVID-19 and HIV, respectively. The median c-reactive protein was 168 mg/dl, urea 7.8 mmol/L and creatinine 92 µmol/L. The mean potassium level was 4.8 ± 0.9 mmol, and glycosylated haemoglobin 11.2 ± 3%. The main outcomes included major amputation in 69.3% (79/114) and mortality of 37.7% (43/114) died. AI. The levels of potassium, urea, creatinine and HbA1c were significantly higher in the deceased. Conclusions: The COVID-19 pandemic led to an increase in the rate of major amputation and mortality in patients with DFS. The in-hospital mortality was higher in patients above 60 years of age who tested positive for COVID-19. The Random Forest algorithm of ML can be highly effective in predicting major amputation and death in patients with DFS.

ASSESSMENT OF LABORATORY PARAMETERS IN PATIENTS WITH ACUTE PANCREATITIS OF VARIOUS ETIOLOGIES

Summary. Abstract. Acute pancreatitis remains one of the most prevalent diseases worldwide. Alcoholic and biliary factors are considered the most common causes of AP. The aim of the study was to investigate the laboratory characteristics of patients with AP, taking into account the etiological variant of the disease. Materials and methods: the study is retrospective. Medical records of 677 patients hospitalized for AP in two medical institutions from 2017 to 2022 were analyzed: Vinnytsia сity сlinical emergency hospital and Vinnytsia regional clinical hospital named after M.I. Pyrogov. For further study of laboratory parameters of all AP patients, they were divided into four groups depending on the etiology: alimentary, biliary, alcoholic, and postoperative. The laboratory data obtained within the first 24 hours of hospitalization were analyzed. Results. Intergroup differences in the distribution of laboratory parameters were observed among different etiological variants of AP. Some of them showed only significant intergroup deviations within reference values, while some also deviated from the norm. Specifically, for alimentary AP, there was a significant increase in creatinine levels compared to other groups. For biliary AP, there was a significant increase in leukocyte count, neutrophil-to-lymphocyte ratio, total bilirubin, blood glucose levels, and a significant decrease in lymphocyte count. For postoperative AP, there was a significantly the lowest level of increase of serum amylase levels, significant elevation in ALT and AST levels, and significant increase in stabs neutrophils and ESR compared to other groups. Conclusions. Analysis of blood and urine laboratory parameters in patients with AP allowed to identify intergroup differences in their distribution for different etiological variants of AP without deviation from the norm, as well as deviations from reference values. The obtained data should be taken into account at the stage of hospitalization and the beginning of inpatient treatment of patients with AP for further stratification and development of individualized diagnostic and therapeutic programs.