Protocol For Management Of Patients Research Articles

Dental Management of patient with Parkinson’s Disease

Background: Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder. This disease affects about 1 in 1000 people in the general population and 1% of the over 60 age group. The main features of the disease are: resting tremor, bradykinesia, postural instability, muscle rigidity and inexpressible face (mask-like face). People with PD face a series of pathological manifestations from the oromaxillofacial region related to the disease, while some of the drugs used to treat PD also lead to adverse effects from the oral cavity. Purpose: The dentist should be able to recognize the basic signs and symptoms of the disease, its basic oral manifestations and the basic dental management protocols of patients with PD. This review aims to contribute in this direction. Method: In pubmed database we searched with keywords “dental and Parkinson’s disease”, “Parkinson disease and dental management”, ‘Parkinson and periodontal’, “oral hygiene and Parkinson disease’, “periodontitis and Parkinson’s disease”. We concluded that 141 papers were to be used in our review. We also used Little’s and Scully’s books on the medically compromised patient, as well as Dougall’s series of articles for disabled patients. Last, we used few website links of official dental sites. Conclusion: PD patients may suffer from a multitude of pathological manifestations from the oral-maxillofacial area, while they need special dental management due to motor, mental and autonomic neural system disorders. The insufficient experience and training of the majority of dentists in treating patients with PD is given. The dental community in collaboration with the medical community and the State is important to contribute to the improvement of the oral health of PD patients, by educating patients and dentists.

Sustained mitigation of ST-segment elevation in a patient with Brugada syndrome type 1 during sevoflurane and remifentanil anesthesia: a case report

BackgroundDuring general anesthesia, patients with Brugada syndrome are at risk of malignant arrhythmias following worsened ST-segment elevation, potentially leading to sudden cardiac death. The protocol for safe anesthetic management of patients with Brugada syndrome has not yet been established.Case presentationA 63-year-old man, diagnosed with a spontaneous Brugada type 1 pattern, was scheduled for a pleural biopsy using video-assisted thoracoscopic surgery under general anesthesia. We planned general anesthesia using volatile induction and maintenance anesthesia with sevoflurane and remifentanil. We monitored ST-segment morphology and observed sustained mitigation of ST-segment elevation throughout general anesthesia.ConclusionThe present case may indicate that safe anesthetic management of patients with Brugada syndrome depends on whether the anesthetics used can reduce ST-segment elevation.

Implementation of a Standardized Management Protocol Improved the Survival of Patients with Necrotizing Fasciitis

Abstract Background Necrotizing fasciitis (NF) is a life-threatening soft tissue infection requiring urgent interventions. This study aimed to investigate the effect of implementation of a standardized management protocol on the outcome of NF patients admitted to the intensive care unit. Methods We initiated a management protocol for NF patients in 2012 at our institution. The protocol consisted of early surgical intervention, initial board-spectrum antibiotic regimen, daily wound inspection, repeated debridement, and inter-professional collaboration. Herein, we reviewed the NF cases admitted between 2005 and 2018 and compared their clinical features and outcome before and after the protocol implementation. All of the NF cases underwent were confirmed by intraoperative findings. Results We included 134 NF patients before (2005 to 2011, n = 62) and after (2013 to 2018, n = 72) the protocol implementation. The baseline patient profile from these two periods were largely similar, except that after protocol implementation, more patients presented with erythema (64.5% vs 84.7%) and a higher C-reactive protein level (65.5% vs 85.5%) on admission. Notably, the day 28-censored mortality was significantly lower after protocol implementation (40.3% vs 13.9%). By analyzing the 28-day mortality with univariate and multivariate model, initial presentation with neutropenia was identified as a risk factor [hazard ratio (HR) = 8.45, 95% confidence interval (CI) = 1.76-40.6], while protocol implementation (HR = 0.27, 95% CI = 0.11-0.71) was a protective factor. Conclusions A multidisciplinary bundle care protocol for NF including board-spectrum empirical antibiotic regimen and inter-professional collaboration was feasible, which was associated with improved overall and 28-day survival.

Creating an Innovative Business Model for the Performance of Commercial Dental Clinics

Providing dental care to the population is associated with the active introduction of new technologies, personnel management methods, and business processes. In this sense, dentistry is at the forefront of the development of medicine and other economic sectors. However, the active practical implementation of advanced technologies for the provision of dental services requires personnel to have increased motivation and highly qualified labor, to develop new protocols for patient management, and to use more advanced equipment and materials, while administrative and management personnel should introduce progressive methods of labor motivation and economic and mathematical models of material and moral stimulation. This research aims to create an innovative business model for the development of a commercial dental clinic (CDC) that provides paid dental services. Economic and mathematical modeling and nonlinear programming are aimed at maximizing dentists’ wages, together with financial incentives for the work of administrative and managerial personnel and deductions for the development of a typical commercial dental clinic in Moscow based on the actual volume of dental services and the costs of their provision. With the volume of paid dental services growing by one and a half times, the innovative business model makes it possible to increase clinic income by a factor of 1.66 and dentists’ salaries by a factor of 2.24, raise deductions for labor incentives for administrative and managerial personnel by a factor of 1.66, and increase total profit by a factor of 1.75. During the research, it was possible to ensure early repayment of a loan of 5 million rubles for clinic development in 21 months. Additional research is needed because of the possible variability of the dental market and lending conditions. Doi: 10.28991/HIJ-2024-05-01-05 Full Text: PDF

Essential amino acids in total knee and hip joint replacement: a narrative review

The increasing availability of total joint replacement especially for knee and hip joints has increased their rates substantially across the globe. It is associated with increased risk of sarcopenia with loss of muscle mass and strength in the postoperative period. The supplementation of proteins along with exercises have been mainframe strategy to improve the functional ability after total knee arthroplasty and total hip arthroplasty. However, supplementation of proteins necessitates effective proteolytic digestion and conversion to amino acids for exerting substantial effects. In overcoming this challenge, supplementation with essential amino acids can be an attractive approach In this article, we review the clinical evidence with use of essential amino acids in patients undergoing TKA and THA. In the nine studies included in the review, seven assessed EAAs in TKA and two in THA. In TKA studies, improvement in muscle mass, muscle strength and functional recovery has been significant over 6 weeks postoperatively in majority of the studies. Over long term (2 years), improved recovery of rectus femoris and quadriceps had been reported. In THA as well, significant improvement in hip function and stability has been reported. Thus, EAAs in addition to the existing rehabilitation program are helpful to improve sarcopenia and enhances the recovery to perform activities of daily living. We propose from current evidence that administration of EAAs 7 to 10 days prior to planned TKA or THA and continued for 14 to 20 days in the postoperative period along with rehabilitation program is optimal in enhancing the muscle strength and help in physical functional recovery. Current evidence indicates supplementation with EAAs should be a part of routine management protocol in patients undergoing TKA or THA.

Artificial intelligence-based quantification of COVID-19 pneumonia burden using chest CT

AbstractDuring the coronavirus disease 2019 (COVID-19) pandemic, artificial intelligence (AI) based software on chest computed tomography (CT) imaging has proven to have a valuable role in accelerating diagnosis and screening. The proposed AI-based tools proved to be rapid and reproducible techniques to guide patient management and treatment protocols. Although no specific guidelines exist, CT-imaging and clinical features are used for patient staging. To shed light on the role of AI techniques that have been developed in fighting COVID-19, in this review, studies investigating the usage of commonly used AI models on chest CT imaging for disease quantification and prognostication are collected.

Systematic Review of Clinical Guidelines for the Treatment of Functional Dyspepsia

An analysis of the literature data on the treatment of functional dyspepsia (FD) was performed. In the Kyrgyz Republic there have been no studies on the prevalence of FD, there are no protocols for diagnosis and management of patients with this pathology. We analyzed clinical recommendations on FD of the leading five world gastroenterological associations, the comparison of which showed the general principles of patient management, as well as some discrepancies.

Analysis of a Combination Therapy Protocol for the Treatment of Oral Mucous Membrane Pemphigoid: A Retrospective Case Series Study.

Mucous membrane pemphigoid (MMP) is an autoimmune-based bullous disease affecting the mucous membranes, mainly oral and ocular. One of the most common clinical manifestations is desquamative gingivitis (DG), characterized by intense symptoms and functional limitations. The dentist is among the first specialists to observe DG and, therefore, must be able to diagnose it. In this regard, the purpose of the present study was to evaluate the efficacy and safety of a clinical protocol for the topical management of patients with DG and MMP buccal lesions. Thirteen patients with clinical and histologic diagnoses of MMP-localized DG in the oral cavity were retrospectively enrolled. Each patient received topical treatment with clobetasol propionate oral gel 0.05%; nicotinamide; oral probiotic (contains Bifidobacterium lactis HN019, Kluyveromyces marxianus fragilis B0399, colostrum, and biotin); and doxycycline. Before and after 3 months of therapy, clinic records were collected for each patient. Seven patients (53.8%) had a complete response to treatment; four patients (30.8%) had a partial response to treatment; and, finally, two patients (15.4%) had no benefit from therapy. Dental management of patients presenting solely with oral manifestations of MMP may involve the use of topical corticosteroids, doxycycline, vitamin supplements, and probiotics and associating professional oral hygiene procedures.

Correlation between lymphopenia and other hematological parameters with duration of hospital stay as a measure of severity in Covid-19: a retrospective study

PurposeThe SARS-CoV-2 (corona) virus is evolving fast because of the scale at which it has infected people around the world. Updated data is needed to manage Covid-19 efficiently with limited resources. After thorough literature review, there were very few studies that correlated variation of hematological parameters with duration of hospital stay.Here, the aim of the study was to determine correlation between variation in hematological parameters and duration of hospital stay as a predictor of severity of disease.MethodologyThe study was conducted at central laboratory of HIMS, Varanasi. The present study was an observational study done retrospectively. The study duration was from 1st July, 2020 to 30th October, 2020. RT-PCR-positive confirmed cases admitted in the institute whose CBC data was available over a period of multiple days were included in the study to find out the correlation.Study designPatients were categorized into two study groups. Group I (A and B): duration of hospital stay from 2 to 10 days and Group II (A, B, and C): duration of hospital stay more than 11 days. Chi-square test was applied to both the groups to see whether correlation between variation in hematological parameters and duration of hospital stay was significant or not.ResultA total of 276 Covid-19 patients were included in the study. Patients were divided into groups and subgroups according to the duration of hospital stay. A total of 50% (103) of patients in Group I (hospital stay from 2 to 10 days) had lymphopenia as compared to 72.86% (51) of patients with lymphopenia in Group II (hospital stay from 11 to 40 days). Similarly, 44.17% (91) of patients in Group I had leukocytosis as compared to 72.86% (51) of patients with leukocytosis in Group II. The percentage increase in lymphopenia and leukocytosis in Group II was same, and this increase was found to be statistically significant (p-value < 0.05). Both these variables were increasing with increase in days of hospital stay.ConclusionHence, to conclude, complete blood count parameters especially lymphopenia and leukocytosis are most significant and economical in guiding the management protocol of Covid-19 patients as well as in predicting the number of days of hospital stay.

Incidence of urinary incontinence after hip fracture surgery and associated risk factors: a prospective study

BackgroundThe contribution of the postoperative process to developing or worsening urinary incontinence (UI) after hip fracture surgery (HFS) remains unclear. We aimed to evaluate UI incidence and worsening among older patients undergoing HFS, and explore associated risk factors.MethodsThis prospective cohort study included patients ≥ 75 years admitted between October 2019 and October 2021 to the Traumatology Service of three hospitals in the Consorci Sanitari de Alt-Penedès i Garraf (Barcelona, Spain) with hip fracture requiring surgical treatment. UI was assessed using the first two questions of the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) at baseline and at days 30 (± 3 days) and 90 (± 3 days) after HFS. Surgery-related data and post-surgical complications were recorded.ResultsA total of 248 patients with a mean (SD) age of 85.8 (6.78) years were included; 77.8% were female and 154 (62.1%) had UI at baseline. After HFS, 3.24% experienced urinary tract infections (UTIs), 3.64%, acute urinary retention (AUR), 8.57%, constipation, and 53.9%, prolonged catheterization (> 24 h). Fifty-eight patients without baseline UI developed UI at 30 days, resulting in a UI incidence of 61.7% (95% CI 51.1–71.54) between days 0 and 30. Of the 248 patients, 146 (59.1%) experienced worsening of UI. AUR and UTIs were identified as risk factors for UI development and worsening after HFS, respectively.ConclusionThe incidence of UI in older patients after HFS is significant. Patient management protocols should consider AUR and UTIs to reduce or eliminate the incidence of UI in older patients undergoing HFS.

Update on Focal Infection Management: A Czech Interdisciplinary Consensus

BackgroundThe focal infection theory has been used to explain several chronic systemic diseases in the past. Systemic diseases were thought to be caused by focal infections, such as caries and periodontal diseases, and dentists were held responsible for these diseases due to the spread of oral infections. As knowledge of the interrelationship between oral microorganisms and the host immune response has evolved over the last few decades, the focal infection theory has been modified in various ways. The relationship between oral and systemic health appears to be more complex than that suggested by the classical theory of focal infections. Indeed, the contribution of the oral microbiota to some systemic diseases is gaining acceptance, as there are strong associations between periodontal disease and atherosclerotic vascular disease, diabetes, and hospital-associated pneumonia, amongst others. As many jurisdictions have various protocols for managing this oral-systemic axis of disease, we sought to provide a consensus on this notion with the help of a multidisciplinary team from the Czech Republic. MethodsA multidisciplinary team comprising physicians/surgeons in the specialities of dentistry, ear-nose and throat (ENT), cardiology, orthopaedics, oncology, and diabetology were quetioned with regard to their conceptual understanding of the focal infection theory particularly in relation to the oral-systemic axis. The team also established a protocol to determine the strength of these associations and to plan the therapeutic steps needed to treat focal odontogenic infections whenever possible. ResultsScoring algorithms were devised for odontogenic inflammatory diseases and systemic risks, and standardised procedures were developed for general use. ConclusionsThe designed algorithm of the oral-systemic axis will be helpful for all health care workers in guiding their patient management protocol.

The Enhanced Recovery After Surgery protocol for the perioperative management of pituitary neuroendocrine tumors/pituitary adenomas.

Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care pathway that has radically modified the management of patients in multiple surgical specialties. Until now, no ERAS Society guidelines have been formulated for the management of cranial pathologies. During the process of ERAS certification for their neurosurgical department, the authors formulated an ERAS protocol for the perioperative care of patients with pituitary neuroendocrine tumors (PitNET), along with a compliance checklist to monitor the adherence to it and its feasibility. The authors describe the protocol and checklist and report the results, including a cost-minimization analysis, with the application of the ERAS philosophy. The steps that led to the development of this ERAS protocol, including items concerning the preoperative, intraoperative, and postoperative period, are detailed. The authors report their preliminary results through the comparison of the care practice of a historical cohort with a consecutive surgical cohort of patients with PitNET who underwent operation after the implementation of this ERAS protocol. A compliance checklist with key performance indicators was useful to monitor the adherence to the protocol and the changes in the perioperative management. Following the introduction of this ERAS protocol, the authors significantly shortened the duration of the antibiotic therapy (p < 0.00001) and increased the use of mechanical (p < 0.00001) and pharmacological measures to prevent deep venous thrombosis (p = 0.002). The median length of hospital stay was significantly shorter for the ERAS group (p = 0.00014), and there was no increase in readmission rate or postoperative complications. The documentation and data tracking strongly improved in the ERAS cohort and the authors were more attentive in pain evaluation (p = 0.001), postoperative hormonal supplementation (p = 0.001) and early feeding and mobilization (p = 0.0008 and p < 0.00001, respectively). More patients were discharged on day 3 after surgery in the ERAS group (p < 0.00001). The compliance to the whole process increased from 64.2% to 89.5% (p = 0.016), and the compliance per patient was also found to have significantly increased (p < 0.00001). The introduction of a standardized ERAS protocol for the perioperative management of patients with PitNET allowed the authors to improve the multidisciplinary management of these patients. With the application of simple cost-effective interventions and with the avoidance of unnecessary measures, gains were made in terms of early mobilization and feeding, thereby resulting in a shorter in-hospital stay.

The safety of patient management in family medicine in Slovenia during Covid-19: a cross-sectional study

BackgroundDuring the Covid-19 pandemic, family medicine practices (FMPs) changed to improve safety against new coronavirus infections for both patients and employees. Protocols for treating patients with suspected Sars-Cov-2 infections were established to protect medical staff and other patients from being infected. However, these protocols also led to increased safety risks, such as delays in treating patients with other medical conditions. This exploratory study aimed to investigate safety risks in treating patients in FMPs during the Covid-19 pandemic and to suggest improvements to prevent Covid-19 in FMPs in Slovenia.MethodsA cross-sectional study was rolled out in FMPs in Slovenia as part of the international Pricov-19 study. Data collection on safety management during the Covid-19 pandemic in FMPs in Slovenia took place from November 2020 until January 2021 using a self-administered online survey for FP working in Slovenia. A chi-square test, ANOVA, independent samples t-test or bivariate correlation test was performed to explore associations regarding the safety of patients’ management variables.ResultsFrom the 191 participating family physicians (FPs) (15.2% response rate), 54.8% reported having treated patients with fever (not Covid-19) late due to the new protocols at least once, and 54.8% reported patients with urgent conditions having been seen late at least once due to not coming. In the suburbs and rural environments FPs more often reported that at least once patient with a fever (not Covid-19) was seen late due to the protocol (p = 0.017) and more often reported that at least once patient with an urgent condition was seen late due to not coming to their FP (p = 0.017). The larger the practice, the more they reported that at least once a patient with fever (not Covid-19) was seen late due to the protocol (p = 0.012) and the more they reported at least once a patient with an urgent condition was seen late due to not coming to their FP (p = 0.012).ConclusionCovid-19 affected the safety of patient management in FMP in Slovenia. The most common problem was foregone care. Therefor, protocols for chronic patient management in the event of epidemics need to be established.

Factor First: An Assessment of Emergency Department Care of Patients with Hemophilia

Background: With the establishment of hemophilia treatment centres (HTCs) and home infusion programs for factor replacement therapy, emergency department use among patients with hemophilia occurs less frequently, with patients often presenting for significant bleeding events only. As a result, the management of patients with hemophilia can represent a challenge to emergency department (ED) physicians and staff. Both delays in diagnosis of a bleeding event, and timely administration of hemostatic therapy have been associated with patient morbidity and mortality. The World Federation of Hemophilia, in addition to other organizations, emphasize the importance of timely receipt of clotting factor replacement therapy, providing treatment at the time a bleed is suspected. If a patient with hemophilia is registered with a HTC, they often carry a wallet card, or have a formalized treatment plan, outlining their diagnosis and emergency treatment of bleeding recommendations to ensure timely access to hemostatic therapy. The aim of this study was to describe ED management of patients with hemophilia at a single Canadian HTC, with a focus on use of individualized emergency bleeding management protocols, and time to receipt of hemostatic therapy within the ED. Methods: Adult patients with hemophilia A or B (FVIII or FIX ≤40%), of any severity, followed at the Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, were identified for inclusion. ED health utilization and ED encounter management data for each of the four hospital sites in Calgary, AB was obtained from the electronic health record for the cohort, through to 2022. Results: A total of 191 patients with hemophilia A and B were identified for study inclusion. 153 patients with hemophilia A (mild 64.7%; moderate 5.9%; severe 28.8%) and 38 patients with hemophilia B (mild 44.7%; moderate 36.8%; severe 18.4%). Males comprised 77.5% of the patient cohort. A total of 393 ED visits occurred over the study period. Less than a third of ED visits were associated with receipt of hemostatic therapy (either desmopressin or clotting factor concentrate). The median time from triage to ordering of hemostatic therapy was 2.9 hrs (IQR 2.3-3.2), and median time from triage to administration of hemostatic therapy was 4.2 hrs (IQR 3.1-4.2). For ED visits due to suspected bleeds, the proportion of patients who received either coagulation factor replacement or desmopressin within two hours of ED triage is depicted in Figure 1. Time to receipt of hemostatic therapy did not significantly differ whether desmopressin or clotting factor concentrate was administered. The number of ED visits in which the individualized emergency bleeding management protocol was accessed is depicted in Figure 2. Among those accessed in 2022, the proportion of protocols that were updated within the last 365 days was 86.8%. Less than 20% of ED visits were associated with a hematology consultation. Conclusions: Increasing utilization of individualized emergency bleeding management protocols for patients with hemophilia was observed; however, significant delays in timely receipt of hemostatic therapy remains, with infrequent involvement of hematology in consultation. Time to receipt of potentially life-saving hemostatic therapy for our cohort falls outside of hemophilia care standards. This data provides a better understanding of the experience of patients with hemophilia in the ED and provides an opportunity to define further quality improvement interventions to ensure quality care metrics in this population are met.

Postoperative Scar Management Protocol for Asian Patients.

Postoperative scar formation remains a morbidity for patients even with the advent of minimally invasive techniques. Furthermore, the significant difference between the Asian and Caucasian skin results in poorer postoperative scar outcomes in Asians, supporting the need for an evidence-based scar management protocol. Following a literature review of the PubMed and the Cochrane databases over the past 10 years, we constructed a novel postoperative scar management protocol for the Asian skin, utilized in a Singaporean tertiary healthcare institution. We describe a timeline-based scar protocol from the point of skin closure to a minimum of 1 year of follow-up. We support the use of intraoperative botulinum toxin for selected high-risk individuals upon skin closure with a follow-up regimen in the postoperative setting. For recalcitrant keloids, we have described a multimodal therapy comprising elements of intralesional steroids, botulinum toxin, lasers, surgery, and radiotherapy. A consolidated postoperative scar management protocol provides the necessary guidance for improved scar outcomes in the Asian skin. There is inherent potential in expanding the protocol to include post-traumatic and burn wounds or support other skin types including the Caucasian skin. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Disorder of the Microbiota and Mucosal Immunity of the Genital Tract in Women of Reproductive Age with Different Clinical Courses of Acute Uncomplicated Pyelonephritis

The research deals with the study of immuno-microbiological parallels of the genital tract in women with acute uncomplicated pyelonephritis with concomitant chronic pelvic inflammatory diseases. In addition to etiotropic antibacterial therapy, correction of the mucosal immunity state of the genital tract is crucial for the treatment of the disease and prevention of its recurrence. The purpose of the work was to investigate the contamination and state of local immunity of the genital tract in women with acute uncomplicated pyelonephritis with different clinical courses. Methods. 246 women of reproductive age suffering from acute uncomplicated pyelonephritis were studied, divided into three variants of the disease clinical course: group 1 - mild (n=105), group 2 - moderate (n=90), and group 3 - severe (n=51) courses. The scrapings of the mucous membrane of the cervical canal and washings from the vagina were obtained before the start of antimicrobial therapy. Quantitative determination of pathogens was carried out by sowing the biological material on solid nutrient environment. Identification of detached bacteria was carried out according to Bergeys. Mollicutes (Ureaplasma spp., Mycoplasma hominis) were determined by the cultural-fermentative method using test systems and the polymerase chain reaction. Vaginal washings of 121 sick women were used for immunological studies. The levels of myeloperoxidase, lysozyme, human β-defensin-2, immunoglobulins M, A, G, secretory IgA, lactoferrin, C3-component of complement, secretory component, and tumor necrosis factor-α were determined. The reference group consisted of 23 clinically healthy women. The Statistica 12.0 program package for Windows was used, and a difference of p&lt;0.05 was considered verifi able. Results. In the majority of patients with acute uncomplicated pyelonephritis (85.6% of cases), concomitant chronic pelvic inflammatory diseases (colpitis, salpingitis, underlying medical condition of cervix) were observed. Classical bacteria were more often detected in vaginal washings of patients of all groups, while mollicutes were detected in scrapings of the mucous membrane of the cervical canal, whereas the frequency of their detection increased with increase in the pyelonephritis severity. The analysis of indicators of local immunity determined disorders of mucosal immunity of the genital tract in the form of increased levels of myeloperoxidase, IgA, and IgG relative to reference values. The highest levels of lysozyme and myeloperoxidase were determined in patients with a severe course of acute uncomplicated pyelonephritis (by 5.3 and 3.6 times more, respectively), and the content of immunoglobulins A, M, and G in patients with a mild course of the disease (by 3.2, 3.1, and 4.0 times more, respectively). An increase in the level of tumor necrosis factor-α was detected in all patients, although no significant differences from controls were found in any group, but the highest median value was recorded in patients with severe pyelonephritis. In the group of patients with a severe clinical course, the lowest median was observed for β-defensin-2, which makes it impossible to inhibit the synthesis of TNF-α and, thus, supports the inflammatory process. Conclusions. It has been proven that in women with acute uncomplicated pyelonephritis, the severity of the course probably correlates with infection of the genital tract by mollicutes, mainly in association with classical bacteria and with level of mucosal immunity disorder. The obtained results of microbiological and immunological studies of biological material collected before the start of antibacterial therapy in patients with acute uncomplicated pyelonephritis proved the need for a mandatory examination by a gynecologist to ascertain concomitant chronic pelvic inflammatory diseases and establish infection with mollicutes to provide relevant etiotropic treatment. The above is the basis for adding the data regarding laboratory examination and treatment to the management protocols of patients with acute uncomplicated pyelonephritis.

Successful Extracorporeal Membrane Oxygenation Implementation at a Non-tertiary Medical Center: A Single-Center Experience.

The inexperience and limited resources at non-tertiary medical centers pose unique challenges to the successful development of an extracorporeal membrane oxygenation (ECMO) program. The current literature does not provide a detailed framework that addresses the unique challenges encountered at these facilities. We outline a proactive approach to developing an ECMO program and provide a retrospective analysis of patient demographics, clinical characteristics, ECMO configuration, duration of ECMO support, major adverse events, and survival to hospital discharge. Data are summarized using mean, median, percentages, standard deviation, and interquartile range. Eleven patients were cannulated between December 2021 to March 2023. The age range of the patients who received ECMO varied significantly, with the youngest being 25 years old and the oldest being 69 years old. The mean age was 38 years old, with a standard deviation of 15.9. Hypertension was the most common co-morbid condition occurring in 64% (n=7) of patients. Only one patient had a major adverse event, and survival to hospital discharge was 73% (n=8). Of the patients that survived hospital discharge, seven patients were discharged home and one to a rehabilitation facility. These findings suggest that the safe implementation of an ECMO program at a non-tertiary hospital with inexperienced staff and limited resources is feasible. Adherence to established guidelines is essential for new programs, especially with regard to patient selection. Furthermore, a proactive approach that emphasizes high-yield training techniques, patient management protocols, and strategies that mitigate adverse events may be the key to achieving survival rates that exceed those of larger academic hospitals.

Protocols for Oral Health Management of Paediatric Patients with Inherited Bleeding Disorders: A Narrative Review

Introduction: The provision of dental care for paediatric patients with inherited bleeding disorders (IBD) can present a challenging scenario for dentists. Although patients with a low bleeding risk can safely receive preventive procedures in the community, many dentists lack confidence when treating this cohort. Consequently, most patients with IBD are seen in hospital dental clinics. There is currently no protocol for shared delivery of primary dental care for paediatric patients with IBD in Australia. Aim: To provide a narrative review of the protocols for oral health management of paediatric patients with inherited bleeding disorders. Materials and methods: An electronic search of four databases relating to the oral health management and outcomes of paediatric patients with IBD was conducted. Results: Thirty-eight papers were included in this review. Several patient and clinician factors in accessing and providing dental care for paediatric patients with IBD were identified. IBD specific considerations for the provision of safe dental care were discussed relating to elective and emergency dental management principles. There was a paucity of paediatric specific protocols for dental management of children with IBD, with only one paediatric specific shared care protocol identified in this review. Conclusions: This review has highlighted the need for further exploration into patient and clinician related barriers and enabling factors in accessing and providing primary dental care for paediatric patients with IBD. The development of a shared model of care between community and hospital dental clinics may improve both clinician and patient experiences in providing and accessing safe dental care.

THU088 Perioperative Management Of Patients With Pituitary Tumors Undergoing Surgery: A Retrospective Review

Abstract Disclosure: J.T. Batch: None. H. Belal: None. G.Y. Gandhi: None. Background: Pituitary tumors account for 10% of brain neoplasms with transsphenoidal resection of these tumors responsible for 20% of all intracranial operations performed for primary brain tumors. Hypothesis: We suspected significant heterogeneity and lack of standardized protocols in the perioperative endocrine evaluation and management of patients undergoing resection of sellar masses. Methods: From June 2016 through November 2022, we identified 46 adult patients (23 females, mean age 52 years, age range 25 to 84 years) who underwent pituitary mass resection (44 transsphenoidal and two transcranial approaches) at our institution. We abstracted information about perioperative endocrine evaluation from their medical records. Results: The vast majority (32 patients) had nonfunctioning pituitary macroadenomas. Other indications for surgery included Cushing’s disease (3), prolactinomas (2), acromegaly (3), pituitary metastasis (1), gonadotroph adenomas (2), Rathke cleft cyst (2), and epidermoid cyst (1). Preoperative cortisol level was not measured in 8 patients. The decision to administer intraoperative corticosteroids was not consistently based on preoperative cortisol levels. 24 patients had cortisol levels &amp;lt;11 mcg/dL; 22 received intraoperative corticosteroids at anesthesia induction. 13 patients had cortisol levels ≥11 mcg/dL, and 11 received intraoperative steroids. Two patients had very large pituitary masses (over 4 cm), and one received intraoperative corticosteroids. Of the two patients with Cushing’s disease, one received intraoperative corticosteroids. Cortisol level was checked in 27 patients in the first four weeks after surgery; in the rest, it was measured between 2 months and three years after surgery. All five patients with confirmed adrenal insufficiency with cortisol levels &amp;lt;3 mcg/dL were treated with corticosteroids. 22 patients had cortisol levels in the equivocal zone (3 to 15 mcg/dL), and 16 were treated with corticosteroids. Nine patients ultimately did not have a follow-up in endocrinology. The long-term permanence of the diagnosis of diabetes insipidus could not be established due to a lack of uniform follow-up testing. Conclusions: Patients with pituitary gland tumors represent a heterogeneous yet commonly encountered neurosurgical population. Successful surgical management is critically dependent on the quality of perioperative care. Understanding preoperative evaluation, intraoperative management, potential complications, their management, and strategies for avoidance are fundamental to reduce morbidity and mortality. High-quality evidence guiding perioperative practices in this population is needed. We have used the information gathered in this study to create a multidisciplinary perioperative protocol with expertise from endocrinologists, neurosurgeons, neuro-ophthalmologists, and neuroradiologists. Presentation: Thursday, June 15, 2023

Disseminated adult Wilms tumor in pregnancy: Leveraging multidisciplinary care in a low-resource setting.

Wilms tumor (WT) occurring in adults is rare and even much more rarely found to coexist with pregnancy. Clinical outcome in adults is worse overall compared with pediatric patients with WT and is often misdiagnosed with no standardized protocols for care guided by high-evidence clinical trials. We present a case of a 23-year-old woman diagnosed with WT who was found to be pregnant immediately following nephrectomy. Workup findings showed that she had disseminated disease but was successfully managed in a multidisciplinary team setting with modified intrapartum chemotherapy followed by postpartum chemotherapy. In low-resource settings, management protocols for adult patients with WT can be individualized by multidisciplinary teams to leverage available resources for best outcomes.