Risk Of Developing Complications Research Articles

Impact of first-trimester body mass index on pregnancy outcomes: observational study

The epidemic of obesity is gradually becoming a global health concern across all age groups. In pregnant mothers, overweight or obesity have been known to be associated with significant antenatal, intrapartum, postpartum, and neonatal complications. Therefore, this study aimed to investigate the association between high maternal Body Mass Index (BMI) and adverse pregnancy outcomes. This was a longitudinal observational study done at the Lagos University Teaching Hospital between May 2019 and February 2020. Antenatal women with gestational age <12 weeks with singleton pregnancies were recruited for the study. They were followed up throughout pregnancy and postpartum to assess for complication during pregnancy, labour, and puerperium. A total of 568 pregnant women were involved in the study. Five hundred and fifty six (556) had complete data and were included in the data analysis. Of these, 169 (30.4%) had BMI of 30 and above while 387 (69.6%) had BMI<30. Women with BMI of 30 and above had significant (p<0.05) risk for development of complications in pregnancy. There is an obvious association between increased maternal BMI and adverse pregnancy outcomes. Public health implications of obesity are enormous for both the mother and baby during pregnancy and delivery. Preconception counselling and health education programs may be beneficial in order to maintain normal BMI in women of reproductive age.

Acute mastoiditis in children: A tertiary care center experience in 2015-2021.

Acute mastoiditis is a suppurative infection of mastoid air cells and is the most common intratemporal complication of otitis media. This study aimed to evaluate the demographic and clinical characteristics and treatment outcomes of children with acute mastoiditis (AM). We retrospectively reviewed the medical records of hospitalized pediatric patients aged between 1 month and 18 years with a diagnosis of AM between May 2015 and December 2021. A total of 28 hospitalized children with AM were enrolled in this study, of whom 22 (78.6%) were males and 6 (21.4%) were females with a mean ± standard deviation age of 93.5 ± 53.2 months (range = 6 months-16.1 years). The most common clinical symptoms were postauricular erythema (n = 17, 60.7%), tenderness (n = 16, 57.1%), swelling (n = 14, 50%), fever (n = 14, 50%), and auricular protrusion (n = 7, 25%). Mastoiditis complications occurred in 10 (35.7%) children. The most common extracranial complication was subperiosteal abscess (n = 8, 28.6%). The erythrocyte sedimentation rate (ESR) and the rate of antibiotic use before hospitalization were higher in patients with complicated mastoiditis (P = 0.006 and P = 0.039, respectively). Surgery was performed in 12 (42.9%) patients. Statistically, more surgical interventions were performed in patients who developed complications (P = 0.003). AM continues as an important disease of childhood. Successful results are obtained with systemic antibiotic therapy and additional surgical intervention as necessary. A careful evaluation of patients with a high ESR and those who received antibiotic therapy before hospitalization is appropriate due to the correlation between these factors and the risk of complication development.

English

BACKGROUND Dengue fever (DF) is caused by a flavivirus and is transmitted to humans by the vector Aedes aegypti. Industrialization and unplanned urbanization have led to an increase in incidence of DF. DF can lead to organ-specific complications especially in those with co-morbidities. The present study was done to estimate the prevalence of organ-specific complications in DF and determine the association of comorbidities and development of organ-specific complications. METHODS This is a prospective cross-sectional observational study. 148 participants with DF as confirmed by NS1 antigen or dengue IgM presenting to medicine outpatient department of Government Medical College, Trivandrum were enrolled in the study after obtaining written informed consent and obtaining Institutional Ethics Committee approval. Examination findings, laboratory investigations [complete blood count (CBC), liver & renal function tests (RFT)], chest radiograph, ultrasonography (USG), magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) examination were done as routine procedures wherever necessary, and the details were collected in case record forms. Data was analysed using Rafter assessment of normality and homogeneity and chi square test was used to determine the association between parameters and organ specific complications. P < 0.05 was considered statistically significant. RESULTS Acalculous cholecystitis (29.1), hepatitis (4.7 %), aseptic meningitis (4.1 %), encephalopathy (4.1 %), myocarditis (3.4 %), encephalitis (2.7 %), acute kidney injury (2 %), acute respiratory distress syndrome (2 %), pericardial effusion (1.4 %), pleural effusion (1.4 %) and conduction anomalies of heart (0.7 %) were the organ specific complications associated with DF. Participants with co-morbidities were at a higher risk of developing organ-specific complications when compared to the healthier individuals. CONCLUSIONS Acalculous cholecystitis was the most common complication associated with DF and the presence of co-morbidities was a significant risk for development of complications. Proper planning for vector control measures especially during highrisk seasons would reduce the transmission of the disease and reduce the healthcare burden, mortality and morbidity associated with dengue fever. KEY WORDS Dengue Fever, Organ Specific Complications, Acalculous Cholecystitis, Hepatitis, Meningitis

СТРАТЕГИЯ И ОПЫТ ЛЕЧЕНИЯ ИНФАНТИЛЬНЫХ ГЕМАНГИОМ

Objective. To analyze the treatment results of patients with infantile hemangiomas using various methods. Methods. The study is grounded on the treatment results of children (n=189) with infantile hemangiomas during the period of 2000-2018 years. All patients were divided into the groups: 1) dynamic observation - 23 (12.2%) children; 2) local destruction - 78 (41.3%); 3) surgical treatment - 22 (11.6%); 4) drug therapy - 66 (34.9%) patients. The interstitial coagulation (n=28) and electrocoagulation of hemangioma (n=50) were applied for the local destruction. 18 patients underwent the complete removal of hemangioma and 4 - segmental resection of tumor with the subsequent propranolol treatment. Propranolol was used for the drug treatment and it was combined with the topical application of timolol (n=13). Results. Hemangioma regression was registered in 18 (78.3%) patients of the first group. Among the patients of the second group, involution of hemangioma was observed in 26 (92.6%) patients when the interstitial coagulation was applied and 2 (7.4%) children had hemangioma recurrence. A strongpositiveeffect can be reached by electrocoagulation of superficial hemangiomas (all patients). With primary radical intervention, complete cure was noted in all children, and with segmental resection only one (4.5%) child had a relapse. Keloid scars were formed in 3 (13.6%) children after surgery. Propranolol seemed to be effective in treating hemangiomasinchildrenof all ages, and in 41 (62.1%) patients hemangiomas completely disappeared. Conclusion. Before initiatingtherapy, thechildrenneed to be assessed for the contraindications and the treatment strategy.In case of infantile hemangioma should be individual based on the results of clinical investigation. Systemic propranolol treatment has gained rapid popularity as the treatment of choice for infantile hemangiomas and may be applied not only as the basic treatment, but also in combination with other methods. Surgical removal of hemangioma remains one of the common treatments components for children with infantile hemangiomas. What this paper adds Different variants of infantile hemangioma treatment have been analyzed: ranging from dynamic observation to surgical and systemic treatment. It has been shown, that in case of infantile hemangiomas, Beta-blockers have become the treatment of choice in case of the absence of contraindications; and surgical treatment is indicated in children with the risk of complications development.

Outcomes of critically ill end-stage kidney disease patients who underwent major surgery.

PurposeEnd-stage kidney disease (ESKD) is a major worldwide health problem. Patients with ESKD are thought to have a significant risk for development of complications following an operation. However, the study of ESKD and its outcomes following major operations remains rare, particularly in critical illness. Therefore, this study aimed to demonstrate how the outcomes of ESKD patients were affected when they underwent a major operation and were admitted to the intensive care unit (ICU), compared with non-ESKD patients.MethodsA retrospective matched case cohort study was conducted in 122 critically ill surgical patients who underwent a major operation and were admitted to the ICU, during 2013 and 2016. Sixty-one ESKD patients who required long-term dialysis were enrolled and compared with 61 matched non-ESKD patients. The matching criteria were the same age interval (±5 years), gender, and type of operation. The ICU mortality was compared to the primary outcome of the study.ResultsPatients’ baseline characteristics between ESKD and non-ESKD were similar to a priori matching criteria and other demographics, except for pre-existing diabetes mellitus and hypertension, which were found significantly more in ESKD (p = 0.03 and 0.04, respectively). For operations, ESKD showed a higher grade of the American Society of Anesthesiologist (ASA) physical status (p < 0.001), but there were no differences for emergency surgery (p = 0.71) and duration of operation (p = 0.34). At ICU admission, the severity of illness measured by the Sequential Organ Failure Assessment (SOFA) score was greater in ESKD (8.9 ± 2.6 vs 5.6 ± 2.5; p < 0.001). However, after eliminating renal domain, SOFA non-renal score was equivalent (5.7 ± 2.2 vs 5.2 ± 2.3, p = 0.16). The ICU mortality was significantly higher in critically-ill surgical patients with ESKD than non-ESKD (23% vs 5%, p=0.007), along with hospital mortality rates (34% vs 10%, p = 0.002). The multivariable logistic regression analyses adjusted for age and SOFA non-renal score demonstrated that ESKD had a significant association with ICU and hospital mortality (adjOR = 5.59; 95%CI [1.49–20.88], p = 0.01 and adjOR = 4.55; 95%CI[1.67–12.44], p = 0.003, respectively).ConclusionPatients who underwent a major operation and needed intensive care admission with pre-existing ESKD requiring long-term dialysis were associated with greater mortality than patients without ESKD. More careful assessment before, during, and after major surgical procedures should be performed in this group of patients to improve post-operative outcomes.

A retrospective assessment of the complications and associated risk factors of laparoscopic cholecystectomy

Aim: The aim of the present study to assess the risk factors and complications of Laparoscopic Cholecystectomy. Material and Methods: This was a retrospectively analysed study conducted in the Department of General Surgery, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh, India, from December 2018 to November 2019. 100 patients who were diagnosed with cholelithiasis and had laparoscopic cholecystectomy were included in this study. We analysed the type and frequency of intraoperative and postoperative complications, as well as factors that increase the risk for development of complications. We noted causes and incidence of conversions and the way they resolved. We noted gender, age, body mass index (BMI), white blood cell count, and level of C-reactive protein (CRP), preoperative ultrasonographic findings, Patho histological findings of the surgically removed gallbladder, as well as their correlation with the occurrence of complications. Results: Out of the 100 patients in the study, 68 were female (68%), and 32 were male (32%). The most common complications noted were: iatrogenic perforations of the gallbladder- 5 (5%), bleeding from the tissues adjacent to the gallbladder 3 (3%), gallstones spilt into the peritoneal cavity 2 (2%). Intraoperative bleeding from the cystic artery occurred in 1 (1%), bleeding from the port in 1 (1%) and bleeding from the ligaments of the liver in 1 patients (1%). The transection of the common bile duct, a major complication, occurred in only one patient (1%). The most common postoperative complications were: bleeding from the abdominal cavity more than 100 ml/24h (in 3 patients or 3%), bile leaks through the drain > 50-100 ml/24h (2 patients, or 2%). In addition, the ultrasonographic findings of empyema, gangrene of the gallbladder wall, and increased gallbladder wall thickness > 3 mm (group II) is a significant predictor of complications and conversion (OR = 4.92, 95% CI 1.61-18.13, p< 0.001). Patho histologic analysis of the surgically extracted gallbladder with the diagnosis of acute cholecystitis was also the significant predictor for complications and conversion (OR 1.82, 95% CI 2.52-16.66, P< 0.001). Conclusion: the laparoscopic cholecystectomy as a new technique for treatment of cholelithiasis, introduced a new spectrum of complications. Major biliary and vascular complications are life threatening, while minor complications cause patient discomfort and prolongation of the hospital stay.

Прогнозирование риска развития осложнений при хирургической коррекции септического эндокардита

Цель. Определить факторы риска развития острой почечной недостаточности у пациентов с септическим эндокардитом. Материал и методы. Проведено одноцентровое проспективное нерандомизированное и ретроспективное исследование, включающее 107 пациентов с септическим эндокардитом. Из них 60 мужчин (56%) и 47 женщин (44%) в возрасте в среднем 42,4±11,3 года (M±ϭ). Пациенты были распределены на две группы: I группа (n=23) – во время искусственного кровообращения (ИК) выполнялась ультрафильтрация крови (УФ) и II группа (n=84) – без применения УФ крови. Всего в анализ были включены 125 возможных факторов риска (возраст, пол, площадь поверхности тела и клинико-биохимические показатели) для прогноза острого почечного повреждения (ОПП). Факторы, демонстрировавшие статистически значимую связь с ОПП, включались в анализ для построения уравнения множественной линейной регрессии. Построение математической модели производилось по методу наименьших квадратов, с вычислением парных коэффициентов корреляции Пирсона. Результаты. В группах не было достоверного различия по длительности ИК и по продолжительности ишемии миокарда (p=0,326, p=0,464). В I группе выявлена линейная связь параметров острого почечного повреждения (ОПП) с количеством лейкоцитов по Нечипоренко (r=0,95), количеством криопреципита (r=0,69), свежезамороженной плазмы (r=0,58), объемом ультрафильтрата (r=0,68), с протеинурией (r=0,66) и с креатинином крови (r=0,67). В II группе выявлена средняя линейная связь ОПП с конечным диастолическим объемом левого желудочка (r=0,69), со скоростью клубочковой фильтрации (r=-0,51), с креатинином крови (r=0,52), с температурой ИК (r=0,42) и длительностью ИК (r=0,59). У одного пациента контрольной группы после операции развилась острая почечная недостаточность. Заключение. Гипертермия во время ИК и увеличение времени ИК повышают риск развития острой почечной недостаточности у пациентов с септическим эндокардитом. Научная новизна статьи Установлено, что гипертермия и увеличение времени искусственного кровообращения повышают риск усугубления дисфункции почек у пациентов с септическим эндокардитом. Выявлено, что с каждой единицей повышения температуры во время искусственного кровообращения риск развития повреждения почек увеличивается на 0,27 (95% ДИ:0,154-0,378; t=4,86; p&lt;0,0001). Увеличение времени искусственного кровообращения на каждую минуту увеличивает риск повреждения почек на 0,008 при 95% ДИ (0,004-0,012), t=3,91; p=0,0005.

Modern Technologies of Medical Rehabilitation of Upper Limb Injury in Children

The relevance of the problem of children with upper limb trauma medical rehabilitation is determined by the high frequency elbow joint fractures; the risk of complications development, disabilityc of the patient. A comprehensive medical rehabilitation program assumes a personalized approach and a differentiated prescription of physical factors, depending on the time period of rehabilitation. Early physical rehabilitation is a key link in the complete recovery of the function of a patient’s limb with damage to the elbow joint. The purpose of this work is to analyze literature and summarize the results of our own research to determine the optimal approaches and methods for medical rehabilitation of children with upper limb injury. The medical rehabilitation program includes various methods of kinesiotherapy, robotic mechanotherapy, massage, a wide range of apparatus physiotherapy to improve the trophism of the periarticular tissues, to maintain mobility in joints free from immobilization; gain of the full range of motion in the damaged joint; normalizing tone and strengthening the muscles of the upper limb. Medical rehabilitation of children with elbow joint injury is carried out from the earliest stage, in stationary conditions, during the period of immobilization. The rehabilitation measures continue in outpatient and polyclinic conditions, during the entire period of immobilization (2–4 weeks) and then in the post-immobilization period until the limb function is fully restored. It is necessary to monitor the main indicators of the function of the upper limb during the entire period of rehabilitation to assess the effectiveness of rehabilitation measures, objectify the course of the rehabilitation process and the continuity of rehabilitation programs. Definition of the tasks of medical rehabilitation, differentiated for each stage; the choice of modern, pathogenetically grounded rehabilitation technologies with an assessment of their effectiveness contribute to a significant increase in the effectiveness of comprehensive rehabilitation programs for children with upper limb trauma.

P1326NATIVE AVF ANEURYSMS RECONSTRUCTION: THE MULTI-CENTER EXPERIENCE

Abstract Background and Aims to analyze the results of surgical correction of native arteriovenous fistula (AVF) aneurysms in hemodialysis patients. Method A retrospective observational study included 158 patients who underwent various surgical interventions. 87 patients (55.1%) underwent pre-emptive surgeries. 71 patients (44.9%) underwent surgeries after AVF thrombosis («on demand» surgery). In the presence of high-flow AVF or in a case of high risk of fistula vein rupture, aneurysmorrhaphy was performed, which was supplemented by transposition of the reconstructed vein – fig. 1. In a case of paraanastomotic stenosis of the vein, aneurysmorrhaphy was enhanced by arteriovenous anastomosis proximalization. In a case of local proximal or distal stenosis of the functional segment of the vein, aneurysmorrhaphy was supplemented with stenosis plastic using the wall of the resected aneurysm. In a case of prolonged proximal stenosis or totally thrombosed proximal aneurysm, the fistula blood flow was switched to v. basilica with its transposition. In the case of a totally thrombosed distal aneurysm, it was excised and proximal AVF was created. Results In the case of pre-emptive surgeries, secondary patency was 69% [95% CI 44.9; 84.2] after 4.8 years (maximum follow-up). In the case of on-demand surgeries the secondary patency was 45.6% [95% CI 23.6; 65.2] after 4.3 years (maximum follow-up) – fig. 2. HR (log rank test) pre-emptive vs. on demand surgeries 0.296 [95% CI 0.147; 0.592], inverse HR = 3.381 [95% CI 1.674; 6.827], p = 0.0002. The risk AVF function loss was lower in patients who received pre-emptive surgeries compared with patients who received on-demand surgery: 2.642 [95% CI 1.406; 4.519] versus 6.268 [95% CI 3.927; 9.49] per 100 patient-years, incidence rate ratio (IRR) = 0.422 [95% CI 0.207; 0.834] (inverse estimate IRR=2.372 [95% CI 1.2; 4.842]), p = 0.0127. The need for CVC was also lower in patients who received pre-emptive surgeries: 1.728 [95% CI 1.38; 2.136] versus 2.821 [95% CI 2.292; 3.434] per 10 patient-years, IRR=0.6125 [95% CI 0.4576; 0.8185] (inverse estimate IRR= 1.633 [95% CI 1.222; 2.185]), p = 0.0009. Moreover, the number of operations was significantly higher in patients who underwent pre-emptive surgeries: 4.207 [95% CI 3.654; 4.821] versus 2.963 [95% CI 2.421; 3.59] per 10 patient-years, IRR=1.42 [95% CI 1.124; 1.802] (inverse estimate IRR= 0.704 [95% CI 0.555; 0.89]), p=0.0031. In almost all cases, fistula vein aneurism has been associated with various hemodynamic disorders. The median volume blood flow Qa was 2.9 [interquartile range - IQR 1.9; 3.8] l/min., (minimum. 1 l/min., max. 4.5 l/min.). Reconstruction in most cases led to significant change in Qa (p&amp;lt;0.0001). After reconstruction, the Qa median was 1.8 [IQR 1.6; 2.1] l/min. (minimum 1.4 l/min., max. 2.1 l/min). It is noteworthy that in patients with low Qa values, Qa increased slightly, and at high values, it decreased significantly. However, additional methods of blood flow reducing were not used. The median of the Qa difference was -1.2 [IQR -1.9; -0.2] l/min. (minimum -2.7 l/min, max. 1 l/min.). Conclusion The indication for surgical treatment is not just aneurism, but its complications, the high risk of complications development or a combined pathology. Preventive surgical interventions can significantly extend the AVF patency and reduce the need for central venous catheters, however, this is achieved by significantly increasing the number of surgeries. The concept of routine monitoring of a normally functioning AVF by a surgeon should replace the concept of on-demand surgery in case of AVF thrombosis or development of other serious complications.

Celiac disease suspected due to chronic iron deficiency anemia: Two case reports from the same family

Celiac disease is an autoimmune disease caused by gluten in genetically predisposed individuals. In addition to classical symptoms, it may occur at any age with atypical findings affecting many systems. The most common extraintestinal finding is iron deficiency anemia. The prevalence of the disease of first-degree relatives of celiac patients was higher than the general population. Anti-gliadin, anti-endomysium and anti-tissue transglutaminase antibodies are first used in the diagnosis. The gold standard is the small intestine biopsy. The risk of complication development is reduced with early diagnosis, diet and replacement therapy. The clinic can be very variable. Therefore, it is very important to suspect the diagnosis of family physicians working in primary care. In this paper, were reported two cases from the same family who were application to family medicine outpatient clinic with diarrhea and abdominal pain in addition to chronic iron deficiency anemia, were diagnosed in adult.

Outcome, Complications, and Body Mass Index Correlation of Horizontal and Combined Horizontal and Vertical Thigh Lift: A 16-year Single-center Experience.

Background:Thigh lift is a procedure used within the aesthetic as well as the post-bariatric field of surgery as it focuses on reducing excess lipodermal tissue within the medial thigh area. Depending on the specific area of excess tissue, common thigh lifting procedures include horizontal (H) and combined horizontal and vertical (HV) tissue reduction.Aims and Objectives:The aim of this study was the analysis of outcome of H and HV thigh lift procedures, including evaluation of comorbidities and complications.Subjects and Methods:Over a 16-year period, all thigh lift procedures performed at our department were assessed for comorbidities and outcome through our hospital documentation system.Results:A total of 151 thigh lifts have been performed over 16 years. Of which, 124 were performed using the HV technique and 27 thigh lifts were performed using H tissue excision only. Of all the patients, 9 of 10 were female, the overall average age was 43 years. Approximately 48% of the HV group of patients had previously undergone bariatric surgery, the mean body mass index (BMI) was 29.3 kg/m2 for this group. Around 19% of the H patient population had previously undergone bariatric surgery. This group had a mean BMI of 25.1kg/m2. Wound-associated problems occurred in 48%, for these patients, surgical revision was necessary for 12%. Remaining excess tissue was an issue for 20% of all patients, for this reason, 14% needed revision surgery. Age was found to be a significant cofactor for wound-associated complications (P = 0.02) and nicotine abuse for scar-related problems (P = 0.032).Conclusion:The rate of overall complication for thigh lifts is high, although surgical revision rate is low. Remaining excess tissue and wound-associated problems are most common, possibly reflecting a too restrictive and radical surgical approach, respectively. Increasing BMI increases the risk for development of complications.

The role of ascending aortic size in outcomes of patients with uncomplicated acute type B aortic dissection

ObjectiveRecent studies demonstrate that uncomplicated acute type B aortic dissection (uATBAD) patients with enlarged descending thoracic aortic diameters are at high risk for development of complications. This study aimed to determine the association of maximum ascending aortic diameter and area and outcomes in patients with uATBAD. MethodsAll patients admitted with uATBAD from June 2000 to January 2015 were reviewed, and those with available imaging were included. All measurements were obtained by a specialized cardiovascular radiologist, including the maximum ascending aortic diameter and area. Outcomes, including the need for intervention and mortality, were tracked over time. Data were analyzed by stratified Kaplan-Meier and multiple Cox regression analyses using SAS 9.4 software (SAS Institute, Cary, NC). ResultsDuring the study period, 298 patients with uATBAD were admitted, with 238 having available computed tomography and 131 having computed tomography angiography imaging and adequate follow-up available for analysis. The cohort had an average age of 60.96 ± 13.4 years (60% male, 53% white). Ascending aortic area >12.1 cm2 and ascending aortic diameter >40.8 mm were associated with subsequent arch and proximal progression necessitating open ascending aortic repair (P < .027 and P < .033, respectively). Ascending diameter >40.8 mm predicted lower intervention-free survival (P = .01). However, it failed to predict overall survival (P = .12). Ascending aortic area >12.1 cm2 predicted lower intervention-free survival (P = .005). However, this was not predictive of mortality (P = .08). Maximum aortic diameter along the length of the aorta >44 mm persisted as a risk factor for mortality (P < .001). Neither maximum ascending aortic diameter >40.8 mm (hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.42-2.83; P = .85) nor area >12.1 cm2 (HR, 0.992; 95% CI, 0.38-2.61; P = .99) significantly predicted mortality when controlling for maximum aortic diameter along the length of the aorta >44 mm (HR, 7.34; 95% CI, 2.3-23.41; P < .001), diabetes mellitus (HR, 6.4; 95% CI, 2.17-18.93; P < .001), age (HR, 1.06/y; 95% CI, 1.03-1.10; P < .001), history of stroke (HR, 5.03; 95% CI, 1.52-16.63; P = .008), and syncope on admission (HR, 21.11; 95% CI, 2.3-193.84; P = .007). Ascending aortic diameter >40.8 mm (HR, 2.01; 95% CI, 1.03-3.95; P = .04) and maximum ascending aortic area >12.1 cm2 (HR, 1.988; 95% CI, 1.02-3.87; P = .04) on admission persisted as predictors of decreased intervention-free survival after controlling for maximum aortic diameter along the length of the aorta >44 mm (HR, 3.142; 95% CI, 1.47-6.83; P < .004), syncope on admission (HR, 26.3; 95% CI, 2.81-246; P < .004), and pleural effusion on admission (HR, 3.02; 95% CI, 1.58-5.77; P < .001). ConclusionsuATBAD patients with ascending aortic area >12.1 cm2 or maximum ascending aortic diameter >40.8 mm are at high risk for development of subsequent arch and proximal progression and may require closer follow-up or earlier intervention. Ascending aortic size (diameter and area) is predictive of decreased intervention-free survival in patients with uATBAD.

The relationship of sarcopenia in patients undergoing pancreaticoduodenectomy with outcome

Objective To explore the prognostic value of sarcopenia in patients undergoing pancreaticoduodenectomy. Method Clinicopathologic data and follow-up information of 116 patients undergoing pancreaticoduodenectomy at Renmin Hospital of Wuhan University between March 2011 and August 2016 were collected for statistical analysis. Results Among the 116 patients, the prevalence of sarcopenia was 42.2% (n=49). When compared to the rest of the patients who did not have sarcopenia, the sarcopenia group had longer recovery time [(17.33±6.54)d vs. (13.46±9.32)d, P=0.013] and increased risk of complications (complications in general, 59.2% vs. 38.8%, χ2=4.714, P=0.030; Clavien-Dindo≥3: 26.5% vs. 10.4%, χ2=5.130, P=0.024). Both the Kaplan-Meier survival analysis (P<0.05) and the Cox proportional hazard model (overall survival: hazard ratio=2.285, 95% CI=1.521-3.431; recurrence-free survival, hazard ratio=2.167, 95% CI=1.445-3.248) indicated sarcopenia as the risk factor for poorer overall survival and recurrence-free survival. Conclusions Sarcopenia was an independent predictor of poor prognosis for patients undergoing pancreaticoduodenectomy. Patients with sarcopenia had higher risk of developing complications after surgery and lower overall survival rate and recurrence-free survival rate. Key words: Sarcopenia; Pancreaticoduodenectomy; Complications; Overall survival; Recurrence-free survival

TRAVEL TO COUNTRY IATROGENIC. YATROGENIYA DIAGNOSTIC PROCEDURES (Message 3)

A special group of iatrogenic complications are associated with various diagnostic manipulations — from a physical examination of the patient to angiographic studies, diagnostic laparoscopy or thoracoscopy. The article presents data on the frequency and nature of diagnostic iatrogenic in clinical practice. The range of diagnostic iatrogenesis in terms of its manifestations, severity and prognosis is wide enough — from skin irritation with gel during ultrasound to dissection of the coronary artery during coronary angiography. The article presents examples of iatrogenic diagnostic procedures, starting with the clinical examination process (collection of complaints and anamnesis, physical examination), and ending with complex invasive examinations. Yatrogenia, which occur with the use of preparations containing contrast (in particular iodine-containing drugs), which are widely used in clinical practice (CT with contrasting, angiography, etc.) with a diagnostic purpose, are considered in detail. The article describes the risk factors, knowledge of which and awareness of their presence in the patient are mandatory before the introduction of drugs containing contrast. The review of complications arising during endoscopic examinations was carried out. The author reminds that iatrogenic events in endoscopic procedures can be manifested not only by complications from the organ under examination (esophagus, stomach, intestines), but also depend on the patient’s condition, his preparation for the procedure, and the specialist’s possession of endoscopic technique. In conclusion, the author gives a clinical observation in which the risk factor of the iatrogenic event was the presence of an anomaly in the liver and pancreas duct systems in the patient. The author of the article encourages colleagues to pay more attention to the process of making a decision to conduct a diagnostic study, always to evaluate the benefit / risk ratio in terms of the real usefulness of the diagnostic study for the patient and the risk of complication development.

Endotracheal Intubation of Rabbits Using a Polypropylene Guide Catheter

Endotracheal intubation in rabbits can be challenging due to their unusual anatomy. Achieving a patent airway during anesthesia is critical for the avoidance of airway obstruction, prevention of gastric tympany, and to allow ventilatory support. Due to the difficulty of intubation, alternative methods such as the use of laryngeal mask airways or laryngeal tubes have been explored. However, these methods do not result in direct access to the trachea and thus may present a risk for development of complications. In addition, lack of direct intubation of the trachea can result in personnel exposure to waste anesthetic gases. Numerous methods for endotracheal intubation have been described, including blind placement, use of a fiberoptic laryngoscope or endoscope, and cricoid placement. Despite these numerous publications, many still struggle to achieve success. Here we provide a detailed description of an intubation technique that can be taught with minimal training with a short time to proficiency. Briefly, after administration of injectable anesthesia and proper positioning of the rabbit, a polypropylene catheter is placed into the trachea by direct visualization using a laryngoscope. The catheter is then used as a guide to direct the endotracheal tube into the trachea. This method allows for intubation without the need for expensive equipment and can be performed by a single individual without the need for an assistant. In conclusion, this technique can be easily taught and performed at very little cost in any clinical or research setting.

Endotracheal Intubation of Rabbits Using a Polypropylene Guide Catheter.

Endotracheal intubation in rabbits can be challenging due to their unusual anatomy. Achieving a patent airway during anesthesia is critical for the avoidance of airway obstruction, prevention of gastric tympany, and to allow ventilatory support. Due to the difficulty of intubation, alternative methods such as the use of laryngeal mask airways or laryngeal tubes have been explored. However, these methods do not result in direct access to the trachea and thus may present a risk for development of complications. In addition, lack of direct intubation of the trachea can result in personnel exposure to waste anesthetic gases. Numerous methods for endotracheal intubation have been described, including blind placement, use of a fiberoptic laryngoscope or endoscope, and cricoid placement. Despite these numerous publications, many still struggle to achieve success. Here we provide a detailed description of an intubation technique that can be taught with minimal training with a short time to proficiency. Briefly, after administration of injectable anesthesia and proper positioning of the rabbit, a polypropylene catheter is placed into the trachea by direct visualization using a laryngoscope. The catheter is then used as a guide to direct the endotracheal tube into the trachea. This method allows for intubation without the need for expensive equipment and can be performed by a single individual without the need for an assistant. In conclusion, this technique can be easily taught and performed at very little cost in any clinical or research setting.

Low risk of complications in patients with first-time acute uncomplicated diverticulitis

PurposeFirst-time acute uncomplicated diverticulitis (AUD) has been considered to have an increased risk of complication, but the level of evidence is low. The aim of the present study was to evaluate the risk of complications in patients with first-time AUD and in patients with a history of diverticulitis.MethodsThis paper is a population-based retrospective study at Västmanland’s Hospital, Västerås, Sweden, where all patients were identified with a diagnosis of colonic diverticular disease ICD-10 K57.0–9 from January 2010 to December 2014. The records of all patients were surveyed and patients with a computed tomography (CT)-verified AUD were included. Complications defined as CT-verified abscess, perforation, colonic obstruction, fistula, or sepsis within 1 month from the diagnosis of AUD were registered.ResultsOf 809 patients with AUD, 642 (79%) had first-time AUD and 167 (21%) had a previous history of AUD with no differences in demographic or clinical characteristics. In total, 16 (2%) patients developed a complication within 1 month irrespective of whether they had a previous history of diverticulitis (P = 0.345). In the binary logistic regression analysis, first-time diverticulitis was not associated with increased risk of complications (OR 1.58; CI 0.52–4.81). The rate of antibiotic therapy was about 7–10% during the time period and outpatient management increased from 7% in 2010 to 61% in 2014.ConclusionsThe risk for development of complications is low in AUD with no difference between patients with first-time or recurrent diverticulitis. This result strengthens existing evidence on the benign disease course of AUD.

Сombined antihypertensive therapy in patients with diabetes mellitus and arterial hypertension

The article presents the data about incidence rate of arterial hypertension in patients with diabetes mellitus (DM) and risk for development of complications. DM is associated with an increased risk of hypertension. Arterial hypertension as comorbidity is present in 20–25% of patients suffering from DM. Simultaneous presence of these two diseases results in a significant increase of cardiovascular risk. Based on the modern recommendations there were discussed issues of target level for arterial blood pressure (BP) in patients with DM including diabetic kidney disease, the onset of medicated antihypertensive therapy and selection of antihypertensive drugs. Antihypertensive drugs can decrease cardiovascular morbidity and mortality. The majority of hypertensive patients need more than one antihypertensive agent to attain BP targets. Monotherapy can effectively reduce BP only in 20–40% of patients. Combined drug therapy is usually required to achieve the BP target value of &lt;130/80 mmHg defined for patients with diabetes. Сombined treatment for hypertension most often include a renin-angiotensin-aldosterone system (RAAS) inhibitor such as angiotensin converting enzyme-inhibitors or angiotensin receptor blockers. These can be/must be combined with low dose, primarily thiazide-like diuretics, calcium channel blockers with neutral metabolic effect, and further options include the addition of beta blockers or alpha-1-adrenoreceptor blockers.

PHENOMENON OF MUTUAL AGGRAVATION OF INJURIES IN POLYTRAUMA

The results of modern experimental and clinical studies, regarding mutual influence of injuries on each other in case polytrauma, are presented in the review. Multiple severe injuries cause the phenomenon of their mutual aggravation, that is, the correlation of pathophysiological processes with worsening of patient’s status of health, growth of risk for development of complications and lethal outcome. Craniocerebral trauma, severe thoracic and abdominal injuries, long and pelvic bone fractures are the most significant in formation of this phenomenon. Mechanisms for realization of mutual aggravation of injuries include shock and hemorrhage, coagulopathy, systemic inflammatory reaction and posttraumatic complications. Mutual influence of injuries is to be taken into account for prediction and prevention of complications, development of pathogenetic methods of therapy and optimization of surgical tactics in treatment of polytrauma.

Study of Serum Ferritin and its relation with Glycemic control in Type 2 Diabetes Mellitus

Introduction: Type 2 diabetes mellitus is a common metabolic disorder. It has been hypothesized that, oxidative stress plays a major role in the etiology of the diabetic process, as well as in pathogenesis of various diabetic complications. Appreciating the role of catalytic Iron released by high serum Ferritin levels, in causation of oxidative stress and insulin resistance, we carried out this study to understand the relationship between the serum Ferritin and type 2 diabetes mellitus and we also studied glycated haemoglobin to know the correlation between glycemic control and serum Ferritin.Objectives: To compare the levels of serum Ferritin in patients with type 2 diabetes mellitus and non-diabetic healthy individuals. To know if any correlation exists between serum Ferritin and Glycated Hemoglobin in type 2 diabetes mellitus.Methods: The study was conducted at Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka from January 2012 to December 2012. The subjects of our study were fifty clinically diagnosed cases of type 2 diabetes mellitus and fifty non-diabetic healthy volunteers in the age group of 30 70 years who have satisfied the inclusion and exclusion criteria. Serum Ferritin levels and Glycated Hemoglobin were estimated by microplate immunoenzymo metric assay and ion exchange resin method respectively.Results: Serum Ferritin levels were significantly high in all cases compared to controls. There was moderate co-relation between serum Ferritin and Glycated Haemoblobin.Conclusion: The findings of the study project that, estimation of serum Ferritin may be useful in screening diabetics with poor glycemic control who are at high risk of developing complications. Thus serum Ferritin estimations in type 2 diabetes mellitus can be one of the adjuvant aids in investigations which guides in taking timely medical intervention and preventing further progression of disease.