Surgical Clinic Research Articles

Clinical, Morphological Justification and First Experience in the Use of Radiofrequency as Well as Microwave Ablation Treatment Methods of Liver Echinococcosis.

The current study considers a new direction of surgical treatment of liver echinococcosis - the use of minimally invasive treatment methods of parasitic cysts. After clinical and morphological substantiation of the very possibility of carrying out such procedures, 9 microwave ablations (MWA) and 3 radiofrequency ablations (RFA) of cysts were performed in patients with liver echinococcosis from 2017 to 2021 in the surgical clinic of Botkin Hospital, Moscow, Russia. A comparative analysis of treatment results of patients with echinococcal liver cysts (12 patients who underwent "percutaneous puncture, aspiration, injection and reaspiration" (PAIR) procedure and 12 patients - MWA and RFA) was carried out. The number of complications according to Clavien-Dindo classification was as follows: 8 after PAIR procedure, 3 after RFA and 3 after MWA. The median hospital length of stay (LOS) after PAIR procedure was 6.46 days versus 4.7 and 4 in the groups of patients who underwent RF and MW ablation, respectively. The frequency of relapses within the first year after PAIR procedure was 25%. The patients who underwent ablation procedures had no relapses of liver echinococcosis during observation. The presented clinical and morphological substantiation and the experience of using various types of ablation techniques on echinococcal cysts, as well as a comparative analysis with a commonly used PAIR treatment method, demonstrated the safety of RFA and MWA for the patient and efficacy in relation to the hydatid process.

Evolution of Inguinal Hernia Publications: A Bibliometric Analysis from 1980 to 2021.

BACKGROUND Despite the increasing number of studies published worldwide focusing on inguinal hernia, a major condition in the surgical field that affects the quality of life of many patients, a bibliometric study on inguinal hernia is yet to be conducted. The present study aimed to analyze the scientific articles published on inguinal hernia using statistical methods. MATERIAL AND METHODS Articles published between 1980 and 2021 on inguinal hernia were downloaded from the Web of Science database and analyzed using statistical methods. RESULTS A total of 11 761 publications were found. The top 5 contributors to the literature were the United States (n=2109, 27%), Germany (563, 6.7%), United Kingdom (595, 5.7%), Turkey (415, 5.3%), and Japan (388, 4.9%). The top 3 most influential journals by average number of citations per article were Annals of Surgery (citations: 67.4), British Journal of Surgery (citations: 49.9), and Surgical Clinics of North America (citations: 43.2). CONCLUSIONS In the current comprehensive bibliometric study on inguinal hernia, which has demonstrated an upward trend in the number of articles published recently, we present a summary of 7810 articles published from 1980 to 2021. According to the results of the analysis conducted to identify trending topics, the keywords studied in recent years are believed to include pediatric, outcomes, minimally invasive surgery, robotic, incisional hernia, umbilical hernia, chronic pain, obesity, bariatric surgery, NSQIP, seroma, surgical site infection, abdominal wall reconstruction, ventral hernia repair, and hiatal hernia repair.

Evaluation of the outcome of “telephone clinic” in the follow-up of surgical patients: innovative use of technology for the convenience and improvement of service for patients

Background: Government-funded health systems are the hallmarks of welfare states. They always suffer from over-burden and are underfunded. This results in painful waiting lists and long clinics. In order to reduce the suffering of patients attending surgical outpatient clinics, the innovative initiative of telephone clinics was taken five years ago. This study was conducted to assess success and find areas or groups requiring attention.

Thyroid follicular carcinomas: current state of the problem and long-term results of treatment

Thyroid follicular tumors remain a difficult category for both cytological and histological diagnosis, due to the lack of reliable cellular signs of malignancy. An important innovation of the 2022 classification is the appearance of a whole group of low‑risk thyroid neoplasms, which took an intermediate place between the groups of benign and malignant neoplasms. Despite the success of cytological diagnosis of thyroid neoplasms, there are unresolved issues related to the diagnosis of follicular neoplasias, which are considered a «gray zone» of cytological diagnosis.
 Objective — to perform a retrospective analysis of the long‑term results of diagnosis and surgical treatment of patients with thyroid follicular carcinoma.
 Materials and methods. The research material was the results of treatment of 113 patients who were operated on in the surgical clinic of the V.Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Sciences of Ukraine due to the thyroid follicular carcinoma. All patients had a pre‑operative cytological conclusion from the Institute's laboratory and were observed by specialists for at least five years (maximal term 35 years).
 Results. Bethesda group IV («follicular neoplasia») was established in 24.8% of cases. A cytological conclusion about a malignant process (Bethesda VI) or a suspicion of it (Bethesda V) was established in 27.4% (15% and 12.4%, respectively). In 41.6% of cases, the Bethesda II group («benign process») was determined, i.e., there were no doubts about the benign nature of the formation at all. According to the final pathological diagnosis, 8 cases were classified as widely invasive follicular carcinoma, 15 were classified as angioinvasive, and 90 were minimally invasive. The combination of signs of thyroid carcinoma with papillary carcinoma was indicated in 5 cases, 4 of them were present in the presence of minimally invasive carcinoma, in one case — widely invasive. In general, the obtained data indicated a favorable prognosis of minimally invasive follicular carcinomas and allowed to confirm the opinion that in general they do not require radioiodine therapy. The performance of definitive thyroidectomy concluded to be debatable.
 Conclusions. The obtained results have shown that thyroid cancer remains difficult to diagnose and predict, but in the most cases, it is effectively cured. In the past decades, the attitude towards all follicular carcinomas was more «aggressive», which needs to be revised in view of new data and corresponds to modern world trends.

The Relationship of Evidence-Based Nursing Attitudes of Nurses Working in Surgical Wards With Patient-Centered Care Competencies

PurposeThe aim of this study was to determine the relationship between the evidence-based nursing attitudes of nurses working in surgical wards and their patient-centered care competencies. DesignThis was a prospective, correlational, and cross-sectional study. MethodsThe sample for this study included 209 surgical nurses working in the surgical clinics of a research hospital. Data were collected between March and July 2020 using the Nurses' Descriptive Characteristics form, Evidence-Based Attitude Toward Nursing Scale (EATNS) and the patient-centered care competency of the nurses, Patient-Centered Care Competency Scale (PCCS). Descriptive statistics and correlation analysis were conducted to analyze the data. FindingsThe mean total EATNS was moderate (53.93 ± 7.18, out of 75), and their approach to patient-centered care behaviors was high (69.46 ± 8.64, out of 85). ConclusionsWe found a medium level of positive correlation and a significant relationship between the attitudes toward evidence-based nursing and patient-centered care competencies of the nurses participating in the study (r = 0.507, P < .05).

Castleman Disease and Literature Review from Mankweng Hospital, Limpopo, South Africa

Castleman disease is a lymphoproliferative disorder and is easily confused with lymphoma or other lymphadenopathy. Castleman’s disease is divided into unicentric Castleman disease, which involved a single enlarged lymph node or region of lymph nodes, and multicentric Castleman disease, which involved multiple lymph node stations. In this paper we highlight the presentation of Castleman’s disease on a female patient to share our experience with literature review. Case Presentation: A 29 years old female patient was referred to our surgical outpatient clinic from the peripheral hospital with right &amp; left painless neck cervical mass slowly growing which started 3 years ago along with a right breast lump and patient was RVD non-reactive. On physical examination she was severely wasted. She had a 4cm by 3cm mass of the right supraclavicular region &amp; another mass of 3cm x 1 cm mass on the left supraclavicular area. Her abdominal examination revealed hepatomegaly which is extended 8 cm below the subcostal margin. Histology report of cervical mass concluded Reactive lymph nodes with features of hyaline vascular Castleman disease and Breast mass revealed fibroadenoma. Immunohistochemistry of cervical node biopsy for HHV8 is negative. Blood result of inflammatory markers: C - reactive protein was 459 mg/L. Conclusions: Owing to the rarity of this condition, Castleman Disease Collaborative Network (CDCN) guideline is important for assessment &amp; treatment plan.

Dermatoplasty for decompensated forms of varicose veins and post-thrombotic syndrome

Objective(s). In order to improve the results of the treatment of the decompensated form of varicose veins and post-thrombotic syndrome, taking into account the angiosomal theory and using VAC and Magott therapy of the recipient woundof the trophic ulcer, evaluate different methods of dermatoplasty depending on the depth and area of the lesion.&#x0D; Methods. In the surgical clinic of the regional hospital named after A. Novak, 174 patients with chronic venous insufficiency (CVI) in the stage of lecompensation were under our observation. According to the etiology of the disease, there were 76 patients with varicose desease (VD) (group I), 98 patients with PTS (group II), while 27 patients with PTS had trophic ulcers on both lower extremities. With a trophic ulcer (TU) diameter of up to 10 cm in the I group of patients, 42.1% had the depth of the lesion of the IIst, and in the patients of the IIa group, the depth of the lesion was the IIIrd. was observed in 51.4% of cases. In the 1st group (76) patients, TU was cleaned with the help of VAC therapy in 32 patients, Magott therapy was used in 18 patients. TcpO2 was measured in the angiosomes of the anterior tibial artery (APA), posterior tibial artery (PTA), and peroneal artery (PA), as the corresponding arteries participate in the perfusion of the corresponding skin-muscle flaps&#x0D; Results. Rejection (lysis) of the graft was observed in 5 (6.6%) patients of the 1st group, and only in patients with dermatoplasty using the vintage method. Graft lysis was observed in 4 (5.6%) patients of the IIa group, in two with the vintage method and in two with split graft transplantation. In the IIb group (both limbs affected), partial lysis of the transplanted perforated split graft was observed in three limbs (6%). No complications were observed when the tissue complex was transplanted freely.&#x0D; Conclusions. Free flaps are units of tissue that can be transplanted from the donor site to the recipient wound while maintaining its blood supply. Pieces can be classified by the type of blood supply, their tissue composition, the method of transplantation, or the orientation of the vessels. The concept of angiosomes and venosomes explains the blood supply to the recipient wound necessary for the viability of the flap. Various monitoring methods are used to monitor patients after surgery, including assessment of physiological parameters and auxiliary methods (dopplerography, transcutaneous and epidermal oximetry). Factors affecting the viability of transplants after surgery include: thorough surgical intervention, adequate immobilization after surgery, prevention of infection, and adequate vascularization of the recipient wound.

Ileal Lipoma Causing Ileo-Ileal Intussusception: A Case Report

Intussusceptions are rare entities among adult and adolescent populations. It is relatively common among children. Due to the lack of specific clinical features in adult and adolescent patients, its diagnosis is often delayed. Adult and adolescent intussusception could be due to many reasons, but malignancy is one of the key causes among them. Thus, unlike in children, adult and adolescent patients need proper evaluation to find the cause of intussusception pre-operatively. Having a pre-operative diagnosis prevents unnecessary bowel resections. It also helps not to miss a malignancy and to carry out the correct surgery. Intestinal lipoma is a rare entity that could cause intussusception among adults and adolescents. But most of the lipoma does not cause any symptoms and may only find during a post-mortem following an unrelated death. Intestinal lipomas are benign lesions that can occur anywhere in the gastrointestinal tract. A quarter of intestinal lipomas occur in the small intestine. Among those lipomas, 90% arise from the submucosa of the intestine. Here we report a 17-year-old boy presented to the surgical clinic with progressively worsening colicky abdominal pain. Further imaging revealed an ileal lipoma causing intussusception. The patient was treated with laparoscopy-assisted ileal segment resection and primary anastomosis. He made an uneventful recovery. Histology confirmed the diagnosis of a lipoma and it was arising from the subserosa of the intestine, making it a rare type of lipoma. Since lipomas are benign lesion patient did not need any follow-up after the surgery. The case presented here is the first documented case in Sri Lanka of ileo-ileal intussusception as a result of a subserosal lipoma.

Hospital-acquired insomnia scale: A validity and reliability study.

Sleep breathing, one of the basic human needs, is a physiological need that affects cardiac functions, body temperature, daily vitality, muscle tone, hormone secretion, blood pressure, and many more. In the international literature, studies reported that patients have had sleep problems in the hospital since the 1990s, but no measurement tool has been developed to determine the causes of hospital-acquired insomnia in individuals. These findings suggest that sleep remains in the background compared to activities such as nutrition and breathing. Although patients generally experience hospital-acquired sleep problems, there is no measurement tool to determine hospital-acquired sleep problems. These features show the originality of the research. To develop a measurement tool to determine the sleep problems experienced by patients in the hospital. A personal information form, hospital-acquired insomnia scale (HAIS), and insomnia severity index (ISI) were used to collect research data. The study population consisted of patients hospitalized in the internal and surgical clinics of a research hospital in Turkey between December 2021 and March 2022. The sample consisted of 64 patients in the pilot application stage and 223 patients in the main application stage. Exploratory factor analysis and confirmatory factor analysis (CFA) analyses were performed using the SPSS 20 package program and the analysis of moment structure (AMOS) package program. Equivalent forms method used. The HAIS consisted of 18 items and 5 subscales. The Cronbach alpha values of the subscales ranged between 0.672 and 0.842 and the Cronbach alpha value of the overall scale was 0.783. The scale explained 58.269% of the total variance. The items that constitute the factors were examined in terms of content integrity and named as physical environmental, psychological, safety, socioeconomic, and nutritional factors. CFA analysis of the 5-factor structure was performed in the AMOS package program. The fit indices of the obtained structure were examined. It was determined that the values obtained from the fit indices were sufficient. A significant correlation was determined between the HAIS and the ISI, which was used for the equivalent form method. The HAIS is a valid and reliable measurement tool for determining patients' level of hospital-acquired insomnia. It is recommended to use this measurement tool to determine the insomnia problems of patients and to adapt it in other countries.

THE RATIO OF THE LENGTH OF THE LABYRINTH SEGMENT TO THE LENGTH AND WIDTH OF THE SKULL IN VARIOUS CRANIOTYPIC FORMS OF THE SKULL

The aim of the study was to study the ratio of the length of the labyrinthine part of the facial canal to the length and width of skulls with different cranial indices, as well as different age groups. Material and methods. The material for the study was 133 tomograms taken from the archives of the radiological department and the department of radiation diagnostics and therapy of the Educational and Surgical Clinic of the Azerbaijan Medical University. The material is divided according to age groups. All skulls are divided into brachiocranes (80.0 and above), dolichocranes (74.9 and below) and mesocranes (75.0-79.9) according to the cranial index. The length of the labyrinth segment of the facial canal was measured in the axial (sagittal) and coronal projections of the tomogram slices. Research results. Comparison of the ratio of the length of the labyrinth segment to the length of the skull between age groups shows that the difference is significant on the right side (PH=0.024) in brachiocranial skulls and on the left side (PH=0.008) in dolichocranial skulls. In mesocranial skulls, this ratio does not have significant differences. The difference in the ratio of the length of the labyrinth segment to the width of the skull is also noted on the right in brachiocranial skulls and on the left in dolichocranial skulls. Statistical analysis of this indicator did not reveal a significant difference in mesocranial skulls. Conclusions. Thus, the difference in the ratio of the length of the labyrinth segment to the length and width of the skull revealed asymmetry, which was on the right side of the skulls of the brachiocranial type and on the left side of the dolichocranial type. In mesocranial-type skulls, statistical differences in these parameters were not found either in age groups or on the right and left sides.

Normal values of respiratory oscillometry in South African children and adolescents.

Noninvasive measurement of respiratory impedance by oscillometry can be used in young children aged from 3 years and those unable to perform forced respiratory manoeuvres. It can discriminate between healthy children and those with respiratory disease. However, its clinical application is limited by the lack of reference data for African paediatric populations. The aim of the present study was to develop reference equations for oscillometry outcomes in South African children and adolescents. Healthy subjects, enrolled in the Drakenstein Child Health Study, HIV-uninfected adolescents in the Cape Town Adolescent Antiretroviral Cohort and healthy children attending surgical outpatient clinics at Red Cross War Memorial Children's Hospital were measured with conventional spectral (6-32 Hz) and intra-breath (10 Hz) oscillometry. Stepwise linear regression was used to assess the relationship between respiratory variables and anthropometric predictors (height, sex, ancestry) to generate reference equations. A total of 692 subjects, 48.4% female, median age of 5.2 years (range: 3-17 years) were included. The median (interquartile range (IQR)) for weight for age z-score and height for age z-score was -0.42 (-1.11-0.35) and -0.65 (-1.43-0.35), respectively. Stepwise regression demonstrated that all the variables were significantly dependent on height only. Comparison to previous reference data indicated slightly higher resistance and lower compliance values in the smallest children. We established the first respiratory oscillometry reference equations for African children and adolescents, which will facilitate use in early identification and management of respiratory disease. Our results suggest differences in oscillometry measures by ancestry but also highlight the lack of standardisation in methodology.

Evaluation of Sharps Injuries of Health Professionals Working in a Tertiary Care Hospital During Five Years

Objective: This study aims to evaluate occupational injuries in healthcare professionals exposed to the blood and body fluids of patients in our hospital for five years. Methods: A retrospective analysis of applications of healthcare professionals to the Infection Control Committee (ICC) between 2013-2017 was conducted based on the “registry and follow-up form for exposure to body fluids.” Results:175 personnel applied to the ICC, and the average age of applicants was 31.5±8. 58.5% of the cases were male, and 41.5% were female. Nurses constituted the majority of applicants at 37.7%, followed by caregivers at 21.7% and interns at 17.1%. Most injuries were inflicted in operating rooms 22.3%, emergency services 18.8%, intensive care units 18.3% and surgical clinics 12.6%. 62.5% of the cases were needlestick injuries, 24.0% were due to sharps, and 13.5% were due to mucosal exposure. The source patient was identified in 144 cases (82%), whereas in 31 cases (%18), the source patient could not be identified. Sixteen of the source patients were HBsAg positive, five were anti-HCV positive, and one was anti-HIV positive. None of the personnel was infected due to the injuries. Conclusion: The number of sharp injuries can be reduced by employing more personnel, reducing work hours, and encouraging the use of personal protective equipment. In addition to providing fundamental medical knowledge, training programs should also encourage a positive attitude toward HIV / AIDS.

Laparoscopic Low Anterior Resection and Total Mesorectal Excision.

Surgical Clinic 2, Hospital Maciel (Montevideo, Uruguay) Funding/Support: None reported. Financial Disclosures: None reported. Informed consent was obtained. Correspondence: Dr. Javier Chinelli, 1472, Mercedes Street, Postal Code 11200, Montevideo, Uruguay. E-mail: [email protected]

Cerrahi Kliniklerde Çalışan Hemşirelerin Sağlık Kalitesi Algıları ile Hasta Güvenliği Kültürleri Arasındaki İlişki

Objective: The study was carried out to determine the effect of health quality perceptions of nurses working in surgical clinics on patient safety culture. Materials and Methods: The research is descriptive type and correlational. The sample of the research consisted of 237 nurses. Personal Information Form created by the researchers, Patient Safety Culture Scale (PSCS), and Quality Perception Scale (QPS) were used as data collection tools in the study. Data were collected between January 2021 and February 2022. Results: The total mean score obtained from PSCS was found to be 3.36±0.21 in the study. In the study, it was found that the total mean score obtained from the QPS was 82.15±6.80. A positive, moderate correlation was found between the total score of PSCS and the total score of QPS (r= 0.407, p&amp;lt;0.01). Conclusions: It was determined that the increase in the quality perceptions of the nurses working in the surgical clinics increased the patient safety culture. It was observed that nurses who care for surgical patients attach importance to patient safety culture, especially in terms of patient benefit. It is recommended to organize in-service training programs to increase both quality perceptions and patient safety culture of healthcare professionals.

Patient focused interventions and communication in the surgical clinic: a systematic review and meta-analysis.

Communication is the foundation of a strong doctor-patient relationship. Holistic care of the patient involves good communication and empathy. There are various tools and interventions aimed at increasing the Surgeon's performance, but these have the drawback of heavy cost and time commitments. In contrast, patient focused interventions are often simple and cheap. In surgery this is an evolving field, and little is known about the impact these interventions have on clinical encounters. The aim of this review is to determine how patient focussed interventions impact communication in the Surgical Outpatient Consultation. In this systematic review and meta-analysis, two reviewers independently searched MEDLINE (incl. PubMed), EMBASE, EMCARE, CINAHL, and the Cochrane Library for the period starting 01 February 1990 to 01 February 2022. Filtration and screening was performed in accordance with PRISMA guidelines. Conflicts were resolved by discussion. Risk of Bias was assessed using the RoB 2 tool. Meta-analyses were conducted by an independent statistician using Stata Statistical Software. This systematic review was prospectively registered with PROSPERO (ID CRD42022311112). After screening, 38 papers were included in the final analysis. These involved 6392 patients consisting of 32 randomised controlled trials (RCT), one crossover RCT, three non-randomised experimental studies, and three cohort studies. All articles were published between 1999 and 2022. Four types of intervention were identified: Patient Decision Aids, Educational Materials, Question Prompt Lists and Patient Reported Outcome Measures. There was much heterogeneity in the reported results but ultimately four recurring domains for assessing quality of communication were identified: Patient knowledge; decisional conflict; satisfaction; and anxiety. Meta-analyses showed that patient focussed interventions increased patient knowledge and reduced decisional conflict. Meta-regression demonstrated significant knowledge increases in females compared with males. Results regarding satisfaction and anxiety were not statistically significant. Our study suggested that patient focused interventions demonstrate promising results for increasing patient engagement and improving communication. Further multicentre randomised controlled trials with consistent validated endpoints should be conducted to evaluate this evolving field. There was no funding source for this study.

Influence of health institution related factors on health seeking behaviors among men suffering from lower urinary tract symptoms attending surgical outpatient clinic at a county referral hospital Meru Kenya

Background: Currently there is an increase in cases of men presenting with lower urinary tract symptoms (LUTS) especially in low resource countries. The purpose of this study was to establish the influence of health institution related factors on health seeking behaviors among men suffering from LUTS attending surgical outpatient clinic at Meru county referral hospital, Kenya. Methods: Descriptive cross-sectional study design was used. Population involved 120 men suffering from LUTS, 2 physicians and 2 nurses. The study tools used were questionnaires, key informant interview guides and focus group discussion guides. The quantitative data was analyzed using chi-square test and binary logistic regression. Hypothesis testing was done at an alpha level of significance of 0.05 such that any p-values below the alpha were deemed significant. Qualitative data was analyzed thematically Results: Health institutional related factors which included adequate personnel 2.57 [95% CI=1.09-6.06, p=0.032], adequate drugs 3.14 [95% CI=1.36-7.23, p=0.007], treated well by the health care workers 2.95 [95% CI=1.18-7.36, p=0.021], short duration time taken to be served in the hospital 2.40 [95% CI=1.12-5.16, p=0.025] and distance to the health facility 2.21 [95% CI=1.01-4.84, p=0.047], significant parameters associated with health seeking behaviors Conclusions: There was significance influence of health institution related factors on health seeking behaviors among men suffering from LUTS.

Unusual Presentation of Anca Vasculitis with Otitis Media and CVA

A 42-year-old African female (Kenyan in origin), known to have hypertension that was diagnosed during gestation and persisted; presented with a history of dysphagia for four years. Before her admission, she had presented to the surgical clinic with ear fullness and ear pain with throbbing headaches, and she was diagnosed with bilateral oto-mastoditis. Her symptoms subsequently, progressed to a multisystemic disease involving the lungs, brain, kidneys, and peripheral nerves. ANCA vasculitis is a rare disease, the main target organs in granulomatous polyangiitis include the ear, nose throat, and upper respiratory tract, and glomerulonephritis of the kidney and the lungs. Localized disease manifestation can include the nose (rhinorrhea, nasal crusts, septal perforation) and ear (otitis media, hearing loss, sensorineural deficits). The diagnosis of vasculitis from localized disease manifestation can be difficult to diagnose.

Spectrum of bacterial microflora of trophic ulcers against the background of varicose and post-thrombotic decompensated venous insufficiency

Annotation. The main cause of long-term wound healing is chronic inflammation, microcirculation disorders, and bacterial contamination of wound surfaces with the formation of biofilms. The frequency of trophic ulcers of the lower extremities, microbial resistance, and a significant recurrence rate (20-70%) is a topical issue today. The purpose of this work is to establish their bacterial component and possible relationships with microcirculation depending on the etiology of decompensated chronic venous insufficiency in order to improve the healing of trophic ulcers. From 2018 to 2022, 174 patients with chronic venous insufficiency (CVI) C6 according to CEAP, aged from 38 to 69 years (on average, 55±5.3 years), were treated in the surgical clinic of the regional hospital. To monitor microflora and susceptibility to prescribed antimicrobials, a bacteriological study was conducted comparing the widely used paper disc method with the quantitative method of measuring the minimum concentration of growth inhibition. The study of the microcirculation of the skin of the lower extremities was carried out taking into account the angiosomal approach on the TCM 400 Radiometer device (Denmark). The study used the ratio of the value obtained in the first metacarpal area of the lower limbs to the same value in the chest. Statistical processing and analysis of the obtained results was performed using the Jamovi program. Analysis of the selected samples showed the diversity of the polymicrobial community, Gram-positive bacteria (Staphylococcus spp., Enterococcus spp.) were detected in the upper layers of the biofilm, Gram-negative and microscopic fungi Malassezia and Candida – in the deep layers. Anaerobic microorganisms (Prevotella spp., Porphorymonas spp.) were also isolated from samples of such wounds in 2%. When studying the microbial landscape of ulcers, it was found that the share of Staphylococcus spp. is: 65%; Enterococcus spp. – 60%; Pseudomonas spp. – 39%; Proteus spp., Enterobacter spp. and Citrobacter spp. – about 25%; Streptococcus spp. – 26%; Escherichia spp. – 15%; Morganella spp. – 9%; Klebsiella spp., Acinetobacter spp. – 4%; Xanthomonas spp., Prevotella spp., Porphorymonas spp. – 2%, respectively. Fungi culture Candida spp. and Malassezia spp were detected in all patients with CVI in the decompensation stage. The change in tcpCO2 indicators (46.4±1.4) is observed more in patients with gram-negative infectious agents and more acidic pH. In the group of patients where Gr+ infectious agents were detected, the average tcpCO2 level was 44.6±1.5.

A comparative study between Wagner’s classification and new wound based diabetic foot ulcer severity score

Background: Diabetes is considered to be one of the most common health problems all over the world in 21st century. In fact, it has been coined the ‘Black death of the 21st century due to its stark similarities with the 14th century plague in terms of rapid increase in its prevalence, morbidity and mortality. According to WHO, the number of diabetic patients in 2000 reached to 171 million and was predicted to increase to 380 million by 2020. The Indian diabetic population is expected to increase to 57 million by the year 2025. Diabetic foot ulcers are one of the most distressing complications of diabetes affecting around 15% of people with diabetes. The annual incidence of diabetic foot ulcers is around 3% and the reported incidence in U.S and U.K studies ranges as high as 10%. It has been reported that 85% of the lower limb amputations in diabetic patients are preceded by foot ulceration. These systems are variously based on the site of ulcer, depth, and presence or absence of neuropathy, infection and peripheral arterial disease and have been used to compare the outcomes. Diabetic ulcer severity score (DUSS) is one of the latest wound-based systems of classification. However, there is paucity of enough data to validate whether DUSS system is better as compared to other established and commonly used scoring system like Wagner’s classification. Hence, it was decided to validate DUSS scoring system with Wagner’s classification by comparing both keeping in view outcome of the disease. Methods: Patients admitted under various surgical units from January 2022-January 2023, at Mamata medical college and hospital, Khammam. Total of 40 diabetic patients with diabetic foot ulcers irrespective of their duration, attending surgical outpatient clinic or admitted into the hospital (Mamata general hospital) were recruited into the study based on the inclusion and exclusion criteria mentioned below. Results: DUSS score and Wagner’s score were found to be almost equal in evaluating the scores for treatment as p value was found to be statistically significant (p=0.001) and by KAPPA stats there was an absolute agreement (score 1) between DUSS and Wagner’s scoring system. Conclusions: The new severity scoring system (DUSS) is equal to gold standard Wagner’s scoring system for predictive analysis which also provides an early idea regarding hospital admission, local surgery and health care costs. Since this scoring system 72 can be easily applied in daily clinical practice, it may be suitable in estimating putative healthcare costs.

Twelve-Month Outcomes in Patients with Obesity Following Bariatric Surgery-A Single Centre Experience.

As obesity rates continue to rise worldwide, many surgeons consider bariatric procedures as a possible cure for the upcoming obesity pandemic. Excess weight represents a risk factor for multiple metabolic disorders, especially for type 2 diabetes mellitus (T2DM). There is a strong correlation between the two pathologies. The aim of this study is to highlight the safety and short-term results of laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB, laparoscopic gastric plication (LGP) and intragastric balloon (IGB) as methods used in the treatment of obesity. We followed the remission or amelioration of comorbidities, tracked metabolic parameters, weight loss curves and hoped to outline the profile of the obese patient in Romania. The target population of this study was represented by patients (n = 488) with severe obesity who qualified for the metabolic surgery criteria. Starting from 2013 to 2019, patients underwent four types of bariatric procedures and were subsequently monitored over the course of 12 months in the 3rd Surgical Clinic at "Sf. Spiridon" Emergency Hospital Iași. Descriptive evaluation indicators, as well as those of analytical evaluation were used as statistical processing methods. A significant decrease in body weight was recorded during monitoring and was more pronounced for patients who underwent LSG and RYGB. T2DM was identified in 24.6% of patients. Partial remission of T2DM was present in 25.3% of cases, and total remission was identified in 61.4% of patients. Mean blood glucose levels, triglycerides, LDL and total cholesterol levels decreased significantly during monitoring. Vitamin D increased significantly regardless of the type of surgery performed, while mean levels of vitamin B12 decreased significantly during monitoring. Post-operative intraperitoneal bleeding occurred in 6 cases (1.22%) and a reintervention for haemostasis was required. All procedures performed were safe and effective methods of weight loss and improved associated comorbidities and metabolic parameters.