Articles

Objectives: Our main objectives are to reveal the pregnancy and neonatal impacts of COVID-19 infection and to compare it to the results that are reported in the literature. Methods and materials: The characteristics of the admitted pregnant patients COVID-19 positive with their initial presentation, course at the hospital, and short term follow-up are exposed. Correlation of the age and gestational age with the severity of the disease was calculated. Results: Thirty five COVID-19 positive pregnant patients presented between the beginning of March and the end of April 2020. From 5 weeks till 41 weeks of gestation, all trimesters were included. The mean of age is 32 and the BMI equal 28.2. Associated comorbidities included not only diabetes and hypertension but also PCOS. The symptomatology was considered mild in most of the cases. The distribution of the symptoms included cough in 86%. 10 out of 35 delivered and cesarean was performed in 50% of the cases. The mean length of stay is 6 days. Neither maternal nor neonatal deaths occurred. There is a significant correlation between the age of the patient and the severity of the disease but this is not the case with gestational age. Conclusion: Our results were comparable to the literature in terms of initial presentation, associated comorbidities and the length of stay. Despite the fact that the cesarean rate was high, it was far below that of the literature. More data is still needed about COVID-19 in pregnancy.

In various patients conditions involved in lower urinary tract disease LUT (like overactive bladder, bladder neck sclerosis, dis –synergy (with our synenrgic contraction between bladder detrusor and bladder neck, BPH, recurrent cysytitis, interstitial cystitis, chronic prostatitis, uretral stenosys, loss of sfinteric coordination. Prostatic cancer, anatomic abnormalities and other the receptor status play relevant role to reduce effect of vicious clycle that can be responsible in progression of the pathologic process. In this work the complex receptorial status is analyzed to verify new therapeutic strategies. Starting from the observation that various irritant substanties produce irritant stimulus in Prostatic Patients or in bladder neck condition is interesting to deep understand the etio-patogenesys and Functional results. In Various prostatic, bladder neck or ureteral condition a reduced urinary fluss can produce infectious. Conditions like acute or chronic prostatitis. Irritants sustanties in diet (in example etilic alcohol drink, hot spices, crud meats, carbonate drinks, caffeine and other) can produce Painful stimulus in innervations of vecical trigonous, bladder neck and prostatic urethra. The same recurrent cystitis and Bph contribute in a complex situation. This stimulus produce ipertonus of bladder muscle involved in the expulsion of urine. The event related inflamation and edema (bladder, prostatic uretra, trigonus) contribute to the global effect. So conditions like bladder neck sclerosys IPB, recurrent prostatitis and cistitys in acts in a vicious circle. (Also immunomediated: Bph and cronic prostatitis with linfocite infiltration and tissue remodeling). The ormonal status check the systems (see 5-ARI efficacy in Bph). Simpatic, parasimpatic and other system are deeply involved. Also behavioral habits or diet can influence in example urinary flux in a complex system like LUT. (Bladder and prostatic irritants that can produce edema and acute inflamation). Other behavior habits are deeply involved as too much sedentary, water intake, coffee, pee modality and also psychological profile and stressing conditions. Some disease like diabetes produce high consequences in all this systems due to Bladder modification, oxidative stress, osmotic movens, and increase susceptibility of urinary infections. This article are verified this kind of movens that contribute in physio -pathology of some low urinary tract conditions. The anatomic abnormalities produces, obviously, physiological disfuntions. Recurrent urinary tract infections, inadequate antimicrobial therapy: Profile of resistance, duration of therapy, kind of antimicrobials, posology, Pk. Kinetics, associations, compliance, biofilms, micro calcifications (recurrent chronic prostatitis) contribute to a progression of the condition.

The aim of this study was to investigate and compare the complications including infection and mortality associated with enteral and parenteral nutrition on patients in the ICU of a university hospital. In this study, a total of 100 patients who were under follow-up in the ICU for two years were examined. In our study, demographic characteristics, the reason for admission, comorbidity, initial ICU laboratory values, morbidity and mortality during the follow-up period of the patients who only received enteral nutrition (EN) or parenteral nutrition (PN) were evaluated, and the results between two were compared as well as evaluating the complications within the groups. The comparison of the reason for admission between the EN and PN groups showed that surgical reasons were significantly higher in the PN group. Nosocomial infections, the presence of infection and the development of sepsis were significantly higher in the EN group. The 28-day mortality rate was higher in the PN group compared to the EN group. The length of stay in the ICU and on mechanical ventilation was longer in the EN group. There was no significant difference in the 28-day mortality, readmission to the ICU and repeated endotracheal intubation between the two groups. Because there is no statistical difference between EN and PN groups in point of infection and mortality, we conclude that the length of stay in the ICU and reason for admission play a more crucial role in the development of infection and on mortality rather than enteral or parenteral nutrition route.

Introduction: Chronic low back pain is one of the most prevalent musculoskeletal disorders. Studies have shown certain relations between physical fitness and chronic low back pain (CLBP) by examine some measures of physical fitness. The aim of study was to measure lung function using winspiro PRO in patient with CLBP versus normal healthy individual, and relation of lung function with duration and intensity of CLBP. Methodology: The study population is comprised of a total of 120 adult persons. 60 subjects with chronic low back pain (41 male and 19 female) with a mean age of 30.69 years (+4.34) and 60 normal individual (39 male and 21 female) with mean age of 29.00 years (+5.34). Results:The result of comparison of the respiratory parameter forced vital capacity (FVC), and maximal voluntary ventilation (MVV) of individual with CLBP show a significant difference as compare to the normal healthy population. In unrelated ‘t’ test the patient with CLBP (N=60) of age 30.51(SD±4.33), height 169cm (SD±1.23), weight 57.86(SD±7.73) and body mass index (BMI) 20.46 (SD±2.54) show a significant difference in respiratory parameter FVC ( t=17.244, P=0.000), and MVV ( t=11.048, P=0.000) as compare to the normal healthy persons (N=60) of age 29.79 (SD±5.28), height 170cm (SD±1.13), weight 59.40(SD±6.97) and BMI 21.59 (SD±3.29).In patient group- FVC range is 34.0% to 75.00% (52.85%±9.30). MVV range is 45.0% to 86.80%. (63.11%±12.06)In control group FVC range is 63.90% to 98.83% (83.63%±7.59). MVV range is 63.00% to 98.00% (78.96%±7.86). Conclusions:The overall result of the study show that there is a significant difference in the respiratory parameter that is FVC (forced vital capacity), and the MVV (maximum voluntary ventilation) in persons with chronic low back pain as compare to the healthy person of same age, height, weight and body mass index (BMI).

The choice of the optimal muscle relaxant in one-day surgery in children with “small” surgical interventions remains relevant to this day. In modern pediatric surgery, the requirements for the quality of muscle relaxation are highest. However, along with the effectiveness of the drug, its duration and controllability of the action, as well as the safety of use, are important [1-7]. The aim of the study: To determine the pharmacoeconomic rationale for the rational use of muscle relaxants, depending on the duration of operations in one-day surgery in children. Material and research methods: The study was conducted in surgical clinics of the Azerbaijan Medical University. The study included 156 children who were operated on routinely from 0 to 16 years old (risk of anesthesia I-II ASA), who used combined endotracheal anesthesia during surgery. Based on the requirements of the GCP international program (Good Clinical Practice), the inclusion of children in the study was carried out only after the written consent of the parents. The studied patients were divided into 3 groups depending on the muscle relaxant used: IA (n = 52) - rocuronium bromide (esmeron), IB (n = 52) - atracurium besilate (tracrium), IC (n = 52) - cisatracurius besilate (nimbex). Depending on the type of general anesthesia, these groups were also divided into 2 subgroups: anesthesia based on isoflurane + fentanyl ″ + iso ″ and anesthesia based on sevoflurane + fentanyl ″ + sev ″. The main groups were also divided into 2 age subgroups: children under 2 years of age – IA1, IB1, IC1 and children from 2 to 16 years old – IA2, IB2, IC2.

Background: Neonatal Near-miss is defined as complications of neonates so severe as to be imminently life-threatening but survived due to chance or treatment. The number of neonates who survived morbidities were approximately 3 to 6 times greater than those who died. There was little evidence about neonatal near miss in Ethiopia. This study attempted to identify the determinants of neonatal near miss among neonates admitted to the Ambo University Referral Hospital and Ambo General Hospital. Methods: Hospital-based quantitative unmatched case-control study was conducted at the Ambo University Referral Hospital and Ambo General Hospital from March 1 to 28, 2019. The respondents, 134 cases and 268 controls were recruited by simple random technique. Data were coded, entered and cleaned in EpiInfo version 7 and exported to SPSS. Both Bivariable and multivariable logistic regression was computed at 95% CI and the final model was checked by Hosmer and Lemeshow goodness -of-fit test. Multi collinearity and cofounders were not detected. Result: Multivariate analysis showed that distance more than 15km away from health facilities [AOR=2.11, 95% CI: (1.09, 4.095)], Unwanted, and unplanned current pregnancy [AOR=3.71, 95% CI: (1.28, 10.79)], less than four Antenatal care visit [AOR=6.55, 95% CI: (3.07, 13.98)], Instrumental delivery [AOR=4.62, 95% CI: (1.78, 11.98)] were positively associated with Neonatal Near Miss. Whereas Term Neonates [AOR= 87%, 95% CI: (0.05, 0.32)], and Normal birth weight [AOR=91%, 95% CI: (0.03, 0.28)] were negatively associated with Neonatal Near Miss. Conclusion: Distance from health facilities, Antenatal care visit, current pregnancy type, birth weight, gestational age and mode of delivery were determinants of Neonatal Near Miss. Therefore, providing adequate Antenatal services, health education and training is needed to improve neonatal health.

Ischemic heart disease may occur in isolation, or in combination with the pathological process of vascular ageing, arteriosclerosis. These two conditions have differing impacts on the haemodynamic changes in response to anaesthesia and surgery. Hypertension is not a feature of ischemic heart disease, and vice versa, but where the two conditions co-exist, hypertension aggravates and accelerates the pathological processes of ischemic heart disease. Patients older than 40 yrs. presenting for anaesthesia and surgery must therefore be considered at risk of any combination of these three conditions. Anaesthetic techniques must also be chosen to minimize haemodynamic changes which in the normal healthy patient cause no serious morbidity, but which, in the patient with ischemic heart disease, can lead to serious morbidity or death. Here we report a 70 years old (BMI of 23.3) elderly, hypertensive Male patient with ischemic heart disease with previous MI (EF of 40% - 5%) undergoing elective Inguinal hernia repair. We Opted Spinal anesthesia over General anaesthesia as it should be an asset in cardiac patients undergoing non-cardiac lower abdominal surgeries to reduce preload and after load, stress response, coagulation responses, improves coronary perfusion, provides better postoperative analgesia, reduces incidence of perioperative MI, maintains myocardial oxygen supply demand ratio and avoids harmful effects of GA such as hypotention due to intravenous induction drugs, tachycardia and hypertension due to pressor response during direct laryngoscopy and tracheal intubation.

The Czech model for reducing maternal and neonatal mortality for countries in sub-Saharan East Africa was created on the basis of the Archdiocesan Charity Prague project for a specific region-subcounty Buikwe, Diocese of Lugazi, Mukono Region in Uganda, a region with about 30,000 inhabitants. The aim of the first phase of the project was to build a new hospital, equip it completely for obstetric and surgical operations from the Czech Republic, ensure its activities with Czech and Slovak doctors experts, junior Ugandan doctors and Ugandan medical staff, provide obstetric training for villagers, ensure connections with villages and possibility of fast transport and urgent solution of all acute pathologies in the hospital, capable of 24-hour surgical readiness. In the second phase of the project, a school for midwifery was to be established. This second part of the project has not yet been implemented. The project could serve as an example and guide for similar humanitarian activities in other regions of Uganda and other countries in equatorial Africa.

Background: Oral cancer accounts for 30% of all types of cancer in India. Surgery is the mainstay of treatment but due to the recent outbreak of COVID-19, there is a partial or complete disruption of health services in the country. The initial delay in the treatment was due to cancellations of planned surgeries as per government regulations and reduction in public transportation. In the latter half of the initial relaxation of the lockdown, we formulated our institutional protocol for the surgical treatment of oral cancer patients. On admission, all patients were kept in isolated wards followed by RT-PCR (Reverse Transcriptase-Polymerase Chain Reaction) testing on the same day. RT-PCR negative patients are subjected to HRCT Thorax (High-resolution Computer Tomography). This ensured the safety of health care workers, patients, and patient attendees. Keeping this in mind, we did an observational study on the role of HRCT in the pre-operative screening of asymptomatic oral cancer patients.  Materials and methods: Retrospective analysis of prospectively collected data of 150 patients was done. HRCT reporting was done by two experienced senior radiologists of the Department of Radiology at our hospital. Results: The number of patients under the CO-RADS 1 category was 121 and CO-RADS 2 category was 29, according to CO-RADS classification. The results of RT-PCR and HRCT were compared and there was a 100% positive correlation between RT-PCR and HRCT Thorax. Conclusion: Our study supported the use of HRCT Thorax as a diagnostic tool in pre-operative screening of oral cancer patients for COVID 19, particularly in RT-PCR negative cases.

Background: We have developed a femoral supporting pad with an integrated ultrasound probe holder and examined its practical usability on patients with lower limb surgery. Objectives: To evaluate the function of this novel femoral supporting pad with respect to its practicability during the performance of a distal sciatic nerve blockade, the time needed to perform this blockade including the catheter insertion and the quality of postoperative analgesia within the first 24 hours. Methods: 50 patients which had been scheduled for elective lower leg, ankle or foot surgery had received a continuous blockade of the distal sciatic nerve. Sciatic nerve blockade was performed sonographically controlled with the patients in supine position by using our novel femoral supporting pad with an integrated ultrasound probe holder. Primary endpoint: duration of the intervention. Secondary endpoints: pain intensity (visual analogue scale VAS 0-10) at the first postoperative day; cumulative opioid (piritramide) requirement during their stay on the post Anaesthesia care unit (PACU) with vs. without distal sciatic nerve blockade. Results: 49/50 patients received a distal sciatic catheter, which had been sonographically placed within a mean time (mean ± sd) of 11:30 ± 3:13 minutes. VAS at the first postoperative day was (mean ± sd) 1 ± 2 at rest and 2 ± 2 as maximum. The piritramide requirement during PACU stay (mean ± sd) was 11 ± 8 mg without vs. 3 ± 6 mg with distal sciatic nerve blockade (p< 0.05). Conclusion: Continuous distal sciatic nerve blockade using a novel femoral supporting pad with an integrated ultrasound probe holder was feasible in 49 of 50 patients within 11 minutes and 30 seconds.