Effect of linagliptin plus insulin in comparison to insulin alone on metabolic control and prognosis in hospitalized patients with SARS-CoV-2 infection

To evaluate the effect of the combination of linagliptin and insulin on metabolic control and prognosis in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hyperglycemia. A parallel double-blind randomized clinical trial including hospitalized patients with SARS-CoV-2 infection and hyperglycemia, randomized to receive 5 mg linagliptin + insulin (LI group) or insulin alone (I group) was performed. The main outcomes were the need for assisted mechanical ventilation and glucose levels during hospitalization. Subjects were screened for eligibility at hospital admission if they were not with assisted mechanical ventilation and presented hyperglycemia, and a total of 73 patients with SARS-CoV-2 infection and hyperglycemia were randomized to the LI group (n = 35) or I group (n = 38). The average hospital stay was 12 ± 1 vs 10 ± 1 days for the I and LI groups, respectively (p = 0.343). There were no baseline clinical differences between the study groups, but the percentage of males was higher in the LI group (26 vs 18, p = 0.030). The improvements in fasting and postprandial glucose levels were better in the LI group that the I group (122 ± 7 vs 149 ± 10, p = 0.033; and 137 ± 7 vs 173 ± 12, p = 0.017, respectively), and insulin requirements tended to be lower in the LI group than the I group. Three patients in the LI group and 12 in the I group required assisted mechanical ventilation (HR 0.258, CI 95% 0.092–0.719, p = 0.009); 2 patients in the LI group and 6 in the I group died after a follow-up of 30 days (p = 0.139). No major side effects were observed. The combination of linagliptin and insulin in hospitalized patients with SARS-CoV-2 infection and hyperglycemia reduced the relative risk of assisted mechanical ventilation by 74% and improved better pre and postprandial glucose levels with lower insulin requirements, and no higher risk of hypoglycemia.This study is registered at clinicaltrials.gov, number NCT04542213 on 09/03/2020.

Comparative assessment of mortality and lethality rates of newborns at the regional level

In order to assess the mortality and lethality rates of newborns in obstetric organizations of the North-Western Federal District in 2013–2019, a comparative analysis of official statistics data was carried out. It was found that in the North-Western Federal District in the period from 2013 to 2019, there was an almost annual decrease in newborn mortality rates. The overall decrease in mortality in maternity care organizations of the Federal District (from 2,5% to 1,9%) was mainly due to a decrease in mortality in obstetric hospitals of the first and second levels (respectively from 3,2% to 1,2% and from 1,7% to 0,7%), while most children died in perinatal centers, where the mortality rate has not changed in recent years (2013 – 4,1%; 2019 – 4,0%). The study showed a decrease in mortality rates in the subjects of the Russian Federation that are part of the federal district, except for the city of St. Petersburg. The average hospital lethality rate of newborns in maternity care organizations of the North-Western Federal District during 2013–2019 was in the range of 1,9%–2,0%, did not change significantly and corresponded to the national average. However, the level of hospital lethality significantly differed in individual subjects of the district – in more than half of them, the level of hospital lethality exceeded the average, while in others it was significantly lower. Thus, the decrease in the mortality and lethality rates of newborns in maternity care organizations indicates an increase in the quality of medical care for children in the North-Western Federal District. dicates an increase in the quality of medical care for children in the North-Western Federal District.

Functional outcome assessment for surgical decompression of cervical spondylotic myelopathy

Background: Cervical spondylotic myelopathy (CSM) is one of the most common dysfunctions of spinal cord occurs due to degenerative changes in cervical spine disc and facet joints. It is a form of progressive spine disease including herniated disc and spinal cord stenosis which manifests as changes in gait, skilled hand movements, muscle strength, bladder dysfunction etc. Recent studies and trials have established that surgical decompression of cervical spinal is a cost-effective treatment modality which provide satisfactory functional recovery. This study aimed at the functional outcome of surgical decompression of CSM.Methods: The prospective study of 100 cases of cervical myelopathy for which decompressive surgery was done from August 2020 to August 2021. Results were analysed according to Nuricks and modified Japanese orthopedic association scoring system (MJOA).Results: Seventy one males and 29 females were included in this study with average age was 53 and average hospital stay was 3.55 days. Average pre-op Nurick score was 1.93, while score after 6 months and 1year were 1.44 and 1.15respectively. Average pre-op MJOA score was 13.63, while score after 6 months and 1 year were 14.58 and 15.74 respectively.Conclusions: The functional results of decompressive surgeries for cervical myelopathy are satisfactory. Both anterior and posterior approaches are recommended for multiple cervical myelopathy with comparable outcomes. DM and age was observed as the independent predictor for functional outcome, while, gender and level of disease got less significant predictive value.

Robot-Assisted Radical Prostatectomy in High-Risk Prostate Cancer

Background. Prostate cancer (PC) is subdivided into risk categories according to patient prognosis. High-risk disease was previously typified by a higher risk of metastasis and mortality, which implied comprehensive treatment. Manifold studies have concluded that surgery is a key measure in such cases, even as monotherapy. Open radical prostatectomy (RP) was routinely performed in most high-risk PC patients until robot-assisted radical prostatectomy (RARP) had become a reasonable choice as improving outcomes in low- and intermediate-risk PC patients. Reliable RARP assessments in high-risk PC are still lacking. Th e review summarises published data on functional and oncological RARP outcomes in high-risk PC patients and analyses surgical inpatient cases at the BSMU Clinic for 2018—2021.Materials and methods. The surgical outcomes in high-risk PC inpatients were analysed retrospectively at the BSMU Clinic for 2018—June 2021. Among 540 RARPs performed, 199 PC patients were identified as high-risk in the D’Amico criteria.Results and discussion. Mean operation time was 100 min, blood transfusion rate — 3.5 %. Bladder catheterisation time was 5 days, average hospital stay — 7.1 days.Conclusion. RARP may facilitate optimal therapeutic efficacy and favour postoperative recovery as monotherapy or the first step in a multimodal treatment of high-risk PC patients.

ANALISIS PENYEBAB OBAT KADALUARSA DI INSTALASI FARMASI RUMAH SAKIT IBU DAN ANAK ERIA BUNDA PEKANBARU TAHUN 2020

Pelayanan kefarmasian merupakan pelayanan penunjang serta pusat pendapatan utama bagi rumah sakit. Instalasi farmasi merupakan salah satu unit pelaksanaan fungsional yang menyelenggarakan seluruh kegiatan pelayanan kefarmasian. Di instalasi farmasi Rumah Sakit Ibu dan Anak Eria Bunda Pekanbaru berpotensi menghasilkan obat kadaluarsa yang dapat menimbulkan kerugian bagi rumah sakit. Tujuan dari penelitian ini adalah untuk mengetahui penyebab obat kadaluarsa di instalasi farmasi Rumah Sakit Ibu dan Anak Eria Bunda Pekanbaru. Penelitian ini merupakan penelitian kualitatif deskriptif. Subjek penelitian ini terdiri dari Kepala Instalasi Farmasi, Penanggung Jawab Farmasi Rawat Inap, Koordinator Perbekalan Farmasi dan Alkes, Staf Farmasi Rawat Jalan, dan Staf Gudang Farmasi. Dengan metode pengumpulan data menggunakan observasi dan wawancara. Dari hasil penelitian dapat disimpulkan bahwa penyebab obat kadaluarsa di instalasi farmasi Rumah Sakit Ibu dan Anak Eria Bunda Pekanbaru disebabkan oleh perencanaan obat yang terlalu berlebih dari konsumsi pemakaian rata-rata rumah sakit, pengadaan obat yang tidak memperkirakan berapa banyak obat yang mau dipesan, serta penyimpanan obat dikarenakan human error dimana kesalahan pada saat penyimpanan yang tidak FIFO dan FEFO. Saran bagi instlasi farmasi Rumah Sakit Ibu dan Anak Eria Bunda Pekanbaru yaitu dengan mengadakan pelatihan dan sosialisasi terhadap perencanaan dan pengadaan obat, serta meningkatkan pengawasan dalam melakukan penyimpanan obat. Pharmaceutical services are support services as well as the main revenue center for hospitals. The pharmacy installation is one of the functional implementation units that organize all pharmaceutical service activities. The pharmacy installation at the Eria Bunda Mother and Child Hospital in Pekanbaru has the potential to produce expired drugs that can cause harm to the hospital. The purpose of this study was to determine the causes of drug expiration in the pharmacy installation of Eria Bunda Mother and Child Hospital Pekanbaru. This research is descriptive qualitative research. The subjects of this study consisted of the Head of the Pharmacy Installation, the Person in Charge of Inpatient Pharmacy, the Coordinator of Pharmacy and Medical Devices, the Outpatient Pharmacy Staff, and the Pharmacy Warehouse Staff. With the data collection method using observation and interviews. From the results of the study, it can be concluded that the cause of expired drugs in the pharmacy installation of Eria Bunda Mother and Child Hospital Pekanbaru is caused by excessive drug planning than the average hospital consumption, drug procurement that does not predict how many drugs to order, and storage. medicine due to human error where the error during storage is not FIFO and FEFO. Suggestions for the pharmacy installation of Eria Bunda Mother and Child Hospital Pekanbaru, namely by holding training and socialization of drug planning and procurement, as well as increasing supervision in carrying out drug storage.

P-BN14 Differences in rate of complications between emergency and elective laparoscopic cholecystectomy at district general hospital

Background Current NICE guidelines recommend healthy low risk patients who present with acute biliary disease should be offered laparoscopic cholecystectomy on the same index admission. The increased complexity of the acute operations may impact on the operative complication rates; hence the aim of this study is to evaluate and compare the operative complication rates between elective and emergency laparoscopic cholecystectomies and additionally to assess the difference in surgical techniques comparing complete cholecystectomy versus subtotal versus open procedures. Methods Retrospectively, data was collected from emergency and elective Laparoscopic Cholecystectomies completed in the period 01/01/2021-01/06/2021 at the Queen Elizabeth Hospital Gateshead. The data set was gathered from an electronic theatre database and the individual cases were sub-analyzed further by delving into the electronic patient records database. Statistical analysis done by using Excel 2010. Results The average age of both groups was 50 years. There wasn’t a statistical significance on the rate of complication between the elective Vs emergency cholecystectomies (Elective 2%, Emergency 9% P = 0.17). Out of 42 Elective procedures, 4 had Sub-total cholecystectomy Vs 3 out of 42 patients on the emergency group who had Subtotal cholecystectomy (9% Vs 7%), implying there was no significant difference noted between the two groups. Average hospital stays was 5.6 days for the acute presentation with biliary disease Vs 0.14 days on the planned elective group. 2% of the elective group were noted to have a surgical drain inserted during the operation; whilst the emergency cohort had a slightly higher rate at 5%. Conclusions Overall there was no significant difference noted between the surgical complications arising in emergency cholecystectomy compared to planned surgeries. In addition to this the data also suggests that there is negligible difference in the rates of sub-total cholecystectomies in both cohorts.

CURRENT RESULTS OF CONVENTIONAL LUMBAR ARTHRODESIS

ABSTRACT Objective: To evaluate the peri- and postoperative results and clinical repercussions in patients undergoing decompression surgery and single-level lumbar arthrodesis using the traditional technique (OTLIF) and to compare with the results of minimally invasive techniques (MITLIF) described in the literature. Methods: Our sample consisted of 22 patients who underwent TLIF surgery using the open technique (OTLIF) in the period October 2019 to January 2021, in our hospital. We compared the patients’ functional clinical results using the Oswestry scale in the preoperative period and 15 days after surgery, analyzed variables related to the perioperative period: surgery time, length of hospital stay, blood loss, use of a suction drain, and admission to the ICU, and compared these with the results reported in the literature for patients treated by the MITLIF technique. Results: The average age was 48.95 years and the most operated level was L4-L5 (55%). The average surgery time was 112.63 min. We did not use a suction drain in the postoperative period, there was no need for a blood transfusion in any patient, and no patient was admitted to the ICU. The average hospital stay was 1 day. Regarding the Oswestry Disability Index, the mean preoperative score was 44.73 and after 15 days, it was 24.05. Conclusions: surgical treatment using the OTLIF technique for single-level lumbar degenerative disease showed largely positive results, with improvement in disability scores, short hospital stay and low incidence of complications. When properly indicated, OTLIF is an excellent and safe option for the treatment of degenerative lumbar disease. Level of evidence IV; Case series study.

Laparoscopic Surgical Management of Rectal Cancer at Tertiary Care Hospital

Objective: To evaluate the consequent outcomes in the patients with rectal cancer endured laparoscopic surgical excision at Department of Surgery, Liaquat University of Medical and Health Sciences Jamshoro, Hyderabad and to review their curative resection and recurrence rates, postoperative morbidities and complete survival. Methods: This prospective case series study was done at the Department of General Surgery of Liaquat University of Medical & Health Sciences, Jamshoro, Sindh, Pakistan. All patients of 30-65 years ages with rectal cancer and underwent diagnostic laparoscopy either of gender were included. After removing the tumor, the specimen pinned out on a flat surface and placed in fixative solution to allow the orientation of the specimen and assessments of the exact margins. As the specimens had acceptable clear margins and limited invasion to the submucosa, no further surgical procedure was proceeded. Data was collected via study proforma. Results: A total of 40 patients were studied. Patients in the laparoscopic operation lost less blood with an amount of only 200mL during 190 minutes average operation time. The bowel functioning returned in 2 days averagely with 8 days average hospital stay. Conclusion: It is concluded that laparoscopic surgery for rectal cancer is an effective, safe and feasible approach in terms of less post-operative complications and recovery time as well as Hospital stay. Key words: Rectal Cancer, laparoscopic surgery

Current epidemiological trends and in-hospital mortality of acute pancreatitis in Germany: a systematic analysis of standardized hospital discharge data between 2008 and 2017

Background Acute pancreatitis (AP) represents a common gastrointestinal disorder. Complicated disease courses in particular still represent a major clinical challenge and are associated with high mortality. Evaluation of existing data sets and their careful interpretation can support a rational discussion to optimize outcomes of this common gastrointestinal disease. Methods We used standardized hospital discharge data provided by the Federal Statistical Office of Germany to evaluate hospital mortality and current developments of AP in Germany between 2008 and 2017. Results In this analysis, 516,618 hospitalized AP cases were included. Main disease etiologies featured biliary (29.9%) and alcoholic (22.7%) AP. The annual frequency of AP increased from 48,858 (2008) to 52,611 (2017), mainly due to a rising incidence of biliary AP. Average hospital mortality was 2.85% and significantly improved over time. While uncomplicated AP had low hospital mortality (1.38%), the presence of organ complications was associated with a mortality of 12.34%. The necessity of mechanical ventilation dramatically increased hospital mortality to 44.06%. Hospital mortality was significantly higher in female patients (3.31%) than males (2.55%) and showed a stepwise increase with patient age. We further identified type 2 diabetes mellitus and obesity as factors associated with increased hospital mortality. Hospital mortality was lowest among patients treated at departments specializing in gastroenterology. Finally, high case volume centers (defined as >98 annual AP cases) had the lowest hospital mortality for patients with complicated courses of AP. Conclusion With over 50,000 annual hospitalization cases, AP is one of the most important inpatient treatment indications in gastroenterology in Germany. Overall, AP mortality has improved in recent years, presumably due to improved interdisciplinary treatment concepts. In this study, we identified important clinical and epidemiological risk factors for an unfavorable course, which could help to improve risk prediction and triaging, and thus the management of AP.

Impact of a multifaceted strategy in end-of-life care in a tertiary hospital: A quasi-experimental study

Objective To evaluate the impact of a multifaceted strategy for quality end-of-life care in a tertiary public hospital in Brazil. Methodology The study design was quasi-experimental. The multifaceted strategy was applied between January and June 2017, and involved training the healthcare team in end-of-life discussions, the creation and documentation of advance directives, and consultation with the team specialized in palliative care. The periods analyzed were the pre-test period (Time 1, July 2015 to June 2016) and the post-test period (Time 2, July 2017 to June 2018). Results Time 1 involved 302 deaths, with an average hospital stay of 21 days; Time 2 involved 410 deaths, with an average hospital stay of 16 days. Patients were prescribed morphine (44.04% vs. 36.3% [ p = 0.367]), methadone (9.60% vs. 4.39% [ p = 0.247]), midazolam (43.05% vs. 47.80% [ p = 0.73]), blood transfusions (31.13% vs. 24.63% [ p = 0.828]), enteral feeding (56.62% vs. 38.54% [ p = 0.59]) and antibiotic therapy (50.73% vs. 50.73% [ p = 0.435]). Conclusion This study found no changes in the end-of-life care quality indicators after the strategy was implemented. Multimodal educational strategies that develop communication skills in palliative care may enhance the quality of end-of-life care.