A COVID–19-járvány miatt bevezetett járványügyi intézkedések hatása a hasi sebészeti ellátásra a Bajcsy-Zsilinszky Kórházban

Összefoglaló. Bevezetés: 2020 első negyedévében a koronavírus gyors terjedése, az általa okozott betegségek súlyos következményei miatt világszerte, így hazánkban is megváltozott az egészségügyi ellátás. Közleményünkben bemutatjuk, hogyan befolyásolták egy fővárosi kórház hasi sebészeti osztályának betegellátását, az ellátott esetek számát és összetételét a járvány első, 2020-as tavaszi hulláma idején bevezetett járványügyi korlátozó intézkedések. Célkitűzés: Célunk az volt, hogy adatokkal összehasonlítsuk 2021., 2020. és 2019. április sebészeti fekvőbeteg-ellátásának jellemzőit osztályunkon. Módszer: A 2019. április 1. és 30., 2020. április 1. és 30. és 2021. április 1. és 30. közötti időszakokban a fővárosi Bajcsy-Zsilinszky Kórház Sebészeti, Érsebészeti és Mellkassebészeti Osztályán az általános sebészeti fekvőbeteg-ellátás keretében végzett hasi sebészeti műtéti beavatkozások adatait hasonlítottuk össze. Az adatokat MS Excel és SPSS (25. verzió) programokkal vizsgáltuk, és statisztikai elemzéseket végeztünk. Eredmények: A bevonási kritériumoknak 197 eset felelt meg 2019 áprilisában, 77 eset 2020 áprilisában és 95 eset 2021 áprilisában. Az osztályos ápolási idő 2019-ben átlagosan 4,51 nap, míg 2020-ban 6,31 nap és 2021-ben 6,29 nap volt. 2019-ben napi átlagban 2,54 akut és 6,2 tervezett műtét, 2020-ban napi 2 akut és 1 tervezett műtét, míg 2021-ben napi 2,8 akut és 0,9 tervezett műtét történt. Az 1 főre jutó kísérő betegségek száma a tervezett műtétek esetében 2019-ben 1,69 volt, míg 2020-ban 2,97, 2021-ben pedig 2,74. Az akut műtétre került betegek kísérő betegségeinek eloszlása szignifikánsan eltért, 1 betegre 2019-ben átlagosan 2,5, 2020-ban 3,75, míg 2021-ben 3,25 kísérő betegség jutott. Az akut sebészeti ellátáson átesett betegek halálozása 2019-ben 11,8%, 2020-ban 13,33%, 2021-ben 15,66% volt. Következtetés: A COVID–19-járvány miatt bevezetett járványügyi intézkedések velejárója volt, hogy hasi sebészeti osztályunkon lényegesen kevesebb elektív műtétet végeztünk. A sürgősséggel ellátott páciensek kísérő betegségeinek száma szignifikánsan emelkedett, valószínűleg ezzel magyarázható a halálesetek számának párhuzamos emelkedése. Orv Hetil. 2021; 162(44): 1761–1768. Summary. Introduction: Due to the rapid spread of the coronavirus and the serious consequences of the diseases, the organization of healthcare worldwide changed in the first quarter of 2020. We show effects of restriction due to protection against the first (April 2020) wave of coronavirus in our surgery care. Objective: The aim of this study was to compare characteristics of general surgical inpatient care in April 2020 and April 2021 with April 2019 by the hospital database. Method: We compared general surgical data of April 2021, 2020, and 2019 from the medical informatic system at the General, Vascular and Thoracal Surgery Department of the Bajcsy-Zsilinszky Hospital in Budapest. The data were analyzed with MS Excel and SPSS (version 25) programs. Results: Study inclusion criteria met with 197 cases from April 2019, 77 cases from April 2020, and 95 cases from April 2021. Length of stay at surgical department was average 4.51 days in 2019, 6.31 days in 2020, and 6.29 days in 2021. In 2019, average 2.54 urgent and 6.2 planned operations were done, in 2020 these numbers were average 2 and 1 per day and in 2021, 2.8 urgent and 0.9 planned surgical procedures were performed. The number of co-morbidities per capita in elective cases was 1.69 in 2019, 2.97 in 2020, and 2.74 in 2021. Distribution of coded co-morbidities in the case of patients with urgent surgery was significantly different between the groups, in 2019 it was 2.5, in 2020 3.75, and in 2021 3.25 per capita. Postoperative mortality at the same care of patients after urgent surgery was 11.8% in 2019, 13.33% in 2020, and 15.66% in 2021. Conclusion: Due to the government instructions because of COVID-19 pandemic, less elective general surgery procedures were performed in our department. Co-morbidities of patients with urgent surgery significantly increased, probably this is responsible for the increase of postoperative mortality. Orv Hetil. 2021; 162(44): 1761–1768.

Description of an Integrated and Dynamic System to Efficiently Deal with a Raging COVID-19 Pandemic Peak

BackgroundTo describe an innovative and functional method to deal with the increased COVID-19 pandemic-related intensive care unit bed requirements.MethodsWe describe the emergencial creation of integrated system of internistic ward, step-down unit and intensive care unit, physically located in reciprocal vicinity at the same floor. The run under the control of a single intensive care staff, sharing clinical protocols and informatic system, following a single director supervision. The intention was to create a dynamic and flexible system, allowing for rapid and fluid patient admission/discharge, depending on the requirements due to the third Italian peak of COVID-19 pandemic in March 2021.Results142 COVID-19 patients and 66 non-COVID-19 patients were admitted, no critical patient was left unadmitted and no COVID-19 severe patients referring to our centre had to be redirected to other hospitals due to bed saturation. This system allowed shorter hospital length-of-stay in general wards (5.9 ± 4 days) than in other internistic COVID-19 wards and an overall mortality in line with those reported in literature despite the peak raging.ConclusionThis case report shows the feasibility and the efficiency of this dynamic model of hospital rearrangement to deal with COVID-19 pandemic peaks.

MO292MALIGNANT DISEASE IS MORE COMMON WITH DETERIORATING KIDNEY FUNCTION IN PATIENTS WITH MEMBRANOUS NEPHROPATHY

Background and Aims Membranous nephropathy (MN) can be associated with tumor and present a paraneoplastic condition. Recently, development of tumors during the course of follow up is more in focus. It is especially interested whether patient with MN are prone to tumors, or tumors are condition indipendent of membranous nephropathy or consequence of imunosupressive therapy (IS). Method Retrospective data of all adult patients diagnosed with MN from 1987 to 2017 at the Department of Nephrology of University Hospital Centre Zagreb were analysed. Medical data regarding antropometric measeures and preexsisting comorbid disease at presentation and during follow up were derived from medical records and hospital informatic system. Furthermore, data regarding kidney function were used, namely serum creatinine (SCr), proteinuria. Renal function was assessed using CKD-EPI equation. CKD stages, partial and complete remission were defined according to KDIGO guidelines. Results From 1987 till 2017 a total of 122 patients were diagnosed with MN. Eighty nine (72.9%) were treated with imunosupressive therapy. Most commonly prescribed initial therapy was combination of corticosteroids and cyclophosphamide (N=66; 74%). Three (0,02%) patients had history of tumor with median of 3y (min – max 1-4 y) before glomerular disease presentation, two solid tumor, adenocarcinoma pulmonum and carcinoma prostatae, and one condition after allogenic haematopoetic transplantation due to acute myeloid leukemia. There was no difference in clinical presentation between those with positive history of malignant disease and others (proteinura 11.7 g/du (25-75C 3.4-15.7) vs. 5.8 g/dU (25-75C 3.4 – 8.5); p=0.232 and eGFR 57 ml/min/1,73m2 (25C-75C 14 – 59) vs. 81 ml/min/1.73m2 (25-75C 54 – 100); p=0.066). During follow up 11 (9%) patients developed tumor, median age of pts 67 y (min – max 59 – 71); nine solid tumors most comonly of gastrointestinal origin (pancreas, colon N=5 (45%)), then pulmonum (N=2(18%)) and urogenithal origin (ca renis and prostate N=2 18%). Also two hematological malignancies (B-ALL, B-NHL) occurred. Median time till confirmed malignant disease was 9 y (min – max 5 -24). At the time of detecting the tumor six (54%) patients were in complete and partial remission (4 and 2) and 2 (18%) patients had nephrotic syndrome. No difference was observed in proteinuria between those with malignant condition and other MN patients (1,4 g/dU (25 – 75C 0.2 – 5.6) vs. 0,29 g/dU (25 – 75C 0.13 – 0.74); P=0.154). MN patients with malignant disease during follow up had lower estimated glomerular filtration rate (eGFR 45 ml/min/1,73m2 (25 – 75C 22 – 70) vs. 77 (25 – 75C 58 – 92); p=0.010). There was no difference in cummulative dose of cyclophosphamide between those who developed tumor with others (24 g(25 – 75C13.5 – 30) vs. 27 g(25 – 75C 15 – 38)p=0.592). Conclusion Our data emphasize the need for long term follow up of patients with membranous nephropathy despite accomplishing remission of MN and period screening for malignant disease, especially in those with deteriorating kidney function.

Zoonotic Risk Technology Enters the Viral Emergence Toolkit

In light of the urgency raised by the COVID-19 pandemic, global investment in wildlife virology is likely to increase, and new surveillance programs will identify hundreds of novel viruses that might someday pose a threat to humans. Our capacity to identify which viruses are capable of zoonotic emergence depends on the existence of a technology—a machine learning model or other informatic system—that leverages available data on known zoonoses to identify which animal pathogens could someday pose a threat to global health. We synthesize the findings of an interdisciplinary workshop on zoonotic risk technologies to answer the following questions: What are the prerequisites, in terms of open data, equity, and interdisciplinary collaboration, to the development and application of those tools? What effect could the technology have on global health? Who would control that technology, who would have access to it, and who would benefit from it? Would it improve pandemic prevention? Could it create new challenges?

The effects of heat stress on the behaviour of dairy cows – a review

Heat stress in livestock is a function of macro- and microclimatic factors, their duration and intensity, the environments where they occur and the biological characteristics of the animal. Due to intense metabolic processes, high-producing dairy cows are highly vulnerable to the effects of heat stress. Disturbances in their thermoregulatory capability are reflected by behavioural, physiological and production changes. Expression of thermoregulatory behaviour such as reduction of activity and feed intake, searching for a cooler places or disturbances in reproductive behaviours may be very important indicators of animal welfare. Especially maintain of standing or lying position in dairy cattle may be a valuable marker of the negative environmental impact. Highly mechanized farms with large numbers of animals have the informatic system can detect alterations automatically, while small family farms cannot afford these type of equipments. Therefore, observing and analysing behavioural changes to achieve a greater understanding of heat stress issue may be a key factor for developing the effective strategies to minimize the effects of heat stress in cattle. The aim of this review is to present the state of knowledge, over the last years, regarding behavioural changes in dairy cows (Bos Taurus) exposed to heat stress conditions and discuss some herd management strategies provided mitigation of the overheat consequences.

Telemedicine, diabetes and endocrinologic diseases in the COVID-19 era: the patients’ point of view from a high impacted area. (Preprint)

BACKGROUND The effectiveness of telemedicine has been widely investigated, also in a diabetologic setting. Available evidence support an important role of telemedicine in emergency times, like the present COVID-19 outbreak. OBJECTIVE The aim of the study is to evaluate the feasibility and patient satisfaction associated with virtual visit use in an outpatient diabetology and endocrinology unit in Pavia, Italy, during the present COVID-19 pandemic. METHODS We submitted a custom-made satisfaction questionnaire to each patient who underwent a televisit from the 1st of April to the 1st of May 2020. The questionnaire was proposed to 51 subjects. Furthermore, the patients were asked about their gender, age and visit reason. RESULTS All patients accepted to answer our questionnaire. Their mean age was of 38 years (minimum 20, maximum 79) and most of patients were women (39). The patients resulted affected by different disease: type 1, type 2 and gestational diabetes, hypothyroidism during pregnancy, Graves’ disease, Klinefelter Syndrome, Acromegaly, Cushing syndrome and hypopituitarism. The majority of them didn’t find any difficulty in using the informatic system, recognized a value of telemedicine in preventing COVID-19 contagion, and considered the tele-visit useful. CONCLUSIONS Our results show that patients were overall satisfied of this new approach. Telemedicine, also in a diabetologic and endocrinologic setting, can be of help in providing continuing healthcare, while keeping health providers and patients safe during COVID-19 pandemic. CLINICALTRIAL

Sistem Monitoring Lulusan Perguruan Tinggi Dalam Memasuki Dunia Kerja Menggunakan Tracer Study

This research is titled Monitoring System of Higher Education Graduates in Entering the World of Work Using Tracer Study. The problem raised in this study is that the BKK (Bursa Kerja Khusus) STMIK Widya Cipta Dharma Samarinda get information about the performance of STMIK graduate students Widya Cipta Dharma, analyze graduate data to obtain the relevance of the competency of STMIK graduates Widya Cipta Dharma Samarinda, change the old system into a system that new. The purpose of this research is to provide information and reports on the results of tracer study data collection from alumni of STMIK Widya Cipta Dharma Samarinda. Data collection methods used are literature study, field studies. The system development method used is the waterfall method. Informatic System of Alumnus Record Tracer Study Based Website of STMIK Widya Cipta Dharma Samarinda is a computer-based system that was built with the aim of processing the alumnus search to find out the description of the profile, performance, and distribution of work location of the alumnus. Informatic System of Alumnus Record Tracer Study Based Website of STMIK Widya Cipta Dharma Samarinda is expected to help assist the BKK (Bursa Kerja Khusus) in recording alumnus and record the track record of alumnus scattered in serveral areas.

PEMBELAJARAN MATEMATIKA BERBASIS INFORMATIKA

The Mathematic Teaching and learning based informatic system is learning system implementing computerization technology as a learning tool in theteaching and learning process. This teaching and learning process in which it combines conventional method with the application practice has been constructed on the basis of the implemented curriculum in a college. The use of media in a teaching and learning process like computer as a learning tool will make the teaching and learning process more effective because it will create an interesting teching and learning process as well as stimulate the students’ creativity. In addition, the teaching and learning process not only as a tutorial qctivity but also it provides the implentation of the theories given. The Mathematic teaching and learning based informatic is done to know the comparison of problem solving in mathematic using Mathematic software application. The standardized process and the use of informatic are constructed based on the exsisting curriculum in order to control the quality of the learning proses and result.