ANALYSIS OF ONCOLOGICAL MORBIDITY AND MORTALITY IN THE VORONEZH REGION AND PROSPECTS FOR THE DEVELOPMENT OF THE ONCOLOGICAL SERVICE

Злокачественные новообразования являются одной из самых значимых проблем, затрагивающих не только систему здравоохранения, но и общество в целом. Обеспокоенность и повышенное внимание к онкологии обусловлены устойчивой тенденцией роста заболеваемости во всем мире, которая и в обозримом будущем продолжит нарастать, что объясняется рядом субъективных и объективных причин: постарением населения, экологическими, социальными, экономическими и другими факторами. Так, в 2019 г. в Российской Федерации впервые в жизни выявлен 640 391 случай злокачественных новообразований. Прирост данного показателя по сравнению с 2018 годом составил 2,5%. На конец 2019 года в территориальных онкологических учреждениях России состояли на учете 3 928 338 пациентов, что на 4,2% больше, чем в предыдущем году. Около 43% впервые выявленных злокачественных новообразований диагностируют в III-IV стадии. Это приводит к росту показателя смертности и значительной инвалидизации больных. Ежегодно в России более 200 тыс. больных впервые признают инвалидами от онкологического заболевания (20,0% от общего числа впервые признанных инвалидами). Умерло от злокачественных новообразований в 2019 году 293 тыс. человек, что составляет 16,4% в общей структуре смертности (вторая причина после сердечно-сосудистых заболеваний). Среди умерших в трудоспособном возрасте (15-59 лет) доля умерших от злокачественных новообразований составила 16,5%. Потери от злокачественных новообразований в репродуктивном возрасте (20-44 года) в женской популяции составили 17,7%. Все это свидетельствует о чрезвычайно высокой социальной значимости ранней диагностики, профилактики и лечения онкологических заболеваний. За последние годы достигнуты значительные успехи в профилактике, диагностике и лечении новообразований, но многие вопросы все еще изучены недостаточно Malignant neoplasms are one of the most significant problems that affect not only the healthcare system, but also society as a whole. Concern and increased attention to oncology are caused by a steady trend of increasing morbidity worldwide, which will continue to increase in the foreseeable future, which is explained by a number of subjective and objective reasons: aging of the population, environmental, social, economic and other factors. Thus, in 2019, 640,391 cases of malignant neoplasms were detected in the Russian Federation for the first time in life. The growth of this indicator compared to 2018 was 2.5%. At the end of 2019, 3,928,338 patients were registered in territorial oncological institutions of Russia, which is 4.2% more than in the previous year. About 43% of newly detected malignant neoplasms are diagnosed in stage III-IV. This leads to an increase in the mortality rate and significant disability of patients. Every year in Russia, more than 200 thousand patients are recognized as disabled from cancer for the first time (20.0% of the total number of people recognized as disabled for the first time). 293 thousand people died from malignant neoplasms in 2019, which is 16.4% of the total mortality structure (the second cause after cardiovascular diseases). Among those who died at the working age (15-59 years), the proportion of those who died from malignant neoplasms was 16.5%. Losses from malignant neoplasms in the reproductive age (20-44 years) in the female population amounted to 17.7%. All this testifies to the extremely high social significance of early diagnosis, prevention and treatment of oncological diseases. In recent years, significant progress has been made in the prevention, diagnosis and treatment of neoplasms, but many issues are still insufficiently studied

The spectrum of vital activity restrictions in disabled people due to thyroid cancer

BACKGROUND: The most common malignant neoplasm of the endocrine system is thyroid cancer. In Russia, as in other countries of the world, the incidence rate is steadily increasing. Thus, it is extremely important to assess the problem of health disorders due to thyroid cancer within the framework of socially significant disability caused by malignant neoplasms in the Russian Federation. AIMS: To analyze the spectrum of types and degree of disability in people with disabilities due to thyroid cancer. MATERIAL AND METHODS: The article presents the results of the analysis of the spectrum of the main types of disability in the general contingent of disabled people due to thyroid cancer among the adult population of Moscow (20152019). RESULTS: The dynamics of disability both in the contingent of first recognized and in the contingent of re-recognized disabled people (VPI and PPI) was characterized by an increase in the number of disabled people and the transformation of the structure of general disability. There is a clear change in the ratio towards an increase in the share of PPI from 55.1% in 2015. up to 68.0% in 2019, while the share of VPI decreased from 44.9% in 2015 to 32.0% in 2019. The predominant gender cohort was women, and the age category was the elderly. The main types of life restrictions were the restriction of the ability to self-serve (98.6% of the VPI and 97.9% of the PPI), to work (94.7% of the VPI and 94.6% of the PPI) and to move (21.3% of the VPI, 21.8% of the PPI). A low proportion of restrictions on the ability to control ones behavior, learning, communication and orientation was revealed (0.31.2%). The first degree of disability prevailed in the contingents of VPI and PPI (p 0.0001). In the contingent of men, the proportion of disabled people with the third degree of disability was higher compared to the contingent of women. CONCLUSION: Dynamic assessment of the degree of severity of functional disorders and associated life restrictions should be carried out at all stages of medical and social rehabilitation in order to monitor the effectiveness of medical and rehabilitation measures, assess the quality of life and prevent progression (secondary prevention of disability).

Prevalence and correlates of disability in Latin America and the Caribbean: Evidence from 8 national censuses

We estimate disability prevalence rates and gaps in social conditions in eight Latin America and the Caribbean (LAC) countries and project current and future disability prevalence rates in the region. Using data from representative samples of the population in eight countries, we find that reported disability prevalence varies widely across countries, ranging between 4.5 percent in Trinidad and Tobago (2011) to 24.9 percent in Brazil (2010). Differences in surveying approaches and demographic structures likely explain a part of this variation. We find marked sociodemographic gradients for disability. We also report significant disability gaps: people living with disabilities have lower educational attendance and completion rates and lower employment rates. We use age and sex-specific disability rates from our sample of countries and information on the current and future demographic structures in LAC countries to project disability prevalence for the whole region. We project that the total number of people with disabilities in this region will increase by approximately 60 million between 2020 and 2050. Our projections suggest that countries need to systematically plan and implement inclusion policies to adequately address the growing population of people with disabilities in the years to come.

Rehabilitation in post-COVID patients. A single center experience

The COVID 19 disease is frequently associated with significant disability related to intensive care unit-acquired weakness, decontitioning, myopathies and neuropathies. However there are no data on the results of a specific rehabilitative treatment in this group of patients. The aim of our work was to evaluate the effectiveness f a personalized rehabilitative therapy in group of post-COVID patients (A, 47 patients, average age 65.3±11.6 y, 27 M,) comparing the results with a group of post-cardiosurgical patients COVID 19 negative (B, 47 patients, average age 63.5±10.3 y, 29 M) evaluating the degree of clinical complexity (Rehabilitation Complexity Scale, RCS-E V13) and the degree of autonomy recovery (Six-minute walking test SMWT, Barthel Index, BI) pre and post-treatment. In Group A patients the Rehabilitation program is associated with a significant improvement in autonomy recovery (BI admission 29.7±20 vs discharge 72.7±28.6 p<0.005, SMWT admission 146±25 vs 318±18 m, p<0.005) and in clinical complexity (RCS admission 10.9±1.1 vs discharge 5.3, p<0.05). At admission the comparison between Group A vs B has show: 1. a reduced pre-rehabilitation hospital stay (days) in Group Vs A (B 8.2±2 vs 31±5 0.005) 2. a similar degrre of clinical complexity (RCS scale A 10.9±1.1 vs 1.6±11.2 p ns) 3. a greater loss autonomy in post-COVID patients (BI scale A 29.7±20 vs B 47.7±19, p 0.05; SMWT A 145±25 m vs B 255±18 m, p 0.05) After a similar period of rehabilitation (A 29.7±12.8 days vs B 29.6±10 days, p ns) we observed in both Groups: 1. a reduction of clinical complexity ((RCS scale A 5.3±2 vs 6.6±2 p ns 2. an improvement of degree of autonomy recovery ((BI scale A 72.7±28 vs B 47.7±19, p ns; SMWT A 385±18 m vs B 410±25m, p ns) Conclusions Post-COVID patients show a greater loss of autonomy than post-cardiosurgery patients. Rehabilitative treatment has proven effective in ensuring adequate functional recovery with similar results to those obtained in the population of cardiological subjects COVID 19 negative. FUNDunding Acknowledgement Type of funding sources: None.

Effectiveness Study of Typical and Atypical Antipsychotics on Patients with Schizophrenia using WHO Disability Assessment Schedule (WHODAS 2.0)

Background and Objectives: Schizophrenia is the commonest and one of the best known mental disorder which usually starts before 25 years of age, leading to significant disability in both behavioural and social life. Usually the person with any mental disability has to face social ignorance, this further leads to deterioration of their health and productivity. The deterioration of the health is not only due to the course of the disease but also may be due to treatment by some of the antipsychotics, which are the main drugs for the schizophrenia management. So, the present study has been designed to determine the effectiveness of typical and atypical antipsychotics in patients with schizophrenia in terms of disability reduction caused by them using WHODAS 2.0. Methods: After taking ethics committee approval and informed consent from study participants this prospective, observational, questionnaire based study has been conducted in the Department of Psychiatry and Pharmacology of V. S.S. Institute of Medical Sciences and Research, Burla, Odisha using WHODAS 2.0 in patients suffering from schizophrenia. Results: Atypical antipsychotics lead to more reduction in disability in patients with schizophrenia than typical antipsychotics both at 6 and 12 month duration. On comparing the various atypical antipsychotics used in the study, there was no significant difference among them. Conclusion: Based on the above findings, it can be concluded that atypical antipsychotics are more effective than typical antipsychotics in terms of disability reduction. The findings may help clinicians to get better insight in the management of schizophrenia.

Mini craniotomy for chronic subdural haematoma: surgical outcome from a single institution experience and predictors of success

Background: Chronic subdural hematoma (CSDH) is an increasingly common neurological disease in daily neurosurgical practice. Despite the wide prevalence of CSDH, there remains a lack of consensus regarding numerous aspects of its surgical management. The diagnosis and treatment are well established but there are different surgical procedures and outcome related to these procedures are not completely understood.Methods: The study conducted was conducted in department of neurosurgery at Ibrahim cardiac hospital and research institute, Dhaka, Bangladesh between January 2019 to July 2020, 105 patients were treated for chronic subdural haematoma This study evaluated the clinical features, radiological findings and surgical outcome by mini craniotomy assessed by modified Rankin scale (mRS) score and Glasgow outcome scale (GOS) score in a large series of patients treated at single institution.Results: At 6 months follow up, only one patient died (0.95%) because of co-morbidities and not directly related to the chronic subdural haematoma, 15 patients (14.3%) improved to mRS 0, 33.33% showed only mild symptoms without any significant disability-mRS 1, slight disability was observed in 28.5% patients, moderate disability was observed in 17.14% patients-mRS 3, moderately severe disability was observed in 5.7%-mRS 4.Conclusions: GOS score at 6 months follow up which shows majority of the patient improved to GOS score 4 (45.71%) and 5 (38.09%). Based on these results, among various method of surgical management, mini craniotomy provides better outcome.

942 Outcome of Image Guided Intra-Articular Thumb Base Steroid Injections-Retrospective Study of Consecutive Patient Over 4 Years in A Plastic and Hand Surgery Unit in West Lothian, Scotland

Introduction Osteoarthritis of the thumb base is a common condition. Usually effects the elderly population causing significant disability. Modalities of treatment of osteoarthritis which includes conservative measures, non-operative interventions, and surgery. In this study we endeavored to assess how effective are image guided steroid injections for base of thumb Osteoarthritis as assessed by subjective pain relief perceived by patient and what percentage of these patients proceed to operative treatment. Method Retrospective data between January 2015 and December 2018 of the patients who underwent Steroid injections to the Base of thumb joints (CMCJ and/or STTJ) for Osteoarthritis under image intensifier guidance was collected from Hospital management system –TRAK and eHealth services. Follow up of the patients were done for Maximum 1 to 5 years. Results A total number of 692 patients with thumb base osteoarthritis were included in the study of which 546 patients underwent Image guided steroid injection to the thumb base. The mean Age of patients was 64.5 years and the Female: Male ratio was 401:145. Mean number of injections each patient received- 3.25 (1 – 7 times). Pain relief after first, second and third injections were 3.15 months, 2.63 and 1.75 months, respectively. 127 (23.2% of injections patients) underwent trapeziectomy. Mean time between first injection & Surgery was 1.3yrs (6 months -2 years) Conclusions This study demonstrates the effectiveness of image guided steroid injections for thumb base osteoarthritis. Though about a quarter of these patients proceed to operative management, steroid injections can delay the same considerably.

Deconstructive versus reconstructive endovascular approaches for intracranial dissecting aneurysms

Background The annual incidence of the intracranial dissecting aneurysms is about 1 to 1.5 per 100,000. This is a well-known cause of stroke and subarachnoid hemorrhage in young and middle-aged patients (Santos-Franco et al. in Neurosurg Rev, 2008. https://doi.org/10.1007/s10143-008-0124-x). Various surgical and endovascular treatment methods have been proposed for intracranial dissecting aneurysms. All treatment methods aim to reduce the blood flow in the dissected region. Deconstructive techniques sacrifice the parent artery, whereas reconstructive techniques aim to maintain a parent artery (Stéphanie et al. in Lancet Neurol 14(6):640–654, 2015. https://doi.org/10.1016/S1474-4422(15)00009-5). Due to its dissecting nature, wall friability can make surgical clipping difficult and even risky. On the other hand, recanalization after coiling alone is almost certain. Therefore, deconstructive modalities of treatment like trapping or parent vessel occlusion, performed either surgically or endovascularly, have predominated for managing those lesions, usually with good results. Nevertheless, in absence of efficient collateral pathways, the deconstructive technique carries an ischemic risk. In situations in which parent artery preservation is mandatory, the use of stent-assisted techniques may be the most appropriate choice (de Barros Faria et al. in Am J Neuroradiol 32(11):2192–2195, 2011. https://doi.org/10.3174/ajnr.A2671). However, the usage of stent with recently ruptured aneurysms is always perplexing due to the necessity of dual antiplatelet administration. Hence the management of dissecting aneurysms remain challenging. Results Between January 2017 and July 2019, 19 patients presenting with intracranial dissecting aneurysms were referred to our department for endovascular treatment. Among the nineteen patients, 11 cases were treated by parent artery occlusion representing 57.9% of the cases, and 7 cases (36.8%) were treated by artery preserving technique, and only one case (5.3%) was treated by combination of parent artery occlusion and artery preserving technique. One week after the intervention 26.3% of patients had no disability (mRS = 0), 47.4% had no significant disability (mRS = 1), 15.8% had slight disability (mRS = 2) and 10.5% had moderate to severe disability (mRS = 3–4). After three months we found an overall improvement of the clinical outcome, as 57.9% of patients had no disability (mRS = 0), 26.3% had no significant disability (mRS = 1) and 15.8% had mild disability (mRS = 2). Finally, after six months reassessment with angiography showed that 89.5% of patients had stable aneurysmal occlusion, and 10.5% had recurrence of aneurysm. Conclusions Both endovascular approaches, whether parent artery occlusion or artery preserving technique showed favorable outcome which indicates the safety and efficacy of both approaches if selected properly according to the morphology of the aneurysm.

Audit of paediatric surgical intensive care unit admissions in north Jordan

An audit was carried out over a 12-month period at a district general hospital in the north of Jordan. The study aimed to establish the reasons for and outcome of paediatric intensive care unit admissions. Of the 854 admissions, 107 were paediatric surgical cases. The causes of trauma were: road traffic accident [42 cases], burns [35] and falls [18]. The remaining 12 cases were either post-operative admissions [7 cases] or acute admissions [5 cases]. A total of 31 patients died and 8 children were left with significant disability or brain death. We conclude that trauma is a significant cause of disability, morbidity and mortality in children in our area. Society as a whole needs to look at the causes of childhood trauma and identify ways of reducing it

Evaluation and Management of Septic Arthritis in Emergency Department “Narrative Review”

Septic arthritis (SA) is a secondary infective disease due to joints inflammation. It often appears with mono- or oligoarticular acute arthritis that frequently leads to an emergency department (ED) visit with need for prolonged hospitalization. SA is an orthopedic emergency that can threaten both life and limb due to its potential rapid destruction of the joint with fulminant sepsis, causing significant disability within hours to days. Delayed or poor treatment of septic arthritis can lead to irreversible joint damage with consequent disability in addition there to significant mortality rate. Management includes early detection and treatment with antibiotics, joint aspiration, and consultation for orthopedic surgery as potential operative management. This review aims to summarize current evidence regarding evaluation and management of septic arthritis in emergency department, and to highlight the difficulties of diagnosing and managing SA that face the healthcare providers to help overcome those difficulties and to recommend further studies to be done regarding those problems and their solutions.