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2021 ◽  
Vol 27 (12) ◽  
pp. 1137-1411
Author(s):  
Fatih Cakmak ◽  
Afsin Ipekci ◽  
Banu Karakus Yilmaz ◽  
Serap Biberoglu ◽  
Yonca Akdeniz ◽  
...  

Background: As a result of the Syrian civil war, > 5 million Syrian citizens have fled to neighbouring countries, particularly Turkey, under refugee status. Aims: To analyse the cost and justification for surgery of Syrian refugees treated in a secondary care hospital in Sanliurfa, Southeastern Turkey, close to the Syrian border. Methods: We enrolled 1458 Syrian refugees who were operated upon between 2012 and 2015. The data were obtained through a retrospective search of the hospital information system. Patients were divided into traumatic and nontraumatic cases. Injured body regions, anaesthetic technique, duration of operation, length of hospital stay, sociodemographic features and treatment cost were recorded and analysed. Results: Length of the hospital stay was 7.66 (0.31) days for all 1458 patients. The most common operations were orthopaedic, urological and cranial surgery. The total healthcare costs while patients stayed in hospital was ~US$ 2 million, and cost per patient was US$ 1400. Conclusions: The number of trauma operations performed has declined between 2012 and 2015. Health spending on refugees is an indicator of the economic burden on the country


2021 ◽  
Vol 26 (4) ◽  
pp. 113-117
Author(s):  
V.O. Shaprinskyi  ◽  
O.O. Vorovskyi ◽  
O.A. Kaminskyi ◽  
Ya.M. Pashynskyi

The results of treatment of 72 patients with echinococcosis of the liver were analyzed, women – 62 (86.2%), men – 10 (13.8%). Primary echinococcosis was detected in 69 (95.8%) patients, secondary – in 3 (4.2%). Among instrumental research methods, ultrasound and computed tomography examination were of diagnostic value. Single liver cysts were found in 63 (87.5%) patients, multiple – in 9 (12.5%). Among patients with solitary cysts, the right lobe was more often affected than the left – 48 (66.7%) vs 24 (33.3%) cases. Echinococcosis of central localization was less common and was noted in 8 (11.1%) cases. Echinococcosis complications were observed in 16 (22.2%) patients. Among them, most often there were suppurations of the cyst – in 13 (18.1%); a bursting of the cyst into the free abdominal cavity – in 1 (1.4%), in the pleural cavity – 1 (1.4%), in the biliary tract – in 1 (1.4%). Partial or complete liming of the hand was observed in 12 (16.7%) patients. In 20 (27.8%) cases, the operation was performed from the upper median access, in 42 (58.3%) – from oblique hypochondria accesses by Kocher or by Fedorov. Pericystectomy was performed in 48 (66.7%) patients, in 8 (11.1%) patients underwent resections of liver segments with an echinococcal cyst, in 4 (5.6%) – cyst opening with removal of contents and treatment of its cavity. Laparoscopic echinococectomy was used in 12 (16.7%) patients. In the postoperative period complications were observed in 16 (22.2%) patients. The use of the welding electrocoagulator EK-300M "Swarmed" in the thermal rehabilitation of the walls of the residual cavity after echinococectomy allowed to reduce blood loss from 2200±210 ml to 250±50 ml. With the use of laparoscopic echinococectomy, intraoperative blood loss was reduced by 9 times (р=0.0001); duration of operation – 2 times (р<0.05), stay in hospital – 3.3 times (р=0.002). There were no fatal outcomes. Before and after operation antirelapse antiparasitic therapy with albendazole (Vormil) was performed in two cycles of 28 days, separated by a 14-day break. The dose at body weight over 60 kg was 400 mg 2 times a day, and for less than 60 kg the drug was calculated at a rate of 15 mg/kg/day. There were 2 (2.8%) cases of relapse, there was no mortality.


2021 ◽  
Author(s):  
Raymond Nicholas Burke ◽  
Abdallah Mohd AR Al Tamimi ◽  
Wael Salem Al Shouly ◽  
Mohamed Ali Jaber ◽  
David Erik Baetsen

Abstract Industry-wide, the degradation and corrosion of steel infrastructure and the associated maintenance to prevent or mitigate this, poses a heavy environmental and operational burden across many industry segments. To address these challenges, ADNOC Group Technology, led by our Non-Metallic Steering Committee and ADNOC Upstream, in partnership with several selected specialist product companies, is deploying a range of innovative solutions as pilot trials within a holistic R&D program – which is aiming to transform our production and processing facilities, with a close focus on integrity management – and specifically we are assessing the deployment of non-metallic pipelines, storage and process vessels as well as downhole tubing and casing. Focusing specifically on flowlines and pipelines - traditional steel pipes used in the oil patch are burdensome to store, transport and install, as well as susceptible to degradation, corrosion-driven wall loss in challenging operational environments, such as those found Onshore and Offshore Abu Dhabi. This vulnerability results in increased operating risks as facilities mature, adding cost and time for inspection, maintenance and eventually - replacements that will lead to production deferrals or interruptions. A range of non-metallic pipeline technologies are being assessed and piloted in this program, including stand-alone extruded polymeric pipe and liners, Reinforced Thermoplastic Pipe (RTP) used Onshore and Offshore, specialized non-metallic flexible pipelines for Offshore including Thermoplastic Composite Pipe (TCP) and downhole tubulars. The methodology involves placing segments of RTP into live pipeline systems for a finite duration of operation – usually one year – and then removing sections to assess any degradation in performance, or capability of the RTP during that time. These test results will be the subject of a further publication at the end of this trial period. In this paper, we will focus on RTP piloting Onshore and specifically mention a unique trial in an ultra-sour gas field, where the technology has already delivered the required performance: safely transporting gas with levels of H2S up to 10% by volume. This trial also proves that specifically engineered non-metallic products may be successfully operated at the high temperature and high pressure (HPHT) levels that are characteristic of our reservoirs.


2021 ◽  
Vol 8 ◽  
Author(s):  
Wenshuai Fan ◽  
Tianyao Zhou ◽  
Jinghuan Li ◽  
Yunfan Sun ◽  
Yutong Gu

Objective: To compare freehand minimally invasive pedicle screw fixation (freehand MIPS) combined with percutaneous vertebroplasty (PVP), minimally invasive decompression, and partial tumor resection with open surgery for treatment of thoracic or lumbar vertebral metastasis of hepatocellular carcinoma (HCC) with symptoms of neurologic compression, and evaluate its feasibility, efficacy, and safety.Methods: Forty-seven patients with 1-level HCC metastatic thoracolumbar tumor and neurologic symptoms were included between February 2015 and April 2017. Among them, 21 patients underwent freehand MIPS combined with PVP, minimally invasive decompression, and partial tumor resection (group 1), while 26 patients were treated with open surgery (group 2). Duration of operation, blood loss, times of fluoroscopy, incision length, and stay in hospital were compared between the two groups. Pre- and postoperative visual analog scale (VAS) pain score, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) grade, ambulatory status, and urinary continence were also recorded. The Cobb angle and central and anterior vertebral body height were measured on lateral radiographs before surgery and during follow-ups.Results: Patients in group 1 showed significantly less blood loss (195.5 ± 169.1 ml vs. 873.1 ± 317.9 ml, P = 0.000), shorter incision length (3.4 ± 0.3 vs. 13.6 ± 1.8 cm, P = 0.000), shorter median stay in hospital (4–8/6 vs. 8–17/12 days, P = 0.000), more median times of fluoroscopy (5–11/6 vs. 4–7/5 times, P = 0.000), and longer duration of operation (204.8 ± 12.1 vs. 171.0 ± 12.0 min, P = 0.000) than group 2. Though VAS significantly decreased after surgery in both groups, VAS of group 1 was significantly lower than that of group 2 immediately after surgery and during follow-ups (P &lt; 0.05). Similar results were found in ODI. No differences in the neurological improvement and spinal stability were observed between the two groups.Conclusion: Freehand MIPS combined with PVP, minimally invasive decompression, and partial tumor resection is a safe, effective, and minimally invasive method for treating thoracolumbar metastatic tumors of HCC, with less blood loss, better pain relief, and shorter length of midline incision and stay in hospital.


2021 ◽  
pp. 19-22
Author(s):  
Balaji Karnasula ◽  
Rakesh B ◽  
Kamala Priya Tata

This study aims at nding out the common organisms responsible for surgical site infections following emergency non - traumatic abdominal operations and their sensitivity patterns of the microorganisms were ascertained. Determination of factors responsible for infections to reduce the infection rate and thereby reduce the morbidity and mortality. The patients admitted to various surgical wards in KIMS General Hospital, who are operated for emergency non -traumatic abdominal operations are included in this study. A proforma for study of all consecutive patients of emergency non-traumatic abdominal operations will be used. Culture and sensitivity of the organism at the surgical site infection are documented. Various statistical and epidemiological parameters used will be are mean and standard deviation. It was revealed that, overall surgical site infection rate was17.14 per cent. It was observed that among the various host factors studied age, sex, and educational status of the patients were not statistically signicant, but presence of comorbidity played a signicant role in causing SSI. Among the perioperative / environmental factors category of operations, types of incisions, and delay to initiate operation did not play signicant role, but duration of operation and degree of wound contamination played statistically signicant role. It can be concluded from the ndings of the study that microorganisms that are normal inhabitants of our body are mainly responsible for surgical site infection (SSI). Various host factors like malnutrition, obesity, patients’ knowledge about hygiene, presence of co- morbidity etc. coupled with environmental factors such as condition of the wounds, delay to initiate operation, duration of operation, prolonged exposure of peritoneal cavity to environment, prophylactic use of antibiotics and factors associated with surgery like type of incision, type of operation greatly contribute to occurrences of SSI. So, quality of surgical care including immediate assessment of patients, resuscitative measures, adequate preparation of patients and aseptic environment are important for control of SSI.


2021 ◽  
pp. 1-8
Author(s):  
Rawaa Y Al-Rawee ◽  
Bashar Abdul-Ghani Tawfeeq

Aims and objectives: To compare the efficacy and outcome of arch bar versus plating fixation on the integrity of the osteomised segment. Materials And Methods: The study involved a total of 43 patients (86 jaws) undergoing upper (Wassmund) and lower (Kole) anterior segmental osteotomy from (2006-2013) in the Maxillofacial Department in Al-Salam Teaching Hospital/Mosul. The sample was divided into two groups, group A (43 jaws), the osteotomized segments fixed with the arch bar, while group B (43 jaws) fixed with mini-plates. The clinical evaluation includes the following criteria: pain, swelling, bleeding, wound healing, oral hygiene ,integrity of stabilization, relapse rate and duration of operation. Results: Clinical parameters as pain, swelling, and wound healing show no significant differences between groups; on the contrary, the bleeding scale and gingival health scale show very high significant differences in p-value. The integrity of stabilization immediately in operation reveals stable surgical correction in both groups. Still, one jaw from each group develops significant mobility (grade II) that necessitate the use of additional local types of fixation. Duration of operation: this manure could be operator skill dependent, in that most cases managed clinically in teaching hospitals necessitating some delayed time in operative work, but as a mean time overall patients in group A was 90 minutes, while in group B was 77 minutes. Conclusions: According to this study, we prefer to use an arch bar rather than manipulates for fixation of anterior segmental osteotomies. Key words: Arch Bar, Complication, Fixation, Miniplate, Osteotomy.


2021 ◽  
Vol 16 (2) ◽  
pp. 51-54
Author(s):  
Mohammad Faruq Iqbal ◽  
Arif Imtiyaz Chowdhury ◽  
Sharkar Rushdi Aziz

Introduction: Open appendectomy and laparoscopic appendectomy are two modalities in the treatment of appendicitis. Superiority of one over another is not clear. Objectives: To compare per-operative and post operative outcomes between open and laparoscopic appendectomy. Material and Methods: Prospective comparative study was conducted on patients with acute appendicitis who underwent open appendectomy (OA) (n=43) or laparoscopic appendectomy (LA) (n=59) from October 2018 to October 2019 in Combined Military Hospital (CMH), Savar. The two groups were compared in respect to patients' characteristics, duration of operation, operative findings, post operative pain, return of peristalsis, resume of oral feeding, post operative complications, return to activities and cosmesis. Statistical analysis was performed using SPSS 25.0. Continuous and categorical variables were analyzed using independent sample t test and chi-square test respectively and p <0.05 was considered statistically significant. Results: There was no statistical difference regarding patient characteristics between the two groups except total leukocyte count (TLC) and neutrophil count, both were higher in OA group (p<0.001). LA group was associated with less post operative pain (p<0.001), early resume of oral feed (OA-34.74±8.34 minutes vs LA-24.51±6.13 minutes; p<0.01), early return to light work (OA-4.26±1.3 days vs LA-2.53±0.7 days; p<0.001), heavy work (OA-66.93+19.38 days vs LA-37.36+10.02 days; p<0.001) and better cosmesis (highly satisfied in LA group 96.6% vs 30.2% in OA group). No significant difference was seen in duration of operation (50±13.72 and 53.31±7.69 minutes in OA and LA groups respectively; p>0.05). There was no significant difference in post operative complications (p>0.05). Conclusion: Laparoscopic appendectomy was found clearly superior to open appendectomy in terms of less post operative pain, early resume of oral feed, early return to light and heavy works and better cosmetic result. Both procedures are comparable in terms of duration of operation and post operative complications. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 51-54


2021 ◽  
Vol 5 (11) ◽  
pp. 1186-1193
Author(s):  
Randi Dwiyanto ◽  
Kristanto Yuli Yarso

Background : The development of technology has grown rapidly in surgical science, especially the use of endoscopy to develop operations in producing minimal scar tissue. Endoscopic VABS is a surgical technique and began to develop since 1995. The technique has several approaches, namely through the chest wall, mammary and axilla. The descriptive study aims to report our first experience in the management of benign breast tumors with Endoscopic Video Assisted Breast Surgery. Methods : Ten patients with benign breast tumor have performed Endoscopic VABS in the period March 2017 to September 2017 at the Hospital in Surakarta. The largest diameter at the nodule, duration of operation, length of postoperative care, postoperative pain, cosmetic outcomes and complications were observed retrospectively. Result : All patients are women with median age 28 years. The largest diameter that can be taken is 3.5 cm with median 2 cm. One patient performed the conversion into a lumpectomy with conventional techniques due to difficult dissection and uncontrolled bleeding. The median duration of surgery was 60 minute with an average length of treatment for 2 days postoperatively. Average VAS Score was 4. No postoperative complications were found. But cosmetically, all patients are satisfied with the results of surgical wounds. Conclusion : The VABS endoscopic procedure is safe and effective procedure and has excellent cosmetic benefits because it does not show scar tissue in the breast area. This VABS Endoscopic technique has a weakness in terms of longer duration of operation compared to conventional techniques, but this can be overcome with the expertise and experience of the operator.


Author(s):  
Maryam Fatima ◽  
Zainab Ali ◽  
Zubia Zafar

Background: Systemic uptake of hypotonic fluid during irrigation performed at the time of Transurethral Resection of the Prostate (TURP) may cause electrolyte changes including sodium, potassium and calcium. The present study was aimed to assess the degree of sodium changes during Transurethral Resection of Prostate (TURP). Methods: 50 males aged 54 to 86 years, presented for TURP, were enrolled in the study with ASA classification of I to IV grades. Glycine 1.5% was used with height of irrigation kept at 60 cm. One day preoperatively and one hour postoperative, levels of serum sodium were measured for all the patients. Results: Spinal anaesthesia was given in 31 patients, whereas 19 patients were managed under general anaesthesia, with mean duration time being 72.42 ± 24.77min. The mean size of the resected prostate was 54.82 ± 25.04g. 58% patients developed mild hyponatremia, 4% had asymptomatic moderate hyponatremia and no patient developed severe hyponatremia or TURP Syndrome. The systemic diseases like hypertension, DM, or IHD found to be insignificant. Conclusion: TURP was associated with a high incidence of asymptomatic mild hyponatremia. Duration of operation was one of the most important factors.


2021 ◽  
Vol 13 (21) ◽  
pp. 11870
Author(s):  
Humberto Verdejo Fredes ◽  
Benjamin Acosta ◽  
Mauricio Olivares ◽  
Fernando García-Muñoz ◽  
Francisco Tobar ◽  
...  

The Chilean socio-political explosion in October 2019 embodies a milestone in Chile’s national history, challenging the current government’s administration and the management of state resources. One of the triggering factors of this crisis was the increase in electricity prices for those clients previously subject to flat pricing. As an example, in 2019, electricity fees increased by 25% at the national level. In order to solve the conflict, the Ministry of Energy proposed a mechanism, applicable for two years, which would freeze energy charges for companies, industries and domestic customers subject to a regulated tariff. This mechanism was employed and would produce a debt favoring generation companies, which could not exceed CLD 1.350 million. This article analyzes the effectiveness of the energy price stabilization mechanism and the effects of the Chilean socio-economic instability—resulting from the aggregated debt generated by the mechanism applicability—on the exchange rate over its duration of operation. The results suggest that the effects of the current law will not fulfill the purpose of tariff stabilization until 2024; additionally, there will be a sustained increase in tariffs until the year 2027.


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