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Comparison of blunt and sharp dissection techniques during cesarean hysterectomy in placenta percreta
Get PDFObjectives: This study aimed to compare the effects of the blunt dissection technique (BDT) with finger and the sharp dissection technique (SDT) with scissors during cesarean hysterectomy (CH) in patients with placenta percreta. Material and methods: We included 70 patients with placenta percreta who underwent CH in a territory hospital between 2020 and 2023. The patients were divided into two groups: Group 1 included 34 patients who underwent blunt bladder dissection, and Group 2 included 36 patients who underwent sharp bladder dissection. Demographic data, operative complications, surgical parameters, and transfusion rates were compared between the two groups. Results: BDT was associated with a statistically significant reduction in operation time compared to SDT (95.62 ± 20.76 min vs 107.08 ± 26.04 min, p = 0.046). Moreover, the rate of bladder injury was significantly lower in the BDT group compared to the SDT group (11.8% vs 33.3%, p = 0.032). Although there were no significant differences in blood transfusion products between the two groups, postoperative transfusion amounts tended to be lower in the BDT group. Conclusions: BDT may be a proper surgical method to reduce bladder injury rates and operation time compared to SDT in CH of placenta percreta cases
Hospital management support for patient safety
Get PDFINTRODUCTION: Hospital management support can play an important role in addressing the issue of patient safety. There is increasing concern about patient safety, as it is often linked to a lack of effective managers who can use their influence to change health professionals’ behavior, leading to a decrease in work pressure and medical errors and enhancing patient safety.
MATERIAL AND METHODS: A cross-sectional study was conducted at three private hospitals. The sample (n = 315) consisted of health professionals from different private hospitals in Jeddah, Saudi Arabia. A 40-item questionnaire addressed patient safety, teamwork, collaboration, hospital management support, supervisor support, work pressure, and communication. The quantitative data were analyzed using the Statistical Package for Social Sciences (SPSS) version 23 and the standard multiple regression analysis was the method used to test hypotheses in this study.
RESULTS: The results of this investigation indicate that a significant amount of variance in perceived patient safety (R2 = 0.41) is accounted for by the predictor variables. The most significant predictor of patient safety is teamwork with a β weight of 0.33, followed by work pressure, with a β weight of 0.31, and hospital management support, with a β weight of 0.30.
CONCLUSIONS: This study has shown that patient safety can be improved by enhancing teamwork, collaboration, and communication among health professionals within hospitals. Patient safety can be improved when heads of units or clinical supervisors use their influence to change behavior and implement procedures that support health professionals working together as a team
Measuring multifidus muscles atrophy after midline lumbar fusion with cortical bone trajectory screws due to spinal instability and spondylolisthesis: a retrospective case series
Get PDFIntroduction. This study aimed to assess the impact of midline lumbar fusion with cortical bone trajectory screws (MIDLF/CBT) on the multifidus muscles, focusing on the evaluation of their postoperative atrophy.Clinical rationale for the study. MIDLF/CBT is a relatively new technique increasingly used to treat spinal instability. Despite its reduced invasiveness compared to traditional posterior lumbar interbody fusion with traditional pedicle screws (PLIF/TP), concerns remain about potential damage to the multifidus muscles that are crucial for spinal stability. Understanding the extent of muscular atrophy post-MIDLF/CBT is vital for improving surgical outcomes, and potentially patient rehabilitation strategies.
Material and methods. This study retrospectively analysed preoperative and postoperative MRI scans of patients who underwent MIDLF/CBT for degenerative segmental spondylolisthesis. The bilateral width of the multifidus muscles at the operated segment and adjacent segments was measured using axial T2-weighted MRI scans. Statistical comparisons were made using a paired t test, with significance set at p < 0.05.
Results. The study included 16 patients with an average age of 57 ± 10 years, 10 of whom (62.5%) were women, and featured a mean follow-up period of 37 ± 25 months. Postoperative measurements showed a significant reduction in the width of the multifidus muscles at the operated segment (mean difference −3.3mm, p = 0.02) and the inferior adjacent segment (−7.4 mm, p < 0.01). A decrease in muscle width at the superior adjacent segment was also observed, although this was not statistically significant.
Conclusions and clinical implications. Our study concluded that MIDLF/CBT results in significant multifidus muscle atrophy at and below the operated segment, potentially impacting postoperative rehabilitation and recovery. These findings highlight the need for further research comparing MIDLF/CBT to other spinal stabilisation techniques. Additionally, incorporating functional electromyographic assessments of paraspinal muscles could provide deeper insights into the long-term consequences of spinal surgeries and helpdevelop new approaches and strategies to mitigate paravertebral muscles atrophy, thus enhancing patient outcomes
Does botulinum toxin type A treatment influence non-motor symptoms in cervical dystonia patients? A systematic review
Get PDFThe effect of botulinum toxin A (BoNTA) on non-motor symptoms (NMS) in patients with cervical dystonia remains an area of significant clinical interest, given the profound impact of these symptoms on patients’ quality of life. While the therapeutic efficacy of BoNTA in alleviating motor symptoms of cervical dystonia is well established, its impact on NMS such as depression, anxiety disorder, and sleep disturbance requires further investigation.This systematic review synthesizes the latest evidence on the effects of BoNTA on these selected non-motor symptoms.A comprehensive search of the PubMed, Web of Science, and Scopus databases identified 266 articles, of which eight studies met our strict inclusion criteria. Pre- and post-intervention changes in depression, anxiety, and sleep disturbance were assessed in a total of 280 adult patients with cervical dystonia treated with BoNTA.The results indicate that BoNTA has a positive effect on depressive symptoms, with most studies showing a statistically significant improvement after treatment. Similarly, studies are reporting significant reductions in anxiety scores following BoNTA treatment. However, the effects of this treatment method on sleep disturbances were less conclusive, with none of the reviewed studies showing significant improvements in sleep quality or daytime sleepiness.The results highlight the potential of BoNTA to positively influence non-motor symptoms, particularly depression and anxiety, in patients with cervical dystonia, although its effects on sleep remain unclear. These findings underscore the need for further research to fully understand the mechanisms underlying the non-motor effects of BoNTA and to develop comprehensive treatment strategies
Pulmogenetyka w praktyce klinicznej cz.1 — diagnostyka wariantów rodzinnych i chorób monogenowych, czyli kiedy wiadomo, który konkretnie wariant lub gen u pacjenta ocenić
No full textW niniejszym artykule przedstawione są praktyczne zasady dotyczące wykonywania testów genetycznych w przypadku chorychze znanym wariantem genetycznym oraz podejrzeniem choroby o jednoznacznej etiologii monogenowej
Nierozpoznana choroba Dariera współistniejąca z niejednoznaczną infekcją wirusową
No full textWprowadzenie: Choroba Dariera (DD, Darier’s disease) jest rzadką, dziedziczoną na drodze autosomalnie dominującej genodermatozą, charakteryzującą się występowaniem hiperkeratotycznych grudek zlokalizowanych głownie na obszarach łojotokowych, z zajęciem skory dłoni i stop, paznokci lub błony śluzowej jamy ustnej. Choroba ma przebieg przewlekły, z możliwością wystąpienia koinfekcji — najczęściej wirusem opryszczki pospolitej. Każde nowe zakażenie może przyczyniać się do znacznego nasilenia objawow.
Opis przypadku: Czterdziestodwuletni pacjent, u ktorego od dłuższego czasu występowały brązowoszare grudki na kończynach i tułowiu, nasilające się w okresie letnim, został przyjęty na oddział dermatologii. Zgłaszał pogorszenie stanu zdrowia i pojawienie się zmian skornych w obrębie ramion, klatki piersiowej, szyi oraz częściowo na twarzy, ktore utrzymywały się od tygodnia. Celem hospitalizacji było rozpoznanie i leczenie tych zmian. Zmiany były bardziej nasilone po stronie lewej i początkowo objawiały się jako intensywny rumień, następnie pokrywając licznymi grudkami i zgrupowanymi pęcherzykami, czemu towarzyszyło uczucie pieczenia i gorączka. Analizy laboratoryjne wykazały podwyższone markery stanu zapalnego. W badaniu ultrasonograficznym ujawniono obrzęk tkanki podskornej oraz powiększone węzły chłonne szyjne po stronie lewej. W posiewie krwi wykryto oporny na metycylinę szczep gronkowca złocistego (MRSA, methicillin-resistant Staphylococcus aureus). Układowe leczenie podawanymi dożylnie antybiotykami i acyklowirem doprowadziło do powolnej poprawy klinicznej i normalizacji wynikow badań laboratoryjnych. Badanie histopatologiczne w korelacji z danymi klinicznymi sugerowało zakażenie Poxviridae oraz typowy obraz choroby Dariera.
Wnioski: Choroba Dariera, szczegolnie powikłana skornymi infekcjami wirusowymi, może manifestować się w nieoczywisty sposob, co zaobserwowano w przedstawionym przypadku. Ciężki przebieg choroby można tłumaczyć wypryskiem opryszczkowym, wypryskiem poszczepiennym lub pokswirusowymi chorobami odzwierzęcymi. Kluczowe znaczenie dla dokładnego rozpoznania ma badanie histopatologiczne
Łagodna postać epidermolysis bullosa pruriginosa z nową mutacją w genie COL7A1 w polskiej rodzinie: opis przypadku i przegląd piśmiennictwa
No full textEpidermolysis bullosa pruriginosa jest niezwykle rzadką postacią dystroficznej pęcherzowej epidermolizy naskórka, której przyczyną jest mutacja najczęściej zlokalizowana w obrębie genu COL7A1. W zależności od rodzaju mutacji (mutacje zmiany sensu, mutacje nonsensowne, mutacje przesuwające ramkę odczytu, mutacje typu splice-site) u pacjentów można obserwować odrębne, swoiste fenotypy. W niniejszym badaniu przedstawiono serię przypadków obejmującą troje członków rodziny z województwa pomorskiego, charakteryzujących się nową mutacją zmiany sensu p.Val2402Gly:-c.7205T > G w eksonie 94 genu COL7A1
Maintenance therapy with a P2Y12 receptor inhibitor after cangrelor in patients with acute coronary syndrome. The ELECTRA-SIRIO 2 investigators’ viewpoint
Get PDFAccording to the ESC guidelines, cangrelor may be considered in P2Y12-inhibitor-naïve acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). The aim of this review is to summarize available evidence on the optimal maintenance therapy with P2Y12 receptor inhibitor after cangrelor. Transitioning from cangrelor to a thienopyridine, but not ticagrelor, can be associated with a drug-drug interaction (DDI); therefore, a ticagrelor loading dose (LD) can be given any time before, during, or at the end of a cangrelor infusion, while a LD of clopidogrel or prasugrel should be administered at the time the infusion of cangrelor ends or within 30 minutes before the end of infusion in the case of a LD of prasugrel. Administration of any oral antiplatelet agent at the end of a cangrelor infusion will also result in a transient period of increased platelet reactivity. The inter-individual variability of this period is difficult to predict because it depends on many factors related to the patient and the treatment. In addition, experimental studies indicate that cangrelor may exert a cardioprotective effect beyond the blockade of platelet aggregation. Considering the available data, the potential use of cangrelor in ACS patients goes well beyond the current indications. Furthermore, we believe that it might be prudent to avoid use of thienopyridines during and soon after a cangrelor infusion until conclusive data on the effect of the DDI on the clinical outcome are available. On the other hand, ticagrelor seems to be an optimal oral agent for continuation of P2Y12 inhibition in patients receiving cangrelor infusion
The impact of shock therapy on depression development and remote prognosis in cardiac resynchronization therapy recipients
Get PDFBackground: The aim of this study was to assess the incidence and clinical significance of depression in patients with cardiac resynchronization therapy with an implantable cardioverter-defibrillator (CRT-D). The study was also to evaluate the impact of shock therapy on depression development and long-term prognosis.
Methods: The prospective study encompassed 396 consecutive heart failure (HF) patients implanted with CRT-D. All patients completed the Beck Depression Inventory (BDI-II) and underwent a psychiatric examination at baseline. 221 patients free of depressive symptoms at baseline were included into the final analysis. The assessment of psychiatric status was routinely repeated every 6 months as well as after the shock delivery. The primary outcome was a composite endpoint of death or hospitalization for HF.
Results: During long-term observation (median 37.1 months) 52 (23.5%) patients suffered from an implantable cardioverter-defibrillator (ICD) shock, whereas 48 (21.8%) subjects developed depression. The incidence of new-onset depression was significantly higher in patients after shock delivery (Shock Group), CRT non-responders and subjects with atrial fibrillation. The risk for a composite endpoint was higher in the Shock Group than subjects without an ICD intervention: 57.7% vs. 25.4% and in patients with new-onset depression compared to the population free of this disorder: 62.5% vs. 24.9% (all p < 0.001). New-onset depression (HR 1.7) and an ICD shock (HR 2.1) were strong independent predictors of poor prognosis.
Conclusions: Depression is a common mental disorder in CRT-D recipients, that adversely affects long-term prognosis. Subjects suffering from ICD shocks and those with HF progression are at higher risk of experiencing depressive symptoms