Evaluation of short-term complications in laparoscopic peritoneal dialysis catheter placement - a single tertiary center experience

Background. Peritoneal dialysis is a form of kidney function replacement that is not as widespread as hemodialysis. However, it has recognized advantages, such as preservation of residual renal function, lack of vascular access, and the ability to be performed at home. On the other hand, it requires the correct insertion of a peritoneal dialysis (PD) catheter and maintaining its patency. Methods. We conducted a retrospective study of 126 patients with end-stage renal disease who underwent laparoscopic Tenckhoff catheter placement for peritoneal dialysis between January 2016 and December 2022. The study analyzed the frequency and type of complications registered within three months, in order to validate laparoscopy as a safe method of catheter insertion (with reduced periprocedural complications), as well as the importance of the multidisciplinary team in the care of patients with peritoneal dialysis. Results. In about 14% of patients, we encountered a total of 23 complications: 61% in the first month, 34.7% in the second month, and 4.3% in the third month. The most frequent complication was infection (peritonitis 35%, catheter exit site infection 30.4%), followed by peri-catheter leak (21.7% of total complications). Catheter migration, hernia, and significant bleeding were rare events (4.3% of total complications each). All complications were managed by medical treatment, except two cases which required replacement of the catheter. Conclusions. Laparoscopic catheter insertion is a safe procedure with low post-procedural complications in patients who are dependent on peritoneal dialysis

Advantages of total parathyroidectomy in patients with secondary hyperparathyroidism induced by end stage renal disease

IntroductionSecondary hyperparathyroidism, as a result of chronic kidney disease could be treated medically or surgically. When pharmacotherapy fails, patients undergo surgery - parathyroidectomy, the curative treatment of secondary hyperparathyroidism (SHPT). There are currently 3 accepted surgical techniques, each with supporters or opponents – total parathyroidectomy, subtotal parathyroidectomy and parathyroidectomy with immediate autotransplantation.MethodsIn this paper we described our experience on a series of 160 consecutive patients diagnosed with secondary hyperparathyroidism who underwent surgery, in 27 cases it was totalization of the intervention (patients with previously performed subtotal parathyroidectomy or with supernumerary glands and SHPT recurrence). We routinely perform total parathyroidectomy, the method that we believe offers the best results. ResultsThe group of patients was studied according to demographic criteria, paraclinical balance, clinical symptomatology, pre- and postoperative iPTH (intact parathormone) values, SHPT recurrence, number of reinterventions. In 31 cases we found gland ectopy and in 15 cases we discovered supernumerary parathyroids. A percentage of 96.24% of patients with total parathyroidectomy did not show recurrence.DiscussionsAfter analyzing the obtained results, our conclusion was that total parathyroidectomy is the intervention of choice for patients suffering from secondary hyperparathyroidism when pharmacotherapy fails in order to prevent recurrence of the disease and to correct the metabolic parameters

Morphological and Tribological Properties of PMMA/Halloysite Nanocomposites

From an environmental and cost-effective perspective, a number of research challenges can be found for electronics, household, but especially in the automotive polymer parts industry. Reducing synthesis steps, parts coating and painting, or other solvent-assisted processes, have been identified as major constrains for the existing technologies. Therefore, simple polymer processing routes (mixing, extrusion, injection moulding) were used for obtaining PMMA/HNT nanocomposites. By these techniques, an automotive-grade polymethylmethacrylate (PMMA) was modified with halloysite nanotubes (HNT) and an eco-friendly additive N,N′-ethylenebis(stearamide) (EBS) to improve nanomechanical properties involved in scratch resistance, mechanical properties (balance between tensile strength and impact resistance) without diminishing other properties. The relationship between morphological/structural (XRD, TEM, FTIR) and tribological (friction) properties of PMMA nanocomposites were investigated. A synergistic effect was found between HNT and EBS in the PMMA matrix. The synergy was attained by the phase distribution resulted from the selective interaction between partners and favourable processing conditions. Modification of HNT with EBS improved the dispersion of nanoparticles in the polymer matrix by increasing their interfacial compatibility through hydrogen bonding established by amide groups with aluminol groups. The increased interfacial adhesion further improved the nanocomposite scratch resistance. The PMMA/HNT-EBS nanocomposite had a lower coefficient of friction and lower scratch penetration depth than PMMA/HNT nanocomposite.Financial support by the EU Commission through Project H2020-686165-IZADINANO2INDUSTRY is gratefully acknowledged

Management of Peritoneal Dialysis-Associated Emergencies during the COVID-19 Pandemic: The Experience of a Center of Excellence

The COVID-19 pandemic struck unexpectedly; emergency services and chronic care institutions, including dialysis centers, were overloaded. A significant problem was the care of COVID-positive patients alongside the care of chronically dialyzed patients who presented emergencies. In our hospital, which became a COVID support center for dialysis patients with severe forms of the disease, we had to care for PD patients with dialysis-related emergencies. We present two cases of patients managed on an outpatient basis or 1-day hospitalization who were treated successfully without compromising the quality of the care provided. We used remote monitoring, worked in a multidisciplinary team, and shortened the duration of the patients’ hospitalization (and implicitly the risk of contact). In pandemic conditions, the advantage of PD was the possibility of patient isolation; in the first 6 months of the pandemic, we recorded no deaths in this category of patients. In hemodialysis patients, infection and mortality rates were high. Although we expected an increase in the number of peritoneal dialysis patients in the post-pandemic period, this did not happen. We continue to plead for the popularization of the PD method among patients and doctors, which has proven advantages in pandemic conditions

INNOVATIVE TREATMENT TECHNIQUES IN POLYCYSTIC OVARY SYNDROME (PCOS)

Polycystic ovary syndrome (PCOS) is a common condition among women in the fertile period and can have a wide range of symptoms including menstrual disorders, infertility, and, excessive hair growth and metabolic problems. PCOS treatment may vary depending on individual symptoms and patient goals, some of the emerging technologies and innovative approaches that have been investigated in the context of PCOS treatment are: laser therapy for ovarian cysts (HIFU), focused high-intensity ultrasound therapy, gene therapy , stem cell treatment , nutrigenomics and personalized diet , etc , artificial intelligence (AI) interventions. Each technique brings with it promises and challenges, and their implementation in clinical practice requires extensive clinical studies and attention to detail. It is essential to keep the balance between innovation and safety in order to ensure real benefits for patients. Despite the early stage of much research, these innovative approaches pave the way for more efficient and personalized PCOS management

DIABETIC NEUROPATHY: INNOVATIVE TREATMENT TECHNIQUES

Diabetic neuropathy represents a frequent and debilitating complication of diabetes, affecting the peripheral nervous system and contributing to symptoms such as pain, tingling, and numbness. In this review, we explore innovative treatment techniques that have been studied to alleviate the symptoms of diabetic neuropathy. Key aspects covered include low-level laser therapy (LLLT), transcutaneous electrical nerve stimulation (TENS), the use of antiepileptic and antidepressant medications, stem cell therapy, and the integration of virtual reality in pain therapy. LLLT has shown promise in stimulating nerve regeneration, while TENS provides a non-invasive approach to managing neuropathic pain. Antiepileptic and antidepressant medications have demonstrated significant benefits, and stem cell therapy is at the forefront of research for tissue regeneration. Additionally, the integration of virtual reality in pain therapy offers an innovative perspective, distracting patients from their symptoms and improving their quality of life. Managing diabetic neuropathy extends beyond conventional therapies, evolving constantly through the integration of innovative techniques with the potential to significantly enhance the quality of life for affected patients. It is essential to continue research and rigorously evaluate the effectiveness of these approaches, collaborating with healthcare professionals to provide personalized and efficient solutions

Extraperitoneal Laparoscopic Approach in Inguinal Hernia—The Ideal Solution?

Background: After more than 20 years since laparoscopy was proposed as a solution for one of the most common surgical pathologies, inguinal hernia, the choice of an intra- or extraperitoneal approach has remained a highly debated topic. Purpose and objectives: This study aimed at analyzing the feasibility of the extraperitoneal approach, by routine for this team/ and answering the question of whether this type of approach can be considered a safe one. Although indications for an intra- or extraperitoneal approach largely overlap, it may also be a matter of surgeon preference in choosing one technique. Methods: The study was retrospective, conducted on a group of 493 patients operated on for inguinal hernia in the clinic, by a single operating team, between January 2012 and March 2022. Results: It was proven that out of the 493 surgeries for inguinal hernia, 95.1% (n = 469) were operated upon by laparoscopic TEP (total extra peritoneal patch plasty approach); 1.62% (n = 8) by laparoscopic TAPP (transabdominal intraperitoneal); and 3.24% (n = 16) by the open, anterior approach (Lichtenstein). There were no intraoperative complications recorded in any of the procedures, while postoperative complications were found in 10.23% of cases (n = 48) in the extraperitoneal approach, and recurrences after the TEP approach were recorded in 0.40% of cases (n = 2). Conclusions: For correctly selected cases, TEP hernia surgery can be considered a safe and reliable approach

THE CHALLENGES OF MAINTAINING ORAL HEALTH IN HEPATITIS C

Hepatitis C is a global health problem, affecting millions of people and having significant implications for the whole organism. In this context, attention to oral health among people with hepatitis C is becoming increasingly important. Hepatitis C is a chronic viral infection of the liver, transmitted mainly by contact with infected blood, and its treatment involves the use of strong antiviral drugs. However, these treatments can have side effects and influence the oral health of patients. Adopting a regular oral hygiene regimen, including dental brushing, flossing and mouthwash, is an essential component in maintaining oral health for people with hepatitis C. Schedule regular visits to the dentist for dental exams and professional cleanings contributes to the early identification of oral problems and the prevention of complications.People undergoing treatment for hepatitis C should be aware of possible side effects, such as dry mouth, and take appropriate measures to manage these symptoms