Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Profile of persons involved in traffic accidents in Romania

Abstract: Background: Romania had in 2010 the highest fatality by traffic accidents in EU and the lowest progress in reducing the traffic deaths during the decade 2001 -2010 (3% decrease). Objective: Our study aimed to present the profile of persons involved in traffic accident in Romania during [2005][2006][2007][2008][2009][2010]. Methods: A descriptive cross-sectional study was performed. The profile of persons involved in traffic accidents was analyzed globally and by subgroups, considering the injury type and the road user. The main data source was the electronic database of Road Police Directorate. Results: Globally, 344467 persons were involved in traffic accidents during the study period, from which 4.7% died, 13.2% were seriously injured and 39.9% had slight injuries. 75% of the persons involved in traffic accidents were males. 9.1% of the victims were children, 83.8% were adults and 7% elderly. Globally, half of the persons wore safety equipments (seat belt, helmet and child safety seats).. Conclusion: Too many persons are involved in traffic accident in Romania, and too many of them still die or are seriously injured, as a consequence of a traffic accident. The decreasing trend registered in European Union is not visible in our country. Undertaking the EU legislation is not enough for reducing the deaths and injuries by traffic accidents and a coordinated national strategy is necessary for halving the traffic deaths in the next decade, 2011 -2020

ANASTOMOTIC RECURRENCE AFTER 1/3-YEAR RECTAL NEOPLASM OPERATED WITH PRESERVATION OF THE ANAL SPHINCTER

The quality of surgery, the limits of resection, the total excretion of "mesorectum", mechanical or manual anastomosis and pre-and postoperative oncologic treatment of rectal cancer, all these, may influence the incidence of local recurrence. We have analyzed the case of a 62-year old patient with rectal bleeding , diarrhea, and rectal tenesmus. The colonoscopy revealed a rectal tumor located at 10 cm from anal-rectal limit. A biopsy was taken from the tumor: moderately differentiated adenocarcinoma. CEA and CA19.9 tumor markers were found within normal limits. There was performed rectal resection with end-to-end colonic – rectal anastomosis with Stapler 32. Postoperatively, pathological examination: rectal adenocarcinoma NOS with low degree of malignancy G2 – moderately differentiated, diffuse infiltration to the musculature, without metastasis in regional nodes (only identified 5), completely excised surgically – it was classified as pT2pNo (G2) stage. Postoperatively, the patient did not perform oncology treatment. Colonoscopy which was performed 1 year after surgery, revealed a bleeding tumor located at the anastomosis level. Biopsies were taken from the anastomosis tumor. The result confirms the local recurrence of invasive adenocarcinoma. Milles rectum amputation is decided and practiced. Postoperatively the patient performs oncological treatment. Preoperative staging is an important factor in determining the indication of radiotherapy

Cervical Cancer Mortality in Romania: Trends, Regional and Rural–Urban Inequalities, and Policy Implications

Background and Objectives: Despite being largely preventable, cervical cancer mortality still remains an important public health problem globally, in Europe, and in Romania. The European Union member states are urged to implement systematic, population-based screenings for cervical cancer, but the programs developed by the countries remain very heterogeneous. This study aimed to investigate the differences in cervix cancer mortality between Romania and EU and within Romania over the last two decades and to reveal the major sources of inequalities and the policy implications. Materials and Methods: We analyzed the number of deaths and the mortality rates by cervical cancer, standardized using the direct method, over two decades (2001–2016 for the EU, and 2001–2019 for the national and sub-national analyses). Trends, mortality reduction over the years, and mortality differences at the beginning and end of the time interval have been calculated for the EU and Romania, at national and sub-national levels (rural–urban and regions). Results: Our results revealed differences in cervical cancer mortality between Romania and EU and within Romania (among regions and rural–urban areas). These differences used to be very high in the past and are still persisting. Conclusions: The country should revisit its national cervical cancer screening program, which has been implemented for many years, but with a very limited participation rate. Due to the similar problems existing in Central-Eastern Europe, targeted support from the EU for the members from this geographical area could contribute to the minimization of differences in cervical cancer mortality among the EU members