Dexketoprofen/tramadol 25 mg/75 mg: randomised double-blind trial in moderate-to-severe acute pain after abdominal hysterectomy

Statistical Analysis of TOTPAR over 2, 4, 6 and 8 h (ANCOVA) (ITT Population) (single-dose phase). (DOCX 16 kb

New System for the Acceleration of the Airflow in Wind Turbines

Background: This patent is based on the wind industry technology called Diffuser Augmented Wind Turbines (DAWTs). This technology consists of a horizontal axis wind turbine, which is housed inside a duct with diverging section in the direction of the free air stream. In this paper, a review of preceding patents related to this technology is carried out. Objective: This paper presents an innovative patent to improve the performance of horizontal axis wind turbines. In particular, this system is aimed at improving the performance of those turbines that otherwise might not be installed due to the low wind resource existing at certain locations. Methods: The most innovative elements of this patent are: (1) the semi-spherical grooves, which are mechanized on the surface of the two diffusers in order to guarantee a more energetic boundary layer; (2) the coaxial diffuser, which is located downwind following the first diffuser in order to increase the suction effect on the air mass close to the inlet; (3) the coaxial rings located around the first diffuser outlet, which are used to deflect the external airflow toward the turbine wake; and (4), the selforientating system to orientate the system by the prevailing wind direction. Results: An application of the patent for increasing the power generated by a horizontal axis wind turbine with three blades is presented. The patent is designed and its performance is evaluated by using a Computational Fluid Dynamics code. The numerical results show that this system rises the airflow going through the rotor of the turbine. Conclusion: The patented device is an original contribution aimed at enabling a more profitable installation of wind turbines in places where the wind resource is insufficient because of the wind shear caused both by the proximity of the earth and the obstacles on the earth surface.This work was supported by the OASIS Research Project that was cofinanced by CDTI (Spanish Science and Innovation Ministry) and developed with the Spanish companies: Iridium, OHL Concesiones, Abertis, Sice, Indra, Dragados, OHL, Geocisa, GMV, Asfaltos Augusta, Hidrofersa, Eipsa, PyG, CPS, AEC and Torre de Comares Arquitectos S.L and 16 research centres. The authors also acknowledge the partial funding with FEDER funds under the Research Project FC-15-GRUPIN14-004. Finally, we also thank Swanson Analysis Inc. for the use of ANSYS University Research programs as well as the Workbench simulation environment

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

A Rare Case of Acute Abdomen: Garengeot Hernia

Rezumat Un caz rar de abdomen acut: hernie Garengeot Asocierea apendicitei acute cu hernia femuralã strangulatã sau încarceratã, reprezintã o patologie rar întâlnitã, dar bine documentatã în literatura de specialitate medicalã, aaea numita hernie a lui Garengeot. Dezvoltarea unei apendicite acute în sacul de hernie femuralã, devine o urgenåã chirurgicalã de abdomen acut. Diagnosticul este întotdeauna confundat cu cel de hernie încarceratã sau strangulatã, diagnosticul de certitudine fiind stabilit intraoperator, ocazie cu care la deschiderea sacului herniar se constatã prezenåa apendicelui cecal, aflat în diferite stadii morfologice ale inflamaåiei, care pot merge pânã la gangrena aei perforaåia acestuia. În aceastã lucrare, am raportat cazul unei femei de 76 de ani, care se prezintã pentru prezenåa unei formaåiuni tumorale femurale, încarcerate, dureroase, care a fost iniåial consideratã ca hernie femuralã încarceratã, diagnosticul final fiind stabilit intraoperator. Tratamentul acestor "hernii" este în general simplu, atunci când nu existã complicaåii ale apendicitei acute, precum prezenåa de puroi în sacul de hernie, aei constã în apendicectomie aei herniorafie. Absenåa unei simptomatologii specifice apendicitei acute, face ca de cele mai multe ori intervenåia chirurgicalã sã fie temporizatã ceea ce duce la apariåia frecventã a complicaåiilor aei la creaeterea morbiditãåii. Cuvinte cheie: hernie femuralã, încarcerare, apendicitã Abstract The association of acute appendicitis with femoral hernia, strangulated or incarcerated, represents a rare but well documented pathology in the specialized medical literature, also known as Garengeot hernia. The development of an acute appendicitis in the femoral hernia sac becomes a surgical emergency of acute abdomen. The diagnosis is always mistaken for the one of incarcerated or strangled hernia, the correct diagnosis being established intraoperatively, occasion which exposes the cecal appendix by opening the herniary bag, found in different morphological stages of inflammation that can go as far as gangrene or even perforation. In this paper, we have reported the case of a 76 year-old female that presented with femoral tumours, incarcerated, painful and initially considered as an incarcerated femoral hernia, the final diagnosis being made intraoperatively. The treatment for these "hernias" is generally simple, when there are no complications of acute appendicitis as the presence of pus in the hernia sac, and consists in appendectomy and herniorrhaphy. The absence of symptoms for an acute appendicitis often delays the surgery which leads to frequent complications and increased rate of morbidity

The Contribution of Procalcitonin, C-Reactive Protein and Interleukin-6 in the Diagnosis and Prognosis of Surgical Sepsis: An Observational and Statistical Study

George Tocu,1,2,&ast; Raul Mihailov,3,4 Cristina Serban,4,5 Bogdan Ioan Stefanescu,5,6,&ast; Dana Tutunaru,1,2 Dorel Firescu4,5,&ast; 1Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, Galați, Romania; 2Clinical Laboratory of Medical Analysis, Emergency County Clinical Hospital “Sf. Ap. Andrei” Galati, Galați, Romania; 3Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, Galați, Romania; 4Department of Surgery, Emergency County Clinical Hospital “Sf. Ap. Andrei” Galati, Galați, Romania; 5Department of Clinical Surgery, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, Galați, Romania; 6Department of Obstetrics and Gynecology, Emergency County Clinical Hospital “Sf. Ap. Andrei” Galati, Galați, Romania&ast;These authors contributed equally to this workCorrespondence: Raul Mihailov, Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 47 Domneasca Street, Galați, 800008, Romania, Tel +40745250391, Email [email protected] Cristina Serban, Department of Clinical Surgery, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 47 Domneasca Street, Galați, 800008, Romania, Tel +40728249228, Email [email protected]: Sepsis affects over 30 million people worldwide each year, causing approximately 6 million deaths. Challenges in clinical diagnosis and the need for an early diagnosis to prevent mortality due to sepsis have led to dependence on inflammatory biomarkers like Procalcitonin (PCT), C-reactive protein (CRP), and Interleukin-6 (IL-6).Objective: This study was performed to observe the contribution of inflammatory biomarkers in the diagnosis and prognosis of patients with surgical sepsis.Methods: We performed a retrospective observational study in a Clinical Emergency Hospital, which included a number of 125 patients with surgical sepsis admitted between January 2020 and December 2021. The patients were included in the study based on the Sepsis-3 definition. PCT, CRP, IL-6, Sepsis-related Organ Failure Assessment (SOFA) score, Charlson Comorbidity Index (CCI), the time up to surgery, the days of treatment in Intensive Care Unit (ICU) and the total days of hospitalization had been statistically analyzed.Results: The mean age of all patients was 65.14 years. The mean value in all patients for PCT was 20.08 ng/mL, for CRP was 175.42 mg/l, and for IL-6 was 799.6 pg/mL. The strongest correlation between biomarkers was between CRP and IL-6 (r = 0.425; p < 0.0001). Of all biomarkers, the CRP correlated the strongest with patient outcomes (r = 0.544; p < 0.0001). The area under curve (AUC) for the mean values of the inflammatory biomarkers was calculated and the best diagnostic performance was for CRP with 0.816 (95% CI: 0.744– 0.887).Conclusion: CRP and IL-6 were the most efficient in sepsis diagnosis. The association of PCT, CRP and IL-6 has increased the range of certainty in sepsis diagnosis. CRP was the most efficient biomarker in the prognosis of sepsis.Keywords: inflammatory biomarkers, SOFA score, septic shock, surgical sepsis, postoperativel

EXOTIC CONGENITAL SCOLIOSIS – THE EFFECTS OF EARLY ARTHRODESIS

Aim. The article presents the difficulties encountered in the treatment of exotic scoliosis and the optimal treatment options for this pathology. Material and method. The case presentation of an exotic scoliosis with T6-T11 vertebral block with hemivertebrae, rib fusions and rib agenesis on the concave side, L1-T12 butterfly vertebrae, L2 hemivertebra and lumbar rachischizis, associated with a diastematomyelic bony spur at T12-L1 level, previous operated, requiring surgical reintervention. Results. Surgical decisions not optimized for each patient may lead to worsening of evolution and raise difficulties in later treatment. Discussions. The resection of the hemivertebra and spinal fusion limited to 2 levels is the optimal treatment for congenital scoliosis that corrects the scoliosis curve and stops progression. The VEPTR device is the most effective choice to ensure pulmonary development compatible with life in patients with thoracic insufficiency syndrome. Conclusions. Exotic scoliosis is a challenging pathology that requires prognosis of development in order to be able to choose the optimal treatment to ensure the growth and development of the thoracic cavity, the pulmonary system and the spinal cords