INVENTORY CONTROL OF DISPOSABLE MEDICAL DEVICES IN HOSPITALS USING THE ECONOMIC ORDER QUANTITY (EOQ) AND REORDER POINT (ROP) METHOD

Controlling the supply of disposable medical devices at RSUD Dr. Pringadi not completely running well. The purpose of this research is to control the supply of disposable medical devices in order to determine the amount optimal ordering and to find out the number of reorders on all types of disposable medical devices. In this research also did calculating the value of the investment in each type. Calculation results for the investment level group of 0-70% has 11 types of disposable medical devices with a financial value of IDR 64,136,040.00 or 70% of the total investment with Economic Order Quantity can be ordered from a total of 14-152 items, Buffer Stock or safety stock starts stocking from 1-198 items and Reorders Points range from 1-318 items. For the investment level group 71-90% have 21 types of disposable medical devices with a financial value of Rp 181,953,529.00 or 20% of the total investment with EOQ can be ordered from quantity 2-21237item, buffer stock from 2-1237item and ROP from reordered 4-1987item.For the investment level group of 91-100% has 71 types of disposable medical devices with a financial value of Rp 85,103,749.00 or 9.4% of the total investment with EOQ calculations ordered starting from 1-421, buffer stock starting from 2-247 items and ROP starting from 2 - 397items.So this research is useful to help the warehouse Pharmacist at RSUD Dr. Pringadi in controlling the supply of medical devices disposable

Screening and prognostic factors for ovarian cancer

Ovarian cancer is one of the neoplastic gynecological diseases that is the most difficult subject to screening. This is the reason that most newly-diagnosed cases are at III-IV FIGO stage. The lack of an appropriate screening method affects the oncologic results and, therefore, the ovarian cancer presents with the worst prognosis of all neoplasms of female reproductive organs. This review attempts to discuss some methods for early diagnosis of ovarian cancer, especially in cases with adnexal formation. The prognostic factors in the literature available influencing on patients' survival and treatment outcomes are considered.Scripta Scientifica Medica 2013; 45(2): 27-31

The role of splenectomy and distal pancreatectomy as cytoreductive procedures in ovarian cancer patients with upper abdominal involvement

Ovarian cancer has the highest mortality rate of all gynecologic cancers as 62% of cases are diagnosed at an advanced stage. The main concern in the surgical management of ovarian cancer is to achieve optimal cytoreductive surgery. Effective cytoreductive surgery at the time of initial therapy has been identified as the most important prognostic factor in the management of advanced ovarian cancer. This aggressive approach can cause unusual surgical management modalities including diaphragm stripping/resection, bowel resection, hepatic resection and splenectomy. Thus, splenectomy occasionally happens to be part of the ovarian cancer surgery.The indications and technique of splenectomy and distal pancreatectomy as cytoreductive procedures in ovarian cancer patients were described. The authors have presented the indications and techniques of splenectomy and distal pancreatectomy as cytoreductive procedures in ovarian cancer patients. Intraoperative and postoperative complications were reported in this study

Surgical staging in early ovarian cancer

Ovarian cancer can be intraoperatively staged only. This staging is based on intraoperative findings and histological postoperative result. In early-staged ovarian cancer, it is essential to exclude a higher FIGO stage as a result of intraoperative staging. This review presents the most significant aspects of the staging process and the importance of surgical treatment of early ovarian cancer.Scripta Scientifica Medica 2013; 45(2): 23-26

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Lymphovascular Space Invasion in Patients with FIGO Stage I Endometrial Endometroid Carcinoma // Инвазия в лимфните и кръвоносните съдове при ендометриален ендометроиден карцином – I стадий по FIGO

Endometrial cancer is one of the most common neoplasms of female genitalia. It is highest in postmenopausal women. It is divided into two histologic subtypes - endometrioid type 1 and nonendometroid type 2. In 70% - 80% of the cases it is diagnosed in the early stages of the disease (Stage I). Patients with Stage 1 type I have a good prognosis for survival, however, in 10-15% of them, relapses are found. In order to develop a better and more effective individualized treatment plan, it is necessary to identify the group of patients at high risk for metastases. There is an increasing evidence in literature regarding the prognostic role of lympho-vascular invasion in endometrial carcinoma in relation to patient survival. This dissertation is a retrospective study aimed at establishing the prognostic role of lympho-vascular invasion in patients with FIGO stage I endometrial endometrioid carcinoma.[BG] Ендометриалния карцином е една от най-честите неоплазми на женските гениталии. Най-голяма е честотата му при постменопаузални жени. Разделя се на два хистологични подтипа – ендометроиден тип 1 и неендометроиден тип 2. В 70% - 80% от случаите се диагностицира в ранните стадии на заболяването (I стадий). Пациентите с тип 1 в I стадий имат добра прогноза за преживяемост, въпреки това в 10-15% от тях се откриват рецидиви на болестта. За да се изгради по-добър и ефективен индивидуален план за лечение е нужно да се установи групата от пациенти имащи висок риск за възникване на метастази. В съвремието в литературата има все повече данни за прогностичната роля на лимфо-васкуларната инвазия при ендометриален карцином спрямо преживяемостта на пациентите. Дисертационния труд представлява ретроспективно проучване, чиято цел е да установи прозаичността роля на лимфо-васкуларната инвазия при пациентки с I стадий по FIGO ендометриален ендометроиден карцином

Prognostic factors in combined therapy of invasive cervical cancer IB1 Stage // Прогностични фактори при комбинирано лечение на инвазивен рак на маточната шийка IB1 стадий

[EN] This thesis examines the prognostic factors for overall and disease-free survival of patients with cervical cancer in stage IB1. Treatment of cervical cancer meets some challenges – in a few of the medical centers across the country quality surgical treatment takes place; the radiotherapy equipment is insufficient in terms of quantity and quality; no unified doctrine and universal algorithms of treatment and behavior are in place. The purpose of this thesis is to identify prognostic factors for overall and disease-free survival for patients with cervical cancer in stage IB1, and based on the above to build prognostic groups in order to create an optimal treatment approach. This is an ambispective clinical-epidemiological study including 132 patients with cervical cancer (stage IB1) diagnosed, treated and with a follow-up. The cases reviewed are from the in St. Anna’s Gynecological Clinic in Varna and the Hospital of Oncology in Varna for the period 2002-2012. The frequency distribution of demographic and clinical characteristics of the sampled patients is presented. A quantitative assessment of risk factors for overall and disease-free survival is made. The patients are separated into two groups with different levels of risk for death and three groups (low, medium and high risk) for relapse occurrence based on which a more individualized and optimum treatment of patients (for the first time in Bulgaria) is conducted. Factors influencing the occurrence of lymphatic metastasis are researched and rated quantitatively. The relationship between indicators included in the study and the emergence of post-treatment complications is part of the study as well. The thesis presents a broad view of the problematic choice of treatment approach (surgery only or surgery in combination with a radiotherapy / chemo-radio-therapeutic treatment) in patients with cervical cancer in stage IB1 and enables gynecologist-oncologists to choose the most optimal treatment depending on the postoperative histological findings without the risk of insufficient or overtreatment. Individual treatment approach is the optimal treatment approach - thanks to this dissertation gynecologist-oncologists can apply individually optimal treatment for their patients.[BG] Представеният дисертационен труд разглежда прогностичните фактори за обща и свободна от заболяване преживяемост за пациентки с рак на маточната шийка в IB1 стадий. Лечението на рака на маточната шийка среща някои предизвикателства- в малко центрове се извършва качествено хирургично лечение, липсва достатъчно в качествено и количествено отношение лъчетерапевтична апаратура, липсва единна доктрина и всеобщи алгоритми на лечение и поведение. Целта на дисертационният труд е да се установят прогностичните фактори за обща и свободна от заболяване преживяемост за пациентите с рак на маточната шийка в стадий IB1, на базата на които да се изградят прогностични групи с цел създаването на оптимален лечебен подход. За първи път в България е направено амбиспективно клинико-епидемиологично проучване обхващащо 132 пациентки с рак на маточната шийка (IB1 стадий по FIGO) диагностицирани,лекувани и проследени в Гинекологична клиника на МБАЛ "Св.Анна-Варна" АД и Онкологичен диспансер-Варна за 11 годишен период. Представено е честотното разпределение на демографските и клинични характеристики на включените в извадката пациенти Направена е количествена оценка на рисковите фактори за обща и свободна от заболяване преживяемост. Обособени са две групи с различна степен на риска за летален изход и три групи (с нисък, среден и висок риск) за възникване на рецидиви, на базата на което се детайлизира и оптимизира лечението на пациентките (за първи път в България). Изследвани и оценени в количествен аспект са факторите влияещи върху възникването на лимфни метастази. Изследвана е връзката между включените в проучването показатели и възникването на посттерапевтичните усложнения. Дисертацията дава широк поглед върху проблема за избор на лечебен подход (само хирургично лечение или хирургично + лъчетерапевтично/химио-лъчетерапевтично лечение) при пациентите с рак на маточната шийка в IB1 стадий и предоставя възможност на онкогинеколозите да подберат най-оптималното лечение в зависимост от следоперативните хистологични находки, без риск от недостатъчно или свръхлечение. Индивидуалният лечебен подход е оптималният лечебен подход - благодарение на този дисертационен труд онкогинеколозите ще могат да приложат оптимално индивидуално лечение за своите пациенти

Ultrasound in Gynaecological Emergencies

Introduction: The increased development of ultrasonography as a diagnostic tool and its safe, non-invasive, patient-accepted factors make it the preferred imaging modality for gynaecological emergencies. Since the indications of ultrasound usage are numerous, choosing the type of ultrasound depending on the clinical picture of the patient and the hospital amenities varies. Materials and Methods: The information for this scientific review was gathered using the search platform of Google Scholar using the keywords `gynaecology`, `ultrasonography`, `emergency`. All of the articles used in this review have been published in peer-reviewed journals with impact factor.Results: The safety of ultrasonography for all stages of known and unknown pregnancies make it a preferred imaging diagnostic tool for the female pelvis in general. Patients arriving with complaints of abdominal or pelvic pain and vaginal bleeding may have vastly different diagnosis despite the common symptoms, therefore, they would need a different therapy course. Ultrasound can aid in differentiating quickly and accurately among many of the causes at admission to emergency room. At the top of the list are complicated ectopic pregnancy, complicated pelvic inflammatory disease, adnexal torsion and haemoperitoneum of any gynaecological origin. Depending on the clinical indications, most of the used ultrasound types are abdominal, transvaginal, pelvis or point-care ultrasound for gynaecological emergencies. Patient care is managed actively and based on observation the treatment might be maintained or changed depending on the overall results.Conclusion: Ultrasound is among the most common diagnostic tools especially the transvaginal type, followed by medical history, clinical examination and laboratory tests. Therefore, even when it precedes other imaging tests, being competent in it is still a core skill for clinical care in both gynaecology and emergency medicine because of  its efficiency as a tool in decision making

Cytoreductive surgery for advanced-stage ovarian cancer

Usually, ovarian cancer develops asymptomatically. Nearly 30%-40% of the newly-diagnosed cases are already at III-IV stage of FIGO. In such patients, there are metastases on the peritoneum of the whole abdominal cavity. The survival rate of the patients with advanced ovarian cancer directly depends on the residual tumour after surgery. This review considers the place and role of cytoreductive surgery in the treatment of advanced ovarian carcinoma.Scripta Scientifica Medica 2012; 44(2): 11-13