Quantum-Safe Protocols and Application in Data Security of Medical Records

The use of traditional cryptography based on symmetric keys has been replaced with the revolutionary idea discovered by Diffie and Hellman in 1976 that fundamentally changed communication systems by ensuring a secure transmission of information over an insecure channel. Nowadays public key cryptography is frequently used for authentication in e-commerce, digital signatures and encrypted communication. Most of the public key cryptosystems used in practice are based on integer factorization (the famous RSA cryptosystem proposed by Rivest, Shamir and Adlemann), respectively on the discrete logarithm (in finite curves or elliptic curves). However these systems suffer from two potential drawbacks like efficiency because they must use large keys to maintain security and of course security breach with the advent of the quantum computer as a result of Peter Shor\u27s discovery in 1999 of the polynomial algorithm for solving problems such factorization of integers and discrete logarithm

Acute lithiasis cholecystitis; particularities of diagnosis and treatment in the elderly

Objectives. The incidence of acute cholecystitis increases with age, when patients usually associate additional comorbidities. Such comorbidities and the late presentation to the doctor make the treatment more complex, associating higher rates of complications. The present study aims to evaluate the methods of diagnosis and treatment applied to a group of older patients with acute cholecystitis. Materials and Methods. 585 patients were enrolled in the study between 2019 and 2023. The inclusion criteria in the study were represented by the presence of the diagnosis of acute cholecystitis in patients over 65 years of age, while patients who presented complex locoregional pathologies (trauma, cancer, etc.) were excluded. Results. In about 91% of cases, acute cholecystitis was determined by gallstones. 61.19% of cases benefited from laparoscopic cholecystectomy, the rest of the patients requiring additional procedures or open surgery. Morbidity and mortality were not significantly influenced, but some of the patients required complex interventions and longer hospital stay. Conclusions. The clinical manifestations of acute cholecystitis can be diminished in some of the elderly patients (neurological disorders, diabetes, immunosenescence, etc.), being initially appreciated as mild forms. Later it is found (by imaging or intraoperatively) that these are much more severe forms, which often require a customized therapeutic approach

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Ultrasound-based assessment of hyomental distances in neutral, ramped, and maximum hyperextended positions, and derived ratios, for the prediction of difficult airway in the obese population: a pilot diagnostic accuracy study

Background: Ultrasonography-assessed hyomental distance (HMD) ratio has been found to discriminate betweenobese patients with Cormack-Lehane grades 1 or 2 vs. those with grades 3 or 4. The aim of our study is to evaluatethe performance of the HMD evaluated ultrasonographically in neutral, ramped, and maximum hyperextended positions,as well as for the ratios obtained by dividing the HMD in the ramped position to that in the neutral position(HMDR1) and by dividing the HMD in maximum hyperextension to that in the neutral position (HMDR2), in order topredict the occurrence of Cormack-Lehane grades 3 or 4 during direct laryngoscopy. Methods: Ultrasound measurements were performed preoperatively in 25 patients with morbid obesity, measuringthe HMD in the neutral, ramped, and maximum hyperextended positions. Pre-epyglotic soft tissue thickness,Mallampati and upper lip bite test scores were recorded. Cormack-Lehane grading was considered as an outcomevariable in the Receiver Operating Characteristics curve analysis. Results: HMD in the neutral, ramped and maximum hyperextended positions presented similar sensitivities, 100%[39.8–100.0]. For HMD, specificity was 42.86% [21.8–66.0] in the neutral position, 61.9% [38.4–81.9] in the rampedpostion, and 71.4% [47.8–88.7] in the maximum hyperextended position. For HMDR1, the cut-off value was 1.12. Thisthreshold provides 75% [19.4–99.4] sensitivity and 76.2% [52.8–91.8] specificity. For HMDR2, a cut-off value of 1.23provides 100% [39.8–100.0] sensitivity and 90.5% [69.6–98.8] specificity. Conclusion: HMDR2 seems to have superior diagnostic accuracy in predicting difficult laryngoscopy in the obesepopulation compared to HMDR1, as well as compared to the HMD in the neutral, ramped, and maximum hyperextendedpositions

Comparison between Retrograde Flexible Ureteroscopy and Percutaneous Nephrolithotomy for the Treatment of Renal Stones of 2–4 cm

Background and objectives: Renal stones are widespread, with a lifetime prevalence of 10% in adults. Flexible ureteroscopy enables urologists to treat lower calyx stones or even complex renal stones through the natural orifice and achieve an acceptable stone-free rate. Hence, we analyzed the effectiveness and safety of FURS versus PCNL in treating renal stones between 20 and 40 mm in diameter. Materials and methods: We retrospectively analyzed 250 consecutive patients with large renal solitary stones (stone burden between 2 and 4 cm) from 1 January 2019 to 31 December 2020. The patients were divided into two groups: group 1 (125 patients), in which the patients were treated by a retrograde flexible ureteroscopic approach, and group 2 (125 patients), in which we used percutaneous nephrolithotomy. Stone characteristics and anatomical data were observed based on the computed tomography (CT) and/or KUB (Kidney-ureter-Bladder) radiography imaging archive. Results: The mean stone burden was 26.38 ± 4.453 mm in group 1 and 29.44 ± 4.817 mm in group 2. The stone-free rate after the first ureteroscopy was higher for the PNL(percutaneous nephrolithotomy) group (90.4%) than the F-URS group (68%). After two sessions of ureteroscopy, the SFR was 88.8% in the first group, and after three procedures, the SFR rose to 95.2%. The overall complication rate was higher in group 1 than in group 2 (18.4% vs. 16.8%), but without statistical relevance (p > 0.5). Furthermore, we encountered more grade III and IV complications in the PNL group (8.8% vs. 4.8%, p Conclusion: Flexible ureteroscopy proves to be efficient in treating renal stones over 2 cm. However, the patients must be informed that more than one procedure might be necessary to overcome the entire stone burden