Martius' flap for recurrent perineal and rectovaginal fistulae in a patient with Crohn's disease, endometriosis and a mullerian anomaly

Background: Rectovaginal fistulas represent 5% of all anorectal fistulae and are a disastrous manifestation of Crohn's disease that negatively affects patients' social and sexual quality of life. Treatment remains challenging for colorectal surgeons, and the recurrence rate remains high despite the numerous available options. Case presentation: We describe a 31-year-old female patient with a Crohn's disease-related recurrent perineo-vaginal and recto-vaginal fistulae and a concomitant mullerian anomaly. She complained of severe dyspareunia associated with penetration difficulties. The patient's medical history was also significant for a previous abdominal laparoscopic surgery for endometriosis for the removal of macroscopic nodules and a septate uterus with cervical duplication and a longitudinal vaginal septum. The patient was successfully treated using a Martius' flap. The postoperative outcome was uneventful, and no recurrence of the fistula occurred at the last follow-up, eight months from the closure of the ileostomy. Conclusion: Martius' flap was first described in 1928, and it is considered a good option in cases of rectovaginal fistulas in patients with Crohn's disease. The patient should be referred to a colorectal centre with expertise in this disease to increase the surgical success rate

The Role of Management Information Systems (MIS) in Improving Hospital Service Efectiveness and Efficiency

The development and progress of information technology are overgrowing today. Application systems in various fields are a must for an agency/company to utilize information as a basis for administration and data processing, including in hospitals. The goal of this study was to see how effective the Hospital Information System (HIS) was at improving the efficiency of health care. In the 2010-2021 time frame, the research method was a literature review related to HIS in improving the effectiveness and efficiency of hospital services. Databases used include Sciencedirect, PUBMED, Google Scholar, and Researchgate. Researchers used a thematic structure based on thinking to collect literature review data, organized by grouping and discussing literature sources according to the issue. The keywords used are "hospital information system," "information system effectiveness and efficiency," and "healthcare effectiveness and efficiency." The findings of this study show that HIS can reduce the complexity of health services by increasing the effectiveness and efficiency of a hospital as an organization through innovation in developing information systems. The results are business process redesign, automation of service flows, paradigm shifts, cost reduction, improved hospital performance, and improving the quality of human resources, organizational development, and technology to achieve effectiveness and efficiency in-hospital services. Nevertheless, there are still some obstacles to implementing HIS in Indonesia. These obstacles are mainly in terms of infrastructure and human resources. Organizational policies are expected to be more in favor of increasing the use of HIS in the future.Keywords: Hospital information systems, healthcare, effectiveness and efficienc

Metode Komunikasi Dengan Generasi Milenial Dalam Membentuk Sumber Daya Manusia Yang Berkarakter pada Masyarakat Baros, Sukabumi, Jawa Barat

Pengabdian ini berjudul Metode Komunikasi Dengan Generasi Milenial Dalam   Membentuk Sumber Daya Manusia yang Berkarakter  Pada Masyarakat Baros. Sukabumi, Jawa Barat. Tujuan umum dari kegiatan pengabdian kepada masyarakat ini adalah Memberikan pelatihan dan pengetahuan secara praktis ilmu manajemen dan metode komunikasi pada anak yang berdampak pada pembentukan karakter anak sejak dini. Generasi Millenial adalah mereka yang lahir antara 1982 – 1994 (ada juga yang menyebutkan sampai sebelum tahun 2000). Generasi Millenial telah mendapatkan perhatian yang tinggi di dunia kerja. Generasi ini lebih menyukai telepon seluler daripada PC atau TV. Karena generasi ini lahir di era dimana teknologi sudah sangat berkembang dan canggih. Bagaimana cara menjalin komunikasi dengan generasi milenial yang mempunya karaktersitik berbeda dengan generasi saat ini atau bahkan generasi sebelumnya yang menyebabkan kesulitan berkomunikasi atau bahkan misscommunication. Pada akhirnya karakter anak inilah yang akan membawa mereka berbaur dengan masyarakat, sehingga diperlukan pemahaman sejak dini bagaimana berkomunikasi dengan anak yang sudah berbeda generasi dengan orang tua mereka. Studi ini dilakukan di lingkungan masyarakat Baros Kota Sukabumi.Kata Kunci: Manajemen, Metode Komunikasi, Sumber Daya Manusia Berkarakter This service is entitled Communication Methods With Millennial Generations in Forming Character Human Resources in the Baros Society. Sukabumi, West Java. The general purpose of this community service activity is to provide training and practical knowledge of management science and communication methods to children which have an impact on the formation of children's character from an early age. Millennials are those born between 1982 – 1994 (some say before 2000). Millennials have received high attention in the world of work. This generation prefers cell phones over PCs or TVs. Because this generation was born in an era where technology is very developed and sophisticated. How to establish communication with the millennial generation who have different characteristics from the current generation or even the previous generation which causes communication difficulties or even miscommunication. In the end, it is this child's character that will bring them into the community, so an early understanding is needed on how to communicate with children who are already different generations from their parents. This study was conducted in the Baros community, Sukabumi City.Keywords: Management, Method of Communication, Character Human Resource

Hydraulic Design of Way Kandis River Embankment (Case Studies at the Lampung State Polytechnic River Section)

Flooding is a condition where there is overload of water in the channel or inhibition of water flow to the drainage channel, so the overflow of water inundated the surround area. Embankment is defined as a waterwork which it was used to reduced or prevented the overtoping of water. The purpose of this study were (1) determine the plan flooding discharge of Way Kandis river, (2) made the hydraulic design of Way Kandis River embankment segment Polinela. Steps of research activities were the preparation, survey and topographical measurements, collected hydrological data,  processed of topography and hydrology data, counted the design maximum discharge, design of embankment river. The results showed that (1) the design discharge of  return period 25 years was 29.13 m³/s, (2) the result of hydraulic design of Way Kandis River embankment at the POLINELA segment were the design channel capacity by 30.18 m3/s, the base width of the channel (b) by 5.1 m, the depth of flow (h) by 1.7 m, the slope embankment (1:m) by 1:2, height of freeboard by 0.5 m. Keywords: hidraulic design of embankment,  plan of  flooding discharge, design of channel capacit

Qual a influência do oxigênio em alta concentração na câmara hiperbárica no metabolismo ósseo?

Objectives: To know the actions of oxygen in high concentration in the hyperbaric chamber (HC) in the expression of genes related to bone metabolism in osteoblastic cell lines and human trabecular bone. Material and methods: The differential expression of several genes related to bone metabolism (SOST, RUNX2, MMP14, OPG, HIF-1α and SIRT1) was analyzed in two cell lines of human osteoblasts (Saos and Super-Saos) and in bone fragments human trabecular submitted to one, three or five sessions of CH (90 minutes, 100% oxygen; 2.3 atmospheres). A control that did not receive CH was used in each experiment. Results: We found no significant differences after CH in the expression of the studied genes, neither in cells nor in trabecular bone. Only in the Super-Saos strain did OPG expression decrease after 5 CH sessions 6 times compared to the control group (2 -ΔCt of 72; p = 0.01). Conclusions: Oxygen in high concentrations in the hyperbaric chamber does not appear to influence the expression of genes related to bone metabolism.Objetivos: Conhecer as ações do oxigênio em alta concentração na câmara hiperbárica (HC) na expressão de genes relacionados ao metabolismo ósseo em linhagens de células osteoblásticas e osso trabecular humano. Material e métodos: A expressão diferencial de vários genes relacionados ao metabolismo ósseo (SOST, RUNX2, MMP14, OPG, HIF-1α e SIRT1) foi analisada em duas linhagens celulares de osteoblastos humanos (Saos e Super-Saos) e em fragmentos de osso trabecular humano submetidos a uma, três ou cinco sessões de CH (90 minutos, oxigênio a 100%; 2,3 atmosferas). Um controle que não recebeu CH foi usado em cada experimento. Resultados: Não encontramos diferenças significativas após o CH na expressão dos genes estudados, nem nas células nem no osso trabecular. Apenas na linhagem Super-Saos a expressão de OPG após 5 sessões de CH diminuiu 6 vezes em relação ao grupo controle (2 -ΔCt de 72; p = 0,01). Conclusões: O oxigênio em altas concentrações na câmara hiperbárica não parece influenciar a expressão de genes relacionados ao metabolismo ósseo

Short-Term Outcomes of Polycarbophil and Propionibacterium acnes Lysate Gel after Open Hemorrhoidectomy. A Prospective Cohort Study

Background: Pain is the most common complication after open excisional hemorrhoidectomy (OEH). We assessed the effectiveness of polycarbophil and Propionibacterium acnes lysate gel (Emorsan(R)Gel) on pain control after OEH. Research design and methods: Fifty consecutive patients undergoing OEH were included. All patients received stool softeners and oral analgesia in the post-operative period. Emorsan(R)Gel was also used topically by the last 25 patients (Emorsan(R)Gel group (EG)) until Post-Operative Day 20 (POD 20). The primary outcome was the effectiveness of Emorsan(R)Gel on pain relief using an 11-point visual analogue scale (VAS). Morbidity, wound healing (WH), and time to work were documented at POD 1, POD 10, POD 20, and POD 40. Results: Of the 50 patients enrolled, twenty-eight (56%) were males; median age, 49 (range, 28-73) years. The VAS score decreased over time in all patients, with significantly lower scores at POD 20 in the EG (1.44 (SD, 1.16) vs. 2.12 (0.93) in the control group (CG); p = 0.045). All patients in the EG achieved complete WH at last follow-up, compared to only 17 (68%) in the CG (p = 0.004). The likelihood of WH was 66% higher in the EG (OR, 1.66 [95%CI, 0.80-3.44; p = 0.172). Conclusions: Emorsan(R)Gel is safe and effective at reducing pain after EOH, promoting earlier WH compared to standard care treatment

Mesoglycan for pain control after open excisional HAEMOrrhoidectomy (MeHAEMO). An observational multicentre study on behalf of the Italian Society of Colorectal Surgery (SICCR)

Background: Excisional haemorrhoidectomy is the gold standard technique in patients with III and IV degree haemorrhoidal disease (HD). However, it is associated with a significant rate of post-operative pain. The aim of our study was to evaluate the efficacy of mesoglycan in the post-operative period of patients who underwent open excisional diathermy haemorrhoidectomy (OEH). Methods: This was a retrospective multicentre observational study. Three hundred ninety-eight patients from sixteen colorectal referral centres who underwent OEH for III and IV HD were enrolled. All patients were followed-up on the first post-operative day (T1) and after 1 week (T2), 3 weeks (T3) and 6 weeks (T4). BMI, habits, SF-12 questionnaire, VAS at rest (VASs), after defecation (VASd), and after anorectal digital examination (VASe), bleeding and thrombosis, time to surgical wound healing and autonomy were evaluated. Results: In the mesoglycan group, post-operative thrombosis was significantly reduced at T2 (p < 0.05) and T3 (p < 0.005), and all patients experienced less post-operative pain at each time point (p < 0.001 except for VASe T4 p = 0.003). There were no significant differences between the two groups regarding the time to surgical wound healing or post-operative bleeding. There was an early recovery of autonomy in the mesoglycan group in all three follow-up periods (T2 p = 0.016; T3 p = 0.002; T4 p = 0.007). Conclusions: The use of mesoglycan led to a significant reduction in post-operative thrombosis and pain with consequent early resumption of autonomy. Trial registration NCT0448169

Altered Fecal Small RNA Profiles in Colorectal Cancer Reflect Gut Microbiome Composition in Stool Samples

Dysbiotic configurations of the human gut microbiota have been linked to colorectal cancer (CRC). Human small noncoding RNAs are also implicated in CRC, and recent findings suggest that their release in the gut lumen contributes to shape the gut microbiota. Bacterial small RNAs (bsRNAs) may also play a role in carcinogenesis, but their role has been less extensively explored. Here, we performed small RNA and shotgun sequencing on 80 stool specimens from patients with CRC or with adenomas and from healthy subjects collected in a cross-sectional study to evaluate their combined use as a predictive tool for disease detection. We observed considerable overlap and a correlation between metagenomic and bsRNA quantitative taxonomic profiles obtained from the two approaches. We identified a combined predictive signature composed of 32 features from human and microbial small RNAs and DNA-based microbiome able to accurately classify CRC samples separately from healthy and adenoma samples (area under the curve [AUC] = 0.87). In the present study, we report evidence that host-microbiome dysbiosis in CRC can also be observed by examination of altered small RNA stool profiles. Integrated analyses of the microbiome and small RNAs in the human stool may provide insights for designing more-accurate tools for diagnostic purposes.IMPORTANCE The characteristics of microbial small RNA transcription are largely unknown, while it is of primary importance for a better identification of molecules with functional activities in the gut niche under both healthy and disease conditions. By performing combined analyses of metagenomic and small RNA sequencing (sRNA-Seq) data, we characterized both the human and microbial small RNA contents of stool samples from healthy individuals and from patients with colorectal carcinoma or adenoma. With the integrative analyses of metagenomic and sRNA-Seq data, we identified a human and microbial small RNA signature which can be used to improve diagnosis of the disease. Our analysis of human and gut microbiome small RNA expression is relevant to generation of the first hypotheses about the potential molecular interactions occurring in the gut of CRC patients, and it can be the basis for further mechanistic studies and clinical test