A study of the pulmonary complications of preterm infants after prenatal corticosteroids prophylaxis in a major Bulgarian hospital

Abstract: An increasingly common problem in obstetrics and neonatology is premature birth. This problem is the cause of many health complications in premature neonates and is leading to neonatal mortality. These complications affect the whole body of premature babies, the respiratory system has the largest percentage due to lack of the period for intrauterine maturation of the lung. A retrospective study was carried out at the Clinic of Obstetrics and Gynecology, University Hospital St. Georgi, Plovdiv, Bulgaria for the period 2015-2016. 167 preterm infants have been studied. They were divided into two main groups: a working group of 89 preterm infants with prenatal corticosteroid prophylaxis and a control group of 78 preterm infants without prenatal prophylaxis. Data on clinical outcomes, health status, background complications of prenatal corticosteroid prophylaxis have been analyzed. The summary, however, of the results that is: the 3.6% difference has been found between newborn children with RDS and those with all other disabilities; this shows that in preterm infants the priority is to damage the respiratory system. Over 60% of the prematurity develop respiratory distress syndrome. The presence of respiratory complications is dew to the earlier gestational week of birth and the older age of the mother and is somewhat limited by the prenatal administration of corticosteroids.peer-reviewe

COMORBIDITY AND CAUSE OF DEATH IN THE DIFFERENT VARIANTS OF SARS-COV-2 VIRUS, WITH CONTRIBUTION OF 20 AUTOPSY CASES

Analyzing the clinical and epidemiological data of COVID-19 suggests that specific comorbidities increase the risk of infection leading to worse lung injury and an even higher risk of death. The most common comorbidities reported up till now are hypertension, cardiovascular diseases, and diabetes.  Aim to study: The design of the study includes comorbidity of patients and cause of death in alfa, delta, and omicron variants of SARS-CoV-2 virus, histological changes in the lungs, thrombotic complications of coronavirus infection and laboratory tests concerning thrombotic changes. Materials and Methods: We systematically evaluated 20 autopsies of patients deceased by COVID-19 infection. Collecting data was from February 28th, 2020, until June 2022. The cases were diagnosed with a PCR (Polymerase Chain Reaction) test and a rapid antigen test. 10 of the deceased patients were from the first, second, third, and fourth wave (I group) infected predominantly with the alfa and delta variants of coronavirus (from March 2020 until October 2021), and 10 patients infected after that date with predominantly the omicron variant (II group). Results: Most patients were over 50 years of age with multiple co-morbidities (28-88, average 63.9). Post-mortem case studies have shown Arterial hypertension in 80% (I/II gr), 60%/90% of patients with chronic ischemic heart disease, chronic and acute ischemic brain disease in 30%/10%, atherosclerosis, 60%/90%, diabetes mellitus 30%/40%, obesity stage III, 100%/95%). Clinical laboratory studies, in connection with thrombotic complications, revealed the increased value of creatine kinase, fibrinogen, D-dimers, and CRP. Lymphopenia was observed in 60%. All of the cases with COVID-19 viral desquamative pneumonia, at different stages, developed vascular thrombosis in medium-sized pulmonary vessels. Two patients developed pulmonary thromboembolism. We established 5 patients with generalized thrombosis. Three patients were complicated by infarcts in the brain, kidney, and spleen.  Conclusion: The autopsies revealed a consistent pattern of pulmonary alveolar damage and generalized vascular/thrombotic disease in patients with frequent co-morbidities. The high frequency of generalized thrombotic complications was observed in predominant alfa and delta variants of the infection, while in the group with the omicron prevailing variant, the lung lesions were dominant, without extrapulmonary thrombotic complications, which we explain by the effective antithrombotic therapy. Major complications in these patients were secondary bacterial infection, sepsis, and respiratory distress syndrome

How different strains of COVID-19 affect LUTS in BPH patients?

In late 2019, an outbreak of pneumonia of unknown etiology was reported in Wuhan (China). The causative agent was quickly identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the impact of COVID-19 (coronavirus disease 2019) on various organs and symptoms has been studied, there is still a dearth of data regarding its effect on the genitourinary system. In this study, we investigated the impact of different COVID-19 strains on lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH). A total of 69 patients who had previously been infected with COVID-19 from August 2021 to October 2021 and January 2022 to May 2022 were assessed. The two periods were purposively selected based on the dominant COVID-19 variant: the Delta strain for the first period and Omicron for the second, respectively. All patients had BPH and were followed up in two outpatient practices. Demographic information was collected, and LUTS were assessed using the international prostate symptom score (IPSS) questionnaires before and after COVID-19. Ultrasound examinations were performed to determine the prostate gland volume and the post-voided residual (PVR) in each patient. All patients affected by COVID-19 exhibited a worsening of LUTS. The degree of deterioration differed between those infected with different COVID-19 strains. Patients infected with the Delta strain had more severe LUTS than those with the Omicron strain. There is currently limited information available regarding the emerging pathophysiological processes in the urogenital system related to COVID-19. This present study serves as a preliminary investigation into the impact of COVID-19 on LUTS in BPH patients and could serve as a basis for more extensive multicenter studies leading to fundamental discoveries

Estimating reference values of parenchymal stiffness of normal pancreatic parenchyma by means of point shear wave elastography

Introduction: There are numerous imaging modalities available to describe pancreatic parenchyma. None of the broadly accepted diagnostic methods uses elasticity as an indicator of tissue damage. Aim: The aim of the present study was to establish reference values of parenchymal stiffness of normal pancreatic parenchyma through point shear wave elastography. Materials and methods: The design of the study is prospective single-center cohort study. Sixty patients were included in the study. The ultrasound-based point shear wave elastography (pSWE) imaging technique was applied. The mean and median shear wave velocity values of the pancreatic parenchyma in the head, body and tail were calculated. The influence of certain variables on the shear wave velocity (SWV) values was estimated. Results: A reference range for the entire pancreatic parenchyma of 0.66-1.62 m/s and a mean value of 1.17±0.22 m/s were calculated. Apart from age, none of the evaluated factors proved to have statistically significant influence on the obtained results. A measurement success rate of 94.5%, 97.2%, and 95.8% was established for the head, body, and tail of the pancreas, respectively. Transabdominal pSWE could be utilized for assessment of pancreatic parenchyma with high success rate. A mean value of 1.17 m/s was measured which is consistent with the existing literature on the matter. None of the external factors examined in the study, apart from age, was found to have statistically significant influence on the SWV values. Conclusions: The obtained results suggest that pSWE is a highly objective method for evaluating pancreatic parenchyma. Calculated reference range and mean values could be used in future studies to assess the capabilities of the method for differentiating between normal pancreatic parenchyma and diffuse and focal pancreatic disorders

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Analysis of Pathology in Premature Infants in Obstetrics and Gynecology Clinic at St George University Hospital, Plovdiv between 2013 and 2015

Introduction: Premature birth is now one of the most profound prenatal problems worldwide because of the high morbidity and mor-tality it is associated with at the beginning of life. Advances in prenatal medicine over the past decades have led to a significant improve-ment of neonatal survival in risk groups of newborns. Infants of gestational age of 22-25 weeks represent the greatest medical, social, and ethical dilemma in neonatology. Most of these newborns need intensive care to survive, and most infants born between 28 and 32 weeks of gestation require special care. Those born 34 to 36 weeks’ gestation also have higher rates of short-term morbid premature birth-related conditions such as respiratory distress syndrome (RDS) and intraventricular hemorrhage (IVH) than their peers born at term.Aim: To carry out an analysis of morbidity during the neonatal period in premature babies.Materials and methods: A retrospective triennial study was conducted on 598 premature newborns.Results: The results of the study show that morbidity rate in premature born infants is high. The most frequent reasons for admission to the neonatal intensive care unit are the other forms of respiratory distress syndrome (45%). Respiratory distress syndrome (RDS) was observed in 23.41% of the prematurity, 10.7% of them were suspected of having other pathology, and 20.9% of premature neonates  manifested no complications in the neonatal period. There was a significant difference in the diagnosis of newborns after birth (p=0.0001, r=0.58), with the newborns with RDS demonstrating the most complications in the neonatal period.Conclusions: The conclusions to be drawn from the analysis of the data are as follows: there is wide comorbidity in the prematurity of RDS. Lower gestational age strongly correlates with the development of RDS. If no corticosteroid therapy is administered the risk of developing hyaline membrane disease increases. There is extremely high probability of neonatal mortality in children with hyaline membrane disease. There is significant difference between the primary diagnosis and the condition of the child at discharge from the medical establishment. Adequate and specialized prenatal care is essential when trying to reduce the incidence of preterm birth

Conventional and digital pleural drainage systems – advantages and disadvantages

Introduction: Pleural cavity drainage is a crucial component of the surgical management of patients with various chest diseases. Digital drainage systems are increasingly used in contemporary thoracic surgical procedure, which is likely a result of their effectiveness in achieving early postoperative ambulation, cutting down on hospital stays and lowering costs. The vast majority of thoracic surgeons worldwide prefer digital drainage systems to traditional ones. The advantages of the former, however, are disputed by some researchers. Aim: The objective of this study was to compare the two types of pleural drainage mechanisms, conventional and digital, in terms of duration of pleural drainage in days, financial cost, and postoperative air leak duration. Materials and methods: The study focused on 80 patients who underwent various thoracic surgical interventions in the Clinic of Thoracic and Abdominal Surgery at St George University Hospital in Plovdiv. They were divided into two groups: group 1 consisted of 42 patients who were postoperatively attached to a conventional non-mobile pleural drainage system, and group 2 consisted of 38 patients in whom a mobile digital pleural drainage system was used. The main analyzed data were duration of pleural drainage, duration of postoperative air leak, hospital stay, and financial costs. Results: The average duration of pleural drainage, regardless of surgery and type of drainage system applied was 4.86±0.8 days. The average duration of pleural drainage in patients attached to the mobile digital drainage system was shorter than that in patients with a conventional pleural non-mobile drainage system, regardless of the type of surgery done. This difference was statistically significant in favor of the digital pleural drainage system. The study also found a statistically significant difference in terms of financial costs in favor of digital draining system. The average cost of a hospital stay for patients attached to a mobile digital drainage system was BGN 119.40±7.15, whereas the average cost of a hospital stay for patients connected to a traditional pleural drainage system (PDS) was BGN 159±10.50. Regarding the duration of postoperative air leak, the difference between the types of pleural drainage mechanism used was not convincing. Conclusions: Digital pleural drainage systems provide clinicians with an opportunity to assess the postoperative air leak more precisely, track its dynamics, shorten hospital stays, reduce postoperative costs, and optimize the time to remove the chest drain. Based on these features, they will undoubtedly continue to enter everyday surgical practice

Advantages and disadvantages of laparoscopic inguinal hernia repair (hernioplasty)

Aim: The aim of this study was to explore the advantages and disadvantages of laparoscopic hernioplasty by comparing them with conventional surgeries. Materials and methods: The study included 376 patients (344 men and 32 women) who underwent inguinal hernia repair in inpatient settings over a 3-year period (2017–2020). The patients were divided into two groups: patients with conventional hernioplasty (CH) - 312 patients (291 men and 32 women, mean age 55±15 years, range 18–93) and 64 patients with laparoscopic hernioplasty (LH), all of them middle-aged men at mean age 45±15 years (range 24–69). Results: Thirty-eight patients (59.38%) with LH were ASA class 1 patients while the CH patients were stratified in ASA classes 1 to 4. The LH group consisted of 39 patients who had transabdominal preperitoneal (TAPP) surgery and 25 who received total extraperitoneal (TEP) repair. The average operating time was 12 minutes (range 90–200 min) for TAPP and 50 minutes (range 20-125 min) for TEP. The mean intensity of pain score measured by VAS (0-10) was 4 (2-5) for CH patients and 3 (2-4) for LH patients. The duration of pain was 3 days (2-4) for CH patients and 2 days (1-3) for the LH group. Ninety-five percent (61/64) of LH patients defined their quality of life as “better”. Conclusions: The following factors are of particular importance for the choice of hernioplastic technique: operating time, possible intraoperative complications, the level of postoperative pain and potential postoperative analgesics, possible complications, patient recovery, length of hospital stay, cost, quality of life, and long-term results of the treatment

Catecholamine-induced cardiomyopathy – a clinical case

A 27-year-old patient presented with a 3-month history of episodic headaches and persistently rising blood pressure (up to 240/120). The clinical, laboratory, and instrumental findings (episodes of severe hypertension, increased levels of metanephrine in urine, and MRI showing a mass of 5.1×5.5 cm in diameter) led us to the diagnosis of pheochromocytoma of the right adrenal grand. Preoperative medication included alpha blockers, calcium channel blockers, and plasma. The right adrenal gland was completely removed using the retroperitoneal access. During the extraction of the tumour, a ventricular tachycardia was recorded after which acute heart failure issued. In the first few hours, echocardiographic imaging showed a reduced EF of 9% – catecholamine-induced cardiomyopathy. The patient underwent a complex and adequate reanimation in the intensive care unit which lasted 20 days. A slow but steady increase in the ejection fraction along with a decrease in congestion was observed. Magnetic resonance imaging was used to confirm the normalisation of myocardial morphology. A German histological laboratory was used to confirm the benign form of the tumour. For the next three months, the patient was on a standard therapy with beta blockers, angiotensin-converting-enzyme inhibitor and mineralocorticoid antagonists. Тhe catecholamine surge during the removal of a large pheochromocytoma could lead to severe cardio-vascular complication, even with a complete and adequate preoperative protective medication. The reversibility of the process implies the necessity of an adequate and timely postoperative treatment for a complete involution of the pathomorphological changes

Advantages and disadvantages of laparoscopic inguinal hernia repair (hernioplasty)

Aim: The aim of this study was to explore the advantages and disadvantages of laparoscopic hernioplasty by comparing them with conventional surgeries. Materials and methods: The study included 376 patients (344 men and 32 women) who underwent inguinal hernia repair in inpatient settings over a 3-year period (2017–2020). The patients were divided into two groups: patients with conventional hernioplasty (CH) - 312 patients (291 men and 32 women, mean age 55±15 years, range 18–93) and 64 patients with laparoscopic hernioplasty (LH), all of them middle-aged men at mean age 45±15 years (range 24–69). Results: Thirty-eight patients (59.38%) with LH were ASA class 1 patients while the CH patients were stratified in ASA classes 1 to 4. The LH group consisted of 39 patients who had transabdominal preperitoneal (TAPP) surgery and 25 who received total extraperitoneal (TEP) repair. The average operating time was 12 minutes (range 90–200 min) for TAPP and 50 minutes (range 20-125 min) for TEP. The mean intensity of pain score measured by VAS (0-10) was 4 (2-5) for CH patients and 3 (2-4) for LH patients. The duration of pain was 3 days (2-4) for CH patients and 2 days (1-3) for the LH group. Ninety-five percent (61/64) of LH patients defined their quality of life as “better”. Conclusions: The following factors are of particular importance for the choice of hernioplastic technique: operating time, possible intraoperative complications, the level of postoperative pain and potential postoperative analgesics, possible complications, patient recovery, length of hospital stay, cost, quality of life, and long-term results of the treatment