Risk factors in appearance of acute appendicitis complications

Catedra de chirurgie nr. 2, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Apendicita acută reprezintă cea mai frecventă urgenţă chirurgicală, iar complicaţiile sale intraabdominale continuă să determine o mortalitate postoperatorie constantă. Scopul: studierea factorilor de risc ai evoluţiei complicaţiilor apendicitei acute. Material şi metode: Studiul include analiza rezultatelor tratamentului chirurgical al 449 bolnavi, operaţi în aa.2015-2017 şi divizaţi în 2 grupe: 117 pacienţi cu complicaţii ale apendicitei acute (intra- şi extraabdominale) şi 332 bolnavi cu apendicită acută necomplicată. Rezultate: În grupa cu apendicită acută complicată (AAC) s-a constatat o predominare a femeielor cu o rată de 1,60 comparativ cu 1,26 în grupa cu apendicită acută necomplicată (AAN). Rata persoanelor cu vîrstă > 60 ani a fost semnificativ mai mare în cazul AAC- 23,1%, fiind doar 3,9% în AAN. În cazul AAC s-a consemnat o tergiversare în adresare, termenul debut- adresare fiind mult mai mare comparativ cu grupa AAN. Statutul socio-economic jos a avut un impact negativ semnificativ asupra evoluţiei apendicitei acute şi complicaţiilor ei, la fel asupra rezultatelor apendicectomiei. Pacienţii neasiguraţi (n=59, 49,6%) au format practic jumătate din grupa AAC. Comorbidităţi asociate au fost stabilite în 76(16,9%) observaţii, respectiv în AAC- 21,4% vs. 15,4% în AAN. În sumar am notat, că prezenţa comorbidităţilor asociate necorijate de regulă au avut un impact negativ asupra evoluţiei apendicitei acute. Concluzii: Rezultatele noastre sugestă, că evaluările clinice sunt cele mai importante pentru identificarea persoanelor cu risc de evoluţie a complicaţiilor apendicitei acute, iar factorii de risc sus-menţionaţi sunt utili în deciziile chirurgicale de urgenţă.Background: Acute appendicitis is the most frequency surgical emergency, and its intraabdominal complications continue to determine the constant postoperative mortality. Aim of the study: To study the risk factors of the development of acute appendicitis (AA) complications. Methods and materials: The research included 449 patients with AA treated surgically during 2015-2017 divided into 2 groups: 117 patients who were admitted with complicated appendicitis (intra- and extraabdominal complications) and 332 patients with noncomplicated AA were randomly selected from the same period. Results: In the group complicated acute appendicitis (CAA), there was a predominance of women with a ratio of 1.60 versus 1.26 in the uncomplicated acute appendicitis group (NAA). The proportion of people aged > 60 years was significantly higher in the case of CAA-23.1%, while in uncomplicated AA it was only 3.9%. In the case of AA complications, there was an emphasis on late addressing, the debut-addressing term being higher compared to uncomplicated AA. The low socio-economic status has a significant negative impact on the evolution of AA and its complications, as well as on the results of apendectomy. Thus, uninsured patients (n=59, 49.6%) formed almost half of CAA group. Associated comorbidities were established in 76 or 16.9% of cases, respectively in CAA-21.4% vs 15.4% in NAA group. In summary we note that the presence of associated uncorrected comorbidities has an obvious negative impact on the development of AA. Conclusion: Our findings suggest that clinical assessment is most important for identifying individuals at risk of developing complications of AA and the above-mentioned risc factors are useful for emergency surgical decisions

Stable bundles on hypercomplex surfaces

A hypercomplex manifold is a manifold equipped with three complex structures I, J, K satisfying the quaternionic relations. Let M be a 4-dimensional compact smooth manifold equipped with a hypercomplex structure, and E be a vector bundle on M. We show that the moduli space of anti-self-dual connections on E is also hypercomplex, and admits a strong HKT metric. We also study manifolds with (4,4)-supersymmetry, that is, Riemannian manifolds equipped with a pair of strong HKT-structures that have opposite torsion. In the language of Hitchin's and Gualtieri's generalized complex geometry, (4,4)-manifolds are called ``generalized hyperkaehler manifolds''. We show that the moduli space of anti-self-dual connections on M is a (4,4)-manifold if M is equipped with a (4,4)-structure.Comment: 17 pages. Version 3.0: reference adde

Abordarea in echipa mixta chirurgicala a pacientilor cu patologii asociate

Spitalul Clinic de Urgenţă “Bagdasar-Arseni”, Bucureşti, România, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Legate de patologia specialitatii de chirurgie plastica exista uneori cazuri acute (politraumatisme), sau cronice (tumori), care pentru a putea fi tratate corect, complet si cu maximum de profesionalism, trebuie sa fie abordate in echipe mixte, interdisciplinare. Este cazul traumatismelor grave de membre (respectiv a fracturilor deschise Gustillo IIIC), in care cooperarea plastician –ortoped este importanta pentru recuperarea functionala cat mai buna si cat mai grabnica a membrului lezat. Sau al traumatismelor craniofaciale cu distrugeri de parti moi, fracturi ale viscerocraniului, dilacerari craniocerebrale, in care interventia rapida si concomitenta a neurochirurgului, plasticianului si eventual al OMF-istului creste semnificativ nu numai sansa de supravietuire, dar si rezultatul estetic si functional. De asemenea este cazul reconstructiilor imediate de san dupa excizia partial sau totala pentru tumori mamare, in care chirurgul generalist rezeca tumora sau sanul, iar plasticianul il reconstruieste in aceeasi interventie chirurgicala. Chirurgul toracic si plasticianul pot rezolva tumori de perete toracic, penetrante in mediastin, care necesita nu numai o rezectie completa, dar si o reconstructie imediata de perete toracic, menita sa protejeze organele mediastinale.Reconstructia mandibulara si a etajului facial inferior in cazul unor tumori extinse la acest nivel, precum si reconstructiile cervicale anterioare dupa tumori laringiene sau faringiene extinse reprezinta de asemenea exemple in care ORL-istul sau OMF-istul are nevoie de sprijinul unui plastician .Cazuistica care va fi prezentata in lucrare, care apartine colectivului clinicii de chirurgie plastica din Spitalul Clinic de Urgenta “Bagdasar-Arseni”, va exemplifica si sustine rolul benefic al cooperarii disciplinelor chirurgicale avand ca unic scop rezolvarea cazurilor complexe in conditii de siguranta maxima, cu traume cat mai mici pentru pacient si cu rezultat final optim

Study Protocol for an Online Questionnaire Survey on Symptoms/Signs, Protective Measures, Level of Awareness and Perception Regarding COVID-19 Outbreak among Dentists. A Global Survey

The Centres for Disease Control and Prevention and the World Health Organization have developed preparedness and prevention checklists for healthcare professionals regarding the containment of COVID-19. The aim of the present protocol is to evaluate the impact of the COVID-19 outbreak among dentists in different countries where various prevalence of the epidemic has been reported. Several research groups around the world were contacted by the central management team. The online anonymous survey will be conducted on a convenience sample of dentists working both in national health systems and in private or public clinics. In each country/area, a high (~5–20%) proportion of dentists working there will be invited to participate. The questionnaire, developed and standardized previously in Italy, has four domains: (1) personal data; (2) symptoms/signs relative to COVID-19; (3) working conditions and PPE (personal protective equipment) adopted after the infection’s outbreak; (4) knowledge and self-perceived risk of infection. The methodology of this international survey will include translation, pilot testing, and semantic adjustment of the questionnaire. The data will be entered on an Excel spreadsheet and quality checked. Completely anonymous data analyses will be performed by the central management team. This survey will give an insight into the dental profession during COVID-19 pandemic globally

ARMC9 and TOGARAM1 define a Joubert syndrome-associated protein module that regulates axonemal post-translational modifications and cilium stability

Joubert syndrome (JBTS) is a recessive neurodevelopmental ciliopathy, characterized by a pathognomonic hindbrain malformation. All known JBTS-genes encode proteins involved in the structure or function of primary cilia, ubiquitous antenna-like organelles essential for cellular signal transduction. Here, we use the recently identified JBTS-associated protein ARMC9 in tandem-affinity purification and yeast two-hybrid screens to identify a novel ciliary module composed of ARMC9-TOGARAM1-CCDC66-CEP104- CSPP1. TOGARAM1-variants cause JBTS and disrupt its interaction with ARMC9. Using a combination of protein interaction analyses and characterization of patient-derived fibroblasts, CRISPR/Cas9-engineered zebrafish and hTERT-RPE1 cells, we demonstrate that dysfunction of ARMC9 or TOGARAM1 results in short cilia with decreased axonemal acetylation and glutamylation, but relatively intact transition zone function. Aberrant serum-induced ciliary resorption and cold-induced depolymerization in both ARMC9 and TOGARAM1 patient cells lines suggest a role for this new JBTS-associated protein complex in ciliary stability

Clinical Presentation of Patients with Ebola Virus Disease in Conakry, Guinea

BACKGROUND: In March 2014, the World Health Organization was notified of an outbreak of Zaire ebolavirus in a remote area of Guinea. The outbreak then spread to the capital, Conakry, and to neighboring countries and has subsequently become the largest epidemic of Ebola virus disease (EVD) to date. METHODS: From March 25 to April 26, 2014, we performed a study of all patients with laboratory-confirmed EVD in Conakry. Mortality was the primary outcome. Secondary outcomes included patient characteristics, complications, treatments, and comparisons between survivors and nonsurvivors. RESULTS: Of 80 patients who presented with symptoms, 37 had laboratory-confirmed EVD. Among confirmed cases, the median age was 38 years (interquartile range, 28 to 46), 24 patients (65%) were men, and 14 (38%) were health care workers; among the health care workers, nosocomial transmission was implicated in 12 patients (32%). Patients with confirmed EVD presented to the hospital a median of 5 days (interquartile range, 3 to 7) after the onset of symptoms, most commonly with fever (in 84% of the patients; mean temperature, 38.6°C), fatigue (in 65%), diarrhea (in 62%), and tachycardia (mean heart rate, \u3e93 beats per minute). Of these patients, 28 (76%) were treated with intravenous fluids and 37 (100%) with antibiotics. Sixteen patients (43%) died, with a median time from symptom onset to death of 8 days (interquartile range, 7 to 11). Patients who were 40 years of age or older, as compared with those under the age of 40 years, had a relative risk of death of 3.49 (95% confidence interval, 1.42 to 8.59; P=0.007). CONCLUSIONS: Patients with EVD presented with evidence of dehydration associated with vomiting and severe diarrhea. Despite attempts at volume repletion, antimicrobial therapy, and limited laboratory services, the rate of death was 43%

Programme Dementia Prevention (pdp): A Nationwide Program for Personalized Prevention in Luxembourg.

peer reviewedBACKGROUND: With continuously aging societies, an increase in the number of people with cognitive decline is to be expected. Aside from the development of causative treatments, the successful implementation of prevention strategies is of utmost importance to reduce the high societal burden caused by neurodegenerative diseases leading to dementia among which the most common cause is Alzheimer's disease. OBJECTIVE: The aim of the Luxembourgish "programme dementia prevention (pdp)" is to prevent or at least delay dementia in an at-risk population through personalized multi-domain lifestyle interventions. The current work aims to provide a detailed overview of the methodology and presents initial results regarding the cohort characteristics and the implementation process. METHODS: In the frame of the pdp, an extensive neuropsychological evaluation and risk factor assessment are conducted for each participant. Based on the results, individualized multi-domain lifestyle interventions are suggested. RESULTS: A total number of 450 participants (Mean age = 69.5 years; SD = 10.8) have been screened at different recruitment sites throughout the country, among whom 425 participants (94.4%) met the selection criteria. CONCLUSIONS: We provide evidence supporting the feasibility of implementing a nationwide dementia prevention program and achieving successful recruitment of the target population by establishing a network of different healthcare providers.3. Good health and well-bein

A Controversy That Has Been Tough to Swallow: Is the Treatment of Achalasia Now Digested?

Esophageal achalasia is a rare neurodegenerative disease of the esophagus and the lower esophageal sphincter that presents within a spectrum of disease severity related to progressive pathological changes, most commonly resulting in dysphagia. The pathophysiology of achalasia is still incompletely understood, but recent evidence suggests that degeneration of the postganglionic inhibitory nerves of the myenteric plexus could be due to an infectious or autoimmune mechanism, and nitric oxide is the neurotransmitter affected. Current treatment of achalasia is directed at palliation of symptoms. Therapies include pharmacological therapy, endoscopic injection of botulinum toxin, endoscopic dilation, and surgery. Until the late 1980s, endoscopic dilation was the first line of therapy. The advent of safe and effective minimally invasive surgical techniques in the early 1990s paved the way for the introduction of laparoscopic myotomy. This review will discuss the most up-to-date information regarding the pathophysiology, diagnosis, and treatment of achalasia, including a historical perspective. The laparoscopic Heller myotomy with partial fundoplication performed at an experienced center is currently the first line of therapy because it offers a low complication rate, the most durable symptom relief, and the lowest incidence of postoperative gastroesophageal reflux

Call for emergency action to restore dietary diversity and protect global food systems in times of COVID-19 and beyond: Results from a cross-sectional study in 38 countries

Background: The COVID-19 pandemic has revealed the fragility of the global food system, sending shockwaves across countries\u27 societies and economy. This has presented formidable challenges to sustaining a healthy and resilient lifestyle. The objective of this study is to examine the food consumption patterns and assess diet diversity indicators, primarily focusing on the food consumption score (FCS), among households in 38 countries both before and during the first wave of the COVID-19 pandemic. Methods: A cross-sectional study with 37 207 participants (mean age: 36.70 ± 14.79, with 77 % women) was conducted in 38 countries through an online survey administered between April and June 2020. The study utilized a pre-tested food frequency questionnaire to explore food consumption patterns both before and during the COVID-19 periods. Additionally, the study computed Food Consumption Score (FCS) as a proxy indicator for assessing the dietary diversity of households. Findings: This quantification of global, regional and national dietary diversity across 38 countries showed an increment in the consumption of all food groups but a drop in the intake of vegetables and in the dietary diversity. The household\u27s food consumption scores indicating dietary diversity varied across regions. It decreased in the Middle East and North Africa (MENA) countries, including Lebanon (p \u3c 0.001) and increased in the Gulf Cooperation Council countries including Bahrain (p = 0.003), Egypt (p \u3c 0.001) and United Arab Emirates (p = 0.013). A decline in the household\u27s dietary diversity was observed in Australia (p \u3c 0.001), in South Africa including Uganda (p \u3c 0.001), in Europe including Belgium (p \u3c 0.001), Denmark (p = 0.002), Finland (p \u3c 0.001) and Netherland (p = 0.027) and in South America including Ecuador (p \u3c 0.001), Brazil (p \u3c 0.001), Mexico (p \u3c 0.0001) and Peru (p \u3c 0.001). Middle and older ages [OR = 1.2; 95 % CI = [1.125–1.426] [OR = 2.5; 95 % CI = [1.951–3.064], being a woman [OR = 1.2; 95 % CI = [1.117–1.367], having a high education (p \u3c 0.001), and showing amelioration in food-related behaviors [OR = 1.4; 95 % CI = [1.292–1.709] were all linked to having a higher dietary diversity. Conclusion: The minor to moderate changes in food consumption patterns observed across the 38 countries within relatively short time frames could become lasting, leading to a significant and prolonged reduction in dietary diversity, as demonstrated by our findings