THE DIFFERENCES BETWEEN THE FIRST PREFERRED BIOLOGICAL DMARD AND THE DRUG SURVIVAL IN GERIATRIC AND YOUNGER ADULT POPULATION WITH RHEUMATOID ARTHRITIS AND PSORIATIC ARTHRITIS: TREASURE REAL-LIFE DATA

EULAR European Congress of Rheumatology (EULAR) -- JUN 01-04, 2022 -- Copenhagen, DENMARK[Abstract Not Available]European Alliance Assoc Rheumato

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

The role of open abdomen in non-trauma patient : WSES Consensus Paper

The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified.Peer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Comparison of epidural tramadol, tramadol - Droperidol and tramadol-clonidine in the postoperative pain management

In this study, tramadol alone and the combinations of tramadol - clonidine and tramadol - droperidol were compared with regard to their effectiveness and side effects. Epidural catheters were placed to 90 ASA I-II group adult patients undergoing lower abdominal surgery, preoperatively through the L3-4 by using loss of resistance method. The first group received 75 mg tramadol (T), the second group received 75 mg tramadol - 2.5 mg droperidol (TD) and the third group received 75 mg tramadol-150 μg clonidine (TK) in a total volume of 10 ml via epidural route. The time point of initiation and duration of analgesia, visual pain, sedation, nausea scores, blood pressure, heart rate, SpO2 values, respiration rate and side effects were recorded. The durations of analgesia were similar in groups TD and TK and both were significantly longer than group T (p<0.001). Group TK exhibited significant increase in sedation and decrease in blood pressure and heart rate compared to other groups (p<0.01). No side effect was observed in group TD, while significant nausea - vomiting scores were evident in groups T and TK (p<0.001). No significant differences were found between the study groups with regard to the VAS scores, respiration rates, and SpO2 values. In conclusion, it may be suggested that addition of droperidol or clonidine to epidural tramadol may prolong analgesia and when side effects as well as the antiemetic effect were considered, droperidol seems to be a better choice

The addition of droperidol or clonidine to epidural tramadol shortens onset time and increases duration of postoperative analgesia.

PURPOSE: To compare tramadol alone and the combinations of either tramadol-clonidine or tramadol-droperidol with regard to analgesic and adverse effects. METHODS: After Ethic's Committee approval and patient informed consent were obtained, epidural catheters were inserted preoperatively at the L(3-4) interspace in 90 ASA physical status I-II adult patients undergoing lower abdominal surgery. Anesthesia was standardized. Patients were randomly assigned to one of three groups. Group I (T) patients received tramadol 75 mg, Group II (TD) patients received tramadol 75 mg plus droperidol 2.5 mg, and Group III (TC) patients received tramadol 75 mg plus clonidine 150 microg in a total volume of 10 mL administered as a single epidural injection in the postanesthesia care unit. The onset time of analgesia and duration of analgesia, visual analogue pain scores, sedation, nausea scores, vital signs and side effects were recorded. RESULTS: Duration of analgesia was similar in both the TD and TC groups, and significantly longer than in the T group (P < 0.001). Group TC patients displayed a significant increase in sedation scores and decrease in blood pressure and heart rate when compared with other groups (P < 0.001). No adverse effects were observed in Group TD, while nausea scores were high in both the T and TC groups (P < 0.001). Pain score, respiration rate, and SpO(2) values were similar in all study groups. CONCLUSION: We conclude that epidural tramadol in combination with droperidol or clonidine prolongs the duration of analgesia; however, droperidol appears to be a better alternative when adverse effects and antiemetic properties are taken into consideration

Melanoma pulmonar maligno: ¿es fácil determinar su origen?

El melanoma maligno que afecta al sistema respiratorio tiene un origen casi siempre metastásico y los tumores primarios verdaderos son muy frecuentes. En la bibliografía se han publicado aproximadamente 28 casos. Son necesarios estudios clínicos y anatomopatológicos detallados para considerar que el pulmón es la localización primaria del tumor. En este artículo se presenta el caso de un varón de 67 años de edad con un melanoma pulmonar maligno primario en el lóbulo inferior derecho. También se realiza una revisión de la bibliografía

The renal effects of ten hour sevoflurane anaesthesia in rats: The role of soda lime

The aim of this study was to evaluate the effects of sevoflurane anaesthesia on renal functions by conducting with or without soda lime comparatively. Eighteen male Wistar rats were divided into three equal groups randomly. Sevoflurane in 1.5 % concentration were administered directly to first group in 4 L/min fresh gas flow (50 % O2 + 50 % N2O), while the second group were applied the same gas mixture through soda lime, that is exposed to 150 mL/min carbon dioxide. Third group were control group, breathing room air. Glucose in blood specimens at the begining and end of application and glucose, gamma glutamyl transferase and protein levels were measured in urine samples collected during application period. Renal tissue specimens were evaluated histopathologically. Groups were similar with respect to blood glucose levels. Although urine glucose levels were higher in both of two study groups compared to control (p&lt;0.00001), there was no significant difference between them. Mean urinary GGT level was reasonably high in sevoflurane group, that was not used soda lime, with respect to other two groups (p&lt;0.0004). Mean urine protein levels were similar in all groups. Inflammatory cell collections were observed in the renal tissue specimens of study groups. It was concluded that long term sevoflurane anaesthesia can have toxic effects on renal tissue of rats; and in vivo metabolites may have greater role than in vitro ones, that result from reaction with soda lime

TSH levels in pregnant women with iodine deficiency before spontaneous abortus

Background: Iodine deficiency and/or thyroid autoimmunity are the most common causes of hypothyroidism development among pregnant women. In this study, we aimed to investigate the effect of iodine consumption and thyroid autoimmunity on TSH levels and abortus.The study sample consisted of 104 patients, 79 in abortus and 25 in control groups. TSH, free T4, free T3, anti-TPO, anti-Tg, spot urinary iodine concentrations, and thyroid volumes of the cases were measured by ultrasonography.The spot urine concentration was below 100 µg/L in 93% of the cases included in the study. The TSH levels of the abortus group cases were significantly higher than those of the controls (p=0.025). The percentage of subclinical hypothyroid cases were significantly higher among the cases evaluated due to abortus compared to the control group (p< 0.001). Abortus and control groups did not differ statistically with respect to the presence of autoimmune thyroid diseases (p=0.424). Spot urine iodine concentrations of abortus cases with subclinical hypothyroid were significantly lower than those with TSH levels below the defined range (p=0.001). Spot urine iodine concentrations of the cases with subclinical abortus with negative thyroid autoantibodies were also significantly lower than those with TSH levels below the defined range (p=0.017).TSH levels above 1 µIU/mL for the first trimester and 2 µIU/mL for the second trimester may be indicators of iodine nutrition in pregnancy losses