Medicine and Pharmacy Reports最新文献

Background and aims: Sealing devices can produce mechanical and thermal damage to collateral tissue, with few studies analyzing these effects. However, the least harmful device for the surrounding tissue will achieve optimal functional results.

Methods: We compared the tissue damage made by different laparoscopic electro-cauterization instruments while using them as hemostatic means on the stomach and epiploon of Wistar rats, respectively on the diaphragm and urinary bladder of a porcine model. Five devices were used based on either radio frequency diathermy or ultrasound energy, with one coagulation cycle for the automatic hemostasis. Infrared thermography tracked thermal injury on the collateral tissue made by each device on the porcine model.

Results: We analyzed the collateral tissue with irreversible thermal damage caused by each sealing device with infrared thermography with ANOVA statistical test. Based on histopathological examination, we calculated the mean value of the area with edema and coagulation necrosis caused by these maneuvers of hemostasis as a pattern of tissue damage around the sealing mark of every hemostatic device.

Conclusions: Compared with bipolar sealing devices, ultrasound-based devices offered better collateral tissue preservation, with the smallest damaging temperature spread, on animal models. Further research on ultrasound vs. bipolar sealing devices used as hemostatic tools could more accurately assess their impact on functional outcomes in real life surgery setting.

Background and aims: Surgical site infection (SSI) remains a significant global health concern, including in Indonesia. The administration of prophylactic antibiotics plays a pivotal role in the prevention and the reduction in mortality rates associated with SSIs. Prophylactic antibiotic use is recommended in surgical procedures that are at risk of infection, including in clean surgical operations that last more than three hours and clean-contaminated surgeries. The objective of this study was to analyze the quantity of prophylactic antibiotic consumption and to compare the consumption of antibiotics between neurosurgery (clean surgery) and appendectomy (clean-contaminated surgery).

Methods: Data in this observational study were obtained from the medical records of patients who underwent neurosurgery and appendectomy at two hospitals in Surabaya: one private and one public hospital. The quantity of antibiotic consumption will be analyzed descriptively and presented as a defined daily dose (DDD) per 100 bed days.

Results: Research findings revealed a higher quantity of antibiotic consumption in elective neurosurgery, representing 47.43 DDD/100 bed-days, in comparison to 21.26 DDD/100 bed-days and 76.34 DDD/100 bed-days in elective and emergency appendectomy, respectively. The most frequently used antibiotics were broad-spectrum antibiotics, which included cefixime (36.91 DDD/100 bed-days) and ceftriaxone (5.45 DDD/100 bed-days) in elective neurosurgery; and ceftriaxone (14.94 vs 50.86 DDD/100 bed-days) and metronidazole (5.75 vs 19.16 DDD/100 bed-days) in elective and emergency appendectomy, respectively.

Conclusion: The consumption of prophylaxis antibiotics remains a significant concern. In order to develop strategies to prevent bacterial resistance through an antibiotic stewardship program, it is essential to evaluate antibiotic consumption and monitor trends over time.

Background and aim: Chordomas arise from remnants of the notochord. The aim of this study is to report a series of cases with operated skull base chordomas, with reviewing clinical data, assessing surgical strategy and outcome.

Methods: We performed a 13-year retrospective study, between 2009 and 2022, in which we included patients operated for skull base chordomas.

Results: There were 6 males and 9 women, mean age 52.8 ± 16.55 years. Tumor site was clivus (13 patients), left cavernous sinus (one case) and sphenoidal sinus (one case). We performed endoscopic endonasal approach (18 times), transcranial subtemporal approach and combined approach. We achieved GTR in 8 patients, NTR in 4 patients, STR in 7 patients and biopsy in 1 patient. Grade of resection was associated with recurrence incidence (p=0.002).Histological exam revealed conventional chordoma in 14 cases, chondroid chordoma in 5 cases and dedifferentiated (chondrosarcoma) in 1 case. Patients' neurological status improved following surgery (p=0.000). Five patients underwent adjuvant conventional radiotherapy.Five patients presented local recurrence. All recurrences were reoperated using endoscopic endonasal approach. Survival analysis identified grade of resection and adjuvant radiotherapy as predictive factors for recurrence-free survival.

Conclusions: Surgery is the treatment of choice in skull base chordomas. Surgical approach should be tailored according to tumor original site and extensions. Midline chordomas are proper candidates for endoscopic endonasal approach, while lateral lesions require transcranial surgery. Combined approaches should be used in extensive tumors. GTR and radiotherapy prolong recurrence-free survival. Further studies on larger samples of patients are needed.

Background: Our objective was to evaluate the rate of reemployment after having curative radiotherapy for head and neck cancer and to identify the barriers of successful return to work in this patient population.

Methods: The study was retrospective, cross-sectional, analytical and cohort type, it included 52 consecutive patients attending follow-up visits after curative radiotherapy for head and neck cancer at a single tertiary center. Participants completed a survey to assess demographics, tumor characteristics, lifestyle choices and quality of life questionnaires. We analyzed the rate of reemployment and the association with different parameters.

Results: At the time of the survey, the successful return to work rate among head and neck cancer survivors was 55.8%. Most of the returners, 93%, started to work within 14 months from the time of the diagnosis. Educational level, work type and tumor stage were predictive for successful return to work. The main barriers for reemployment were physical symptoms such as fatigue, speech disorders and eating problems.

Conclusions: Head and neck cancer survivors who manage to return to work have a better quality of life and global health status than those who could not return. The most vulnerable patients are those with lower education, doing manual work and with advanced stage cancer. Optimized radiotherapy planning to reduce radiation induced late effects in conjunction with coordinated rehabilitation programs are needed to facilitate head and neck cancer survivors' reemployment.

Due to their physical proximity, the healthy pancreas and the gut microbiome are known to interact in a variety of ways. The gut microbiota has been recognized as a potential factor in the development and progression of exocrine pancreatic insufficiency through several mechanisms. Pancreatic diseases like chronic and acute pancreatitis or pancreatic cancer are frequently accompanied by pancreatic exocrine insufficiency which affects the gut microbiota. Firstly, the gut microbes are controlled by antimicrobial pancreatic secretions, while themselves induce the secretion of substances by the pancreas through metabolite production, such as short-chain fatty acids. Secondly, dysbiosis, the alteration in the abundance and diversity of different species, has been observed in patients with pancreatic diseases. Dysbiosis influences carcinogenesis in pancreatic cancer in ways that are either procarcinogenic or anticarcinogenic and finding these connections will have clinical implications. Identifying microbial biomarkers allow for an earlier diagnosis, improved therapy and prognosis in pancreatic cancer. The gut microbiome has a role in the pathogenesis of pancreatitis by either a bacterial translocation or a host immune response mechanism. The disruption of the normal gut barrier is believed to be the primary source of bacteria in acute pancreatitis which leads to infected pancreatic necrosis. In this paper, we review the current data about the association between pancreatic diseases linked to exocrine insufficiency and gut microbiota.

Background and aim: There are few published data on the mental health problems of women with pregnancy complicated by SARS-CoV-2 infection. Our study aimed to evaluate anxiety and depression related to a COVID-19 diagnosis in women who gave birth in a Romanian tertiary maternity.

Methods: A hospital-based cross-sectional study was conducted between September 2020 and October 2021 on 105 women admitted for term delivery; 51 women were diagnosed with SARS-CoV-2 infection just before delivery, and 54 without infection. Participants were assessed during the first 72 hours postpartum (T1) and the following two weeks postpartum (T2). Hospital Anxiety and Depression Scale (HADS) was used for anxiety and depression assessment at T1. The COVID-19 Pandemic Mental Health Questionnaire (CoPaQ) was applied at T2 only in the COVID-positive cases identified at T1.

Results: Postnatal anxiety levels were higher in COVID-positive women compared to COVID-negative women (p = .004), but there were no differences in the postnatal depression level between the groups. Psychological manifestations related to the pandemic, such as contamination anxiety, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD) symptoms, were positively related to HADS anxiety scores, while maintaining social relationships were negatively associated with the scale. The COVID-19 diagnosis was found to be a significant predictor for adverse pregnancy outcomes (APOs), with COVID-positive women having a 4.72-fold higher risk of developing them than those who tested COVID-negative (OR=4.72, 95% CI [2.05; 10.86]). The multivariate analysis using anxiety and depression as dependent variables indicated a significant effect for COVID-19 diagnosis, Wilks' Lambda = 0.940, p = 0.048.

Conclusion: Increased levels of anxiety, PTSD, and obsessive-compulsive symptoms were associated with the postpartum period in pregnant women with COVID-19 infection during delivery. Maintaining social interaction proved to be a protective factor against the increased anxiety reported by COVID-19-infected women.

Background and aims: This study evaluates the potential of oxidative stress biomarkers, specifically glutathione disulfide (GSSG) and reduced glutathione (GSH), for differentiating bacterial and viral infections. Oxidative stress plays a crucial role in the immune response, and glutathione is a key regulator of cellular redox balance. The aim was to assess whether differences in GSH and GSSG levels could be used as diagnostic markers for infection type.

Methods: A chemiluminescence-based method evaluated GSH and GSSG as potential biomarkers for distinguishing between bacterial and viral infections. The GSH and GSSG concentrations were analyzed across bacterial, viral, and control groups.

Results: Our data revealed significant differences in the GSH/GSSG ratio between the analyzed groups, with bacterial infections showing higher oxidative stress markers compared to viral infections. A combined analysis of GSH and GSSG concentrations, visualized through heatmaps and ROC curves, improved diagnostic accuracy, with clustering patterns distinguishing infection types.

Conclusions: These findings suggest that the GSH/GSSG ratio could be used as a biomarker in distinguishing between bacterial and viral infections, offering potential clinical applications for more accurate diagnosis. Further research is required to validate these results in larger cohorts and to explore the underlying mechanisms of oxidative stress in pathogen-specific immune responses.

Background: Patients with cystic fibrosis (CF) frequently require modulatory therapies such as Lumacaftor/Ivacaftor (LI) and Elexacaftor/Tezacaftor/Ivacaftor (ETI) to manage their condition. Given the potential hepatic complications associated with CF, it is critical to understand the impact of these therapies on liver function and fibrosis indices. This study aimed to evaluate the changes in liver function markers and fibrosis indices in CF patients undergoing LI and ETI therapies, with a specific focus on the influence of underlying hepatic disease.

Methods: In this retrospective analysis, liver function markers and fibrosis indices were assessed in CF patients receiving ETI (n=24), LI (n=4), or LI transitioned to ETI (LI/ETI, n=8). Key liver function markers, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, platelet count, and fibrosis indices (APRI and FIB-4), were measured at baseline and at various time points up to 12 months.

Results: In patients receiving LI therapy, ALT and AST levels demonstrated a slight but non-significant decrease over six months, accompanied by significant fluctuations in total bilirubin levels. Among those receiving ETI therapy, ALT and AST levels initially increased but stabilized over time, while total bilirubin levels significantly increased from baseline to 12 months. No significant differences were observed in liver function markers between patients with and without hepatic disease under ETI therapy. Trends in fibrosis indices (APRI and FIB-4) were modest and largely non-significant across both therapies.

Conclusions: ETI therapy appears to be safe for CF patients, including those with pre-existing hepatic disease, with no significant deterioration in liver function over a 12-month period. However, the observed fluctuations in bilirubin levels underscore the necessity for ongoing monitoring. Further research is warranted to investigate the long-term hepatic effects of LI and ETI therapies.

Background and aims: Breast cancer diagnosis is established late in Romania. This led to 3918 potentially avoidable deaths by breast cancer in 2020. Statistics show that women seldom perform monthly breast self-examinations or mammographies. This research aims to identify personal and health system barriers to breast cancer screening, with the purpose of enabling participation in future breast screening programs.

Methods: A quantitative cross-sectional, online survey of a convenience sample of 184 women aged 20-65 years old from Cluj-Napoca, Romania was used to evaluate the practice of breast self-exam and mammographies and personal and health system barriers against them.

Results: The sample's mean age was 34.73 years (SD=11.31, range 20-65). Women in the sample had a high level of education, most holding a Master's degree (36.4%). The majority declared practicing breast self-examinations from time to time (57.2%) and only (35.5%) did it monthly as per existing guidelines. Personal barriers to breast examination were lack of knowledge (16.3%) and mistrust in self examination (10.3%). Women with higher education engaged in the examination of the breast at least once (X2= (0.047, N = 184), p = 0.003, (CI 95%: 5.515-6.773). Concerning health system barriers, access to information from public health authorities on the availability of mammographies was rated very poor (21.7%). The cost was not a significant barrier to mammographies for 72.8% of the women in the sample.

Conclusions: Our study contributes to the limited data on preventive practices for breast cancer in Romania, the EU country that ranks last for breast control among females and where 13% of the 9000+ cases diagnosed annually are stage IV cancers. Based on the reported factors of a successful breast cancer screening program by our sample, we suggest valuable insights to be taken into consideration when organizing a future breast screening program. Both personal and system barriers to breast self-exam and mammographies must be considered in organizing breast cancer screenings. The focus should be on educational initiatives to improve women's knowledge about the process of self-screening and on improving access to information on the availability of free screening and mammograms as part of a well-promoted screening program designed with a simple enrolment process.