Glucose alert system improves health professional responses to adverse glycaemia and reduces the number of hyperglycaemic episodes in non-critical care inpatients.

AIM: To investigate the effect of a novel glucose alert system, comprising the Melbourne Glucose Alert Pathway and glucose-alert-capable networked blood glucose meters, on nursing and hospital medical officer responses to adverse glycaemia. METHODS: A prospective, pre- and post-observational study was undertaken in non-critical care wards of a tertiary hospital over 4 months (n=148 or 660 patient-days). The intervention consisted of two components designed to promote a consistent staff response to blood glucose measurements: (1) a clinical escalation pathway, the Melbourne Glucose Alert Pathway, and (2) networked blood glucose meters, which provide a visual alert for out-of-range blood glucose measurement. All consecutive inpatients with diabetes were assessed for diabetes management and capillary blood glucose. The primary outcome was documented nursing and medical staff action in response to episodes of adverse glycaemia (blood glucose >15 mmol/l or <4 mmol/l). Secondary outcomes consisted of glycaemic measures. RESULTS: In response to episodes of adverse glycaemia, nursing action increased (proportion with nursing action: 45% to 73%; P<0.001), and medical action increased (proportion with medical action: 49% to 67%; P=0.011) with the glucose alert system in place. Patient-days with hyperglycaemia (any blood glucose value >15 mmol/l: 24% vs 16%; P=0.012) and patient-days with mean blood glucose >15 mmol/l (7.4% vs 2.6%; P=0.005) decreased. There was no difference in hypoglycaemia incidence. CONCLUSIONS: Use of a novel glucose alert system improved health professional responses to adverse glycaemia and decreased hyperglycaemia in the hospital setting.

Rare mimic of pedal osteomyelitis in a patient with diabetes.

BACKGROUND: Diabetic foot infections are an important cause of hospitalization, health expenditure and mortality. Bone biopsy is the gold standard for diagnosing diabetic foot osteomyelitis but it is not routinely performed in most centres. Instead, a combination of history, examination, biochemical and radiological findings are used to make the diagnosis. CASE REPORT: Here, we report a case mimicking diabetic foot osteomyelitis, where the histology was crucial in acquiring the correct diagnosis. CONCLUSION: The absence of ulceration in cases of presumed diabetic foot osteomyelitis should raise suspicion of potential rare mimics of osteomyelitis and bone biopsy should be considered to further evaluate the underlying etiology prior to any definitive surgical management.

[The role of oxidative damage of proteins and lipids in pathogenesis of traumatic disease in severe combined thoracic trauma].

The investigation objective was to study the dynamics of indices of the lipids and proteins oxidative damage, as well as search for possible prognostic criteria in the injured persons with severe combined thoracic trauma. Concentration of carbonyl groups of proteins and malonic dialdehyde was determined on 1-2d, 3-4th and 5-6th day after trauma in the blood plasm of 73 patients, ageing 20 -68 yrs old. While in conditions of massive infusion therapy concentration of the indices investigated do not reflect the oxidative processes intensity. Relative concentration in recalculation on concentration of common protein content constitutes a more demonstratable index. On the 5-6th day after trauma a tendency for normalization of the oxidative damage of lipids and proteins indices was observed in the patients, who have recovered, and while lethal outcome--their further enhancement was noted. There was established a one-direction dynamics of a relative indices in both groups up to 3-4-th day after trauma with a step-by-step its enhancement. Concentration of carbonyl groups of proteins more than 15.86 mcmol/g of protein on the 5-6-th day after trauma ought to be considered a trustworthy criterion of unfavorable prognosis.

[Modelling of the knee joint loading conditions in the view of mechanics].

The results of mathematic modelling of work of femoropatellar joint in normal conditions and in the presence of dysplastic deformity were adduced. There was established, that a knee joint (KJ) by its external appearance and function constitutes a classic cam mechanism. Biomechanical scheme of interaction between the femoral bone processus and patella was elaborated. In accordance to scheme of cam mechanism its experimental roentgenometric investigations were performed. According to statistical analysis performed, in conditions of dysplasia in femoropatellar joint the changes in the KJ occur, which may cause its blockade; the patella position in the KJ depends on peculiarities of anatomical structure of the femoral bone processuses.

[Carcinoids of pancreas and digestion canal clinical signs, diagnostics and surgical treatment].

The review of the literature is presented and results of diagnostics and treatment of 28 patients with carcinoid tumours of the digestion canal of various localization are analysed. Carcinoids were both hormone-active, and hormone-inactive. Before the operation the diagnosis of carcinoid syndrome has been established only for two patients. Carcinoid tumours of a liver were in 4 patients, a gall bladder - in 1, a pancreas - in 5, a stomach - in 1, a duodenum - in 1. Results of methods of laboratory and instrumental examination are given and corresponding conclusions are made.

[Adrenal tumours: diagnosis and modern surgical methods of treatment, including minimale invasive].

The results of diagnosis and treatment of 759 patients (aged from 8 to 78 years) with adrenal diseases were analyzed. A variety of clinical symptoms depended on the adrenal layer lesion. We analyzed the results of biochemical and instrumental methods of examination of patients, hormone levels in the blood, methods of preoperative preparation of patients, postoperative complications. The results of minimally invasive surgery of adrenal tumors were presented. From 1997 till 2010 endoscopic adrenalectomies performed in 81 patients.

[Application of video-assisted parathyroidectomy for treatment of primary hyperparathyroidism].

During the last years for surgical treatment of primary hyperparathyroidism minimally invasive operations were applied. The results of the introduction of video-assisted parathyroidectomy in the clinic in 8 (32%) of 25 patients with primary hyperparathyroidism, who were operated during the 2010-2012 were analysed. Video-assisted parathyroidectomy compared to conventional operation allowed to reduce significantly the duration of the operation, to reduce the incidence of postoperative complications, to achieve a better cosmetic effect.

[Multiple endocrine neoplasia syndrome type 2].

Multiple endocrine neoplasia (MEN) syndrome--is a hereditary disease which is characterized by synchronous or metachronous development of benign (adenoma, hyperplasia) or malignant tumors in the endocrine organs. The presence of medullary thyroid carcinoma and pheochromocytoma are mandatory requirements of MEN 2 syndrome. The purpose of our study was to perform timely diagnosis and optimal surgical treatment of patients with MEN 2 syndrome. Over the 1999-2009 years in the clinic we have diagnosed the MEN 2 syndrome in 5 patients, of whom two women were sisters. In all patients we observed medullary thyroid carcinoma and pheochromocytoma. Two patients had bilateral pheochromocytoma, and the clinical course was characterized with mild arterial hypertension. Primary hyperparathyroidism was observed in 2 patients. In the near relatives of patients with MEN 2 syndrome it must measure calcitonin, catecholamines, calcium rate, conduct ultrasound examination of the neck and retroperitoneal space.

[Drainage in surgery: history, theory, drainage procedures].

Brief historical review of drainage procedures of the wounds and abdominal cavity was adduced. The main mechanisms of the drainage process, from the hydrodynamics laws point, were discussed. There was shown, that drainage occurs due to hydrostatic tissue of liquid and the capillarity laws. The main modern draining gears were analyzed and a comparative characteristics of their efficacy was adduced, depending on the drain construction and clinical situation present.

The relationship between diabetes and surgical site infection following coronary artery bypass graft surgery in current-era models of care.

BACKGROUND: Although diabetes is a recognized risk factor for postoperative infections, the seminal Portland Diabetic Project studies in cardiac surgery demonstrated intravenous insulin infusions following open-cardiac surgery achieved near normal glycaemia and decreased deep sternal wound infection to similar rates to those without diabetes. AIM: We sought to examine a contemporary cohort of patients undergoing coronary artery bypass graft surgery (CABGS) to evaluate the relationship between diabetes, hyperglycaemia and risk of surgical site infection (SSI) in current-era models of care. METHODS: Consecutive patients who underwent CABGS between 2016 and 2018 were identified through a state-wide data repository for healthcare-associated infections. Clinical characteristics and records of postoperative SSIs were obtained from individual chart review. Type 2 diabetes (T2D), perioperative glycaemia and other clinical characteristics were analysed in relation to the development of SSI. FINDINGS: Of the 953 patients evaluated, 11% developed SSIs a median eight days post CABGS, with few cases of deep SSIs (<1%). T2D was evident in 41% and more prevalent in those who developed SSIs (51%). On multivariate analysis T2D was not significantly associated with development of SSI (odds ratio (OR) 1.35; P=0.174) but body mass index (BMI) remained a significant risk factor (OR 1.07, P<0.001). In patients with T2D, perioperative glycaemia was not significantly associated with SSI. CONCLUSION: In a specialist cardiac surgery centre using perioperative intravenous insulin infusions and antibiotic prophylaxis, deep SSIs were uncommon; however, approximately one in 10 patients developed superficial SSIs. T2D was not independently associated with SSI yet BMI was independently associated with SSI post CABGS.

[Modern biotechnologies in estimation of genetic diversity of Ukrainian varieties of hop (Humulus lupulus L.)].

Genetic variety estimation of hop gene pool using DNA-typing of highly polymorphic microsatellite loci and optimization of introduction to the culture of in vitro conditions is the important stage of national varieties resources forming, basis of modern nursery and protect mean of varieties property, and also it is necessary for development of molecular methods of selection of planting-stocks free from pathogens.

[Surgical treatment of chronic duodenal ileus].

The results of surgical treatment in 24 patients suffering chronic duodenal impassability (CDI), caused by various mechanical reasons, were analyzed. The most frequent of them were pancreatic cancer, arteriomesentery compression, pancreatic pseudocyst, volumic formations, adhesive deformity of duodenojejunal juncture, duodenal polyposis. There was proposed the method of duodenal arteriomesentery compression correction, which permits to restore effectively the duodenal motor-evacuatory function. While choosing the method of CDI it is necessary to pay attention to its etiologic cause.

Fully vs. partially integrated services for TB-HIV in Myanmar: a health services review and a cohort study.

In Myanmar, integrated services for tuberculosis (TB) and human immunodeficiency virus (HIV) are operated either fully (as one single unit) or partially (each vertical programme provides both services). To review the fully and partially integrated services for TB-HIV and to assess their TB treatment outcomes. We analysed the compiled service database and conducted a cohort study on newly registered TB-HIV patients in 12 townships in Myanmar. No significant association between region/state and types of integration was detected. Townships with partially integrated services had a significantly larger population size, higher proportion of urban population as well as higher TB and TB-HIV case notification rates; however, the cartridge-based Xpert® MTB/RIF assay was used less frequently than in townships with fully integrated services. Treatment completion rate and unfavourable outcomes were not significantly different between the two models, although fully integrated services reported a higher cure rate. These mixed results suggest that during expansion of fully integrated services, the progress of treatment outcomes should be monitored carefully. .

High prevalence and incidence of tuberculosis in people living with the HIV in Mandalay, Myanmar, 2011-2017.

SETTING: Two human immunodeficiency virus (HIV) clinics providing antiretroviral therapy (ART), Mandalay, Myanmar. OBJECTIVE: To assess prevalent TB at enrolment, incident TB during follow-up and associated risk factors in adult people living with HIV (PLHIV) between 2011 and 2017. DESIGN: Cohort study using secondary data. RESULTS: Of 11 777 PLHIV, 2911 (25%) had prevalent TB at or within 6 weeks of enrolment. Independent risk factors for prevalent TB were being male or single/widowed, daily alcohol consumption, CD4 count 200 cells/µl and anaemia. During 6 years follow-up in 8866 PLHIV with no prevalent TB, the rate of new TB was 2.9 per 100 person-years (95%CI 2.6-3.1). Cumulative TB incidence was 9.6%, with 370 (72%) of 517 new TB cases occurring in the first year. Independent risk factors for incident TB were being male and anaemia. Incident TB was highest in the first year of ART, in PLHIV with CD4 counts 200 cells/µl and those not receiving isoniazid preventive therapy (IPT). Incident TB declined with time on ART and rising CD4 counts. CONCLUSION: Prevalent and incident TB were high in PLHIV in the Mandalay clinics. Consideration should be given to earlier TB diagnosis using more sensitive diagnostic tools, effective ART and scaling up IPT.

Genetic absence epilepsy rats from Strasbourg have increased corticothalamic expression of stargazin.

Stargazin is membrane bound protein involved in trafficking, synapse anchoring and biophysical modulation of AMPA receptors. A quantitative trait locus in chromosome 7 containing the stargazin gene has been identified as controlling the frequency and duration of absence seizures in the Genetic Absence Epilepsy Rats from Strasbourg (GAERS). Furthermore, mutations in this gene result in the Stargazer mouse that displays an absence epilepsy phenotype. GAERS stargazin mRNA expression is increased 1.8 fold in the somatosensory cortex and by 1.3 fold in the thalamus. The changes were present before and after the onset of absence seizures indicating that increases are not a secondary consequence of the seizures. Stargazin protein expression was also significantly increased in the somatosensory cortex after the onset of spontaneous seizures. The results are of significant importance beyond the GAERS model, as they are the first to show that an increase in stargazin expression may be pro-epileptic.

[Possibilities of radical surgical treatment of patients with tumoral obstruction of extrahepatic biliary ducts].

Experience of radical surgical treatment of 32 patients, suffering extrahepatic biliary ducts (EBD) tumor, was analyzed. The respectability index of a Clatskin tumor have constituted 12.5%, and of the EBD middle portion--25%. In 8 patients an open operative intervention was performed and in 1--laparoscopic procedure was applied. The respectability index of a distal EBD tumors have constituted 29.6%. Postoperative lethality was 15.6%.

[Pathologic changes of hernial sac and its content].

Results of treatment of 2308 patients, suffering nonincarcerated hernia of abdominal wall of various localization, were analyzed. In 24 (1.1%) of them different pathologic changes of hernial sac were noted and in 17 (0.7%)--the diseases of organs, localized in hernial sac: an acute appendicitis, ileus, trauma, malignant tumor and others. The course of majority of the above-mentioned diseases was masked by incarcerated hernia signs, demanding the urgent operation performance. The operative intervention volume depended on the character of the organ pathological changes, localized in hernial sac, it was directed on the main disease elimination and on the abdominal wall defect closure.

[The cytokine profile during experimental esophagitis and modification of cytoprotective mechanisms].

The cytokine profile during experimental esophagitis and modification of NO-NOS and prostaglandin activity and the melatonin administration has been investigated.

[Model studies of the involvement of nitric oxide, prostanoids, and glucoconjugates of epithelial barrier of the esophagus in the process of esophagus protection].

Mechanisms of cytoprotection of esophagus mucous coat (EMC) under experimental damage of different origin are considered in the article. It manifested through activation of NO/NOS system and cell membrane stabilization effect of prostanoids. Morphofunctional changes and modification of expression of lectin receptors of the epithelial barrier of EMC under experimental damage of different origin and its correction by melatonin are discussed in the article.

[Peculiarities and results of reconstruction-plastic operations in patients with locally spread forms of the thyroid gland cancer].

The work is devoted to problem of differentiated application of reconstruction-plastic operations in patients with locally spread forms of the thyroid gland cancer with affection of cervical trachea, esophagus, main cervical vessels and mediastinum. For substantiation of choice of tactics and the operative intervention volume there was elaborated and introducted the technology of estimation of the tumoral expansion degree according to diagnostic algorhythm elaborated. The treatment doctrine was formulated, which substantiate the expediency of performance of radical interventions and of reconstruction-plastic operation. Its efficacy is proved by available postoperative complications rate (21.6%), by mortality (3.9%), the patients survival indexes during 3 years (77.8%) and 5 years (64.6%).