Biochemical and Hematological Profile of Covid-19 Patients on Mechanical Ventilation.

Beakground: The prevalence of cardiovascular diseases in COVID-19 patients, such as hypertension, diabetes mellitus, and chronic obstructive pulmonary disease, which are the most common comorbid conditions in COVID-19 patients, is considered a risk factor for premature mortality in the population. The aim of the study is to compare the standard biochemical and hematological markers of COVID-19 patients on mechanical ventilation and those who have recovered, and to identify differences by gender and comorbidities, as well as the dominant marker in comorbidities that frequently shows statistical significance, in order to investigate its prognostic value in further research. METHODS: The study is a retrospective study of patients with RT-PCR confirmed presence of the Sars-CoV-2 virus who were hospitalized at the Zenica Cantonal Hospital. The study lasted from February to April 2021. RESULTS: The results of the study, which included a sample of 302 participants, indicate that men were more represented in both the mechanical ventilation group and the recovered group, with 59.6% compared to women with 40.4%. Among the investigated biochemical and hematological parameters, there was a significantly higher number of leukocytes, urea, creatinine, LDH, and troponin in patients on mechanical ventilation, while the number of platelets was significantly higher in recovered patients. The most common comorbidity was hypertension in both groups of patients, with 24.5%. In patients on mechanical ventilation with cardiovascular disease, there was a significantly higher number of leukocytes, urea, creatinine, LDH, and troponin. In the same patients with three comorbidities, there was a significantly higher number of leukocytes, troponin, and LDH, while recovered patients without comorbidities had a significantly higher number of platelets. CONCLUSIONS: The male gender and comorbidities remain a vicious circle in COVID-19 infection, while biochemical and hematological markers can help in forecasting and improve the clinical treatment of these high-risk patients.

Formation of adhesion after intraperitoneal application of TiMesh: experimental study on a rodent model.

BACKGROUND: After laparoscopic repair of an incisive hernia, intraperitoneal prosthetic mesh, as a foreign material, is a strong stimulus for the development of adhesion, which may be the cause of serious complications. This experimental study compared three different meshes and their ability to prevent the formation of adhesion and shrinkage. METHODS: Ninety rats were divided randomly into three groups: in Group 1 Proceed mesh was implanted, in Group 2 Ultrapro mesh was implanted, and in Group 3 TiMesh was implanted. Mesh samples were fixed as an intraabdominal mesh in the upper part of the abdomen. Ten animals from each group were sacrificed on days 7, 28 and 60 post-surgery. After opening the abdomen, the formation of adhesion was assessed according to the Surgical Membrane Study Group (SMSG) score, the percentage of shrinkage of the mesh was established and inflammatory reaction scored. RESULTS: The SMSG score for adhesion was statistically significantly higher on all the postoperative days in the Proceed and Ultrapro mesh groups than in the TiMesh group which caused milder inflammatory reaction on 60th day than others meshes. The size of the mesh after 7 days was statistically significantly smaller in the Proceed and Ultrapro groups than in the TiMesh group, but after 60 days it was statistically significantly larger than in the TiMesh group. CONCLUSION: The least formation of adhesion was noted in the TiMesh group, in which the highest level of shrinkage was noticed after 28 and 60 days. TiMesh has advantages over the other meshes studied, but a larger size mesh may be recommended for intraperitoneal application.

Biocompatibility and adhesion formation of different endoloop ligatures in securing the base of the appendix.

BACKGROUND AND OBJECTIVES: The common technique used in securing the base of the appendix is Endoloop ligature (Ethicon, Somerville, NJ, USA). Vicryl (polyglactin 910) (Ethicon) and polydioxanone (PDS) (Ethicon) Endoloop ligatures can be used. There are potential benefits of the use of PDS Plus (Ethicon) Endoloop ligature. However, the use of different materials may vary in terms of inflammation, foreign-body reaction, rate of infection in the surgical area, or rate of adhesion formation. An ideal suture would induce minimal inflammatory response and adhesion formation. METHODS: Ninety rats were randomized into 3 groups: group I, in which appendectomy was performed with Vicryl ligature; group II, in which appendectomy was performed with PDS ligature; and group III, in which appendectomy was performed with PDS Plus ligature. The animals were killed on the seventh, 28th, and 60th days after surgery. The secured stump was used for histopathologic and immunohistochemistry analysis, as well as evaluation of the formation of adhesions. RESULTS: Mild and moderate inflammation was more frequent in the PDS and PDS Plus groups than in the Vicryl group on the seventh postoperative day. There were no significant differences in the degree of inflammation on the 28th and 60th postoperative days. The lowest degree of postoperative adhesions was observed in the PDS group. CONCLUSION: Milder postoperative inflammatory changes and a lower degree of postoperative adhesions were seen in the PDS ligature group, suggesting that this could be the standard Endoloop used to secure the base of the appendix.

Tissue reaction to absorbable endoloop, nonabsorbable titanium staples, and polymer Hem-o-lok clip after laparoscopic appendectomy.

BACKGROUND AND OBJECTIVES: The standard technique for securing the base of the appendix during laparoscopic appendectomy is by absorbable endoloop ligature, although clinical reports favor the use of the stapler. Nonabsorbable Hem-o-lok clips have been shown to be an alternative technique to this. However, it is currently not clear whether nonabsorbable clips have any effects on the intestine or promote infection in the surgical area. MATERIALS AND METHODS: Sixty Wistar albino rats were randomized into 3 treatment groups: group I (n=20) the base of the appendix was secured by endoloop 2-0 ligature; group II (n=20) dissection of the appendix was performed by a 45-mm thick stapler; and group III (n=20) the base of the appendix was secured by a Hem-o-lok plastic clip. The animals were sacrificed on the 14th and 28th days after surgery. The secured stump was used for histopathological examination. RESULTS: There were no significant differences in histopathological changes observed on the 14th postoperative day between the groups. On the 28th postoperative day, it was proved that mild and moderate inflammation is more frequent in the endoloop and Hem-o-lok groups than in the stapler group. Reaction to a foreign body is more frequent in the endoloop than in stapler and Hem-o-lok groups. CONCLUSION: The mildest postoperative inflammatory changes were seen in the stapler group, followed by the Hem-o-lok group. However, because of the price of the plastic clip and the simplicity of its application, its use is still favored during laparoscopic appendectomy.

Laparoscopic appendectomy in the treatment of acute appendicitis.

BACKGROUND: Laparoscopic appendectomy (LA) has many advantages over the classic appendectomy (CA), but this method has not been accepted yet in Bosnia and Herzegovina. Therefore, we attempted controlled randomized study in order to compare classic appendectomy with laparoscopic appendectomy and confirm eventual advantages of caring base of appendix with hem-o-lok clips regarding ordinary accepted endoloop method during laparoscopic appendectomy. METHODS: In this prospective study 120 patients were involved which are divided into two groups. In group 1, 60 patients were operated with classic method, and group II was divided into two subgroups; 30 patients were operated with laparoscopic method in which the base of appendix was cared by double endo-loop method and 30 patients were operated by plastic non-resorptive hem-o-lok clip. During this study the time duration of operation was measured, the duration of application of hem-o-lok and endo-loop, postoperative analgesia, the duration of hospitalization, intra-operative complications, anatomic position of appendix, appendicitis, and postoperative complications. RESULTS: The results of the study showed that laparoscopic appendectomy is shorter in duration if compared to the classical appendectomy with statistical significance p < 0.001 (CA 69,4 min; LAH 36,6 min; LAE 37,1 min), hospitalization is shorter p < 0.0001 (CA 3,6 days; LAH 2,3 days; LAE 2,2 days). Quantity of given analgesics in LA is less than in CA without statistical significance between LAE and CA (p > 0.340) and between LAE and LAH (p > 0.148) while there is positive statistical significance between LAH and CA (p < 0.015). Precise period of cicatrization of wound of patients operated by CA was 43 (71.66%) cases, with infection of wound in 3(5%) cases, phlegm of wound in 2 (3.3%) cases, healing of wound per sekundam in 9 (15%) cases and ileus in one (1.6%) patient. One patient had an infection of umbilical wound in LA and the other had cellulitis of front abdominal wall. Duration of application of hem-o-lok is shorter compared to endo-loop with statistical significance p < 0.013 (LAH 68,2 s; LAE 176,9 s). CONCLUSION: Time of surgery is shorter and the duration of hospitalization, amount of given analgesic is smaller, less number of postoperative complications, better cosmetic effect and advantages of application of hem-o-lok over endo-loop laparoscopic appendectomy is preferred.

Laparoscopic repair of traumatic diaphragmatic hernia.

Diaphragm injuries are diagnosed in the acute phase of blunt trauma only in 10% of cases--more often they are presented as hernia. Traumatic diaphragmatic hernia presents unique obstacles to a minimal invasive approach. However, with the proper training and equipment, most of these hernias are amenable to laparoscopic approach. These patients can expect the same well-known benefits of laparoscopic approach. We report here the case of a 56-year-old man, admitted to hospital with symptoms of vomiting, abdominal pain and dispnea who sustained blunt abdominal trauma in a high speed motor vehicle accident nine months ago. X-ray and CT scans confirmed suspected strangulated diaphragmatic hernia which contained stomach, colon, majoromentum and spleen in left hemithorax. The urgent laparoscopic procedure was performed--omentum, colon and stomach were taken backthrough diaphragmatic defect but the spleen was tightly fixed in thoracal cavity and splenectomy was performed. The diaphragmatic defect was repaired with interruptured sutures. This case proves that laparoscopic repair of diaphragmatic hernia is effective, but this should be carried out with caution, sometimes it needs additional complex procedure in emergency setting like splenectomy in this case.

Laparoscopic splenectomy in blunt trauma: is the procedure safe in pregnant patient?

There are increasing reports about laparoscopic splenectomy being performed even in blunt trauma patients, especially when conservative treatment has failed, but there are very rare reports involving pregnant patients operated laparoscopically due to a blunt trauma. The fear of possible injury of the fetus and effects on the course of the pregnancy limited the use of laparoscopic surgery in pregnant trauma patients. We report here a case of the laparoscopic splenectomy performed in a pregnant patient who sustained a blunt abdominal trauma, with grade V splenic injury. After diagnostic laparoscopy, which revealed the presence of a large amount of free fluid in the abdomen and a lesion on hilum of the spleen, laparoscopic splenectomy was performed with vascular staple. The patient had an uneventful recovery and was discharged with no discernible effects on the course of the pregnancy. This case shows that laparoscopic splenectomy is feasible and a safe procedure in pregnant patients who sustained a blunt abdominal trauma, but it requires adequate experience in elective laparoscopic surgery of spleen, continuous monitoring of fetal vitality is required.