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.

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.

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 activity of muscles of the shoulder girdle and shoulder during the constant isometric efforts of the wrist].

Electromyogramms (EMG) of eight muscles of the arm were analyzed in 11 healthy men aged 25-40 years during equal magnitude isometric efforts created by wrist. Subjects had to track cursor that moved around on the screen at a constant speed (16 degrees/s) in a horizontal plane. Thus, the subject slowly changed the direction of generation of efforts, while its amplitude remained constant. It was established that during creation of the static efforts equal in all directions, the extensors activity was mainly in the areas of extension of shoulder and elbow joints, whereas the flexor activity was observed in all directions with maximum, which corresponded to the arm bending. It is assumed that muscular activity is organized on the principle of the synergies that are clearly related to the task and beyond it can not exist.

[Pretective action of peptide pro-gly-pro on electrophysiological characteristics of cultured hippocampal neurones during excitotoxic damage].

Electrophysiological characteristics of hippocampal neurones cultured with Pro-Gly-Pro peptide were studied using glutamate excitotoxisity model (excitotoxic damage was induced by 100 mkM glutamate application during 5 min). It was found that negative changes in neurones cultured with 10 mcM Pro-Gly-Pro were less prominent if compared with control ones. Culturing with the peptide significantly affected the following parameters: resting potential (-55 +/- 4 mV in control; -29 +/- 6 MV after glutamate application; -38 +/- 5 MV cultured after glutamate application), action potential amplitude (91 +/- 4; 65 +/- 5; 84 +/- 5 mV), duration (4,3 +/- 0,4; 9,5 +/- 1,6; 5,2 +/- 0,7 ms), depolarization (56 [38, 84]; 27 [21, 35]; 46 [28, 62] MV/Ms) and repolarization (-29 [-38, -27]; -20 [-21, -18]; -29 [-33, -22] M(V)/MS) rates. The data obtained suggest that PGP exhibit its neuroprotective properties on a level of basic electrophysiological characteristics, appropriate cellular mechanisms require further investigations.

[Characteristics of quantal release of glutamate and GABA in synapses between retinal ganglion cells and superior colliculus neurons in coculture].

We investigated features of quantal release of glutamate and GABA in synapses between retinal ganglion cells (RGC) and superior colliculus (SC) neurons in coculture using dual patch-clamp technique. The main quantal characteristics of neurotransmitters release were defined on the basic of quantal analysis. Number of released quanta distributions for both neurotransmitters were corresponded to the binomial law. It was shown that evoked postsynaptic currents (PSC) in SC neurons as response to generation of action potential (AP) in RGC were mediated by simultaneous release at least from 2 to 14 quanta of glutamate and 2 quanta of GABA. Thereby high efficacy of excitatory and inhibitory signals transmission is guaranteed in retinocollicular projections. It is supposed that multiquantal character of the neurotransmitters release can be related to simultaneous involvement of several closely adjacent excited terminals, each of which possesses one active zone, or by one terminal with several.

[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.

[Changes in the kinetics of calcium signals in response to high frequency stimulation in the cultured hippocampal neurons].

Dynamic changes in the intracellular free Ca2+ concentration ([Ca2+]i) were studied in hippocampal cultured neurons using fluorescent Ca(2+)-indicator dye Indo-1 and somatic whole-cell recordings. During the tetanus stimulation Ca(2+)-transient increased their amplitude up to a steady-state level during repetitive stimulation. We identified two groups of neurons based on Ca-signal dynamics after the end of stimulation: the first group (n = 24) with the monoexponential decay of [Ca2+]i direct after the end of the tetanus; the second group (n = 32) with the monoexponential delayed [Ca2+]i decay after the end of the tetanus, the duration of delay varied from 1 to 27 s and depended on duration and frequency of stimulation. Peak amplitudes of Ca(2+)-transients were statistically different between the first (1820 +/- 195 nM, n = 24) and the second (2618 +/- 165 nM, n = 23) groups. A linear dependence between decay time constant and frequency of stimulation was found for the second group of neurons only. In all cases when the delayed decay was observed the decay time constant changed reliably after emergence of delayed decay; the average rise made up 41 +/- 8%. We suggest dynamic changes and essential rise in the intracellular free Ca2+ concentration arise from the presence of intracellular low-affinity buffer. This statement is to be further tested using pharmacological approach.

[Electrical properties of retinal ganglion cells of rats with streptozotocine-induced diabetes].

On isolated retinal preparation from STZ-induced diabetic rats in whole-cell configuration the basic electrical properties of retinal ganglion cells (RGC) were studied. It was shown that on 8th week after STZ maximal depolarization-induced firing frequency is reduced and decay time constant of high-frequency stimulation-induced calcium signals is increased as compared to controls. The data obtained suggest functional changes in RGC of STZ-induced diabetic rats, possible mechanisms of such changes are discussed.

[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.

[Pre- and postsynaptic expression mechanisms of long-term depression in rats glutamatergic primary afferent synapses on dorsal horn spinal cord neurons in co-culture].

In co-culture of dorsal root ganglion (DRG) and dorsal horn (DH) neurons we studied the long-term depression (LTD) caused by 5 sec(-1) low-frequency stimulation (LFS) of DRG neurons. Dual whole-cell patch clamp recording in the pairs of DRG and DH neurons was used. The monosynaptic AMPA-receptor mediated eEPSC initiated in DH neurons by LFS of DRG neurons were analyzed. LFS with durations from 60 to 360 sec affected the LTD magnitude and involved the different LTD expression mechanisms. The amplitude and variability of miniature EPSC were not changed during LTD. LFS during 60 sec did not alter the eEPSC amplitudes, but significantly increased the coefficient of variation (CV; 56.8% +/- 11.5%, n = 5; P < 0.002) and the paired-pulse ratio (PPR; 37.8% +/- 11.4%, n = 5; P < 0.05), and decreased the release probability (p; 21.9% +/- 5.6%, n = 5; P < 0.05) calculated using binomial analysis. LFS for 120 sec led to LTD (eEPSC decreased to 14% +/- 3.3%, n = 13; P < 0.005); no changes in CV, PPR and p were found. LFS for 160, 200, 240 and 360 sec induced robust LTD: eEPSC decreased to 37.3 +/- 4.3 (n = 9); 48.1 +/- 3.5 (n = 7); 58.3 +/- 2.5 (n = 8) and 57.3% +/- 2.8% (n = 8), respectively; P < 0.001. LTD induced by such LFS durations was not accompanied by significant changing in PPR and p, but showed an increase in CV: 24.4 +/- 8.6 (n = 6); 35.1 +/- 11.2 (n = 6); 37.7 +/- 12.8 (n = 7), and 38.1% +/- 9.3% (n = 8), respectively. LTD magnitude was correlated with the enhancement in CV value at different LFS duration (r = 0.96). Our data suggest that the different mechanisms could be involved in LTD expression according to duration of LFS. Thus, 60 sec LFS induces presynaptic changes, but no change in eEPSC, whereas LTD elicited by 120 and 160 sec LFS affected the postsynaptic site. LTD initiated by longer LFS (200 - 360 sec) probably was caused by a silencing of functional synapses without changes in glutamate release probability.

[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.

[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.

[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.

How I do it: Simple and effortless approach to identify thoracodorsal nerve on axillary clearance procedure.

Breast cancer surgery frequently involves an axillary clearance procedure for nodal metastases. Injury to the thoracodorsal nerve is one of the complications related to the axillary dissection. The thoracodorsal nerve innervates the latissimus dorsi muscle which facilitates in certain movements of the arm. Moreover, it can be used as a nerve graft in long thoracic nerve injury whether in trauma or surgery. Understanding the anatomy structures and good surgical technique in the axillary clearance procedure can identify and prevent such an injury to the thoracodorsal nerve. Here, we demonstrate a simple and effortless technique for identification of the thoracodorsal nerve during axillary surgery.

[Study of the interaction of 2'-5'-oligoadenylates and their analogues with proteins by fluorescence spectroscopy].

The interaction of "core" 2'-5'-oligoadenylates (2-5A) and their analogues with proteins albumin, interferon and immunoglobulin G was studied by fluorescence spectroscopy methods. Strong quenching of protein fluorescence (up to 67%) was observed upon interaction of oligoadenylates in concentration of 5 x 10(-5) M with albumin. Investigated compounds quenched the emission of interferon to a lesser extent, whereas no significant fluorescence changes occurred upon interaction with immunoglobulin under the same conditions. The level of quenching depended on the structure of 2-5A compounds and decreased with the decrease of their concentration. These data suggest that 2-5A actively bind to albumin and less efficiently to interferon, and practically do not interact with immunoglobulin. Taking into consideration different efficiency of quenching of the fluorescence excited at 280 and 296 nm, the assumption has been made about a possible role of tyrosine and tryptophan in the binding of a given compound to proteins. Possible mechanisms of interaction of oligoadenylates with proteins are discussed.

[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.