Gastric teratoma is a extremely infrequent tumor and accounts for less than 1% of all teratomas among children population with male predominance. Case history: Herewith is described a case of mature ...gastric teratoma in a three months-old female infant associated with malrotation, hypotonia, torticollis and fusion of labia minoria. Due to the abdominal distension, the child was admitted to the Paediatric Surgery Department. On physical examination, a large lump was palpable, and laboratory findings were normal. Computed tomography (CT) showed a major heterogeneous solid formation within the right hemi-abdomen, extending to pelvis and crossing the midline. The infant underwent surgery and complete excision of tumor originating from lesser curvature of the stomach was made. Tumor was weighing 600 gr and was 10 x 14 x 8 cm large. The histopathological examination finding pointed to mature gastric teratoma. The post-operative course and further follow-up were eventless. Conclusion: As soon as the diagnosis is made, the surgery is of paramount importance, especially in cases of immature teratomas, where malignant alteration is possible.
Abstract
Background and Aims
The new coronavirus disease (COVID-19) pandemic faced the healthcare sector worldwide with an unprecedented challenge. Although respiratory failure is the main feature of ...the disease, renal involvement is also common, particularly in critically ill patients, and often requires urgent dialysis treatment. This study aimed to analyse clinical features and risk factors for poor outcomes in patients with COVID-19-associated acute kidney injury (AKI) requiring dialysis.
Method
All 98 patients included in this retrospective observational study were treated in the first hospital in Serbia transformed to exclusively admit COVID-19 patients at the onset of the epidemic. Data were collected from clinical charts and patient histories for the period between March 19, 2020, and March 19, 2022, and analysed with SPSS software, version 22 (IBM Corporation, New York, USA).
Results
Out of 6,540 non-pregnant adult patients hospitalized for COVID-19 (1,955 in the intensive care unit) in the observed period, 98 (85.7% male, age range 25-89 years) developed dialysis-requiring AKI. A total of 312 hemodialyses (HD) treatments were performed (3.18±2.39, range 1-12, per patient), mostly intermittent HD (85.7% of patients) pertaining to technical resources. The majority of patients (90.8%) had at least one comorbidity – hypertension (38.8%), diabetes (28.6%), cardiovascular disease (11.2%), cerebrovascular disease (3.1%), chronic respiratory disease (7.1%), malignancy (6.1%), or autoimmune disease (1.0%). Most patients (90.8%) required mechanical ventilation. Only 8 (8.2%) were vaccinated. Nearly half (49.0%) of the patients had bilateral pneumonia and 2.0% had ARDS at presentation, with an average CT severity score of 14.05±6.72 (range 1-25) at presentation. Time to AKI presentation was 8.96±5.14 days (range 2-25). The overall mortality rate was 91.8%. Surviving patients had significantly more HD procedures performed (5.00±2.39 vs 3.02±2.34; P = .024) and significantly lower procalcitonin level (1.89±0.16 ng/mL vs 6.14±9.57 ng/mL; P = .015) at presentation. Fatal outcome was significantly more common in individuals requiring mechanical ventilation (p<0.001). Other demographic (age, sex, smoking habit), clinical (comorbidities, vaccination status, radiographic finding, CT severity score, time to AKI onset, type of dialysis) and laboratory parameters (WBC, neutrophil/lymphocyte ratio, CK, LDH, urea, creatinine, CRP, IL-6, D-dimer, ferritin) were not significantly associated with adverse outcome. Multiple logistic regression showed that fewer HD procedures were significantly associated with a higher mortality rate (OR 0.77, 95% CI 0.60-0.99, P = .039).
Conclusion
Patients who develop dialysis-requiring AKI in the setting of COVID-19 have an extremely high mortality rate. Higher procalcitonin, the need for mechanical ventilation and a lower number of HD procedures are significantly associated with fatal outcomes in this population.
Abstract
Background and Aims
Patients on maintenance hemodialysis (HD) might be particularly vulnerable to severe COVID-19 due to their older age and numerous comorbidities. Furthermore, their ...specific treatment regimen substantially exposes them to the risk of infection. The abrupt onset of the novel coronavirus disease (COVID-19) pandemic required prompt action and immediate reorganization of healthcare services while maintaining the necessary standard of treatment for chronic patients. In this study, we aimed to analyze clinical features and risk factors for poor outcomes in maintenance HD patients with COVID-19.
Method
We analyzed data for 226 maintenance HD patients (67.7% male, age range 25 – 90 years, time on dialysis 6 – 278 months) who contracted COVID-19 in their original dialysis units and were therefore transferred for further HD treatment to the first hospital in Serbia transformed to exclusively admit COVID-19 patients at the onset of the epidemic. According to the local protocol, all patients were hospitalized while being dialyzed. Data were collected from clinical charts and patient histories for the period between March 19, 2020, and March 19, 2022, and analysed with SPSS software, version 22 (IBM Corporation, New York, USA).
Results
A total of 1384 HD treatments were performed in 226 patients (6.12±4.50, range 1 – 34 per patient). Most patients (98.7%) had at least one comorbidity: hypertension (68.1%), diabetes (26.1%), cardiovascular disease (16.4%), cerebrovascular disease (7.5%), malignancy (9.3%), chronic respiratory disease (4.0%) or autoimmune disease (1.8%). The average number of comorbidities was 1.9±1.0 (range 0 – 4). Only 2.2% of all patients were vaccinated. Most patients (78.0%) had bilateral pneumonia upon admission, 15.3% had normal pulmonary X-ray, 5.1% had unilateral pneumonia and 1.7% had ARDS. 34% of the patients required mechanical ventilation. Fifty-seven patients (25.2%) received corticosteroid therapy, 5.3% were treated with chloroquine, 2.7% received antiviral therapy and 1.8% were administered IL6 antagonist. The overall mortality rate was 39.4%. Patients who died were significantly older (67.6±12.4 vs 63.2±12.7; p = 0.012), more often had cardiovascular disease (p = 0.046) and bilateral pneumonia (p<0.001), had worse CT severity score (13.0±5.1 vs 9.2±5.0; p<0.001) and required invasive mechanical ventilation (p<0.001) and had fewer HD treatments performed during hospitalization (5.1±4.8 vs 6.8±4.2; p = 0.007). They also had significantly higher white blood cells count (8.3±5.3 vs 5.6±2.9; p<0.001), serum urea (24.9±12.0 vs 21.1±8.4 mmol/L; p = 0.01), LDH (119.8±95.5 vs 63.9±72.9 IU/L; p<0.001), CRP (157.8±239.1 vs 61.1±94.8 mg/dL; p = 0.008), IL-6 (14.9±36.0 vs 2.8±7.3 pg/mL; p = 0.004), and Ddimer (372.3±294.1 vs 240.7±101.5 ng/mL; p<0.001). Multiple logistic regression showed a significant association between mortality and older age (OR 1.11, 95% CI 1.04-1.18, p = 0.001), need for mechanical ventilation (OR 43.1, 95% CI 9.5-198.6; p<0.001), higher CT severity score (OR 1.16, 95% CI 1.07 – 1.25; p<0.001), fewer HD procedures performed (OR 0.80, 95% CI 0.69-0.93; p = 0.003), and higher D-dimer levels (OR 1.00, 95% CI 1.00 - 1.01; p = 0.012).
Conclusion
Maintenance HD patients are considered a high-risk population for contracting COVID-19 and developing a severe form of the disease. Older age, higher CT severity score
Sleep disorders and psychological disturbances are common in end-stage renal disease (ESRD) patients. However, despite their frequency and importance, such conditions often go unnoticed, since all ...patients do not clearly manifest fully expressed symptoms.
This study aimed to determine the prevalence of depression and poor sleep quality and to examine the association between these disorders and demographic, clinical and treatment-related characteristics of ESRD patients on hemodialysis (HD).
The study included 222 patients (132 men and 90 women), mean age 57.3 +/- 11.9 years, from 3 HD centers in Central Serbia, which provided us with biochemical parameters and demographic data. Sleep quality and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory (BDI), respectively.
The average BDI was 16.1 +/- 11.3. Depressed patients were significantly older (p=0.041), had a significantly lower dialysis adequacy (p=0.027) and a significantly worse quality of sleep (p < 0.001), while they did not show significant difference as regarding sex, employment, marital status, comorbidities, dialysis type, dialysis vintage, shift and laboratory parameters.The average PSQI was 7.8 +/- 4.5 and 64.2% of patients were poor sleepers. Poor sleepers were significantly older (p = 0.002), they were more often females (p = 0.027) and had a significantly higher BDI (p < 0.001), while other investigated variables were. not correlated with sleep quality. A statistically significant positive correlation was found between BDI and PSQI (r = 0.604; p < 0.001).
Depression and poor sleep quality are frequent and interrelated among HD patients.
Introduction. Burkitt lymphoma (BL) is a high-grade, highrisk type of non-Hodgkin lymphoma characterized by a very rapid cell progression. Although BL is a rare cause of intussusceptions, it must ...arouse suspicion if the intussusception occurs outside the characteristic peak. Case report. A previously healthy 7-year-old boy was hospitalized for recurrent abdominal pain, loss of appetite and body weight, a fever of up to 38?C, persistent vomiting and with soft tumefaction ileocecally. Nuclear magnetic resonance (NMR) revealed intussusceptions due to a tumor mass, which was followed by a surgical procedure (right hemicolectomy and terminoterminal anastomosis). Histopathological examination confirmed the diagnosis of primary abdominal Burkitt lymphoma. In spite of the subsequent oncologic treatment lasting for four months, an undifferentiated mass was detected in the retroperitoneal space below the lower pole of the right kidney. Positron emission tomography (PET) scan was performed in order to detect the metabolic activity of the deposit in the retroperitoneal space. A high metabolic activity of Burkitt lymphoma confirmed its presence, as well as the need for additional surgical intervention for tumor extirpation. PET scan undoubtedly contributed to distinguishing the visibility of tumor cells and to the detection of the subcentimeter tumor mass. Conclusion. The timely diagnosis, high tumor sensitivity to chemotherapy as well as the great importance of PET scan in the early detection of tumor recurrence, significantly increase the survival rate in patients with BL.
nema
A direct approach to physical Data Vault design Krneta, Dragoljub; Jovanovic, Vladan; Marjanovic, Zoran
Computer Science and Information Systems,
2014, Letnik:
11, Številka:
2
Journal Article
Odprti dostop
The paper presents a novel agile approach to large scale design of enterprise
data warehouses based on a Data Vault model. An original, simple and direct
algorithm is defined for the incremental ...design of physical Data Vault type
enterprise data warehouses, using source data meta-model and rules, and used
in developing a prototype case tool for Data Vault design. This approach
solves primary requirements for a system of record, that is, preservation of
all source information, and fully addresses flexibility and scalability
expectations. Our approach benefits from Data Vault dependencies
minimizations and rapid loads opportunities enabling greatly simplified ETL
transformations in a way not possible with traditional (i.e. non data vault
based) data warehouse designs. The approach is illustrated using a realistic
example from the healthcare domain.
nema
The development of Extract–Transform–Load (ETL) processes is the most complex, time-consuming and expensive phase of data warehouse development. Yet, the dynamics of modern business systems demand a ...more agile and flexible approach to their development. As a result, current research in this area is focused on ETL process conceptualization and the automation of ETL process development. This paper proposes a novel solution for automating ETL processes using the domain-specific modeling (DSM) approach. The proposed solution is based on the formal specification of ETL processes and the implementation of such formal specifications. Thus, in accordance with the DSM approach, several new domain-specific languages (DSLs) are introduced, each defining concepts relevant for a specific aspect of an ETL process. The focus of this paper is the actual implementation of the formal specification of an ETL process. To this end, a specific ETL platform (ETL-PL) is introduced to technologically support both the modeling of ETL processes (i.e., the creation of models in accordance with the introduced DSLs) and the automated transformation of the created models into the executable code of a specific application framework (representing ETL-PL’s execution environment). It should be emphasized that ETL-PL actually presumes the dynamic execution of ETL models or, more precisely, the executable code is generated at runtime. Thus the execution environment consists of code generator components and the components implementing the application framework. ETL-PL has been implemented as an extension of the .NET platform.
Scaphoid fractures in children Gajdobranski, Djordje; Zivanović, Dragoljub; Mikov, Aleksandra ...
Srpski arhiv za celokupno lekarstvo,
07/2014, Letnik:
142, Številka:
7-8
Journal Article
Odprti dostop
Scaphoid fractures are rare in childhood. Diagnosis is very difficult to establish because carpal bones are not fully ossified. In suspected cases comparative or delayed radiography is used, as well ...as computerized tomography, magnetic resonance imaging, ultrasound and bone scintigraphy. Majority of scaphoid fractures are treated conservatively with good results. In case of delayed fracture healing various types of treatment are available.
To determine the mechanism of injury, clinical healing process, types and outcome of treatment of scaphoid fractures in children.
We retrospectively analyzed patients with traumatic closed fracture of the scaphoid bone over a ten-year period (2002-2011).The outcome of the treatment of"acute"scaphoid fracture was evaluated using the Mayo Wrist Score.
There were in total 34 patients, of mean age 13.8 years, with traumatic closed fracture of the scaphoid bone, whose bone growth was not finished yet. Most common injury mechanism was fall on outstretched arm--76% of patients. During the examined period 31 children with "acute" fracture underwent conservative treatment, with average immobilization period of 51 days. Six patients were lost to follow-up. In the remaining 25 patients, after completed rehabilitation, functional results determined by the Mayo Wrist Score were excellent.
Conservative therapy of "acute" scaphoid fractures is an acceptable treatment option for pediatric patients with excellent functional results.
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