Abbott (Germany)

Penile Thread Tourniquet Syndrome (PTTS), a rare variant of Penile Tourniquet Syndrome (PTS), is a paediatric urological emergency characterized by external constriction of penis by hair or thread, often leading to necrosis, ischemia, and oedema. A urethro-cutaneous fistula, urethral transection, and penile amputation are possible outcomes of this disorder if left untreated. Though commonly reported in infants, this case details a rare occurrence in a 10-year-old male. A circumferential thread at the penoscrotal junction caused localized infection and oedema without urethral damage. Surgical intervention and conservative management resulted in a favourable outcome. This case emphasizes the need for clinical vigilance in atypical age groups and for rare causes of penile injury.

Chronic wound infections are a global health concern, affecting up to 4% of diabetic populations. Biofilm-producing bacteria significantly delay healing and increase multidrug resistance (MDR. This study assessed the prevalence of biofilm-forming bacteria in chronic wounds and their antibiotic resistance patterns. A total of 100 chronic wound samples were collected. Bacterial identification and biofilm quantification were performed using standard microbiological techniques, while antibiotic susceptibility testing followed CLSI guidelines. Data were analyzed using SPSS v26, with p < 0.05 considered significant. Of 100 samples, 85 (85%) showed bacterial growth. Gram-negative isolates predominated (70/85, 82.4%) over Gram-positives (15/85, 17.6%). The most frequent pathogens were Pseudomonas aeruginosa (25, mean 0.29 ± 0.06), Staphylococcus aureus (20, 0.24 ± 0.05), Escherichia coli (15, 0.18 ± 0.04), and Klebsiella pneumoniae (10, 0.12 ± 0.03). Biofilm production was detected in 62 isolates (72.9%): strong (18, 0.29 ± 0.07), moderate (25, 0.40 ± 0.09), and weak (19, 0.31 ± 0.08). Strong biofilm formation was most common in P. aeruginosa (48%, 0.83 ± 0.08) and S. aureus (20%, 0.50 ± 0.08). Antibiotic resistance was high: S. aureus showed 80% penicillin and 60% erythromycin resistance, with 35% MRSA. E. coli (40%) and K. pneumoniae (50%) were ESBL producers. Overall, 45/85 isolates (52.9%, mean 0.53 ± 0.15) were MDR, significantly higher in biofilm producers (67.7%, mean 0.68 ± 0.10) than non-producers (13%, 0.13 ± 0.05; p < 0.01). Polymicrobial infections showed greater biofilm prevalence (83.3%) and MDR (70%) than monomicrobial (45.5%). Chronic wound infections are dominated by biofilm-forming MDR bacteria, particularly P. aeruginosa and S. aureus. Biofilm formation correlates strongly with MDR, wound duration, and polymicrobial infections, emphasizing the need for anti-biofilm therapies in wound management.

Aims/hypothesisIt has been proposed that severe hypoglycaemia events (SHE) may increase the risk of adverse CVD complications in adults with type 1 diabetes. The aim of this study was to evaluate the risk of CVD complications following SHE in a large cohort of adults with type 1 diabetes, and to compare the risk of post-SHE CVD complications for users of intermittently scanned continuous glucose monitoring (isCGM) vs users of blood glucose monitoring (BGM).MethodsThis comparative retrospective cohort study used data from the Swedish National Diabetes Register and the Swedish National Patient Register. We identified people with type 1 diabetes who had a hospitalisation for CVD complications. Rates of hospitalisation were compared between those with an index SHE and those without, and within isCGM or BGM subgroups. The study baseline was date of the first SHE prior to the isCGM index date.ResultsWe identified 14,829 adults with type 1 diabetes with up to 2 years of follow-up, of which 1313 had an index SHE. In the full cohort, the relative rate of hospitalisations for CVD complications was 2.06-fold (95% CI 1.48, 2.85) in those with prior SHE. Of these 1313 participants with prior SHE, 970 were using isCGM and 343 were using BGM. Hospitalisations for post-SHE CVD complications were significantly lower for isCGM users (5.40 per 100 person-years of follow-up; 95% CI 4.59, 6.31) compared with BGM control participants (14.23 per 100 person-years of follow-up; 95% CI 11.95, 16.82), which represents a 78% relative reduction in rates of post-SHE CVD complications for isCGM users (relative rate 0.22; 95% CI 0.11, 0.43; p<0.001), after adjustment for confounders.Conclusions/interpretationIn adults with type 1 diabetes, SHE is associated with an increased risk of hospitalisation for adverse CVD complications. This risk is significantly reduced in isCGM users compared with BGM control participants.Graphical

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*** no abstract, as his is a LtE.

Improving quality and laboratory testing turnaround time (TAT) is a constant challenge for a clinical laboratory. The formulas that describe the best way to manage these goals are outlined in International Organization for Standardization standards. According to standards, improvement must be timely and continuous. Lean methodology is a tool to meet this requirement. One of the fundamental elements of Lean is a systematic approach to process improvement by removing waste to create value for the end-user (eg, patient) of the service. This methodology can be adapted in resource-limited settings. The aim of this study was to test the application of Lean methodology in urinalysis. Lean has various collections of tools and concepts. We applied the most useful for the clinical laboratory: Gemba walk, Takt time, cycle time, and value-stream mapping. Finally, we created and approved workplace standards to improve the performance of urinalysis. We compared the TATs of urinalysis tests before optimization, immediately after, and long after (~5 months). We found that TATs had significantly shortened. The TATs of emergency (STAT) urine tests immediately after optimization improved: automated microscopy to 16% (P =.194), fully automated test-strip to 23% (P = .0172), and standardized urine sediment examination to 20% (P =.0048). The TATs of routine urine tests also improved immediately after optimization: automated microscopy to 18% (P <.0001), fully automated test-strip to 11% (P =.0025), and standardized urine sediment examination to 18% (P =.0011). After 5 months of Lean application within the urinalysis laboratory, TATs of routine urine tests remained improved; however, the improvement of STAT urine test TATs dropped to approximately 4%. The application of the Lean methodology shows significant improvement in TATs of processes in our laboratory.

Background &amp; Objective: Inguinal hernia is a frequently encountered issue in surgical practice. Surgical techniques for hernia repair have significantly advanced and improved. The study objective was to compare early postoperative pain in mesh fixation versus without fixation in open Lichtenstein mesh hernioplasty regarding early postoperative pain. Methods: A randomized control trial was done at the Department of Surgery of the Federal Government Services Hospital, Islamabad from April to December 2023. Total 60 patients meeting the inclusion criteria and were presented with inguinal hernia. Randomly patients were divided into two groups, each consisting of 30 patients and were managed with Lichtenstein repair followed by either suture fixation for mesh or non-fixation of mesh. Patients from both groups were observed for 24-hours and early postoperative pain was recorded using visual analog scale (VAS). The data underwent analysis utilizing SPSS v 25. Results: The mean age of the patients was 46.0±9.2 years. Among 60 patients, 36 (60%) men and 24 (40%) women. The average BMI was 26.34±4.27 kg/m2. No significant difference was observed in postoperative pain between two groups (p ≥ 0.05). A t-test was utilized to compare the VAS score between two groups and it was observed the results insignificant except in patients with BMI less than 25 (p ≤ 0.05). Conclusion: There is no difference in occurrence of postoperative pain in fixed versus non-fixed mesh.

Abstract Background This study investigates the cost-effectiveness of using fenofibrate to treat type 2 diabetes in Australia. The financial burden of type 2 diabetes mellitus is estimated to surpass AUD10 billion, mainly due to the cost of diabetic complications from diabetic neuropathy. Clinical evidence from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study demonstrated that fenofibrate can play a role in reducing the risk of amputation and other diabetes-related complications. Methods This study used a calibrated UKPDS model with an Australian diabetes cohort to simulate a number of complications and deaths over a 20-year time horizon. The effectiveness of fenofibrate was assessed using the FIELD study. Total cost was calculated over the 20-year time horizon. Input data was obtained from the Australian Refined-Disease Related Groups and the Australian Pharmaceutical Benefits Scheme. Results The model estimated that fenofibrate is associated with lower complication costs, which saves over AUD 4.6 million per 1,000 patients, with the most significant savings observed in amputations. The incremental cost-effectiveness ratio for fenofibrate treatment is observed to be AUD 739/LY gained and AUD 1189/QALY gained. Conclusion The use of fenofibrate in Type 2 diabetes patients is estimated to result in cost savings in an Australian setting due to fewer diabetes complications.