scholarly journals Antibiotic prophylaxis before skin incision versus after cord clamping in the prevention of maternal and neonatal infectious morbidity after cesarean section

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
W H Eltantawy ◽  
K M Labib ◽  
A M Farag
Keyword(s):  
Cesarean Section ◽  
Antibiotic Prophylaxis ◽  
Wound Infection ◽  
Gestational Age ◽  
Skin Incision ◽  
Infectious Morbidity ◽  
Cord Clamping ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background the purpose of antibiotic prophylaxis in surgical procedures is not to sterilize tissues but to reduce colonisation pressure of microorganisms introduced at the time of the operation to a level that can be overcome by the patient’s immune system. Aim of the study to compare the effects of antibiotic prophylaxis administered in cesarean section preoperatively versus after neonatal cord clamp on postoperative infectious complications for both the mother and the neonate. Patients and Methods This comparative study was carried out between August 2017 and February 2018, at Ain Shams maternity hospital and Al-Galaa teaching hospital, a prospective randomized control comparativestudy of 874 pregnant ladies undergoing cesarean section after obtaining the approval of the local ethical committee and a fully-informed written consent. Results Of 874 pregnant ladies undergoing cesarean section, mean gestational age in group A (38.71±1.09); while in group B mean gestational age (38.86±1.06). In group A, wound infection 8 cases (1.6%), endometritis 25 cases (5.7%), UTI 18 case (4.1%). In group B, wound infection 16 cases (3.7%), endometritis 35 cases (8%), UTI 28 case (6.4%). No cases suffered from early or long term neonatal complications. Conclusion there is no significant difference between timing of antibiotic either before skin incision or after cord clamping, however there are risk factors that increase the maternal, fetal infectious morbidity as high BMI, low gestational age, previous section, general anaesthesia.

scholarly journals Comparison between scalpel incision and electrocautery incision in midline abdominal surgery: a comparative study

2021 ◽  
Vol 8 (5) ◽  
pp. 1507
Author(s):  
Amit Yadav ◽  
Lakshman Agarwal ◽  
Sumit A. Jain ◽  
Sanjay Kumawat ◽  
Sandeep Sharma
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Abdominal Surgery ◽  
Wound Infection ◽  
Skin Incision ◽  
P Value ◽  
Wound Area ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.

Early versus delayed cord clamping in term neonates.

2021 ◽  
Vol 28 (05) ◽  
pp. 656-660
Author(s):  
Samina Mumtaz ◽  
Shagufta Tabassum ◽  
Saima Afzal
Keyword(s):  
Gestational Age ◽  
Controlled Trial ◽  
Hemoglobin Level ◽  
Delayed Cord Clamping ◽  
Term Neonates ◽  
Cord Clamping ◽  
Significant Difference ◽  
Early Cord Clamping ◽  
Group A ◽  
Group B

Objective: To compare mean hemoglobin levels of neonates after early and late cord clamping. Study Design: Randomized Controlled Trial. Setting: Department of Obstetrics & Gynaecology at Nishtar Hospital Multan. Period: June 2019 to December 2019. Material & Methods: A total of 60 women booked and unbooked were included in study. Selected patients randomized into group A and B, each group comprising of 30 patients depending upon the envelope with assigned treatment (either early or delayed cord clamping) picked up by the patient. Results: In present study, two groups were made. Group A consisted of 30 neonates in whom early cord clamping was done while in group B delayed clamping was done in 30 neonates. Mean age of mothers was 28.4±0.4 vs. 28.6±0.5 years in group A and B respectively. There were 25 mothers (83.3%) in group A and 21 mothers (70%) in group B between 25–30 years. There were 5 mothers (16.7%) in group A and 8 mothers (26.7%) in group B between 31–35 years of age. While none of the mother in group A and 1 mother (3.3%) in group B was between 36–40 years of age. Mean parity of the mothers was 1.1±0.2 vs. 1.4±0.2 in group A and B respectively. Eight mothers (85.4%) in group A and 7 mothers (82.5%) in group B were primipara. While 22 mothers (14.6%) in group A and 23 mothers in group B (17.5%) were para 1–3. Gestational age was 37–38 weeks in 13(43.3%) vs. 19(63.3%) women in group A and B respectively. While there were 17(56.7%) vs. 11(36.7%) women in group A and B respectively of the gestational age 39–40 weeks. Pre-delivery maternal mean hemoglobin levels was 11.9±0.1 gm/dl vs. 12.3±0.1 gm/dl in group A and B respectively. Pre-delivery maternal hemoglobin levels were 10–10.9 g/dl in 2 mothers (6.7%) vs. 1 mother (3.3%) in group A and B respectively. Neonatal mean hemoglobin levels were 16.8±0.2 g/dl vs. 17.7±0.1 g/dl in group A and B respectively. Out of the 31 booked mothers, neonatal mean hemoglobin level was 16.8±0.2 g/dl vs. 17.9±0.1 g/dl in group A and B respectively. While out of the 29 unbooked mothers, neonatal mean hemoglobin level was 16.7±0.2 g/dl vs. 17.5±0.1 g/dl in group A and B respectively. When compared the neonatal mean hemoglobin levels, there was significant difference between mean hemoglobin levels of neonates between the two groups (p=0.000). Conclusion: Delayed cord clamping in term neonates for a minimum of 2 minutes at birth is beneficial to the newborn in terms of improved hemoglobin levels. There is no significant difference seen in pre-delivery maternal hemoglobin levels and neonatal hemoglobin either in delayed cord clamping group or in early cord clamping group.

scholarly journals Comparative Study of Efficiency between Povidone Iodine and Normal Saline Lavage in the Treatment of Acute Peritonitis

2018 ◽  
Vol 4 (1) ◽  
pp. 15-20
Author(s):  
Haridas Saha ◽  
Mohammad Ibrahim Khalil ◽  
Aminul Islam ◽  
Abdullah Al Mamun ◽  
Md Margub Hossain
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Normal Saline ◽  
Povidone Iodine ◽  
Medical College ◽  
Acute Peritonitis ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Saline Lavage

Background: Control of the primary site of sepsis is the main determinant of good surgical outcome. Objective: The purpose of the present study was to compare the efficiency between povidone iodine and normal saline lavage in the treatment of acute peritonitis. Methodology: This was a randomized clinical trial conducted in the Department of Surgery at Dhaka Medical College & Hospital, Dhaka, Bangladesh. Patients with acute peritonitis due to gastrointestinal causes who were admitted in the different units of Dhaka Medical College Hospital during the study period were selected as study population. Among them patients who were treated with povidone iodine were enrolled in the present study in group A and patients who were treated with conventional normal saline were in group B. Results: A total number of 1050 patients were recruited for this study. Among them 100 patients were enrolled in the present study of which group A (50 patients) for povidone iodine and group B (50 patients) for conventional normal saline. On 7th POD wound infection was found in Group A and Group B were 11(22.4%) and 21(44.7%) respectively. Statistically significant difference in post operative complication of wound infection was observed on 7th POD between the groups (p<0.05). Post operative hospital stay in Group A and Group B were 11.50 ± 4.48 and 13.46 ± 5.13 days respectively. There is statistically significant difference in post operative hospital stay between the groups (p<0.05). Conclusion: Statistically significant difference observed in post operative complication of wound infection and burst abdomen on 7th POD between the groups. The present study there is statistically significant difference in post operative hospital stay between the groups also observed. Bangladesh Journal of Infectious Diseases 2017;4(1):15-20

scholarly journals A comparative study of early postoperative feeding versus conventional feeding for patients undergoing caesarean section

2019 ◽  
Vol 8 (12) ◽  
pp. 5002
Author(s):  
Neeraja S. ◽  
Naritha Reddy ◽  
Naima Fathima
Keyword(s):  
Cesarean Section ◽  
Comparative Study ◽  
Caesarean Delivery ◽  
Normal Diet ◽  
Early Feeding ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Postoperative Feeding

Background: Early alimentation after caesarean delivery probably has limited clinical significance in terms of improved energy and protein intake. Decreasing the post-operative ileus is possible with early feeding. Objective of this study was to study efficacy of early postoperative feeding versus conventional feeding for patients undergoing caesarean section.Methods: Present study was hospital based comparative study carried out among 200 women who fulfilled the selection criteria. The cases were divided into 2 groups of 100 each by suitable random sampling technique. Group A included 100 cases who were given early feeding within 6 hours of caesarean delivery. Group B included 100 control who were given the feeding after 24 hours of caesarean delivery.Results: The mean duration of postoperative hospital stay in Group A and Group B was 4.59±0.65 and 4.81±0.81 days respectively (p <0.05). The mean time to return of bowel sounds in Group A and Group B was 2.79±1.36 and 3.55±1.49 hours respectively (p <0.01). 2(2%) cases in group A had postoperative ileus symptoms, whereas 3 (3%) cases in Group B had the same. Statistically significant difference (p <0.05) was seen in terms of vomiting 1% versus 17%, nausea 5% versus 16%, abdominal distention 2% versus 7%, diarrhea 4% versus 90% in the early feeding versus conventional feeding groups.Conclusions: It can be concluded from present study that fast return to the normal diet is possible with early feeding among women undergoing cesarean section compared to the conventional feeding among women undergoing cesarean section.

scholarly journals ANTIBIOTIC PROPHYLAXIS IN LAPAROSCOPIC CHOLECISTECTOMY: IS IT WORTH DOING?

2016 ◽  
Vol 29 (3) ◽  
pp. 170-172 ◽  
Author(s):  
Márcio Alexandre Terra PASSOS ◽  
Pedro Eder PORTARI-FILHO
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Antibiotic Prophylaxis ◽  
Infectious Complications ◽  
Low Risk ◽  
Double Blind Study ◽  
Significant Difference ◽  
Risk Patients ◽  
Group A ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group B

ABSTRACT Background: Elective laparoscopic cholecystectomy has very low risk for infectious complications, ranging the infection rate from 0.4% to 1.1%. Many surgeons still use routine antibiotic prophylaxis Aim: Evaluate the real impact of antibiotic prophylaxis in elective laparoscopic cholecystectomies in low risk patients. Method: Prospective, randomized and double-blind study. Were evaluated 100 patients that underwent elective laparoscopic cholecystectomy divided in two groups: group A (n=50), patients that received prophylaxis using intravenous Cephazolin (2 g) during anesthetic induction and group B (n=50), patients that didn't receive any antibiotic prophylaxis. The outcome evaluated were infeccious complications at surgical site. The patients were reviewed seven and 30 days after surgery. Results: There was incidence of 2% in infection complications in group A and 2% in group B. There was no statistical significant difference of infectious complications (p=0,05) between the groups. The groups were homogeneous and comparable. Conclusion: The use of the antibiotic prophylaxis in laparoscopic cholecystectomy in low risk patients doesn't provide any significant benefit in the decrease of surgical wound infection.

scholarly journals Prophylactic use of antibiotics as per SIGN 104 guidelines versus routine antibiotic prophylaxis for prevention of surgical site infection in clean and clean contaminated ENT surgical procedures: a comparative study

2019 ◽  
Vol 6 (1) ◽  
pp. 106
Author(s):  
M. Bharath ◽  
J. R. Galagali ◽  
Awadhesh Kumar Mishra ◽  
Ajay Mallick ◽  
E. Nikhilesh
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Surgical Procedures ◽  
Antibiotic Use ◽  
Site Infection ◽  
Significant Difference ◽  
Group A ◽  
Prophylactic Use ◽  
Group B ◽  
Clean Contaminated

<p class="abstract"><strong>Background:</strong> Many clinicians continue to use antibiotic prophylaxis routinely in all surgical procedures, ignoring the guidelines issued by policy makers. In this prospective study we compared the rate of surgical site infection (SSI) in patients who received prophylactic antibiotics as a routine; with the rate of SSI in patients getting antibiotics strictly as per SIGN 104 Guidelines, for clean and clean contaminated procedures.</p><p class="abstract"><strong>Methods:</strong> The study population comprised 235 patients. Group A consisted of 119 patients having 77 (65%) males and 42 (35%) females while Group B had 116 patients - 71 (61%) males and 45 (39%) females. Group A received routine antibiotic prophylaxis in all cases, while Group B received antibiotic prophylaxis as per SIGN 104 guidelines only. Both the groups were followed up for one month post-operatively for SSI and complications.</p><p class="abstract"><strong>Results:</strong> SSI occurred in 2 patients (1.68%) in Group A and in 3 (2.59%) patients in Group B. There was no significant difference in the rate of SSI between the two groups (p=0.68). Procedure wise maximum SSI occurred in tympanoplasty and laryngectomy. Due to infection one case of tympanoplasty had graft failure and one case of laryngectomy had delayed wound healing. No major complications related to infection or antibiotic use occurred in either group.</p><p class="abstract"><strong>Conclusions:</strong> Selective use of antibiotic prophylaxis as per SIGN 104 Guidelines does not lead to increase in SSI in clean and clean contaminated ENT procedures.</p>

A Comparative Study of Single Dose and Multiple Dose Antibiotic Prophylaxis In Caesarean Section

2021 ◽  
Vol 8 (3) ◽  
pp. 89-93
Author(s):  
Dr. Poorvi Agarwal ◽  
Dr. Harshal Nimbannavar ◽  
Dr. Prajakta Khose ◽  
Dr. Supraja Subramanian ◽  
Dr. Himadri Bal
Keyword(s):  
Single Dose ◽  
Caesarean Section ◽  
Antibiotic Prophylaxis ◽  
Multiple Dose ◽  
Prophylactic Antibiotic ◽  
Dose Schedule ◽  
Antibiotic Use ◽  
Skin Incision ◽  
Significant Difference ◽  
Group B

Background: Rampant antibiotic use brought about its own set of problems like the rise in incidence of antibiotic resistant strains, allergies and other complications of antibiotic use. Unfortunately in many of our set ups we are still stuck in prolonged post-operative antibiotic regimes. This study aims to fill that lacunae and thereby aid our gradual shift away from over reliance on prolonged antibiotic usage in prevention of SSI. Hence we decided to investigate the efficacy of the use of a single prophylactic intravenous dose of antibiotic vis a vis multiple doses in reducing post-operative infective morbidity in caesarean sections. Methods: The study included 200 patients at term, satisfying the inclusion and exclusion criteria, reporting to the labour room and undergoing caesarean section. The patients were then divided into two groups of 100 each by simple randomization. Patients in Group A were given a single dose of Inj. Cefotaxime 1gm IV + Inj. Metronidazole 500 mg IV infusion 30 minutes before the skin incision. Group B cases were given the first dose of Inj. cefotaxime 1g IV + Inj. metronidazole 500 mg IV 30 minutes before the skin incision followed by injectables for 2 days: Inj. cefotaxime 1g IV BD and Inj. metronidazole 500mg IV TDS. Subsequently for the next 3 days Tablet Cefixime 200mg BD and Tablet Metronidazole 400mg TDS were administered orally. Results:  The present study did not show any significant difference in the post operative infection incidence between the single dose and multiple dose schedule. Conclusion: our study makes an important observation regarding use of antibiotic prophylaxis and its duration for prevention of post operative infections in mothers without compromising any safety aspects of either the mother or the child.  As noted in our study, there was no difference in the outcome as regards post operative infectious morbidity in patients of both the groups. Hence, based on the findings of our study we conclude that single dose prophylactic antibiotic should be the norm for caesarean sections.

Antibiotic Prophylaxis Before Dental Procedures Can Reduce ONJ Incidence.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3613-3613 ◽  
Author(s):  
Vittorio Montefusco ◽  
Francesca Gay ◽  
Francesco Spina ◽  
Maria Teresa Ambrosini ◽  
Massimo Maniezzo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Zoledronic Acid ◽  
High Risk ◽  
Antibiotic Prophylaxis ◽  
Low Risk ◽  
Dental Procedure ◽  
Dental Procedures ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Osteonecrosis of the jaw (ONJ) is a frequent complication in bisphosphonate-treated multiple myeloma (MM) patients. The pathogenesis is unclear, and major risk factors are duration of bisphosphonate treatment and dental procedures. The histology of osteonecrotic bone shows osteomyelitis and inflammatory infiltrates, and, in most cases, presence of Actynomycetes. Since dental procedures are a major risk factor for ONJ development and oral microflora can be involved in the pathogenesis of the disease, we conducted a retrospective observational trial comparing ONJ occurrence and related risk factors in two groups of MM patients, who received zoledronic acid treatment at two Italian hematological centres. In one centre all patients systematically received as antibiotic prophylaxis amoxicillin-clavulanate 1 gm bid or levofloxacin 500 mg once a day starting from one day before to 3 days after any dental procedure (group A, 52 patients), while in the other centre patients did not receive any prophylaxis (group B, 61 patients). Dental procedures were categorized according to their invasivity and their supposed probability to cause ONJ. Extractions, implants, and professional cleanings were considered at high risk, while fillings were considered low risk procedures. Thirty-three group A patients (63%) and 32 group B patients (52%) received high risk procedures; 4 group A patients (8%) and 5 group B patients (8%) received low risk procedures, while 15 (29%) and 24 (39%) patients, respectively, had a denture. The duration of zoledronic acid exposure differed significantly between the two groups, with a median of 26 months for A patients and 12 months for B patients (p&lt;0.0001). In group A no cases of ONJ were observed, while in group B 8 cases (13%) of ONJ were diagnosed, with a significant difference between the two groups (p=0.007). There was a temporal correlation between dental procedure and ONJ, with a median time of 60 days (range 37–990). The relative risk of ONJ after a dental procedure was 4.8 (p=0.01). The pooled analysis of the two groups showed that age, sex, transplant procedure, and thalidomide therapy did not correlate with ONJ. In both groups the presence of dentures was not associated with ONJ. While in group B incidence of ONJ is consistent with data reported in the literature, which range between 7% and 11%, group A patients had an unexpected low occurrence of this complication, despite a significantly longer exposure to zoledronic acid. This finding suggests a possible role of antibiotic prophylaxis in protecting from ONJ after dental procedures. Further, our observation, along with the correlation between dental procedures and ONJ development, can contribute to the proposal of a comprehensive model of ONJ pathogenesis: trauma of the alveolar bone modified by bisphosphonates induces a bacterial translocation with a subsequent induction of infection, inflammation and necrosis. In this perspective, since antibiotic prophylaxis is a simple and low cost precaution, it’s reasonable to propose it as part of standard care to zoledronic acid treated MM patients before any dental procedure.

scholarly journals Outcome of thyroid lobectomies undergone with and without drains

2020 ◽  
Vol 8 (8) ◽  
pp. 2919
Author(s):  
Sahrish Bachani ◽  
Shahid N. Memon ◽  
Muhammad R. Pathan ◽  
Rehmat Sehrish Shah ◽  
Aneeta Kumari ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Pain Score ◽  
Thyroid Nodules ◽  
University Hospital ◽  
P Value ◽  
Thyroid Lobectomy ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Thyroid lobectomy is a common operative technique of management of benign solitary thyroid nodules in which drains are used routinely. Objective of this study to compare the outcome of thyroid lobectomies undergone with and without drains in patients of benign solitary thyroid nodules.Methods: A comparative cross-sectional research was completed on 98 patients of benign solitary thyroid nodules at surgery department of Liaquat University Hospital Jamshoro. Patients having age of 18-60 years underwent thyroid lobectomies were included and distributed in two groups A and B. Group A includes thyroid lobectomies with drain and Group B without drain. Postoperative outcomes including pain score assessed via visual analog score (VAS), hospital stay and complications including wound infection, seroma and hematoma.Results: Out of 98 cases, 49 underwent thyroid lobectomy with drain and 49 without a drain. Females patients were in majority in group A 42 (85.7%) and also in group B 47 (95.9%). No significant difference (p-value=0.674) was in mean age of group A 30.8±10.2 years and group B 31.8±12.2 years. Higher mean with significant difference (p-value=0.001) was in pain score of group A 5.61±1.25 as compared to group B 3.55±0.70. No significant difference was in complications; seroma 1 (2.04%) vs 5 (10.20%), hematoma 1 (2.04%) vs 1 (2.04%) and infection 3 (6.12%) vs 0 (0.0%) in group A and B respectively. Higher mean with significant difference (p-value=0.001) was in hospital stay of group A 2.40±1.57 days as compared to group B 1.42±0.54 days. No significant difference (p-value=0.748) was in overall rate of complications in group A 5 (10.20%) and B 6 (12.24%).Conclusions: Thyroid lobectomy with drain is not effective in lowering the postoperative complications whereas enhanced the risk of postoperative pain, wound infection and duration of hospital stay as compared to thyroid lobectomy without a drain.

scholarly journals A comparative study of inguinal hernia repair: Shouldice versus Lichtenstein repair

2018 ◽  
Vol 5 (6) ◽  
pp. 2238
Author(s):  
Ram Sagar Shah ◽  
Ajay Kumar
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Wound Infection ◽  
Operating Time ◽  
Cost Effective ◽  
Lichtenstein Repair ◽  
Shouldice Repair ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Inguinal hernia is a common problem and its repair is one of the most frequently performed operation in general surgical practice. There are appreciable advantages of Lichtenstein over Shouldice repair in terms of simplicity, less time consuming and postoperative pain; there in the context of less developed countries with limited economic resources, however Shouldice repair is more cost effective and there are no differences in recurrences and other complications which would be a better proposition. The present study aims at comparing the results of Shouldice versus Lichtenstein’s repair in inguinal hernia in adult male (≥18 years).Methods: Total of fifty cases was included in this study, were equally divided into 2 groups; Group A and Group B and subjected for Shouldice and Lichtenstein mesh repair respectively. Operating time, postoperative complications as Wound infection, Seroma, Hematoma, Postoperative pain, and days of hospital stay, total costs and time to return to usual activity was noted.Results: Out of 50 patients, 36 (72%) were had indirect hernia and most of them were in between 18-29.9 years of age. There were no difference between two groups with respect to postoperative pain, Wound infection 12% and 8%, Seroma  8% and 4% and Hematoma 4% and 4% in Group A and Group B respectively. However, there is significant difference noted in operating time period in which Shouldice repair took more time (Mean time in Shouldice 84.16 min and Lichtenstein 58.80 min). There were no recurrences in either group.Conclusions: So, comparing our results of both groups, Lichtenstein repair were found to be better as it is simple procedure and is less time consuming than Shouldice repair.  However, Shouldice repair was found to be cost effective which could be an important consideration in developing countries.

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