Loose knots and surgical site infections in abdominal surgeries (clean-contaminated and contaminated wounds)

Background: Surgical site infections (SSIs) are associated with high healthcare costs and worsen the post-operative course of a considerable proportion of general abdominal surgical patients. SSIs raise the risk of post-operative morbidity and mortality, necessitating hospitalization, intravenous antibiotics, and potentially surgical reintervention. The aim of the study was to compare the outcome of intermittent loose knots and the conventional vertical mattress suturing in patients undergoing abdominal surgeries.Methods: This prospective comparative study was done in patients undergoing emergency abdominal surgeries for any cause. Patients were divided into 2 groups- (a) group 1 (45 patients): intermittent loose knots between conventional vertical mattress sutures; (b) group 2 (45 patients): conventional vertical mattress suturing.Results: In this study, 31% of patients were in the 41-50 years age group, 53.3% of patients were male. Among various abdominal surgery opted, laparotomy was the most commonly performed procedure (47%). In this study, group 1 patients shown a decrease in wound gap, secondary wound closure and delayed wound approximation than group 2 patients.Conclusions: Loose knots in between conventional vertical mattress sutures are better than conventional vertical mattress suturing in terms of wound gap, secondary wound closure and delayed wound approximation.

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Reduction of the Risk of Relapse of Symptoms When Using Esophagoprotector in Patients Requiring Temporary Cancellation of Antisecretory Therapy

Effective Pharmacotherapy ◽

10.33978/2307-3586-2021-17-16-26-30 ◽

2021 ◽

Vol 17 (16) ◽

pp. 26-30

Author(s):

Yu.A. Kucheryavy ◽

◽

P.R. Movtaeva ◽

D.N. Andreev ◽

R.I. Shaburov ◽

...

Keyword(s):

Comparative Study ◽

Underlying Disease ◽

On Demand ◽

Long Time ◽

Prospective Comparative Study ◽

Group 2 ◽

Significant Regression ◽

Risk Of Relapse ◽

Group 1

Objective: to evaluate the effectiveness of an esophagoprotector in reducing the risk of recurrent symptoms of gastroesophageal reflux disease (GERD) in patients who requiring temporary cancellation of therapy with proton pump inhibitors (PPIs). Material and methods. For the prospective comparative study there were selectively chose patients who had been taking PPIs for a long time (at least one month) for the underlying disease and who required temporary discontinuation of antisecretory therapy due to objective medical reasons. The study included patients with endoscopically and/or pH-metrically verified GERD, as well as histologically verified Barrett's esophagus. In the process of randomization of patients, two equal groups were formed, depending on the therapy received at the time of PPI withdrawal: group 1 received antacids on demand, group 2 received antacids on demand, as well as the esophagoprotector Alfasoxx at a dose of 10 ml four times a day (after each meal and at night). The follow-up period was two weeks. The patients recorded episodes of heartburn in their personal diaries. Results. The study included 60 patients (28 men and 32 women). The average age of the examined patients was 43.1 ± 5.3 years. By the end of the two-week follow-up period, the frequency of recurrent symptoms in group 1 was 36.7%, while in group 2 it was 13.3%. The use of the esophagoprotector Alfasoxx contributed to the significant regression of the risk of heartburn recurrence (odds ratio 0.2657; 95% confidence interval (CI) 0.07328-0.9637; p = 0.0438) in comparison with the group of patients who received only antacids in the on-demand mode. When analyzing the population of patients who had relapsed symptoms, it was demonstrated that the average number of heartburn episodes in group 1 was 6.18 (95% CI 4,1930-8,1706), and in group 2 – 4.50 (95% CI 0,7121-8,2879). Conclusion. This prospective comparative study demonstrated that the use of the esophagoprotector Alfasoxx helps to reduce the risk of relapse of GERD symptoms in patients requiring temporary cancellation of PPI therapy.

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Abstract 15073: Best Anticoagulation Strategy for Stroke Prophylaxis in Atrial Fibrillation Patients With Amyloidosis

Circulation ◽

10.1161/circ.142.suppl_3.15073 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sanghamitra Mohanty ◽

CHINTAN G TRIVEDI ◽

Joseph Gallinghouse ◽

Domenico G Della Rocca ◽

Carola Gianni ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulants ◽

Bleeding Complications ◽

Considerable Proportion ◽

Medical Procedure ◽

Bleeding Events ◽

Full Dose ◽

Half Dose ◽

Group 2 ◽

Group 1

Background: A considerable proportion of elderly patients are known to have coexistent atrial fibrillation (AF) and amyloidosis. Both conditions increase stroke risk. Objective: We evaluated the best anticoagulation strategy in a series of AF patients with amyloidosis. Methods: Consecutive AF patients with coexistent amyloidosis undergoing catheter ablation at our center were included in the analysis. Based on the stroke-prophylaxis approach they were divided into 2 groups; group 1: left atrial appendage occlusion (LAAO) with Watchman and group 2: oral anticoagulation. Following LAAO, all patients remained on full dose non-vitamin K oral anticoagulants (NOAC) for 45 days. Transesophageal echocardiogram (TEE) was performed at 45 days to assess completeness of closure. If the occlusion was complete, patients were kept on aspirin, 81 mg/day for long-term. In case of leak or dense ‘smoke’ in the left atrium (LA) or enlarged LA, they were prescribed half-dose NOAC. NOACs included dabigatran, apixaban, endoxaban and rivaroxaban. Group 2 patients remained on full-dose NOAC during the whole study period (1 year). All patients were prospectively followed up for 1 year. Results: A total of 87 patients were included in the analysis; group 1: 56 and group 2: 31 . CHA 2 DS 2 -VASc score was comparable between the groups (gr. 1: 3.7±1.6 and gr. 2: 3.2±1.7, p=0.18). The most commonly used NOACs were apixaban (45, 51.7%) and rivaroxaban (34, 39%). After the 45-day TEE, 34 patients from group 1 remained on baby-aspirin and 22 on half-dose NOAC. Of the 22, 12 patients had leaks <5 mm, 6 had large LA (mean diameter 5.2±1.4 cm) and 4 patients had dense LA smoke. At 1-year follow-up, 3 stroke and 1 transient ischemic attack were reported in group 1 on baby-aspirin (4/34, 11.8%). No stroke or bleeding complications occurred in the 22 patients on half-dose NOAC. In group 2 patients on full-dose OAC, a total of 5 (5/31, 16.1%) bleeding events (1 subdural hematoma and 4 GI bleedings) were recorded. Additionally, a stroke was reported that happened during brief discontinuation of OAC for another medical procedure. Conclusion: In our series of patients with coexistent AF and amyloidosis, half-dose NOAC following LAA occlusion procedure was observed to be the safest stroke-prophylaxis strategy.

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A COMPARATIVE STUDY TO EVALUATE THE OUTCOME OF PONSETI'S TECHNIQUE AND ACCELERATED PONSETI'S TECHNIQUE FOR CORRECTION OF CLUBFOOT

10.36106/ijar/2802068 ◽

2021 ◽

pp. 59-61

Author(s):

Ashok Vidhyarthi ◽

H.S. Varma ◽

Rajeev Singh ◽

Rajendra Thakur ◽

Darwin Kumar Thakur

Keyword(s):

Comparative Study ◽

Ponseti Method ◽

Congenital Deformity ◽

Duration Of Treatment ◽

Protocol Group ◽

Pirani Score ◽

Prospective Comparative Study ◽

Group 2 ◽

Accelerated Ponseti ◽

Group 1

Introduction: Clubfoot is a common congenital deformity with incidence of1-6.8/1000 live births. Ponseti method is currently the gold standard for treatment of clubfoot which conventionally involves weekly plaster changes. A prospective comparative study was carried out at our hospital where we compared one group with weekly plaster change to other group with twice weekly plaster change, using the classical Ponseti protocol of manipulation. A total 50 feet (36 children ), divided into two Methods: groups, were randomly allocated to either Group 1 – 25 feet(accelerated Ponseti) or Group 2 – 25 feet (standard Ponseti). Group 2 underwent serial manipulations and casting once a week and Group 1 received manipulations and castings twice a week. Pirani score was documented at the time of presentation, after each cast, and at the time of removalof nal cast to assess the success of treatment ( Pirani score ≤1). A tota Results: l 43 feet (29 patients) underwent the entire course of treatment, while 7 patients discontinued the treatment during the course of the study. 14 patients, i.e, 21 feet were treated with Accelerated Ponseti Protocol (APP),i.e Group -1, and 15 patients, i.e, 22 feet were treated with Standard Ponseti Protocol (SPP), i.e Group-2. Mean duration of treatment from the rst cast to tenotomy in the accelerated ponseti protocol group was 20.57 ± 4.5 days (ranging from 12 to 29 days), and in standard ponseti protocol group was 39.66 ± 6.9 days (ranging from 29 to 51 days). Conclusion: Both the methods proved to be equally efcacious for the management of clubfoot in our study. However, the accelerated method had an overall shorter treatment duration making it convenient for the parents. As the patient is under direct observation of surgeons, complications, in any, are detected early and easily. Overall, the accelerated technique is more practical, benecial, and equally efcacious as standard ponseti technique, providing a more rapid correction of the deformity.

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The management of sinogenic orbital complications

The Journal of Laryngology & Otology ◽

10.1017/s0022215100129974 ◽

1995 ◽

Vol 109 (4) ◽

pp. 300-303 ◽

Cited By ~ 15

Author(s):

Bharath Singh

Keyword(s):

Conservative Treatment ◽

Eye Movement ◽

Late Stage ◽

Stage Disease ◽

Intravenous Antibiotics ◽

Late Stage Disease ◽

Group 3 ◽

Group 2 ◽

Orbital Complications ◽

Group 1

AbstractThe place of conservative treatment in sinogenic orbital complications has not been fully explained in the literature. The question that remains unresolved is – at which stage of the disease is surgery indicated?A study was undertaken in 240 patients with sinogenic orbital complications, to determine this. The patients were divided into three groups according to the stage of the disease as determined clinically: Group 1 (52 patients) with early stage disease, as detected by cellulitis only; Group 2 (76 patients) with intermediate stage, as detected by periorbital cellulitis and proptosis, but with full range of eye movement and unaltered vision: Group 3 (122 patients) with late stage disease, as detected by periorbital cellulitis and gross proptosis. with limitation of eye movement and altered vision.Group I and Group 2 patients were treated conservatively, with intravenous antibiotics and antral lavage. Group 3 patients were treated with intravenous antibiotics and surgery. External frontoethmoidectomy was performed in 31 (bilateral in two), ethmoidectomy in 91 (bilateral in five), sphenoidectomy in 15 and bilateral antral washout in all (122 patients). There was 100 per cent success with conservative treatment in Group 1 patients, whilst in Group 2 there was 98.6 per cent failure. The 75 patients in whom conservative treatment failed were successfully treated with surgery: frontoethmoidectomy was performed in 66 and ethmoidectomy in nine. In Group 3 patients, 100 per cent success was achieved with intravenous antibiotics and surgery.Sinogenic orbital complications can be treated conservatively and surgically, depending on the stage of the disease on presentation. Conservative treatment is only suitable for early complications, i.e. patients with periorbital cellulitis only. For disease beyond this stage i.e. intermediate and late stage disease, surgery is the treatment of choice.

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Patterns of Recurrence and Mechanisms of Failure after Open Ventral Hernia Repair with Mesh

The American Surgeon ◽

10.1177/000313481708301131 ◽

2017 ◽

Vol 83 (11) ◽

pp. 1275-1282 ◽

Cited By ~ 7

Author(s):

Jeremy A. Warren ◽

Sean P. McGrath ◽

Allyson L. Hale ◽

Joseph A. Ewing ◽

Alfredo M. Carbonell ◽

...

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Mesh Fixation ◽

Wound Complications ◽

Light Weight ◽

Group 2 ◽

Clean Contaminated ◽

Recurrence Group ◽

Group 1

Recurrence after ventral hernia repair (VHR) remains a significant complication. We sought to identify the technical aspects of VHR associated with recurrence. Patients who underwent open midline VHR between 2006 and 2013 (n = 261) were retrospectively evaluated. Patients with recurrence (Group 1, n = 48) were compared with those without recurrence (Group 2, n = 213). Smoking, diabetes, and body mass index were not different between groups. More patients in Group 1 underwent clean-contaminated, contaminated, or dirty procedures (43.8 vs 27.7%; P = 0.021). Group 1 had a higher incidence of surgical site occurrence (52.1 vs 32.9%; P = 0.020) and surgical site infection (43.8 vs 15.5%; P < 0.001). Recurrences were due to central mesh failure (CMF) (39.6%), midline recurrence after biologic or bioabsorbable mesh repair (18.8%), superior midline (16.7%), lateral (16.7%), and after mesh explantation (12.5%). Most CMF (78.9%) occurred with light-weight polypropylene (LWPP). Recurrence was higher if the midline fascia was unable to be closed. Recurrence with midweight polypropylene (MWPP) was lower than biologic (P < 0.001), bioabsorbable (P = 0.006), and light-weight polypropylene (P = 0.046) mesh. Fixation, component separation technique, and mesh position were not different between groups. Wound complications are associated with subsequent recurrence, whereas midweight polypropylene is associated with a lower overall risk of recurrence and, specifically, CMF.

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PREVENTION OF POST OPERATIVE INFECTIONS IN EMERGENCY CAESAREAN SECTIONS: ROLE OF SURGICAL BUNDLE AND VAGINAL CLEANING

10.36106/paripex/4200167 ◽

2021 ◽

pp. 1-4

Author(s):

Asma Nagori ◽

Deeba Khanam ◽

Shaheen Shaheen ◽

Meher Rizvi

Keyword(s):

Caesarean Section ◽

Prophylactic Antibiotic ◽

Surgical Site Infections ◽

Infectious Complications ◽

Medical College ◽

Antibiotic Regime ◽

The Difference ◽

Group 2 ◽

Group 1

Introduction: Caesarean section (CS) is one of the commonest surgical procedures performed in obstetrics. Postoperative infectious complications including surgical site infections (SSI) are a cause of significant morbidity after CS as compared to vaginal delivery. Aim: To assess the role of application of surgical bundle and vaginal cleaning before caesarean section in preventing postoperative infectious complications. Design: Prospective randomised interventional study. Place and duration of study: Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College and hospital,Aligarh from November 2016 to October 2018. Methodology: Total of 216 patients undergoing emergency CS in the hospital was enrolled in the study. Patients were kept in 2 groups. In group 1, women undergoing emergency C-Section whom conventional preoperative preparation was done using savlon-povidone iodine as skin antiseptic and a 7 day postop prophylactic antibiotic regime was administered.In group 2,surgical bundle and vaginal cleaning was done but postop prophylactic antibiotic regime was reduced to 3 day Results:Overall,SSIs were most common infectious morbidity in both groups with highest incidence in group 1(14.7%) and lower in group 2(7.01%), and the difference was statistically significant. Rates of endometritis, UTI and URTI were similar among 2 groups.Duration of hospital stay was lower for group 2 (6.43+_3.29days).No Significant association was noted between haemoglobin levels <8g/dl and number of >4 vaginal examinations with risk of development of SSI (p<0.05). Conclusion:Bundled approach including vaginal cleaning has decreased the incidence of SSIs after emergency CS but larger clinical studies are needed to prove the definite role

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To Compare the Outcome of Estrogen and Betamethasone Cream in the Treatment of Labial Adhesion in Pre-pubertal Girls

Bangladesh Journal of Child Health ◽

10.3329/bjch.v43i3.49573 ◽

2020 ◽

Vol 43 (3) ◽

pp. 161-164

Author(s):

Gajendra Nath Mahato ◽

Paritosh Kumar Palit ◽

Md Hasanuzzaman

Keyword(s):

Child Health ◽

Adverse Effects ◽

Vaginal Opening ◽

Prospective Comparative Study ◽

Previously Treated ◽

The Difference ◽

Group 2 ◽

Labial Adhesion ◽

Prepubertal Girls ◽

Group 1

Background: Labial adhesion is a condition of prepubertal girls where the labia are fused over the vaginal opening and/or urethra. Objective: The purpose of the study was to compare the outcome of estrogen and betamethasone cream in the treatment of labial adhesion. Materials and methods: This prospective comparative study was conducted among 100 pre-pubertal girls with labial adhesion where at least 50% vaginal opening was fused. Patients previously treated with estrogen or betamethasone for labial adhesion was excluded from the study. Fifty patients were treated with betamethasone cream (group 1) and fifty patients with estrogen cream (group 2) after randomization. All patients were followed at 3rd week, 6th week, 3rd month, 6th month and then release of adhesion and adverse effects were noted. Results: Within 3 weeks no adhesion was found in 84.0% participants in group 1 and 64.0% participants in group 2, which showed significant statistical differences (p=0.023). Within 6 months recurrence of adhesion was found in 2.2% participants in group 1 and 23.4% in group 2, which also showed highly significant statistical differences (p=0.004). Success rate was 90.0% and 72.0% within 6 months in group 1 and in group 2 respectively and the difference was statistically significant (p=0.022). Conclusion: Betamethasone cream appears to be a superior agent in terms of effectiveness, safety and cost than estrogen cream in the treatment of labial adhesion in pre-pubertal girls. Bangladesh J Child Health 2019; VOL 43 (3) :161-164

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The Influence of Different Guided Bone Regeneration Procedures on the Contour of Bone Graft after Wound Closure: A Retrospective Cohort Study

Materials ◽

10.3390/ma14030583 ◽

2021 ◽

Vol 14 (3) ◽

pp. 583

Author(s):

Maoxia Wang ◽

Xiaoqing Zhang ◽

Yazhen Li ◽

Anchun Mo

Keyword(s):

Bone Graft ◽

Bone Regeneration ◽

Bone Substitute ◽

Wound Closure ◽

Guided Bone Regeneration ◽

Collagen Membrane ◽

Group 4 ◽

Surgical Template ◽

Group 2 ◽

Group 1

The aim of this study was to evaluate the impact of different guided bone regeneration (GBR) procedures on bone graft contour after wound closure in lateral ridge augmentation. A total of 48 patients with 63 augmented sites were included in this study. Participants were divided into 4 groups (n = 12 in each group) based on different surgical procedures: group 1: particulate bone substitute + collagen membrane; group 2: particulate bone substitute + collagen membrane + healing cap, group 3: particulate bone substitute + injectable platelet-rich fibrin (i-PRF) + collagen membrane; group 4: particulate bone substitute + i-PRF + surgical template + collagen membrane. After wound closure, the thickness of labial graft was measured at 0–5 mm apical to the implant shoulder (T0–T5). At T0–T2, the thickness of labial graft in group 4 was significantly higher than the other three groups (p < 0.05). And group 4 showed significantly more labial graft thickness than group 1 and group 2 at T3–T5 (p < 0.05). Within the limitations of this study, the use of i-PRF in combination with the surgical template in GBR may contribute to achieving an appropriate bone graft contour after wound closure.

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INTESTINAL ANASTOMOSIS

The Professional Medical Journal ◽

10.29309/tpmj/2010.17.02.2350 ◽

2010 ◽

Vol 17 (02) ◽

pp. 232-234

Author(s):

RANA ASRAR AHMAD KHAN ◽

Mohammad Dilawaiz ◽

FAKHAR HAMEED ◽

Ch. Mohammad Akram ◽

BASHIR AHMED

Keyword(s):

Cost Effectiveness ◽

Double Layer ◽

Intestinal Anastomosis ◽

Single Layer ◽

Cost Effective ◽

Continuous Layer ◽

Prospective Comparative Study ◽

The Difference ◽

Group 2 ◽

Group 1

Objective: To evaluate the safety and cost effectiveness of single layer interrupted intestinal anastomosis in comparison with the double layer conventional method of intestinal anastomosis. Study Design : Prospective comparative study. Period & Setting: Surgical unit 4 DHQ hospital Faisalabad operated by single team during 12 months starting from Feb. 2007 to Jan. 2008. Materials and Methods: The cases were assigned to the two techniques, each being applied on alternate patient, single layer extra mucosal interrupted anastomosis anddouble layer anastomosis. In group 1 we used black silk 3/0 and in double layer we used vicryl 3/0 for inner continuous layer and black silk 3/0 for outer continuous layer. Comparison between two techniques was done on the bases of procedure time, cost effectiveness, morbidity in terms of rate of leakage/. Results: Average time for the construction of the single layer anastomosis was 20 minutes and in double layer was 35 minutes, the difference in average time is statistically significant (p<.001) while average duration of stay was 168 hrs and 216 hrs in group 1 and 2 respectively (p<.001). Leakage rate was double (12%) in group 2 while 6% in group 1. Moreover structure material consumption was more in two layered technique and longer stay added to that lead to more hospital expenses on two layered technique. Conclusion: Anastomosis usinga single layer interrupted extra mucosal technique was faster to perform, cost effective, less likely to leak and as strong as a 2-layer anastomosis.

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Insomnia in patients with migraine

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2019-2-22-29 ◽

2019 ◽

Vol 11 (2) ◽

pp. 22-29

Author(s):

E. M. Evdokimova ◽

G. R. Tabeeva

Keyword(s):

Sleep Disorders ◽

Biological Rhythms ◽

Underlying Disease ◽

Early Morning ◽

Study Participation ◽

Sleep Diaries ◽

Prospective Comparative Study ◽

Group 2 ◽

Chronic Course ◽

Group 1

Objective: to evaluate the significance of insomnia and chronobiological patterns in the development of headache (HA) attacks for the formation of clinical features of migraine and for the elaboration of strategies for its prevention.Patients and methods. A prospective comparative study was conducted in 60 patients aged 18–65 years who were diagnosed as having migraine (with or without aura) with comorbid sleep disorder. Group 1 consisted of 30 patients with migraine and insomnia; Group 2 comprised 30 patients with migraine without insomnia. The study participation included four visits to a physician for 12 months.Results and discussion. Persistent sleep disorders in patients with migraine were shown to worsen the course of the underlying disease: HA attacks had a greater intensity, mainly left-sided localization and a longer duration. Group 1 patients were observed to have a chronic course of the disease with a frequency of ≥8 attacks per month in 33% of cases. Analysis of biological rhythms revealed that individuals with evening and mildly evening chronotypes were characterized by the greatest changes in the sleep-wake cycle, by sleep deprivation and its reduced efficiency. Analysis of the data of HA and sleep diaries kept by the patients for 12 months showed that Group 1 had four peaks of the daily distribution of HA attacks; 13.4% of attacks occurred during sleep and early morning.Conclusion. The coexistence of sleep disorders and HA is not only manifested as the overlapping of clinical manifestation, but also largely determines their natural course and prognosis, i.e. their progression into a chronic form. Therefore, it is imperative to identify sleep disorders in migraines, since their correction is effective and, in most cases, allows chronic HA to progress to an episodic form.

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