The Safty Profile of Blood Salvage Applied for Collected Blood With Amniotic Fluid During Cesarean Section

Abstract Background: The guidelines of National Health Service(NHS) also recommended for use in obstetrics at increased risk of bleeding, requiring two sets to reduce amniotic fluid contamination, however, when comes to massive hemorrhage, it is may difficult to operate because the complex operation may delay time. The aim of the study was to detect the effect of amniotic fluid recovery on intraoperative cell salvage in obstetrics and provide evidence for clinical applications.Method: Thirty-four patients undergoing elective cesarean section were randomly divided into two groups. In group 1, the cumulative blood from the operation field, including the amniotic fluid, was collected using a single suction device for processing. In group 2, after suctioning away the amniotic fluid using another suction device for the cumulative blood from the operation field. From each group, four samples were taken, including maternal venous blood (sample I), blood before washing (sample II), blood after washing (sample III) and blood after filtration with a leukocyte filter (sample IV) , to detect serum potassium (K+), hemoglobin (Hb), white blood cell (WBC), fetal hemoglobin (HbF), alpha fetoprotein (AFP) and squamous cell (SC) levels.Results: The AFP, K+ and WBC levels of sample III and sample IV were significantly lower than sample I in group 1 and group 2 (P<0.05). Significantly more SCs were found in sample III than in sample I in group 1 and group 2 (P<0.05), but SCs of sample IV had no statistical difference compared to sample I in group 1 and group 2 (P>0.05). There was no significant difference in the K+, Hb, WBC, AFP and SC levels of sample IV between group 1 and group 2 (P>0.05). The HbF levels of sample III and sample IV were significantly higher in group 1 than in group 2 (P<0.05).Conclusion: There is little or no possibility for AF contamination to enter the re-infusion system when used in conjunction with a leucodepletion filter. In future, one set of suction device can be considered in obstetric emergency.Trial registration: ChiCTR1800015684, 2018.4.15

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Comparison of Inflammatory Reactions Following Two Different Cesarean Section Techniques: The Modified Misgav-Ladach Versus the Pfannenstiel-Kerr; A Prospective Randomized Trial

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.811 ◽

2018 ◽

pp. 1

Author(s):

Baris Buke ◽

Hatice Akkaya ◽

Cigdem Karakukcu

Keyword(s):

Cesarean Section ◽

Inflammatory Reaction ◽

Operation Time ◽

Blood Samples ◽

Inflammatory Reactions ◽

Tnf Α ◽

Significant Difference ◽

The Difference ◽

Group 2 ◽

Group 1

Objectives: There is not yet a consensus on the optimal surgical technique for cesarean section. This is the first study comparing two different (Cesarean Section) with respect to the following inflammatory reaction in means of changes in inflammatory marker levels. To evaluate the differences in inflammatory reactions following two different (Cesarean Section) techniques, the modified Misgav-Ladach versus the Pfannenstiel-Kerr technique.Study Desıgn: The study population included 88 pregnant women who met the inclusion criteria. These women were randomized into two groups according to Consolidated Standards of Reporting Trials guidelines: Group 1 (Misgav-Ladach group) and Group 2 (Pfannenstiel Kerr group). To compare the inflammatory reactions following surgery, Interleukin-6 (IL-6) and Tumor Necrosis Factor-α (TNF-α) levels were measured in venous blood samples drawn from the patients just before (0 hour) and 24 hours (24th hour) after the surgery. In 5 women from Group 1 and 2 women from Group 2, the 24th hour blood samples could not be obtained or were lost. Thus, a total of 81 women, 39 women from Group 1 and 42 women from Group 2, comprised the population of study. The differences in inflammatory reactions between the 0 and 24th hours were analyzed by calculating the percent change in IL-6 and TNF-α levels, and these percentages were then compared between the groups.Results: There was a statistically significant difference between Group 1 and Group 2 regarding the serum IL-6 level change between 0 and 24th hour (530±653% and 196±168%, respectively, p=0.022. The difference in TNF-α was also higher in Group 2, but the difference was not statistically significant (229±306% vs. 571±824%, p=0.12). The mean operation time was significantly shorter in Group 1 (9.44 min. vs. 16.86 min, p=0.0001).Conclusions: The results of this study indicate that the modified Misgav-Ladach technique has a weaker inflammatory reaction, which indicates fewer short- and long-term surgical complications.

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Abstract 26: Thirty Day And Six Month All-cause Mortality After Stroke In Patients With And Without Dysphagia Screening.

Stroke ◽

10.1161/str.44.suppl_1.a26 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Thomas M Hemmen ◽

Rema Raman ◽

Karin Ernstrom ◽

Debra Paulson ◽

Valerie Lake ◽

...

Keyword(s):

Aspiration Pneumonia ◽

Morbidity And Mortality ◽

Categorical Variables ◽

Stroke Severity ◽

Continuous Variables ◽

Admission Source ◽

Increased Risk ◽

Significant Difference ◽

Group 2 ◽

Group 1

Background: Dysphagia is common after stroke and is associated with an increased risk for pulmonary complications and mortality. Current standards mandate screening for dysphagia before oral intake in all acute stroke patients. We aimed to show if this early screening affects long-term outcomes after stroke. Methods: We included all UCSD Medical Center discharges with diagnosis AIS, ICH and SAH between July 1 2008 and June 30 2011; and evaluated baseline demographics, admission diagnosis (AIS, ICH, SAH), admission source (ED or transfer) length of hospital stay (LOS), ICU-LOS, aspiration pneumonia, in-hospital, 30-day and 6-month mortality by public death records for all patients. Patients were grouped as: 1) no dysphagia screening performed, 2) Nil per os (NPO) until discharge, 3) dysphagia screening performed. Adjustments for stroke severity and CMI were not possible. Statistical comparisons were done with the Kruskal-Wallis test (continuous variables) or Fisher-Freeman-Halton test (categorical variables). For pairwise comparisons we used the Wilcoxon tests (continuous variables) or Fisher’s Exact test (categorical variables), with Holm’s adjusted p-values. Results: A total of 476 patients were included, Group 1: 47, Group 2: 119, Group 3: 310. There was no significant difference in age, gender, race/ethnicity, and diagnosis of HTN, DM, afib, prior stroke and admission source. More patients with SAH and ICH were in Group 2. Overall, LOS and ICU LOS, aspiration pneumonia, in-hospital, 30-day and 6-month mortality were found to be different among groups (p<0.0001). Pair-wise comparisons showed that all outcomes were significantly higher in Group 2, but similar between Groups 1 and 3 (NS). Conclusion: We found no difference in outcomes between patients who received dysphagia screening versus not (Group 1 vs 3). Excluding patients who were left NPO and are more likely to suffer from ICH, SAH with increased morbidity and mortality, it remains uncertain if a targeted early dysphagia screening can reduce morbidity and mortality after stroke. Further studies are needed to find the appropriate population that most benefits from dysphagia screening.

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Acquired Antithrombin III (AT III) - Deficiency in Septicaemia

10.1055/s-0039-1687422 ◽

1979 ◽

Author(s):

E. Deutsch ◽

E. Thaler

Keyword(s):

Septic Shock ◽

Venous Blood ◽

Heparin Therapy ◽

Blood Cultures ◽

Mean Values ◽

Negative Results ◽

Significant Difference ◽

At Iii ◽

Group 2 ◽

Group 1

AT III was measured in 34 patients with clinical and bacteriological evidence of septicaemia using a heparin cofactor assay. Based on the results of positive blood cultures gram-negative septicaemia (G-S) was diagnosed in 10 (group 1) and gram positive septicaemia (G+S) in 9 patients (group 2). From the remaining 15 patients {group 3) blood cultures before onset of antibiotic therapy were not obtained and gave negative results throughout the observation period. Based on bacteria] cultures from other sites than venous blood or bacteriological examination of spinal fluid G-S was assumed in 13 and G+S in 2 patients.In all but one patient of group 1 and one of group 2 AT III activities were decreased below 2 SO of normal controls (n = 91, x = 99.6, SD-8.4) already at the time of the first coagulation screening (patients: n=34, =58.4, SD-16.6). Analysis of var-ance showed no significant difference between the mean values of the three groups at the c per cent (%) level. The minimal AT III activities during the course of the disease were below the norma] range in all patients studied [n=34, =51.2, SD=13.6).Thus AT III deficiency appears to be a constant and early finding in G-S and G+S, causing insufficient inhibition of blood coagulation, and hereby may contribute to irreversible tissue damage caused by microthrombi in septic shock. This deficiency may be an important factor in the failure of heparin therapy to reduce mortality from septic shock.

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COVID-19-associated healthcare worker depression: An increasingly common condition

Praxis of Otorhinolaryngology ◽

10.5606/kbbu.2021.23855 ◽

2021 ◽

Vol 9 (3) ◽

pp. 93-97

Author(s):

Kemal Koray Bal

Keyword(s):

Healthcare Workers ◽

Depressive Mood ◽

Clinical Psychologist ◽

Sufficient Information ◽

Increased Risk ◽

Significant Difference ◽

Group 2 ◽

Work Done ◽

The Relationship ◽

Group 1

OBJECTIVE: This study aimed to evaluate the mood of the employees of the ear-nose-throat (ENT) department with the Beck Depression Inventory (BDI) during the coronavirus disease 2019 (COVID-19) pandemic and determine the relationship between the mood and the quality and quantity of the work done. METHODS: A total of 62 healthcare workers (24 males, 38 females; mean age: 34.3±1.1 years; range 24 to 52 years) of our ENT clinic, who have been actively managing COVID-19 patients since April 2020, were included in the study. Those in the study were classified into two groups as nurses (Group 1) and doctors (Group 2). Group 1 consisted of 33 (53.2%) nurses, and Group 2 consisted of 29 (46.8%) doctors. The participants were assessed with a questionnaire by a clinical psychologist, and BDI was conducted to evaluate depressive mood in these individuals. RESULTS: A statistically significant difference was found between the groups in thinking they have sufficient knowledge on COVID-19, and the employees in Group 2 were more of the opinion that they did not have sufficient information (p=0.002). A statistically significant difference was found between the groups in terms of their viewpoint on the precautions against COVID-19 (p=0.001). Group 2 was more inclined to think that the precautions taken were inadequate (p=0.001). There was no statistically significant difference between the groups in terms of BDI severity, age, and BDI score (p=0.252, p=0.137, p=0.053, respectively). CONCLUSION: Employees of high-risk departments such as ENT may be more prone to a depressed mood. The increased risk of contamination in correlation with the work done can lead to increased BDI scores and depressive mood disorder.

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Comparison of maternal morbidity in Emergency and Elective Cesarean Section

Aegean Journal of Obstetrics and Gynecology ◽

10.46328/aejog.v2i3.56 ◽

2020 ◽

Vol 2 (3) ◽

pp. 10-13

Author(s):

Selami Erdem ◽

Serhat Ege ◽

İhsan Bagli

Keyword(s):

Maternal Morbidity ◽

Elective Caesarean Section ◽

Fetal Distress ◽

Elective Cesarean Section ◽

Bladder Injury ◽

Maternal Complications ◽

Increased Risk ◽

Elective Cesarean ◽

Group 2 ◽

Group 1

Objective: We aimed to compare emergency and elective cesarean patients in our hospital in terms of epidemiological features and maternal morbidity. Material and Methods: We randomly retrospectively reviewed the records of 302 caesarean cases. Demographic features and indications for emergency (group 1) and elective caesarean section (C/S) (group 2) were recorded. The groups were compared in terms of indications and intraoperative and postoperative morbidity. Results: It was found that the mean hematocrit decrease in group 1 was not different from group 2 (5.70 ± 1.16 and 5.62 ± 0.67). When the groups are examined according to cesarean indications; In group 1 patients, fetal distress, cephalopelvic disproportion (CPD), non-progress of labor, abruptio placentae were significantly higher compared to group 2, whereas in group 2 patients the previous 1 C / S and previous 2 C / S indications were significantly higher. Intraoperative hemorrhage and bladder injury were more common in group 1 patients compared to group 2 patients. When the groups are examined according to postoperative maternal complications; In group 1 patients, transfusion, prolonged bladder catheterization, admission to intensive care unite (ICU), was significantly higher compared to group 2. Conclusion: It was found that many intraoperative and postoperative complications were more common in the emergency C/S group. it was also detected that all cases with bladder injuries had previous cesarean sections. Therefore, the presence of experienced personnel in these cases may be important for reducing morbidity due to the increased risk of complications.

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Maintained consciousness during witnessed asystole after spinal anesthesia for Cesarean section

F1000Research ◽

10.12688/f1000research.2-11.v1 ◽

2013 ◽

Vol 2 ◽

pp. 11

Author(s):

Kanishka Rajput ◽

Harvey J Woehlck ◽

Matthias L Riess

Keyword(s):

Heart Rate ◽

Cesarean Section ◽

Spinal Anesthesia ◽

High Mortality ◽

Supine Position ◽

Venous Blood ◽

Cardiac Activity ◽

Elective Cesarean Section ◽

Epinephrine Administration ◽

Increased Risk

Despite its low incidence, cardiac arrest after spinal anesthesia carries a high mortality. Counterintuitively, young and healthy patients with low resting pulse are at increased risk. We report the case of a healthy 24 yr G2P0 at term scheduled for elective Cesarean section whose heart rate decreased to 30 bpm, followed by more than 30 seconds of asystole 3 minutes after spinal anesthesia with a T4 level block. Following atropine and epinephrine administration, the patient had several single heart beats when startled by the anesthesiologist’s loud voice and when touching her chest to prepare for chest compressions. Eventually, regular sinus rhythm returned with a heart rate of up to 160 bpm. The patient was rapidly prepped, and within 5 minutes, the fetus was delivered surgically with Apgar scores of 8 and 9. Most unusually, the patient remained responsive during the entire event and denied having lost consciousness. Supine position and volume loading may have contributed to venous pooling within the cerebral vasculature, so even in the absence of cerebral blood flow during asystole venous blood may still have been present and delayed cerebral hypoxia. Therefore, loss of consciousness in the supine position may occur considerably after the onset of asystole which may reduce the time available for treatment and contribute to its high mortality. Inspiration during the two startle reactions may have decreased vagal tone and permitted enough spontaneous cardiac activity to circulate the resuscitative drugs without CPR.

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The study of cardiotoxicity of hydroxychloroquine and azithromycine combination in hospitalized patients with COVID-19

Sechenov Medical Journal ◽

10.47093/2218-7332.2020.11.2.29-39 ◽

2020 ◽

Vol 11 (2) ◽

pp. 29-39

Author(s):

Yu. N. Belenkov ◽

I. V. Menshikova ◽

I. S. Ilgisonis ◽

Yu. I. Naimann ◽

Yu. V. Pak ◽

...

Keyword(s):

Hospital Mortality ◽

Qt Interval ◽

Ministry Of Health ◽

Cardiovascular Comorbidity ◽

Corrected Qt Interval ◽

Number Of Patients ◽

Increased Risk ◽

Significant Difference ◽

Group 2 ◽

Group 1

Hydroxychloroquine (HCH) is included in guidelines for treatment of novel coronavirus infection (COVID-19). Data on increased risk of cardiovascular complications when using it have been published. Aim. To evaluate the safety and tolerability of HCH and azithromycine (AZM) combination for the treatment of the patients with COVID-19 in recommended by Russian Ministry of Health doses in real practice.Methods. 132 patients (62 men and 70 women of average age 59.2 ± 9.3 years), 59% of whom had cardiovascular comorbidities, were included in prospective сohort study. 112 patients took HCH + AZM (group 1) and 20 patients took other medications without potential cardiotoxicity (group 2). At the admission to the hospital and after 5–7 days of the treatment corrected QT interval was calculated, new rhythm and conduction disorders, other side effects and hospital mortality have been registering. Relative risk (RR) and 95% confidence interval (CI) were calculated. Results. Elongation of corrected QT-interval within the normal range was registered in 22.3% of patients in group 1 and in 15% — in group 2. An increase in the QT length to the upper limit of the norm (480 msec) was observed in 1.8% of patients in group 1. There were no statistically significant differences between the groups in the number of patients with prolonged QT interval (RR = 1.488, 95% CI: 0.496–4.466, р = 0.478). The occurrence of new arrhythmias, conduction disturbances and allergic reactions was not recorded. Tolerability of combination HCH + AZM was satisfactory in the majority of patients. The hospital mortality in group 1 was 1.8%, in group 2 — 5% without statistically significant difference (p = 0.374). Conclusion. A combination of HCL + AZM according to the scheme recommended by the Ministry of Health of the Russian Federation for the treatment of the patients with COVID-19 and cardiovascular comorbidity in inpatient conditions is safe.

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The impact of COVID-19 on primary retinopexy in preventing retinal detachment in a tertiary eye hospital emergency department

European Journal of Ophthalmology ◽

10.1177/1120672121994727 ◽

2021 ◽

pp. 112067212199472

Author(s):

George Moussa ◽

Emma Samia-Aly ◽

Walter Andreatta ◽

Kim Son Lett ◽

Arijit Mitra ◽

...

Keyword(s):

Retinal Detachment ◽

Case Series ◽

Significant Shift ◽

Number Of Patients ◽

Increased Risk ◽

Significant Difference ◽

Male Patients ◽

Group 2 ◽

The Impact ◽

Group 1

Purpose: To review the effect of COVID-19 on rhegmatogenous retinal detachment (RRD) rate following primary retinopexy. Methods: Retrospective consecutive case series of 183 patients attending Birmingham and Midlands Eye Centre undergoing primary retinopexy (cryotherapy and laser) between March 23rd to June 30th in 2019 (Group 1) and 2020 (Group 2). Results: In total we reviewed 183 retinopexies, 122 in Group 1 and 61 in Group 2, a reduction of 50%. In Group 2 compared to Group 1, we showed a significant difference in characteristics of patients having primary retinopexy with an increase in proportion of male patients from 50 (41.0%) to 39 (63.9%) ( p = 0.005), increase in high myopes from 1 (0.8%) to 4 (6.6%) ( p = 0.043), more slit lamp laser retinopexy from 83 (68.0%) to 52 (85.2%) ( p = 0.013) and less cryopexy from 21 (17.2%) to 2 (3.3%) ( p = 0.008). In Group 2, primary retinopexy resulted in significantly more 3-month RRD rate 1 (0.8%) to 5 (8.2%) ( p = 0.016). There were no changes in number of patients requiring further retinopexy ( p = 1.000) Conclusion: This study demonstrates a reduction of primary retinopexy, an increased risk for RRD following primary retinopexy and a significant shift in type of primary retinopexy performed, demographics, operator and change in characteristics of type of retinal break observed during this pandemic. This study contributes to the growing literature of the secondary effects of the COVID-19 pandemic on other aspects of healthcare that is not just limited to the virus itself.

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Comparison of the Mechanical Properties of Early Leukocyte- and Platelet-Rich Fibrin versus PRGF/Endoret Membranes

International Journal of Dentistry ◽

10.1155/2016/1849207 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 20

Author(s):

Hooman Khorshidi ◽

Saeed Raoofi ◽

Rafat Bagheri ◽

Hodasadat Banihashemi

Keyword(s):

Mechanical Properties ◽

Tensile Strength ◽

Venous Blood ◽

Testing Machine ◽

Platelet Rich Fibrin ◽

Significant Difference ◽

The Mean ◽

Group 2 ◽

Success Of Treatment ◽

Group 1

Objectives. The mechanical properties of membranes are important factors in the success of treatment and clinical handling. The goal of this study was to compare the mechanical properties of early leukocyte- and platelet-rich fibrin (L-PRF) versus PRGF/Endoret membrane.Materials and Methods.In this experimental study, membranes were obtained from 10 healthy male volunteers. After obtaining 20 cc venous blood from each volunteer, 10 cc was used to prepare early L-PRF (group 1) and the rest was used to get a membrane by PRGF-Endoret system (group 2). Tensile loads were applied to specimens using universal testing machine. Tensile strength, stiffness, and toughness of the two groups of membranes were calculated and compared by pairedt-test.Results. The mean tensile strength and toughness were higher in group 1 with a significant difference (P<0.05). The mean stiffness in group 1 was also higher but not statistically significant (P>0.05).Conclusions.The results showed that early L-PRF membranes had stronger mechanical properties than membranes produced by PRGF-Endoret system. Early L-PRF membranes might have easier clinical handling and could be a more proper scaffold in periodontal regenerative procedures. The real results of the current L-PRF should be in fact much higher than what is reported here.

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EARLY VERSUS DELAYED ORAL INTAKE IN PATIENTS AFTER CESAREAN SECTION UNDER REGIONAL ANESTHESIA

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i5.3499 ◽

2021 ◽

Vol 71 (5) ◽

pp. 1559-62

Author(s):

Laiqa Hassan ◽

Shazia Tufail ◽

Farheen Aslam ◽

Nilofar Mustafa ◽

Arub Ahmed ◽

...

Keyword(s):

Cesarean Section ◽

Regional Anesthesia ◽

Bowel Movement ◽

Oral Intake ◽

Elective Cesarean Section ◽

Time Interval ◽

Duration Of Surgery ◽

Group 2 ◽

Mean Time ◽

Group 1

Objective: To compare the outcome in early versus delayed oral intake in patients after cesarean section under regional anesthesia. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital Lahore, from Dec 2017 to May 2018. Methodology: A total of 352 women undergoing elective cesarean section under regional anesthesia, nil by mouth for at least 8 hours before surgery were divided in 2 groups. In group 1, patients were given sips of clear oral fluid (water) <5 hours after cesarean section and in group 2, patients received sips of water 8 hours following surgery. Bowel motility was assessed after surgery on hourly basis. Data about time interval to first bowel movement and ileus were noted. Results: Mean age of patients was 32.329 ± 3.44 years and 33.051 ± 3.64 years in group 1 and 2 respectively. Mean gestational age and body mass index was 38.50 ± 0.93 weeks and 29.824 ± 4.97 kg/m2 in group-1 versus 37.937 ± 0.98 weeks and 27.779 ± 2.81 kg/m2 in group 2. Mean duration of surgery was 47.096 ± 6.65 minutes in group-1 and 47.647 ± 8.76 minutes in group 2. Ileus was seen in 17% patients in group-1 and 34.1% in group-2 (p<0.001). Mean time interval for first bowel movement was 8.323 ± 1.20 hours in group-1 and 13.034 ± 2.54 hours in group 2 (p<0.001). Conclusion: Early feeding after an uncomplicated cesarean section has reduced rate of ileus symptoms and mean time interval for bowel......

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