scholarly journals TO ASSESS THE SPECTRUM OF LESIONS IN LYMPH NODES IN HEAD AND NECK REGION

Author(s):  
Dr. Bipin Gandhi

INTRODUCTION: Lower Segment Cesarean Section (LSCS) delivery is a major obstetrical surgical procedure to save the lives of mothers and foetus. Surgical site infections (SSI) are the most common reason about 20% to be unplanned admitted after discharging of the patient to their home. Various risk factors in SSI following LSCS has been identified which includes subcutaneous hematoma, subcutaneous hematoma, tobacco use in pregnancy, incision length > 16.6 cm , body mass index >30 or 35 kg/m2, prolonged second stage (compared with first stage) , no antibiotic prophylaxis, duration of labour >12 h , premature rupture of membranes , gestational diabetes, previous cesarean delivery and emergency delivery. MATERIAL AND METHODS: A total of 646 patients were included in the study of which 27 were diagnosed as SSI. Risk factor for SSI was divided into three categories: 1) host-related factors, 2) pregnancy and intrapartum-related factors, and 3) procedure-related factors. Purulent discharge was obtained from the surgical incision site 48 hours postoperatively with sterile disposable swabs. Blood sample for blood culture was collected when the possibility of septicemia or bacteremia as suggested by the presence of fever, shock, or other signs and symptoms of sepsis associated with the surgical wound. The bacterial isolates obtained were identified as per standard identification procedures in time microbiology laboratory. Antibiotic susceptibility of the organisms done as per protocol. RESULTS: A total of 646 patients were included in the study of which 94 (14.55%) were diagnosed as SSI. mean age of patients who underwent LSCS was 24± 4.57 years. Of the 646 patients in 18 - 20 years 125 (19.3%),21-25 years 304 (47.1%), 26-30 years 189 (29.3%) and in > 30 years age group 28 (4.3%) cases were observed, of the total 94 SSI cases 11 (8.8%) were in the age group if 18 - 20 years, 39 (12.8%) were in the age group of 21-25 years, 32 (16.9%) were in 26-30 years age group and 12 (42.9%) were in the > 30 years age group. Acinetobacter spies was the commonest isolate 29(30.9%) followed by staphylococcus aureus 22 (23.4%), Escherichia coli 21 (22.3%) and Klebsiellapneumoniae. premature rupture of membrane (PROM), antibiotics given earlier than 2 hours and increased duration of stay in the hospital were found to be statistically significant. It was interpreted that PROM > 24 hrs is likely to increase the chances of infection. As the duration of hospital stay increases by 1 day, the chances of infection increase. CONCLUSION: Identification, management and proper assessment of risk factors are necessary to in reduction of SSI rates. Premature rupture of membrane (PROM), antibiotics given earlier than 2 hours, BMI >25 and increased duration of stay in the hospital were associated with increased SSI rate.

Author(s):  
Dr. Dhan Singh Sinsinwar ◽  
Dr. Ravi Gupta

INTRODUCTION: Lower Segment Cesarean Section (LSCS) delivery is a major obstetrical surgical procedure to save the lives of mothers and foetus. Surgical site infections (SSI) are the most common reason about 20% to be unplanned admitted after discharging of the patient to their home. Various risk factors in SSI following LSCS has been identified which includes subcutaneous hematoma, subcutaneous hematoma, tobacco use in pregnancy, incision length > 16.6 cm , body mass index >30 or 35 kg/m2, prolonged second stage (compared with first stage) , no antibiotic prophylaxis, duration of labour >12 h , premature rupture of membranes , gestational diabetes, previous cesarean delivery and emergency delivery. MATERIAL AND METHODS: A total of 646 patients were included in the study of which 27 were diagnosed as SSI. Risk factor for SSI was divided into three categories: 1) host-related factors, 2) pregnancy and intrapartum-related factors, and 3) procedure-related factors. Purulent discharge was obtained from the surgical incision site 48 hours postoperatively with sterile disposable swabs. Blood sample for blood culture was collected when the possibility of septicemia or bacteremia as suggested by the presence of fever, shock, or other signs and symptoms of sepsis associated with the surgical wound. The bacterial isolates obtained were identified as per standard identification procedures in time microbiology laboratory. Antibiotic susceptibility of the organisms done as per protocol. RESULTS: A total of 646 patients were included in the study of which 94 (14.55%) were diagnosed as SSI. mean age of patients who underwent LSCS was 24± 4.57 years. Of the 646 patients in 18 - 20 years 125 (19.3%),21-25 years 304 (47.1%), 26-30 years 189 (29.3%) and in > 30 years age group 28 (4.3%) cases were observed, of the total 94 SSI cases 11 (8.8%) were in the age group if 18 - 20 years, 39 (12.8%) were in the age group of 21-25 years, 32 (16.9%) were in 26-30 years age group and 12 (42.9%) were in the > 30 years age group. Acinetobacter spies was the commonest isolate 29(30.9%) followed by staphylococcus aureus 22 (23.4%), Escherichia coli 21 (22.3%) and Klebsiellapneumoniae. premature rupture of membrane (PROM), antibiotics given earlier than 2 hours and increased duration of stay in the hospital were found to be statistically significant. It was interpreted that PROM > 24 hrs is likely to increase the chances of infection. As the duration of hospital stay increases by 1 day, the chances of infection increase. CONCLUSION: Identification, management and proper assessment of risk factors are necessary to in reduction of SSI rates. Premature rupture of membrane (PROM), antibiotics given earlier than 2 hours, BMI >25 and increased duration of stay in the hospital were associated with increased SSI rate.


Author(s):  
Dr. Manish Bhatt ◽  
Dr. Ela Bhatt

INTRODUCTION: Lower Segment Cesarean Section (LSCS) delivery is a major obstetrical surgical procedure to save the lives of mothers and fetus. Various risk factors in SSI following LSCS has been identified which includes subcutaneous hematoma, subcutaneous hematoma, tobacco use in pregnancy, incision length > 16.6 cm , body mass index >30 or 35 kg/m2, prolonged second stage (compared with first stage) , no antibiotic prophylaxis, duration of labor >12 h , premature rupture of membranes , gestational diabetes, previous cesarean delivery and emergency delivery. Diagnosis of surgical site infection requires evidence of clinical signs and symptoms of infection which may be further supported by microbiological evidence. MATERIAL AND METHODS: A total of 646 patients were included in the study of which 27 were diagnosed as SSI. Risk factor for SSI was divided into three categories: 1) host-related factors, 2) pregnancy and intrapartum-related factors, and 3) procedure-related factors. RESULTS: Among 646 cesarean sections, surgical site infection was observed in 27(4.1%) cases while he remaining cases had no surgical site infection. Mean age of cases with surgical site infection was observed to be 14.8 years with sd of 3.9 years where as it was 22.1 years in cases with no surgical site infections and sd of 3.2 years. Average number of stay in hospital is found to be 14.1 and 7.3 days respectively in cases with and without surgical site infections. Antibiotics were given on 17.3 days on average in cases with SSI whereas patients without surgical site infections were on antibiotics for 3.1 days on average. Out of total 27 surgical site infection E-coli was isolated in 11(40.8%) cases followed by 7(25.9%) isolations of staphylococcus aureus. Klebsiella pneumonia and pseudomonas aeruginosa were isolated in 3(11.1%) cases each. Acitenobacter was found in only 1(3.7%) case. 2(7.4%) isolates were not identified in our study. CONCLUSION: To reduce the SSI rates post LSCS, proper assessment of risk factors and their modification is required. Frequent antibiotic susceptibility testing for resistance is required.


Author(s):  
Pramod P. Singhavi

Introduction: India has the highest incidence of clinical sepsis i.e.17,000/ 1,00,000 live births. In Neonatal sepsis septicaemia, pneumonia, meningitis, osteomyelitis, arthritis and urinary tract infections can be included. Mortality in the neonatal period each year account for 41% (3.6 million) of all deaths in children under 5 years and most of these deaths occur in low income countries and about one million of these deaths are due to infectious causes including neonatal sepsis, meningitis, and pneumonia. In early onset neonatal sepsis (EOS) Clinical features are non-specific and are inefficient for identifying neonates with early-onset sepsis. Culture results take up to 48 hours and may give false-positive or low-yield results because of the antenatal antibiotic exposure. Reviews of risk factors has been used globally to guide the development of management guidelines for neonatal sepsis, and it is similarly recommended that such evidence be used to inform guideline development for management of neonatal sepsis. Material and Methods: This study was carried out using institution based cross section study . The total number neonates admitted in the hospital in given study period was 644, of which 234 were diagnosed for neonatal sepsis by the treating pediatrician based on the signs and symptoms during admission. The data was collected: Sociodemographic characteristics; maternal information; and neonatal information for neonatal sepsis like neonatal age on admission, sex, gestational age, birth weight, crying immediately at birth, and resuscitation at birth. Results: Out of 644 neonates admitted 234 (36.34%) were diagnosed for neonatal sepsis by the paediatrician based on the signs and symptoms during admission. Of the 234 neonates, 189 (80.77%) infants were in the age range of 0 to 7 days (Early onset sepsis) while 45 (19.23%) were aged between 8 and 28 days (Late onset sepsis). Male to female ratio in our study was 53.8% and 46% respectively. Out of total 126 male neonates 91(72.2%) were having early onset sepsis while 35 (27.8%) were late onset type. Out of total 108 female neonates 89(82.4%) were having early onset sepsis while 19 (17.6%) were late onset type. Maternal risk factors were identified in 103(57.2%) of early onset sepsis cases while in late onset sepsis cases were 11(20.4%). Foul smelling liquor in early onset sepsis and in late onset sepsis was 10(5.56%) and 2 (3.70%) respectively. In early onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 21(11.67%), 19 (10.56%), 20(11.11%) and 33 (18.33%) cases respectively. In late onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 2 (3.70%), 1(1.85%), 3 (5.56%) and 3 (5.56%) cases respectively. Conclusion: Maternal risk identification may help in the early identification and empirical antibiotic treatment in neonatal sepsis and thus mortality and morbidity can be reduced.


2020 ◽  
Vol 18 ◽  
pp. 205873922096054
Author(s):  
Faiz Ullah Khan ◽  
Yu Fang ◽  
Zakir Khan ◽  
Farman Ullah Khan ◽  
Zafar Iqbal Malik ◽  
...  

Globally, surgical site infections are one of the common infections which lead to a large amount of mortality and morbidity in postsurgical care. The risk for surgical site infection is multidimensional which includes mainly; patient, surgery, and hospital-related factors. This study is aimed to determine the burden of SSIs along with contributed risk factors. A prospective observational cross-sectional study was conducted in one of the largest public-sector hospitals in Pakistan. A total of 412 patients were recruited in the study with full consent and monitored for 30 days after surgery with direct and indirect surveillance. Overall, in seven different surgical procedures the incidence (29.8%) rate of SSI was observed; in appendectomy ( n = 17, 4.1%), exploratory laparotomy ( n = 51, 12.6%), laparoscopic cholecystectomy ( n = 12, 2.90%), mesh repair ( n = 17, 4.01%), thyroidectomy (5, 1.2%), transurethral resection of the prostate ( n = 11, 2.6%), and transurethral resection of the bladder (10, 2.4%). The average SSI rate in every single procedure was about 18 (4.27%) per surgical procedure out of 123 (29.85%) SSI cases. Types of SSI identified were superficial, deep incisional and organ/space ( n = 76, 18.4%, n = 23, 5.5%, and n = 24, 5.7%). Incidence of SSIs during admission, at readmission, and post-surveillance cases were ( n = 50, 12.1%, n = 25, 6.0% and n = 48, 11.6%). Associated risk factors found contributed to the incidence of SSI ( p < 0.05). Pre-operative ( n = 348, 84.5%) and 6 (1.5%) surgical patients did not received the post-operative antibiotics. The P. aeruginosa ( n = 15, 12.1%) and S. aureus (13, 10.5%). Cefoperazone and sulbactam were the most prescribed antibiotics. Associated risk factors and treatment outcomes of surgical patients have a direct association with the incidence of SSI. Hospital-based antimicrobial stewardship, implementation of surgical guidelines, patient care, and education are needed to develop at wards level in hospitals.


Author(s):  
Pierre M. Tebeu ◽  
Aurelien Kamdem ◽  
Jean P. Ngou-Mve-Ngou ◽  
Esther Meka ◽  
Jesse S. S. Antaon ◽  
...  

Background: Surgical site infection is the invasion by microorganisms of the tissue layers affected by the surgical procedure. Maternal morbidity from infections has been shown to be higher after caesarean section compared to the vaginal delivery. Objective of the research was to analyze the risk factors associated with surgical site infections after caesarean section.Methods: This was a cross sectional (affected/non affected) study approved by the institutional committee for ethics and research of the faculty of medicine and biomedical sciences. A total of 310 medical files were assessed, 62 files from patients with surgical site infections and 248 files from patients without any complications. The data was collected using a pretested questionnaire and analyzed using the statistical package for the social sciences (SPSS) software version 22.0. The Chi squared and the Fisher exact tests were used to assess homogeneity between the 2 groups. Odd ratio 95% confidence interval was used to assess the association between the variables.Results: The proportion of surgical site infections during the study was 1.81%. Factors associated with surgical site infections were premature rupture of membranes (OR: 2.065; 95% CI 1.051-4.05; p=0.035); the vertical midline incision (OR=5.26; 95% CI; 1.41-19.57; p=0.013) and a operation by a resident physician doctor (OR=1.98; 95% CI 1.09-3.59; p=0.02).Conclusions: A factors associated with surgical site infections after caesarean section are a premature rupture of membranes, vertical midline incision and the qualification of the practitioner.


2015 ◽  
Vol 4 (4) ◽  
pp. 23
Author(s):  
Wenxian Dai

<p><strong>Objective: </strong>Related factors and treatment strategies of premature rupture of membranes (PROM) were discussed. <strong>Method: </strong>Retrospective analysis of 182 cases of preterm premature rupture of membranes (PPROM) from Yanshan County Hospital from January 2010 to October 2015. <strong>Results</strong><strong>: </strong>From the 182 cases [123 vaginal delivery and 59 cesarean section (C-section)], there were 79.12% PROM cases were detected in the presence of risk factors. Neonatal mortality and complications were significantly higher at 28−33 + 6 weeks of pregnancy than those at 34−36 + 6 weeks, 28−33 + 6 weeks, and 34−36 + 6 weeks. <strong>Conclusion: </strong>In order to improve the survival rate of newborns, the related factors leading to PPROM should be treated.</p>


Author(s):  
Mehmet Çınar ◽  
Hakan Timur ◽  
Ali İrfan Güzel ◽  
Aytekin Tokmak ◽  
Burak Ersak ◽  
...  

<p><strong>OBJECTIVE:</strong> To evaluate clinical characteristics of surgical-site infections (SSIs) following cesarean section (CS) and to identify infection rates and risk factors associated with SSIs following cesarean section. <br /><strong>STUDY DESIGN:</strong> A total of 197 patients who underwent cesarean and complicated with SSIs was evaluated during hospital stay or within 30 days following cesarean section by readmission to the hospital or by post discharge survey. The clinical characteristics, subsequent microbiological culture results and management were recorded. <br /><strong>RESULTS:</strong> There were 34 (17.25%) patients complicated with preeclampsia and 26 (13.17%) gestational diabetes mellitus (GDM) in the study group. Preterm rupture of membranes (PROM) rate was 17.31% and mean rupture period were 6.61 hours. In the study population, 66 patients had positive culture results. The most isolated microorganism was S. Aureus (n=13, 19.7%). Preeclampsia, GDM and PROM rates were statically significant high in patients with positive culture results (p&lt;0.05). There were 31 patients complicated with PROM in the study group. The rates of positive culture results were significantly increased by PROM (mean 45%, p&lt;0.05).<br /><strong>CONCLUSION:  </strong>Independent risk factors for post-cesarean SSIs are younger age, obesity, diabetes, hypertension, premature rupture of membranes. Information regarding higher rates of SSIs should be provided to obese women undergoing cesarean delivery, especially when diabetes and hypertension coexists.</p>


Open Medicine ◽  
2015 ◽  
Vol 10 (1) ◽  
Author(s):  
Agata Kawalec ◽  
Kamil Nelke ◽  
Krystyna Pawlas ◽  
Hanna Gerber

AbstractClefts that occur in children are a special topic. Avoiding risk factors, and also an early diagnosis of cleft possibility can result in minimizing or avoiding them. If on the other hand when clefts occur they require a long-term, multistage specialized treatment. Etiology of clefts seems to be related to many factors. Factors such as genetic, environmental, geographic and even race factors are important. Identification of risk factors can lead to prevention and prophylactic behaviors in order to minimize its occurrence. Exposure to environmental factors at home and work that lead to cleft predisposition should not be disregarded. It seems that before planning a family it would be wise to consult with doctors of different specializations, especially in high-risk families with cleft history in order to analyze previous lifestyle. Clefts are very common in hereditary facial malformations and are causing a lot of other irregularities in the head and neck region. In this paper after a brief papers review authors present socio-geographic, environmental and also work place related factors that are influencing pregnant women condition and should be taken under serious consideration.


Author(s):  
Bushra Dhuhayyan Alhazmi ◽  
Mohammed Kanan Alshammari

Introduction: Osteoporosis is a common skeletal disease that is characterized by reduction of bone mass and loss of bone microarchitecture leading to increased risk of bone fractures. Objective: To assess knowledge, awareness and practices of Saudi females about osteoporosis. Methodology: Cross-sectional study for 3 months (November, December 2019 and January 2020) on random sample of 537 Saudi females, the data was collected by using a questionnaire in Arabic language, data were analyzed by means of Descriptive statistics. Results: Among the participants, there were 43% in the age group of (18-25 years) and 19% in the age group of (26-35 years), 41% completed university education. The main source of information about osteoporosis was friends and relatives (33%). Mean score of participant’s sufficient knowledge about risk factors of osteoporosis was 52%, mean score of participant’s sufficient knowledge about prevention and treatment of osteoporosis was 67%, mean score of participant’s sufficient knowledge about signs & symptoms of osteoporosis was 43%, mean score of participant’s sufficient knowledge about diagnosis of osteoporosis was 17% and the overall mean score of sufficient knowledge about osteoporosis was 45%. About 55% of study participants previously got vitamin D screening, 46% previously got calcium screening in blood, 8% previously got screened with DXA. Conclusion: The results of the present study indicate that the knowledge and awareness about osteoporosis among Saudi females are poor. The participants lacked knowledge relating to risk factors, signs and symptoms, diagnosis and prevention of osteoporosis and the practice regarding the prevention and detection of osteoporosis is poor.


2018 ◽  
Vol 6 (1) ◽  
pp. 265
Author(s):  
Abhinav Agrawal ◽  
Shivam Madeshiya ◽  
Roshni Khan ◽  
Shashank S. Tripathi ◽  
Gaurav Bharadwaj

Background: Surgical Site Infection (SSI) is second commonest nosocomial complication in surgical speciality. Majority of surgical wounds are contaminated by microbes, but in most cases, infection does not develop because innate host defense are quite efficient in elimination of contaminants. The objective of this study was to evaluate patient related risk factors in causation of surgical site infection in various abdominal surgeries.Methods: All patients who admitted in surgical OPD/emergency and undergoing abdominal surgical procedures were included in study. This observational study was comprised of 952 subjects. Patients were observed in wards and during follow up to assess signs and symptoms of surgical site infection.Results: Result were analysed in terms of age, sex, distribution of cases based on case scenario (elective v/s emergency), wound class, type of surgery (laparoscopic v/s open), smoking, diabetes, duration of surgery, complete hemogram before and after blood transfusion, number of blood transfusions, albumin, blood sugar level, discharge from surgical site, number of days of drains, stoma  and hospital stay.Conclusions: Surgical site infection in emergency cases were found to be higher as compared to elective cases. Occurrence of SSI proportionately increased with degree of contamination, duration of surgery and age of patients. Laparoscopic procedures showed fewer incidences of surgical site infection as compared to open procedures. Various factors showed statistically significant association with surgical site infections were diabetes, smoking, blood transfusions, haemoglobin and albumin levels. Presence of stomas and drains were associated with increased incidence of SSI but could not be proven statistically.


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