The result of using Steriod during cardiopulmonary bypass in children undergoing cardiac surgery

The results of steroid in pediatric after cardiac surgery with steroid during extracorporeal circulation. Objectives: Evaluating the clinical and laboratory characteristics in pediatric patients after cardiac surgery using steroid. Methods: A prospective, randomized, controlled clinical trial on 106 pediatric patients who underwent surgery requiring cardiopulmonary bypass at Hanoi Heart Hospital. Results: The rate of postoperative infection of the group using corticosteroids was 85.5%, the group not using corticosteroids was 96%. The rate of fever after surgery of the group using corticosteroids was 32.7%, the group not using corticosteroids was 35.3%. Troponin T concentration of group using corticosteroids was 1729.3 ± 1874.8 ng/L, group not using corticosteroids was 1855.0 ± 2658.0 ng/L. The time of mechanical ventilation and the time of recovery of the group using corticosteroids was 19.7 ± 23.6 hours and 61.8 ± 53.0 hours, the group not using corticosteroids was 19.8 ± 25.0 hours and 52 ,5 ± 39.1 hours. Conclusion: High-dose corticosteroids in this research did not cause adverse effects as mentioned in some studies, but did not bring any significant benefit to pediatric patients after cardiac surgery.

The Effectiveness of Minor Procedure as the Management of Onychocryptosis in Community Podiatry Setting: A Retrospective Study

Background: Onychocryptosis is a common and debilitating condition that often require surgical management. Despite this minor procedure being the most common and effective method in managing this condition, as well as being one of the essential services provided by Health Care Professional Council (HCPC) registered podiatrists, there is limited evidence around the effectiveness of this procedure in the community setting. The aim of this study was to evaluate the effectiveness of a non-invasive minor procedure for the management of onychocryptosis. Methods: A retrospective study was undertaken within the community podiatry department. All patients who underwent minor procedure for the management of onychocryptosis between June 2018 and December 2019 were included in this study. The data were collected from the electronic patient records using a comprehensive data collection tool. Recurrence rate and infection rate were calculated to determine the effectiveness of the minor procedure. Results: 354 minor procedures were performed on 272 patients presenting with onychocryptosis. The recurrence rate of nail regrowth following intervention was 5.6% (N=20). Patients <40 years old were more likely to experience a recurrence of nail regrowth following an intervention (N=16). The postoperative infection rate was 8.8% (N=31). Patients who had a partial nail avulsion procedure were more likely to experience postoperative infection compared to total nail avulsion.Conclusions: Although the management of onychocryptosis with this minor procedure is effective within the community podiatry department, incorporation of evaluation of patient satisfaction following this procedure is suggested within the recommendations. The limitations of this study have been highlighted and a mixed method research project is recommended to explore this area of specialty to improve patient outcome.

How the COVID-19 pandemic changed postoperative infections in urology wards: A retrospective cohort study from two urology departments

Introduction: We aimed to compare the rate of postoperative infection and drug-resistant organism (DRO) before and during the COVID-19 pandemic in urology departments. Methods: A retrospective cohort study was carried out. Data from all elective surgical procedures carried out in two urology departments between April and June 2018 and the homologous period in 2020 were collected. Main outcomes were the number of postoperative infections during the pandemic, and the number of DROs. Sample size was calculated based on a 50% relative reduction of infections during the pandemic. Variables were compared by Chi-squared test, and multivariable logistic regression was used to estimate predictors. Results: A total of 698 patients undergoing elective surgery were included. The postoperative infection rate during the pre-pandemic period was of 14.1% compared to 12.1% during the pandemic (p=0.494). DROs were lower during the pandemic (92.3% vs. 52.4%, p=0.002). The pandemic period was the main predictor for reduced multi-drug-resistant isolates, with an odds ratio of 0.10 (p=0.010, 95% confidence interval 0.016–0.57). Conclusions: Postoperative infection rates were not significantly reduced during the COVID-19 pandemic, despite the adoption of enhanced infection preventive measures. There was, however, a decrease in the rate of DROs during this period, suggesting a secondary benefit to enhanced infection prevention practices adopted during the COVID-19 era.

Rates of surgical deaths and infections at district hospitals in Malawi and Zambia: a prospective multicentre cohort study

ObjectiveThis paper reports perioperative mortality and postoperative infection rates of surgical patients who underwent operations at district-level hospitals in Malawi and Zambia, and the associations of these outcomes with patient characteristics based on routinely available data.DesignProspective cohort study.SettingEight government district hospitals in Malawi and nine mission and government district hospitals in Zambia.Outcome measuresPerioperative mortality and postoperative infection were used as primary outcome measures in this study. Logistic regression and penalised maximum likelihood logistic regression were used to examine the factors correlated with surgical outcomes.ResultsThe average perioperative mortality rates were 0.19% and 0.43% in Malawi and Zambia, respectively. Penalised maximum likelihood logistic regression showed that age (OR=1.046, 95% CI 1.016 to 1.078) and American Society of Anesthesiologists physical status score II (OR=6.658, 95% CI 2.363 to 18.762) were significantly associated with perioperative deaths. General surgery procedures were significantly more likely than obstetrical procedures to result in perioperative deaths (OR=3.821, 95% CI 1.226 to 11.908). The average rates of postoperative infections in Malawi and Zambia were 2.69% and 2.24%, respectively. Age (OR=1.010, 95% CI 1.000 to 1.020) and male sex (OR=0.407, 95% CI 0.260 to 0.637) were significantly associated with postoperative infections. Additional factors, general procedures (OR=2.319, 95% CI 1.397 to 3.850) and trauma-related procedure (OR=5.490, 95% CI 2.632 to 11.449) were significantly associated with infection rates. There was no significant correlation between surgical outcomes and cadre of lead surgeon (a non-physician clinician or doctor).ConclusionRates of mortality and postoperative infections in this sample of district-level hospitals in Malawi and Zambia were relatively low, with poorer preoperative physical status as the main predictor of both greater postoperative infection and mortality. The study demonstrates that outcomes of major surgical cases do not depend on the cadre (type) of surgeon performing it, and outcomes can be monitored using routine data, at district level in these countries.Trial registration numberISRCTN66099597.

Postoperative mediastinitis after cardiac surgery caused by Mycoplasma hominis: a case report

Background Mycoplasma hominis is a human commensal bacterium of the urogenital tract, and extragenital infection caused by M. hominis has rarely been reported. The identification of M. hominis is challenging, and surgeons are generally not aware that this bacteria can cause postoperative infection. Here, we report a rare case of postoperative mediastinitis caused by M. hominis after cardiac surgery in an immunocompetent patient. Case presentation A 54-year-old man presented with pain and purulent discharge from the wound after aortic valve replacement and patent foramen ovale closure. However, Gram staining and culture of bacteria from the purulent discharge was negative, and empiric sulbactam/ampicillin therapy was not effective. This patient developed mediastinitis and rupture of a pseudoaneurysm of the ascending aorta caused by mediastinitis, and re-operation was performed. Then, postoperative mediastinitis caused by M. hominis or Ureaplasma species was suspected and bacterial cultures targeting these pathogens were performed. M. hominis was identified from abscess and tissue obtained from the surgical site and urine. A final diagnosis of postoperative mediastinitis caused by M. hominis was determined. The patient was initially treated with levofloxacin and then with minocycline for 3 weeks. The patient’s clinical condition improved; the patient was transferred to another hospital. Conclusion The role of M. hominis as a cause of postoperative infection might be underestimated in cardiac surgery. M. hominis should be considered when culture-negative purulent discharge is observed or there is no response to standard empiric treatment of postoperative infections.

Comparison of vacuum-assisted sheaths and normal sheaths in minimally invasive percutaneous nephrolithotomy: a systematic review and meta-analysis

Background A systematic review and meta-analysis was conducted to compare the safety and efficacy of vacuum-assisted sheaths and conventional sheaths in minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of nephrolithiasis. Methods PubMed, Web of Science, Embase, EBSCO, and Cochrane Library databases (updated March 2021) were used to search for studies assessing the effect of vacuum-assisted sheaths in patients who underwent MPCNL. The search strategy and study selection processes were implemented in accordance with the PRISMA statement. Result Three randomized controlled trials and two case-controlled trials that satisfied the inclusion criteria were enrolled in this meta-analysis. Overall, the stone-free rate (SFR) in patients who underwent vacuum-assisted sheaths was significantly higher than that in patients who underwent conventional sheaths (RR 1.23, 95% CI 1.04, 1.46, P = 0.02), with significant heterogeneity among the studies (I2 = 72%, P = 0.03). In terms of the outcome of complications, vacuum-assisted sheath could bring a benefit to the postoperative infection rate (RR 0.48, 95% CI 0.33, 0.70, P < 0.00001) with insignificant heterogeneity among the studies (I2 = 0%, P = 0.68). There was no significant difference in the blood transfusion rate (RR 0.35, 95% CI 0.07, 1.73, P = 0.17), with significant heterogeneity (I2 = 66%, P = 0.35). Three studies contained operative time data, and the results indicated that the vacuum-assisted sheath led to a shorter operative time (MD = − 15.74; 95% CI − 1944, − 12.04, P < 0.00001) with insignificant heterogeneity (I2 = 0%, P = 0.91). Conclusion The application of a vacuum-assisted sheath in MPCNL improves the safety and efficiency compared to the conventional sheath. A vacuum-assisted sheath significantly increases the SFR while reducing operative time and postoperative infection.

FAKTOR YANG MEMPENGARUHI KEJADIAN INFEKSI POST OPERASI DI RUANG RANAP WIJAYA KUSUMAH RSUD KOTA BANJAR

Status gizi, usia dan faktor ekonomi merupakan faktor internal pasien yang mempengaruhi frekuensi infeksi. Masyarakat masih belum mengetahui status gizinya dan tidak dapat memperbaikinya, dengan penyebab yang bervariasi baik dari keadaan ekonomi maupun dari kurangnya pengetahuan masyarakat tentang gizi. Faktor internal lain dalam frekuensi infeksi adalah usia, pada pasien yang lebih tua dari 70 tahun. Faktor usia di atas 70 dapat menurunkan pertahanan tubuh. Tujuan penelitian ini adalah untuk mengetahui faktor-faktor yang mempengaruhi kejadian infeksi post operasi di bangsal Vijaya Kusumah RSUD Kota Banjar. Penelitian ini menggunakan beberapa jenis penelitian korelasi. Populasi penelitian ini terdiri dari seluruh pasien pasca operasi dan sampel sebanyak 21 responden. Alat yang digunakan dalam penelitian ini adalah kuesioner, dan analisis data yang digunakan dalam penelitian ini adalah univariat dan bivariat. Hasil penelitian menunjukkan bahwa tidak ada pengaruh faktor status gizi terhadap kejadian infeksi post operasi, pengaruh faktor status gizi terhadap kejadian infeksi post operasi dan pengaruh faktor ekonomi terhadap kejadian infeksi post operasi. Akibatnya, faktor status gizi tidak mempengaruhi angka infeksi pasca operasi, tetapi faktor status gizi dan tingkat ekonomi ditemukan mempengaruhi angka infeksi pasca operasi. Hasil penelitian ini dimaksudkan untuk digunakan sebagai buku teks dan literatur untuk mengatasi masalah infeksi pasca operasi.Nutritional status, age and economic factors are internal patient factors that affect the frequency of infection. The community still does not know their nutritional status and cannot improve it, with various causes, both from economic conditions and from a lack of public knowledge about nutrition. Another internal factor in the frequency of infection is age, in patients older than 70 years. The age factor over 70 can lower the body's defenses. The purpose of this study was to determine the factors that influence the incidence of postoperative infection in the Vijaya Kusumah ward, Banjar City Hospital. This study uses several types of correlation research. The population of this study consisted of all postoperative patients and a sample of 21 respondents. The instrument used in this study was a questionnaire, and the data analysis used in this study was univariate and bivariate. The results showed that there was no influence of nutritional status factors on the incidence of postoperative infections, the influence of nutritional status factors on the incidence of postoperative infections and the influence of economic factors on the incidence of postoperative infections. As a result, nutritional status factors did not affect postoperative infection rates, but nutritional status factors and economic level were found to influence postoperative infection rates. The results of this study are intended to be used as a textbook and literature to address the problem of postoperative infection.

Diagnostic value of routine chest tube tip culture in surgery for noninfectious lung disease

Background Evaluation of the diagnostic value of routine chest tube tip culture for detection of postoperative infection after surgery for noninfectious lung disease. Methods Included subjects were patients who underwent lung surgery between January 1st 2013 and January 1st 2018 in University Medical Centre Utrecht and of whom a chest tube tip was cultured. Postoperative outcomes included pneumonia, surgical site infection, and empyema within 30 days after surgery. Univariable analysis for diagnostic accuracy of chest tube tip culture results predicting these postoperative outcomes was performed, as well as multivariable analysis using penalized firth logistic regression. Results Patients developed one or more postoperative infections in 42 out of 210 (20%) lung surgeries. Pneumonia, surgical site infection, and empyema were found in 36 (17%), 8 (4%), and 2 (1%) cases respectively. Chest tube tip culture had a sensitivity of 31%, a specificity of 83%, a positive predictive value of 32%, and a negative predictive value of 83% for postoperative infections. In the subgroup of patients who did not have evidence of postoperative infection at the time of chest tube removal, the drain tip culture’s positive and negative predictive value changed to 18% and 92% respectively. Adding additional variables to chest tube tip culture in a prediction model resulting in only limited improvement in diagnostic performance. Conclusions We found insufficient diagnostic performance to support the practice of routine chest tube tip culture after surgery for noninfectious lung disease. Therefore, routine chest tube tip culture is not advisable and should be omitted to unburden the healthcare process and prevent low value care together with extra costs.