Prolapse Surgery: What Kind of Antibiotic Prophylaxis Is Necessary?

<b><i>Introduction:</i></b> The aim of this study was to assess whether antibiotic prophylaxis or therapy is sufficient for laparoscopic or vaginal prolapse surgery with mesh. <b><i>Methods:</i></b> This is a single-center prospective study. The study was divided into 3 groups. Protocol A: metronidazole (15 mg/kg) and piperacillin-tazobactam (2 g) 1 h before surgery and, for postoperative treatment, gentamycin (160 mg) 1 h before surgery in a single dose. Metronidazole and piperacillin-tazobactam were administered until hospital discharge. Protocol B: gentamycin and piperacillin-tazobactam in the same manner as group A. Protocol C: clindamycin (600 mg) and gentamicin (160 mg) 1 h before surgery in a single dose. <b><i>Results:</i></b> We included 87 consecutive patients who underwent prolapse surgery involving mesh prostheses: 57 by the laparoscopic approach and 30 by the vaginal route. Of these, 30 patients were included in protocol A, 30 in protocol B, and 27 in protocol C. There were no statistically significant differences among the 3 protocols regarding any postoperative complications, except for urinary tract infections that were more in the vaginal approach than in the laparoscopic route, in protocol A (<i>p</i> = 0.002). <b><i>Conclusions:</i></b> One-shot prophylaxis can be successfully used in prolapse surgery regardless of the surgical approach.

Fear of An Unprecedented, Invisible Enemy: Difficulties Experienced In Establishing Criteria For The Release of COVID-19 Patients From Isolation

Introduction: The novel coronavirus disease 2019 (COVID-19) has emerged as a global pandemic, and the United States and European authorities established criteria for the release of COVID-19 patients from isolation in October 2020. However, a huge discrepancy exists between the hospital-discharge protocol for COVID-19 patients and the release of patients from in-hospital isolation. Our initially proposed criteria for in-hospital release from isolation was not adhered to by healthcare workers (HCWs) due to prevailing concerns regarding disease infectivity. Herein, we report difficulties encountered in attempting to establish a common understanding of the management of emerging infections. Methods: We performed a Google Form-based questionnaire survey targeting HCWs from Okayama University Hospital, Japan, via e-mail on January 21–28, 2021. The anonymous investigation required respondents to provide information regarding their background as well as perceptions regarding the requirement, level of understanding, and readiness for developing release criteria.Results: We obtained 150 eligible responses, including 57 (38.0%) from medical doctors and 53 (35.3%) from nurses. Most HCWs managing COVID-19 patients advocated for the implementation of the criteria, whereas those not working in that capacity did not (p<0.001). Over half of the HCWs indicated discomfort at seeing COVID-19 patients transitioning to general management even after meeting the criteria. Conclusions: It was challenging to establish a common understanding regarding the ideal criteria for in-hospital release of COVID-19 patients from isolation in our hospital. The dissemination of our experiences and multifaceted discussions with HCWs would be of great value as a countermeasure against the emergent pandemic.

Safety of primary PCI with early discharge? A comparative study of 36 vs > 36 hours primary PCI discharge protocol”.

Objectives: In this study we aimed at establishing the safety of a very early discharge within 24 to 36 hours after a primary PCI. Study Design: Prospective Comparative study. Setting: Punjab Institute of Cardiology, Lahore. Period: July to December 2019. Material & Methods: We randomly assigned a ≤ 36 hours discharge protocol to the very low risk patients after a primary PCI. FASTEST score was used to identify the low risk group. Comparison was made at 30 days between early discharge and ordinary discharge low risk groups for outcomes like reinfarction, stent thrombosis (ST), target lesion revascularization (TLR), bleeding, stroke and death. Results: Among 329 very low risk primary PCI patients, 161 were randomly assigned to early discharge group and 168 to ordinary discharge group. The outcomes were similar at 01 month in early vs ordinary discharge groups. There was no significant difference in the rate of reinfarction (1.24% vs 1.79%, P value 0.68), ST (1.24% vs 1.19%, P values 0.96), TLR (1.24% vs 1.19%, P value 0.96) and bleeding (0.62% vs 0.59%, P value 0.97). There was no mortality or stroke. Conclusions: Using any of the scoring systems, very low risk patients should be routinely identified after primary PCI. Short term major adverse outcomes remain at a low and a very early discharge protocol can be safely implemented in this subgroup. In addition to saving health costs, this can be of particular value during outbreaks like COVID-19