The effects of antithrombotic therapy in ab interno trabeculotomy with a spatula-shaped microhook

To evaluate the effects of the discontinuation of antithrombotic drugs on intraocular pressure (IOP) reduction and complications from ab interno trabeculotomy for patients with glaucoma. We performed a retrospective chart review on the data of patients treated with antithrombotic agents who have undergone ab interno trabeculotomy through Tanito microhook combined with cataract surgery at the Asahi General Hospital and the Tokyo University Hospital, with 6 months of follow-up. The patients were classified into two groups depending on whether they discontinued (AT-) or continued (AT+) antithrombotic therapy during the perioperative phase. The demographics, pre- and postoperative IOP, medication score, best-corrected visual acuity (BCVA), and postoperative complications were analyzed preoperatively and postoperatively at 1 week and 1–6 months. The series included 44 eyes from 44 Japanese patients. The AT- and AT+ groups included 21 eyes from 21 patients and 23 eyes from 23 patients, respectively. The decrease in IOP from the baseline at 1 week postoperative was significantly different between the two groups (p = 0.009), but there were no significant differences observed in the other visits. Hyphema and IOP spikes exceeding 30 mmHg occurred in 10% and 10% of AT- participants, and in 43% and 26% of AT+ participants, respectively. Hyphema and spikes with hyphema occurred more frequently in the AT+ than in the AT- group (p = 0.02 and p = 0.05). The number of patients who had spikes was not significantly different (p = 0.27). In trabeculotomy using the Tanito microhook®, discontinuing antithrombotic therapy had better IOP-lowering effects and less postoperative complications.

CONUT Score Predicts Early Morbidity After Liver Transplantation: A Collaborative Study

Introduction: Liver transplantation (LT) is burdened by the risk of post-operative morbidity. Identifying patients at higher risk of developing complications can help allocate resources in the perioperative phase. Controlling Nutritional Status (CONUT) score, based on lymphocyte count, serum albumin, and cholesterol levels, has been applied to various surgical specialties, proving reliable in predicting complications and prognosis. Our study aims to investigate the role of the CONUT score in predicting the development of early complications (within 90 days) after LT.Methods: This is a retrospective analysis of 209 patients with a calculable CONUT score within 2 months before LT. The ability of the CONUT score to predict severe complications, defined as a Comprehensive Complication Index (CCI) ≥42.1, was examined. Inverse Probability Treatment Weighting was used to balance the study population against potential confounders.Results: Patients with a CCI ≥42.1 had higher CONUT score values (median: 7 vs. 5, P-value < 0.0001). The CONUT score showed a good diagnostic ability regarding post-LT morbidity, with an AUC = 0.72 (95.0%CI = 0.64–0.79; P-value < 0.0001). The CONUT score was the only independent risk factor identified for a complicated post-LT course, with an odds ratio = 1.39 (P-value < 0.0001). The 90-day survival rate was 98.8% and 87.5% for patients with a CONUT score <8 and ≥8, respectively.Conclusions: Pre-operative CONUT score is a helpful tool to identify patients at increased post-LT morbidity risk. Further refinements in the score composition, specific to the LT population, could be obtained with prospective studies.

Targeting Myeloid-Derived Suppressor Cells Derived From Surgical Stress: The Key to Prevent Post-surgical Metastasis

Myeloid-derived suppressor cells (MDSCs) are known to play an essential part in tumor progression under chronic stress settings through their manipulation of adaptive and innate immune systems. Previous researches mainly focus on MDSC's role in the chronic tumor immune environment. In addition, surgery can also serve as a form of acute stress within the patient's internal environment. Nevertheless, the part that MDSCs play in post-surgical tumor development has not gained enough attention yet. Although surgery is known to be an effective definite treatment for most localized solid tumors, there are still plenty of cancer patients who experience recurrence or metastasis after radical resection of the primary tumor. It is believed that surgery has the paradoxical capability to enhance tumor growth. Many possible mechanisms exist for explaining post-surgical metastasis. We hypothesize that surgical resection of the primary tumor can also facilitate the expansion of MDSCs and their pro-tumor role since these surgery-induced MDSCs can prepare the pre-metastatic niche (the “soil”) and at the same time interact with circulating tumor cells (the “seeds”). This vicious, reciprocal mechanism is a crucial point in the emergence of post-surgical metastasis. According to our hypothesis, MDSCs can be the precise target to prevent cancer patients from post-surgical recurrence and metastasis during the perioperative phase to break the wretched cycle and provide better long-term survival for these patients. Future studies are needed to validate this hypothesis.

Intraoperative Post Partum Hemorrhage in a Patient with Dengue Fever

A 33 year old obstetric patient with mild fever of undiagnosed etiology underwent emergency caesarean section under general anesthesia. She had platelet count of 98,000 per microliter and increased APTT of 37.8 s at the time of surgery. After uneventful anesthetic induction and delivery of fetus, slow and oozing type of bleeding led to massive hemorrhage. Patient remained vitally stable throughout perioperative phase and was extubated. Next day, patient’s dengue IgM antibody was reported positive. Neonate was well and his dengue test was negative. Pregnant women are at high risk of developing severe complications of dengue fever with unclear mechanisms related to impaired coagulation. Regional anesthesia may not have safe outcome due to dengue infection. doi: https://doi.org/10.12669/pjms.38.1.4519 How to cite this:Ahmed U, Aman A. Intraoperative Post Partum Hemorrhage in a Patient with Dengue Fever. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4519 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Umgang mit der Dauermedikation bei Patienten mit Diabetes mellitus

ZusammenfassungFür die perioperative Phase besteht bei Patienten mit Diabetes mellitus ein erhöhtes Risiko für Komplikationen, z. B. durch Entgleisung des Glukosestoffwechsels, erhöhte Rate kardiovaskulärer Ereignisse, Verschlechterung einer vorbestehenden Niereninsuffizienz und vermehrt auftretende Wundinfektionen. Zudem können Nebenwirkungen der antidiabetischen Therapie auftreten. Ein spezieller Umgang mit der Dauermedikation bei solchen Patienten ist wichtig.

Clinical implication of bactibilia in moderate to severe acute cholecystitis undergone cholecystostomy following cholecystectomy

There is little evidence of clinical outcome in using antibiotics during the perioperative phase of acute cholecystitis with bactibilia. The aim of current study is to examine the effect of bactibilia on patients with acute cholecystitis and their perioperative clinical outcome. We performed a retrospective cohort analysis of 128 patients who underwent cholecystectomy for acute cholecystitis with moderate and severe grade. Patients who were positive for bactibilia were compared to bactibilia-negative group in following categories: morbidity, duration of antimicrobial agent use, in-hospital course, and readmission rate. There was no difference in morbidity when patients with bactibilia (n = 70) were compared to those without (n = 58) after cholecystectomy. The duration of antibiotics use and clinical course were also similar in both groups. In severe grade AC group (n = 18), patients used antibiotics and were hospitalized for a significantly longer period of time than those in the moderate grade AC group. The morbidity including surgical site infection, and readmission rates were not significantly different in moderate and severe grade AC groups. In moderate and severe AC groups, bactibilia itself did not predict more complication and worse clinical course. Antibiotics may be safely discontinued within few days after cholecystectomy irrespective of bactibilia when cholecystectomy is successful.

Gambaran Kecemasan Praoperasi pada Pasien yang akan Menjalani Operasi Elektif di RSUP Dr. M. Djamil Padang

Background: Most patients who will undergo surgery, experience preoperative anxiety. This can affect the patient's condition in various perioperative phases. Even so, preoperative anxiety has not been systematically managed also the information about preoperative anxiety. Objective: This study aims to determine the description of anxiety in patients who will undergo elective surgery at RSUP Dr. M. Djamil padang. Methode: The design of this research is descriptive with cross sectional study. The number of samples in this study were 54 patients who would undergo elective surgery, and were taken using consecutive sampling techniques. Data were collected using The Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaire. Results: We found 44,4% of patients experienced preoperative anxiety according to the results of the APAIS. Conclusion: Based on the results of the study concluded that the majority of patients did not experience preoperative anxiety, both based on the results obtained from the APAIS questionnaire. However, it is hoped that a systematic evaluation and good management of this preoperative anxiety, as part of improving the quality of patient care, especially in the perioperative phase.

Creation and Validation of an Educational Video about the Importance of the Preanesthetic Consultation

Introduction: The pre-anesthetic consultation (PAC) is considered a fundamental step in the perioperative phase, and it is a moment of communication between the anesthesiologist and the patient, where the patient can be informed and clarified, characterizing this a communicative and therapeutic process. However, its benefits are still generally unknown. Educational videos are surfacing as fast-access media that can reach a wide audience. Some studies have highlighted the benefits of using educational videos about PAC. In this context the current study provides an experience report about the process of creation and validation of an educational video about PAC. Methods: In order to choose an educational product, the technical aspect, as well as the cognitive, multisensory stimuli and personality structure of individuals must be observed. This educational video was made based on the CTM3 method consisting of the following stages: Educational product Conception (C); Theoretical framework (T); and Methodological framework (M3), this last one is based on 3 theories: Transactional Analysis, Multisensory Exploration, and Neurolinguistics. Results and Discussion: The creation and validation of this educational video comprised seven stages. The video length was approximately 2 minutes 24 seconds, and it was projected in 10 scenes. Finally, the video was submitted to a validation process by an ad hoc committee. The advantages of educational resources, particularly videos for health education, are well defined being an increasingly used resource especially in interventions. The use of the CTM3 Method was fundamental because its methodology involves particularly the cognitive and sensory aspects and the specificities of each person. Conclusion: The use of CPA educational videos, due to their great capacity to attract attention of viewers, can help to inform the patient. Based on previous studies about the use of videos, as well as cognitive and sensory aspects, it is also concluded that this educational video is relevant and has the potential to promote CPA information to its target audience.

Perioperative Arzneimittelinteraktionen – was der Anästhesist wissen sollte

ZusammenfassungArzneimittelinteraktionen bedingen hohe Zahlen von Krankenhausaufnahmen und Todesfällen, insbesondere bei polypharmazeutisch behandelten Patienten. Pharmakologische Visiten wie auch EDV-basierte Interaktionssuchprogramme adressieren dieses Problem und verbessern die Behandlungsqualität. Die perioperative Phase wie auch die Narkose sind Risikointervalle, da hier binnen kurzer Zeiträume eine hohe Zahl an Arzneimitteln verabreicht wird. Dies stellt hohe Anforderungen an klinisch tätige Anästhesisten. Ein detailliertes Wissen um Interaktionen ist unabdingbar, um die Kernaufgabe der Anästhesie, die Patientensicherheit peri- und intraoperativ, zu gewährleisten. Während die moderne Anästhesie auf der einen Seite Medikamenteninteraktionen im Rahmen der „balancierten Anästhesie“ nutzt, ist die Kenntnis möglicher unerwünschter Interaktionen, die als direkte chemische Interaktion, aber auch auf pharmakokinetischer oder pharmakodynamischer Ebene auftreten können, erforderlich. Pharmakologische Einflüsse auf die QT-Zeit mit nachfolgenden Risiken sind ebenso relevant wie beispielsweise die medikamentöse Induktion eines Serotoninsyndroms. Eine detaillierte Kenntnis des Metabolismus eingesetzter Pharmaka sowie der Medikamente aus der Dauermedikation beinhaltet die Kenntnis über Stoffwechselwege der Elimination wie das p-Glykoprotein oder Enzyme der Cytochrom-P450-Familie.

Echocardiography and Correction of Mitral Regurgitation: An Unbreakable Link

Background: Degenerative mitral valve (MV) disease causing mitral regurgitation (MR) is the most common organic valve pathology and is classified based on leaflet motion. MV repair is indicated as the preferred technique (Class I indication) when the results are expected to be durable. Therefore, a detailed and systematic evaluation of MV apparatus is pivotal in allowing the proper surgical planning, as well as the screening for trans catheter-based treatment when surgery is not indicated. Aim: The aim of the present review is to describe the crucial role of both Transthoracic Echocardiography (TTE) and Transesophageal Echocardiography (TEE) in the decisional process and the guidance of MV repair procedures. TTE is the main investigation and the first approach used to make diagnosis of MR, to assess the severity and to describe the underlying mechanism, while TEE, especially with 3D echocardiography, has been shown to be useful for clarifying complicated valvular anatomy, assessing the surgical result and detecting complications. The surgical treatment of MR takes advantage of ultrasound evaluation of MV apparatus at any stage of the process, thus making the link between surgery and echocardiography unbreakable throughout the perioperative phase.