Improving Infant Hydrocephalus Outcomes in Uganda: A Longitudinal Prospective Study Protocol for Predicting Developmental Outcomes and Identifying Patients at Risk for Early Treatment Failure after ETV/CPC

Infant hydrocephalus poses a severe global health burden; 80% of cases occur in the developing world where patients have limited access to neurosurgical care. Surgical treatment combining endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC), first practiced at CURE Children’s Hospital of Uganda (CCHU), is as effective as standard ventriculoperitoneal shunt (VPS) placement while requiring fewer resources and less post-operative care. Although treatment focuses on controlling ventricle size, this has little association with treatment failure or long-term outcome. This study aims to monitor the progression of hydrocephalus and treatment response, and investigate the association between cerebral physiology, brain growth, and neurodevelopmental outcomes following surgery. We will enroll 300 infants admitted to CCHU for treatment. All patients will receive pre/post-operative measurements of cerebral tissue oxygenation (SO2), cerebral blood flow (CBF), and cerebral metabolic rate of oxygen consumption (CMRO2) using frequency-domain near-infrared combined with diffuse correlation spectroscopies (FDNIRS-DCS). Infants will also receive brain imaging, to monitor tissue/ventricle volume, and neurodevelopmental assessments until two years of age. This study will provide a foundation for implementing cerebral physiological monitoring to establish evidence-based guidelines for hydrocephalus treatment. This paper outlines the protocol, clinical workflow, data management, and analysis plan of this international, multi-center trial.

Non-contact physiological monitoring of post-operative patients in the intensive care unit

Prolonged non-contact camera-based monitoring in critically ill patients presents unique challenges, but may facilitate safe recovery. A study was designed to evaluate the feasibility of introducing a non-contact video camera monitoring system into an acute clinical setting. We assessed the accuracy and robustness of the video camera-derived estimates of the vital signs against the electronically-recorded reference values in both day and night environments. We demonstrated non-contact monitoring of heart rate and respiratory rate for extended periods of time in 15 post-operative patients. Across day and night, heart rate was estimated for up to 53.2% (103.0 h) of the total valid camera data with a mean absolute error (MAE) of 2.5 beats/min in comparison to two reference sensors. We obtained respiratory rate estimates for 63.1% (119.8 h) of the total valid camera data with a MAE of 2.4 breaths/min against the reference value computed from the chest impedance pneumogram. Non-contact estimates detected relevant changes in the vital-sign values between routine clinical observations. Pivotal respiratory events in a post-operative patient could be identified from the analysis of video-derived respiratory information. Continuous vital-sign monitoring supported by non-contact video camera estimates could be used to track early signs of physiological deterioration during post-operative care.

Challenges of elderly patients with short bowel syndrome

Objective: This is a case report presenting two elderly patients; one with mesenteric ischemia and the second with gallstone ileus, in which their operative management has resulted in short bowel syndrome (SBS). Case: This pathology required prolonged post-operative care and monitoring with the management of different related complications. Conclusion: This case report will cover the pathophysiology, medical and operative management in addition to the acute and chronic complications of SBS

OUTCOME OF SALINE WOUND LAVAGE PRIOR TO WOUND CLOSURE IN GYNAECOLOGICAL AND OBSTETRICAL PATIENTS

Objective: To determine the effectiveness of saline wound lavage in reducing wound infections in patients undergoing gynaecological and obstetrical abdominal surgical procedures. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Pakistan Navy Ship Shifa Hospital, Karachi Pakistan, from Oct 2018 to Sep 2019. Methodology: All the patients undergoing gynaecological or obstetrical surgical procedures were enrolled after informed consent. Participants underwent elective or emergency surgery. In Group A with 551 patients, saline wound Lavage was done before closure, whereas in 533 patients in group B saline wound irrigation was not done. Similar post-operative care was provided to both groups. All patients were observed for febrile illness and wound discharge on 2nd, 8th, 15th and 30th postoperative day. Results: Out of 1084 patients, there were 551 (50.7%) in saline wound irrigation group A, while 533 (49.3%) were in group B where no saline wound irrigation was done. The frequency of febrile illness was observed in 49 (3.8%) patients. Febrile illness was significantly higher in patients without saline wound irrigation as compared to patients with saline wound irrigation (pvalue 0.002). The frequency of wound discharge was observed in 28 (22.2%) patients. Wound discharge was significantly higher in patients without saline wound irrigation as compared to patients with saline wound irrigation (p-value=0.018). Conclusion: Saline wound irrigation prior to wound closure in obstetrical and gynaecological abdominal procedures can lead to a significant reduction in surgical site infection.

Enhanced recovery after surgery protocol versus conventional care in emergency abdominal trauma surgery: a prospective, randomised, controlled study

Background: Since 1990s there has been a defined role of ERAS in elective surgeries, to optimize the peri-operative care, reducing post-operative complications and length of stay and hence, the overall costs. However, there is paucity of literature in its effectiveness in emergency trauma surgeries. The aim of the study was to investigate the feasibility and outcomes of ERAS protocol in emergency abdominal surgery in the setting of trauma.Methods: Institutional IEC approved study. A prospective randomized of 52 patients with abdominal trauma undergoing emergency laprotomy were included in the study and divided into two groups: ERP and conventional group. The ERP included early feeding, early urinary catheter removal, early mobilization/physiotherapy, early intravenous line removal and early optimal oral analgesia. The primary end-points were the length of hospital stay and secondary end-points included complication rate and re-admission rate.Results: The two groups were comparable with regards to age, gender, mechanism of injury and ISS score. Hospital stay was significantly shorter in the ERAS group: 4.67 days verses 13.36 days (p<0.001). There were 15 and 11 complications in the control and study group respectively. When graded as per the Clavien-Dindo classification there was no significant difference in the 2 groups (p=0.306).Conclusions: This study shows that early recovery programs can be successfully implemented with significant shorter hospital stays without any increase in postoperative complications in trauma patients undergoing emergency laparotomy for abdominal trauma.

Comparative analysis of an innovative app versus conventional techniques to improve patient compliance after minor oral surgical procedures (Preprint)

BACKGROUND Certain factors such as compliance, comprehension, retention of instructions, and other unaccounted elements impact the objectives of post-operative care. It is imperative that patients follow the instructions and prescribed regimen diligently for a smooth and placid healing. Keeping the same principles in view, ExoDont was designed by our team, an android-based mHealth app which ensures a smooth post-operative period for the patients after a dental extraction. Besides providing post-operative instructions at defined intervals, the app also sends out drug reminders as an added advantage over other available conventional modes. OBJECTIVE To compare the compliance rate of individuals with respect to the prescribed regimen, postoperative instructions, and additionally, assess any significant changes in post-operative complications rate under the three categories namely Verbal, Verbal plus Written, and ExoDont group. METHODS The patients after tooth extraction were randomly assigned to the aforementioned groups and a one week follow-up through a phone call was planned to obtain the responses from study participants. The result obtained from the three groups was then statistically analyzed. RESULTS The compliance rate in patients for post-operative instructions and prescribed drug adherence was statistically significant in the group using ExoDont app than in Verbal or Verbal plus Written group. However, the difference in the incidence of postoperative complication rate was not significant among the three groups. CONCLUSIONS As evident from the result, it is anticipated that the ExoDont app will be revolutionary in not only circumventing the unaccounted possibilities of missing the prescribed dose and post-operative instructions but also ensure a smooth post-operative phase and easy recovery for the patients.

A Review on Otitis externa: An Approach to a Etiopathogenesis, Epidemiology, Clinical Features and Management Protocol

Introduction: The external ear is the part of our ears which is seen from outside. It is made up of the auricles (pinna) and external auditory canal; and, includes the outer wall of the middle ear, i.e. the eardrum. Otitis externa is a regular presentation when on call for ENT or at the emergency ENT health clinic or centre. Infective and reaction groups of otitis externa are classified. Methodology: The articles reviewed in this narrative review article have been traced from a variety of links and sources over the internet like PubMed, NCBI, ScienceDirect, NHSINFORM, Uptodate, WebmedCentral, American family physician, ClevelandClinic, StatPearls, and many more. References from high yielding sources were taken and the articles were properly assessed. Results: Paying attention to the scientific elements while performing an operative procedure can give a physician extended results. Which operative modality to be chosen depends on the patient. The patient’s choices are also important in the decision making of the operation. Discussion: External otitis is possibly spotted in almost every peer category. Approximately ten percent (10%) of humans may face this condition during their lifetime. Most of the time, the infection is mixed. Medical intervention of the ear can prove painful for most cases, therefore, post-surgery analgesics must be utilized for a time period which the treating physician prescribes. The aim of curing the patient is to free him/her from the symptoms and getting rid-off any pathogen causing a specific infection. Conclusion: The efficacy of operative modalities of extremes of otitis externa will rely on complete patient examination, history and lab results. Selection of the correct intervention, proper knowlege of the regional anatomy, paying attention to scientific elements and good post-operative care is necessary. It is never easy to avoid otitis externa, but we can make an effort to decrease the risk of developing this problem.