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.

A Bacterial Profile of Nosocomial Infections in a Tertiary Care Hospital

Background: Nosocomial infections, may appear either during the hospital stay of the patient or after discharge. Objective: To find out the bacterial profile of nosocomial infections in a tertiary care hospital. Methodology: This cross-sectional study was based on the records of the patients admitted in Ghurki Trust Teaching hospital during the period of January 2016 to December 2017, who developed infections after their hospital admission, and their record was available in the Microbiology section of the Department of Pathology. A total of 1000 complete records of the patients were retrieved. Bacterial culture tests from clinical samples of these patients were performed in the clinical microbiology Laboratory of Lahore Medical and Dental College. Specimens included in this study were urine samples, pus samples from wound discharge, infected implants, and dead necrotic tissue. Data were analyzed using SPSS version 26. Results: Out of 1000 samples, 150 (15%) samples showed positive growth, and among 150 83 (55%) were from females patients. The bacterial profile of these 150 positive samples showed that the most frequently isolated bacteria were Staphylococcus Aureus 45 (30%), MRSA 45 (30%) followed by Klebsiella, 21 (14%), Pseudomonas 15 (10%), E. Coli 12 (8%), Acinetobacter 9 (6%), and Proteus 3 (2%). Conclusion: Staph. Aureus, MRSA, Pseudomonas, Acinetobacter, Klebsiella, E.Coli and Proteus are frequently isolated bacteria from nosocomial infections in our study. Such studies should be done frequently to keep track of bacteria that are prevalent in hospital-acquired infections.

First domestic apparatus for vacuum therapy

The first domestic device for vacuum therapy, Impulse KM-1, has been developed. The device is intended for the treatment of wounds, using a method of VAC therapy. Copyright protected by 2 patents. The device includes: an electronic unit with an internal power source, an external battery charge source, a reservoir for collecting of wound discharge, a disposable sterile dressing kit. The kit consists of a sponge, a film covering, a tube with a fixing head, a connector tube. The device is designed for a multiple use, provides continuous, variable and intermittent operation. Clinical trials of the device have been successfully carried out. As part of clinical trials, 17 patients who were treated at the hospital surgery clinic of the Vitebsk State Order of Peoples’ Friendship Medical University with surgical infections of the skin and soft tissues received vacuum therapy of wounds using the Impulse KM-1 apparatus. A significant reduction in the time of wound treatment was noted. The device has established itself as a reliable, easy to use device. The cost of the Impulse KM-1 apparatus is approximately 2500 $ and the cost of a disposable dressing kit is 40 $.

The Prevalence of blaNDM-1 in Clinical Isolates of Carbapenem-resistant Pseudomonas Aeruginosa: A Systematic Review

Background: Pseudomonas aeruginosa (P. aeruginosa) is a gram negative bacteria that is known to cause nosocomial infections. Carbapenem is used to treat the damage caused by P. aeruginosa, however it is becoming resistant to carbapenems because of the production of β-lactamases. The objectives of the study were to systematically review the prevalence of blaNDM-1 in carbapenem-resistant Pseudomonas aeruginosa (CRPA) and to review and analyze the clinical sources as well as the antibiotic resistance profile of CRPA carrying blaNDM-1. Methods: The researchers systematically searched PubMed, ScienceDirect, and Google Scholar. Studies that met the inclusion criteria were included in the review. In assessing the methodological quality of the included studies, the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data and the JBI Critical Appraisal Checklist for Case Reports were used. Results: A total of nine studies were included in which eight were cross-sectional studies and one was a case report. The highest prevalence rate reported was 54.55% in blaNDM-1 positive CRPA isolates among the cross-sectional studies. The three most frequent sources of clinical isolates of CRPA carrying blaNDM-1 include urine, wound discharge, and tissue, among the included studies. Lastly, this review showed that among the included studies, CRPA isolates carrying blaNDM-1 were most resistant to ceftazidime and gentamicin. Conclusions: There is varying prevalence of blaNDM-1 in CRPA in different countries. Urine, wound discharge, and tissue specimens being the most frequent sources of CRPA isolates carrying blaNDM-1 poses a challenge that must be given attention by the infection control committee, thus the need for proper handling and processing of clinical specimens. Resistance to ceftazidime and gentamicin among the CRPA isolates carrying blaNDM-1highlights the growing challenge of successfully treating infections caused by this bacteria. This challenge reminds us of the importance and purpose of antibiotic stewardship that emphasizes the improvement of proper antibiotic prescription by the physicians and proper antibiotic use by the patients that can help in preventing harm and antibiotic resistance. Doi: 10.28991/SciMedJ-2021-0304-9 Full Text: PDF

Prevalance and distribution of candidia species from diabetic foot ulcer in tertiary care centre, Jamnagar, Gujarat

Diabetes Mellitus is a chronic disease which may cause diabetic foot ulcer, which is a major cause of morbidity and mortality, it may also lead to foot amputation due to gangrene, and may cause cellulitis, abscess etc.To study prevalence of candidiasis in diabetic foot ulcer in a tertiary care centre, Jamnagar.32(10.66%) isolates that were recovered from wound discharge samples (300 samples tested) from November 2017 to September 2018. All isolates were visualized under direct microscopy, cultured, & sugar assimilation tests were performed.Amongst 300 samples 32(10.66%) were positive for fungal culture, in which major isolates was C. albicans (50%), C. tropicalis (18.75%), C. dubliniensis (9.37%), C.krusei (9.37%), C. glabrata (6.25%), C. parapsilosis (6.25%).This study shows that in Diabetic foot ulcer most common fungal pathogens were C. Albicans, C. tropicalis, C. dubliniensis, etc. Early identification of organism can help in early treatment and early recovery.

A prospective comparative study on the use of nanocrystalline silver ion dressing with normal saline dressing in diabetic foot ulcers

Background: A diabetic foot is any pathology that results directly from peripheral arterial disease and/or sensory neuropathy affecting the feet in diabetes mellitus. Proper assessment of the wound followed by an aggressive multidisciplinary approach can reduce the risk of amputation, thereby greatly increasing the patient’s quality of life. Wound dressings play a vital role in diabetic foot care management. Nanocrystalline silver ion dressing is a newer modality that has been in consideration for the treatment of diabetic wounds.Methods: This was a prospective comparative study conducted in the department of general surgery, Sagar hospital-DSI, Bangalore from December 2020 to March 2021. A total of 50 diabetic patients were included in the study and were randomised into the study group and control group. The study group received nanocrystalline silver ion dressings while the control group received dressings with normal saline. Patients were observed for 8 weeks. Data regarding the presence of wound discharge, type of discharge, granulation tissue, presence of slough and changes in the size of the wound was recorded and analysed.Results: Study group showed statistically significant better outcomes (p<0.05) in terms of reduced wound discharge, early granulation tissue, rapid reduction of slough from wounds and reduction in the wound size when compared with the control group. 17 patients responded completely in the study group when compared with the control group, where 8 patients have got a complete response (p<0.05).Conclusions: Wound dressings with nanocrystalline silver ion helps in the early healing of diabetic foot ulcers when compared to normal saline dressings.

A comparative study on the outcome of mattress sutures and subcuticular sutures in caesarean and hysterectomy in obese patients

Background: Selection of method of suturing is very important for a surgeon as it should be cosmetic, less painful, cost-effective and with less post -operative complications. Wound complications are comparatively more in obese than in non-obese patients. This has led to an increase in hospital stay and health cost for the patient. Hence selection of proper suture technique which would result in most favourable outcomes with least complications is of utmost importance. This study aimed to compare the outcome of subcuticular and mattress suture in obese patients.Methods: This was a retrospective study on 50 obese patients who underwent primary caesarean or hysterectomy with no previous surgeries in the past. Purposive sampling method was used for selection of patients. The wound was assessed by induration, wound discharge, infection, gaping, need for resuturing. All the patients underwent standard post-operative care. Statistical analysis was done by descriptive and inferential statistics.Results: Among the patients with subcuticular sutures, 15(60%) had wound induration with severe pain, 10 (40%) developed wound discharge, 6 (24%) had wound gaping and 6 (24%) required resuturing. Among the group with mattress sutures, 7 (28%) had wound induration, 3 (12%) developed wound discharge, 1 (4%) had wound gaping and required resuturing.Conclusions: Not only was wound induration and pain higher among the patients with subcuticular skin sutures but these patients had a significant increase in wound gaping and resuturing also when compared to the patients who had undergone closure with mattress skin sutures.

Species diversity and biological properties of dominant species of causative agents of poststernotomic infectious complications in cardiac surgery

Objective. To study the microbial and biological properties of the dominant species of causative agents of infectious and inflammatory complications after cardiac surgery. Infectious and inflammatory complications (IIC) developing after cardiac surgery with sternal approach such as thoracic and rib osteomyelitis, sterno-mediastinitis are severe life threatening states. Materials and methods. Bacteriological study of the sternal wound discharge from 178 patients with different infectious and inflammatory complications after sternotomic open-heart surgeries was conducted. Biological properties of isolates were investigated. Results. There were detected 242 strains of microorganisms referring to different taxons. Gram-positive bacteria, in particular, S. aureus and S. epidermidis prevailed. Out of gram-negative bacteria, prevailed P. aeruginosa and E. coli. All isolates S. aureus and P. aeruginosa possessed different factors of virulence and persistence including ability to biofilm formation. Carbapenems displayed the greatest bactericidal activity in relation to S. aureus and P. aeruginosa. Conclusions. The obtained data permit to optimize the preoperative preparation of cardiac surgery patients.

Efficacy of Miramistin-Metronidazole Combination in the Treatment of Purulent-Inflammatory Processes of Soft Tissues

Importance of the topic. The patients with purulent-inflammatory processes of soft tissues are the most common category of surgical patients, since the effectiveness of their treatment decreases due to the development of microorganism resistance to antibiotics and antiseptics. The aim of research was to study the clinical efficacy of topical application of miramistin-metronidazole combination immobilized on sodium salt of carboxymethyl cellulose in the treatment of purulent-inflammatory processes of soft tissues.Materials and methods. The study included 60 patients with purulent-inflammatory diseases of soft tissues. They were divided into 2 groups, 30 people in each group. All patients were exposed to partial surgical treatment of the purulent focus. In the first group, the treatment consisted of local application of dioxomethyltetrahydropyrimidine ointment with the antibiotic chloramphenicol, and in the second group with miramistin-metronidazole combination immobilized on the sodium salt of carboxymethylcellulose. The course of the wound process was assessed by the dynamics of the local wound temperature, the percentage of reduction of the wound size and volume and the rate of its healing; the terms of edema and purulent discharge elimination, the onset of the appearance of mature granulations and epithelialization of wounds, the cessation of the microflora growth in wounds, the average number of inpatient days were also registered. Results. Measurements of the local wound temperature demonstrated that the inflammatory process in patients of the first group lasted for 10 days, and in patients of the second group for 5-6 days. Prior to discharge from the hospital, the wound area was 16.1% and the volume of wounds was 14% less in patients of the second group compared with similar findings in patients of the first group. The edema of the tissues surrounding the wound eliminated within 1.5 days, and the exudation from the wound stopped 2 days earlier in patients of the second group. Granulation in the wound appeared 2 days, and marginal epithelialization 1 day earlier in patients of the second group. With bacterial culturing of the wound discharge, the growth ceased 1 day earlier in patients of the second group compared to patients in the first group. Such dynamics of the course of the wound process led to a 3 bed-day decrease in the hospital stay of patients of the second group.Conclusion. Local treatment of purulent-inflammatory diseases of soft tissues with miramistin-metronidazole combination allowed optimizing the course of the wound process, reducing duration of inpatient stay.

A study on the effectivness of Guggulu based Karaveera Ksharasutra in comparison with Apamarga Ksharasutra in the management of Shalyaja Nadivrana w.s.r. to Pilonidal Sinus

Shalyaja Nadivrana is of Agantuja Vranabedha. Nidana Panchaka is described in Sushruta Samhita Nidhana and Chikitsa Sthana. Presence of “Shalya” is hindering factor for healing. Management of Nadivrana includes Ksharasutra ligation. Pilonidal sinus is acquired sinus occurring in young hirsute men’s commonly seen at intergluteal cleft caused by hair penetrating the skin resulting in Pilonidal abscess which gradually forms into sinus with presence of “Hair” leading to wound discharge. It is one of the troublesome diseases which doesn’t respond to medical management till hair is evacuated. The current surgical procedures adopted have surgical risk and recurrence as well. Guggulu and Karaveera is abundantly available and can be preserved easily for long time. Hence can be used as substitute to the standard Ksharasutra. The present study “A study on the effectiveness of Guggulu based Karaveera Ksharasutra in comparison with Apamarga Ksharasutra in the management of Shalyaja Nadivrana w.s.r. to Pilonidal Sinus”was conducted in SJIIM hospital Bengaluru with 40 patients randomly allotted into 2 groups namely - Group A and Group B. Assessment was done based on subjective parameters like (pain, discharge) and objective parameters like (length of tract, tenderness). Observation was done before treatment and on every 7th day till tract is completely cut and healed. Assessment of Pain, discharge, length of tract and tenderness in Group-A showed 100%, 100%, 100% and 100% improvement and in Group-B showed 97.92%, 100%, 100% and 100% respectively. UCT in Group-A is 6.58% and Group-B is 9.15%. Overall results of group A and B is 100% and 99.5% respectively. Statistical analysis revealed that the effectiveness of Guggulu based Karaveera Ksharasutra in Shalyaja Nadivrana is as effective as Apamarga Ksharasutra w.s.r. to pilonidal sinus.