Bacterial Sensitivity To Chlorhexidine and Povidone-Iodine Antiseptics Over Time: A Systematic Review and Meta-Analysis of Human-Derived Data

Background Surgical site infection (SSI) is the most common complication of surgery, increasing healthcare costs and hospital stay. Chlorhexidine (CHX) and povidone-iodine (PVI) are used for skin antisepsis, minimising SSIs. There is increasing concern of developing resistance to topical biocides, though clinical implications remain unclear. Outcomes: Determining whether the Minimum Bactericidal Concentration (MBC) for topical preparations of CHX or PVI have changed over time, in microbes relevant to SSI. Methods We included studies reporting the mean bactericidal concentration (MBC) of laboratory and clinical isolates of common microbes to CHX and PVI. Excluding non-human samples and studies using antimicrobial solvents or mixtures with other active substances. MBC was pooled in random effects meta-analyses. Change in MBC over time was explored using meta-regression. Results 79 studies were including, analysing 6218 microbes over 45 years. Most used CHX (93%), with insufficient data for meta-analysis of PVI. There was no change in MBC of CHX to Staphylococci (β 0.12 [-1.13, 1.37]; I2 99%) or Streptococci (β 0.13 [-0.35, 0.62]; I2 97%). Conclusions There is no evidence of reduced susceptibility of common SSI-causing microbes to CHX over time. Providing reassurance that the worldwide guidance that CHX should remain the first-choice agent for surgical skin antisepsis.

Outcomes of Early Surgery in Children under Four Years Old with Large Angle Intermittent Exotropia

Purpose: To find out the significance of early surgery in children of 4 years old and under with large angle intermittent exotropia of 35 prism diopters (PD) and more by examining the results of bilateral lateral rectus recession surgery and factors influencing the surgical outcome.Methods: It was a retrospective study of patients who underwent bilateral lateral rectus muscle recession surgery between 2006 to 2016 with intermittent exotropia greater than or equal to 35 PD and who were able to follow-up for at least 2 years after surgery were divided into two groups based on age of 4 years old. The surgical motor success was defined as exodeviation less than 10 PD, esodeviation less than 8 PD. The angle of deviation, binocular function, best corrected visual acuity, and amount of corrected PD per lateral recession (PD/mm) were compared at each observation point after surgery.Results: The motor success of bilateral rectus muscle recession surgery was 85% in children of age 4 years and under, 65.5% in age over 4 years. Success rate of early surgery was 1.3 times higher in younger age group, but there was no statistical meaning. The complication of surgery after 2 years of follow up was less in younger group-the rate of recurrent exotropia was 15% in younger group, 31.3% in older group and the rate of consecutive esotropia was 0% and 3.1%, respectively. Stereoacuity after 2 years of surgery was not fall behind in younger group compared to older group.Conclusions: It is possible to obtain good surgical results by performing early surgery rather than hesitating to operate due to the younger age in patients younger than 4 years old with large angle exotropia of 35 PD and more for long-term follow up and efficient patient management.

Near infra-red fluorescence identification of the thoracic duct to prevent chyle leaks during oesophagectomy

Background Chyle leaks following oesophagectomy are a frustrating complication of surgery with considerable morbidity. The use of near infra-red (NIR) fluorescence in surgery is an emerging technology and the use of fluorescence to identify the thoracic duct has been demonstrated in animal work and early human case reports. This study evaluated the use mesenteric and enteral administration of indocyanine green (ICG) in humans to identify the thoracic duct during oesophagectomy. Methods Patients undergoing oesophagectomy were recruited to the study. Administration of ICG via an enteral route or mesenteric injection was evaluated. Fluorescence was assessed using a NIR fluorescence enabled laparoscope system with a visual scoring system and signal to background ratios. Visualisation of the thoracic duct under white light and NIR fluorescence was compared as well as any identification of active chyle leak. Patients were followed up post-operatively for adverse events and chyle leak. Results 20 patients received ICG and were included in the study. The enteral route failed to fluoresce the thoracic duct. Mesenteric injection (17 patients) identified the thoracic duct under fluorescence prior to white light in 70% of patients with a mean signal to background ratio of 5.35. In 6 participants, a possible active chyle leak was identified under fluorescence with 4 showing active chyle leak from what was identified as the thoracic duct. Conclusion This study demonstrates that ICG administration via mesenteric injection can highlight the thoracic duct during oesophagectomy and may be a potential technology to reduce chyle leak following surgery. Clinical trial registration Clinical trials.gov (NCT03292757).

Bacterial Sensitivity to Chlorhexidine and Povidone-Iodine Antiseptics Over Time: A Systematic Review and Meta-Analysis of Human-Derived Data

Background: Surgical site infection (SSI) is the most common complication of surgery, increasing healthcare costs and hospital stay. Topical biocides such as chlorhexidine (CHX) and povidone-iodine (PVI) are used for skin antisepsis to minimise SSIs. There is an increasing concern of developing resistance to topical biocides, however the clinical implications of this remains unclear. Outcomes: The objective of this review was to determine whether the Minimum Bactericidal Concentration (MBC) for topical preparations of CHX or PVI have changed over time, in microbes relevant to SSI. Methods: We searched for studies which reported the mean bactericidal concentration (MBC) of laboratory and clinical isolates of common SSI causing microbes to CHX and PVI. We excluded samples derived from non-humans and studies using antimicrobial solvents or mixtures of biocides with other active substances. MBC was pooled in random effects meta-analyses and change in MBC over time was explored using meta-regression. Results: 79 studies were including, analysing 6218 microbes between 1976 and 2021. Most studies used CHX (93%) and there was insufficient data for meta-analysis of PVI. Enterobacteriales had the highest MBC for CHX (20 mg/L [95% CI 14, 25]; I 2 95%) whilst MRSA had the lowest (3 mg/L [95% CI 1, 2]; I 2 93%). There was no change in MBC of CHX to Staphylococci (β 0.12 [-1.13, 1.37]; I 2 99%) or Streptococci (β 0.13 [-0.35, 0.62]; I 2 97%). Conclusions: There is no evidence of change in susceptibility of common SSI-causing microbes to CHX over time. This study provides reassurance that the worldwide guidance that CHX should remain the first-choice agent for skin asepsis prior to surgery.

Surgical Site Infection Post Caesarean Section: A Case Report

Background. Surgical site infection (SSI) is a major complication of surgery which can increase morbidity, mortality and cost of hospitality. Incidence of SSI at a healthcare provider/facility reflected a service quality of that institution. Case presentation. A 28-years-old woman, a housewife, P2A1, post-caesarean section 12 days ago. Pasien datang dengan keluhan utama badan lemas dan terdapat nanah pada luka bekas operasi. Ia mengeluh perutnya terasa semakin panas, dan keluar cairan bening sebelum muncul nanah pada luka operasi. Pasien juga mengeluh demam, mual dan lemas akhir-akhir ini Laboratory investigations showed Hb 11,9 g/dL, Leukosit 11.100 m/L, trombosit 601.000. MCV 70,7 fL MCH 24 pg MCHC 32 g/dL TIBC 392 mg/dL serum Iron 54 mg/dL Ferritin 19,8 ng/mL, CRP reactive. Patient was wound dressing and given levofloxacin 500mg three times a day intravascular for three days and continue with ciprofloxacin three time a day oral. Patient was suggest to repeat laboratory test after therapy to evaluate therapy response. Conclusion: The result showed that time of prophylactic antibiotics can used to minimize the occurrence of SSI in post-caesarean section patients.

Surgical Site Infection Post Caesarean Section: A Case Report

Background. Surgical site infection (SSI) is a major complication of surgery which can increase morbidity, mortality and cost of hospitality. Incidence of SSI at a healthcare provider/facility reflected a service quality of that institution. Case presentation. A 28-years-old woman, a housewife, P2A1, post-caesarean section 12 days ago. Pasien datang dengan keluhan utama badan lemas dan terdapat nanah pada luka bekas operasi. Ia mengeluh perutnya terasa semakin panas, dan keluar cairan bening sebelum muncul nanah pada luka operasi. Pasien juga mengeluh demam, mual dan lemas akhir-akhir ini Laboratory investigations showed Hb 11,9 g/dL, Leukosit 11.100 m/L, trombosit 601.000. MCV 70,7 fL MCH 24 pg MCHC 32 g/dL TIBC 392 mg/dL serum Iron 54 mg/dL Ferritin 19,8 ng/mL, CRP reactive. Patient was wound dressing and given levofloxacin 500mg three times a day intravascular for three days and continue with ciprofloxacin three time a day oral. Patient was suggest to repeat laboratory test after therapy to evaluate therapy response. Conclusion: The result showed that time of prophylactic antibiotics can used to minimize the occurrence of SSI in post-caesarean section patients.

Prosopagnosia following nonlanguage dominant inferior temporal lobe low-grade glioma resection in which the inferior longitudinal fasciculus was disrupted preoperatively: illustrative case

BACKGROUND Prosopagnosia is a rare neurological condition characterized by the impairment of face perception with preserved visual processing and cognitive functioning and is associated with injury to the fusiform gyrus and inferior longitudinal fasciculus (ILF). Reports of this clinical impairment following resection of right temporal lobe diffuse gliomas in the absence of contralateral injury are exceedingly scarce and not expected as a complication of surgery. OBSERVATIONS The authors describe the case of a young female patient found to have an incidental diffuse glioma in the right inferior temporal lobe despite evidence of preoperative ILF disruption by the tumor. Following resection of the lesion, despite the preoperative disruption to the ILF by the tumor, the patient developed prosopagnosia. There was no evidence of contralateral, left-sided ILF injury. LESSONS Given the significant functional impairment associated with prosopagnosia, neurosurgeons should be aware of the exceedingly rare possibility of a visual-processing deficit following unilateral and, in this case, right-sided inferior temporal lobe glioma resections. More investigation is needed to determine whether preoperative testing can determine dominance of facial-processing networks for patients with lesions in the right inferior posterior temporooccipital lobe and whether intraoperative mapping could help prevent this complication.

Atrial Fibrillation after Lung Cancer Surgery: Prediction, Prevention, and Anticoagulation Management

Atrial fibrillation (AF) is a common complication of the early postoperative period of various types of surgery, including that for lung cancer. Although induced by the homeostatic alterations related to surgery, there is evidence that it is not a mere stand-alone transitory event, but it represents a relevant complication of surgery, bearing considerable prognostic consequences. Different methods have therefore been explored to predict the occurrence of postoperative atrial fibrillation (POAF) and prevent it. In particular, the age among clinical factors, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP), as a marker, have proven to be good predictors, and the use of beta-blockers or amiodarone in primary prevention seems to reduce its incidence significantly. There is growing evidence that POAF significantly increases the risk of stroke and global mortality in the long term; therefore, it should be managed in the same way as spontaneous atrial fibrillation. In this review, we will present the strongest evidence found so far and the most recent findings regarding the management of POAF, with a special focus on patients undergoing thoracic surgery for lung cancer.

High-frequency (10 kHz) spinal cord stimulation for the treatment of focal, chronic postsurgical neuropathic pain: results from a prospective study in Belgium

Aim: Chronic postsurgical pain (CPSP) is a common complication of surgery. This study was conducted to evaluate the efficacy and safety of paresthesia-free, 10-kHz spinal cord stimulation (SCS) as a treatment for CPSP. Patients & methods: Subjects in this prospective, single-arm study had an average pain intensity of ≥5 cm on a 10-cm visual analog scale. The subjects who had pain relief of ≥50% (response) with temporary trial stimulation were permanently implanted with 10-kHz SCS and assessed for 1 year. Results: At 12 months, 94% of subjects were responders to 10-kHz SCS, and 88% had pain remission (visual analog scale ≤2.5 cm). Conclusion: The pain relief was durable in CPSP subjects and the safety profile of 10-kHz SCS was as expected. Clinical trial registration: VT005076953 (Privacy Commission of Belgium)

A rare presentation of systemic complication of hypoxic ischemic encephalopathy in post cochlear implant child

<p class="abstract">Cochlear implant is a small, complex electronic device to restore some hearing in profoundly deaf or severely hard-of hearing people when organ of corti is not developed or destroyed by injury to such an extent that no hearing can be obtained by hearing aids. Many classifications have been proposed for cochlear implant related problems .We report a case of post cochlear implant child who reported to OPD with complaint of progressive weakness of both upper and lower limb which developed 1 year after surgery ,which parents attributed it as a complication of surgery. On retrospective analysis all patient preop investigations were normal. After detailed examination of the child, neurophysician concluded that child is suffering from global developmental delay with dystonic cerebral palsy. MRI brain and cochlea which was done before the surgery which showed T1 hypointense,T2 and FLAIR hyperintense ,bilateral symmetrical foci with high ADC values are seen in bilateral lentiform nuclei .It has been reported that the bithalamic hyperdensities on CT and/or MRI in severely asphyxiated neonates, were suggested of a distinctive pattern of brain injury which might be useful as an early predictor of status marmoratus,afrequent pathological correlate of dyskinetic cerebral palsy. Approximately 1% of infants who survived perinatal asphyxial HIE would develop delayed-onset dystonia in the course of 7 to 13 years (median 10 years) after birth.</p>