The compliance of surgical prophylactic antibiotics with standard protocols in Imam Reza teaching hospital of Birjand, Iran

Background and Objectives: Taking unnecessary or inappropriate prophylactic antibiotics can cause infections with re- sistant organisms. The present study aimed to investigate administration prophylactic antibiotics in surgery ward and its compliance with standard protocol in Imam Reza teaching hospital of Birjand, Iran. Materials and Methods: This descriptive-analytical study was performed to evaluate the pattern of prophylactic antibiotics on patients who underwent surgical operations from October to December 2019. A checklist including demographic informa- tion, type of prophylactic antibiotics, dose and duration of using drug, type of surgery, and compliance with standard protocol was used. The validity and reliability of the checklist were evaluated and confirmed prior to the study. All eligible patients were enrolled and the information of the prescribed drugs in the surgical wards was compared with the Schwartz’s principles of surgery as standard protocol. Results: Out of a total of 300 patients, 187 (62.3%) were male. Among the patients, 155 (51.7%) cases underwent general surgery, 119 (39.6%) cases orthopedic surgery, and 26 (8.7%) cases neurosurgery. The most popular prescribed antibiotics were cefazolin (170 cases) and ceftriaxone + metronidazole (67 cases). Furthermore, the maximum antibiotic administrations were two days (127 cases) and one day (93 cases). More importantly, 67.7% and 92.3% of the patients were in compliance with the standard protocol in terms of the type and time of administration, respectively. Conclusion: Our results showed that duration and route of administrating antibiotics were consistent with the standard pro- tocol, but the type of drugs and indication did not match.

Post-COVID-19 vaccination occurrence of splenic infarction due to arterial thrombosis

We present the case of an 82-year-old woman admitted to a regional emergency general surgery centre with severe left upper quadrant abdominal pain and tenderness within 21 days of receiving the first dose of the ChAdOx1 nCov-19 vaccine (Vaxzevria, AstraZeneca). Following further investigation through CT imaging, a thrombus was discovered in the patient’s splenic artery resulting in a large splenic infarct. Splenic infarcts are rare and it is important to note the association between time of administration of the first dose of vaccine and the occurrence of thromboembolic complications in the noted absence of other risk factors for this condition. We hypothesise a link between Vaxzevria vaccine injection and a rare form of thromboembolic complication: thrombosis of the splenic artery.

The use of hyaluronic acid preparations for the treatment of osteoarthritis of the major joints

The authors of the article analyzed the experience of domestic and foreign experts in the effectiveness of the use of HA preparations in the treatment of osteoarthritis of major joints. Background and Objective. To analyze the literature sources in order to determine the effectiveness of the use of HA preparations in the treatment of osteoarthritis of major ligaments. Materials and methods. Articles in specialized scientific journals and collections, Internet resource.Results. The analysis of literature sources determined the important role of HA preparations in the supplying and functioning of the articular cartilage. Researchers are inclined to believe that the ideal HA preparation should be as close as possible to the physiological HA of the synovial fluid of the joint. The developed domestic drug Artro-Patch fully corresponds to these parameters. Conclusions. The use of modern injectable HA preparations is advisable at stages 1–3 of OA. Anti-inflammatory effect of HA preparations makes it possible to reduce the dose and time of administration of non-steroidal anti-inflammatory drugs and, as a consequence, reduce the risk of developing many adverse side effects of NSAIDs. The high level of safety of HA preparations, the absence of serious side effects during their long-term use determine their widespread use in the clinical practice of modern orthopedists.

A THE EFFECT OF DOSE AND TIME OF ADMINISTRATION OF TRICHODERMA SP ON FUSARIUM OXYSPORUM ON SHALLOT (Allium ascalonicum L)

ABSTRACT This studypaimsptopdeterminepthe appropriate dosepand time ofxadministration ofxTrichoderma sp to control Fusarium oxysporum disease in shallot plants. Thepresearch waspconductedpfrompSeptemberp2020ptoxDecemberx2020 in Karangasem Hamlet, Guli Village, Nogosari District, Boyolali Regency. Thispstudypusedpapfactorialpcompletely randomizedpdesign (RAL) methodpwhich consisted ofp2pfactors. Thepfirst treatmentpfactor was thepdose ofpTrichoderma sp (D) which consisted of 3 g, 5g, 7g and the time of administration (T) which was one week before planting, during planting and a week after planting. Parameterspobservedpwerepnumberpof leaves, number ofptubers, weightpof fresh stover, weight of dry stover and intensity of disease attack. The results showed that the treatment with the best Trichoderma sp (D) dose was obtained in the D3 treatment with a dose of 7 grams / liter of solution had a very significant effect on the number of leaves, fresh stover, dry stover, intensity of disease attack and not significantly different on the number of tubers. The best time treatment for giving Trichoderma sp (T) was obtained in T1 treatment, namely the time of administration one week before planting had a significant effect on the number of leaves, fresh stover, and was not significantly different on the number of tubers, dry stover, intensity of disease attack. Meanwhile, the best combination of dosage and time of administration of Trichoderma sp was obtained in the (D3T1) treatment, namely the administration of a dose of 7 grams / liter of solution and the time of administration one week before planting had a significant effect on dry stover and had no significant effect on other parameters. Keywords : Trichoderma sp, fusarium oxysporum, shallot.

P.106 Intravenous lacosamide use in pre-school children

Background: Data on intravenous lacosamide use in young pediatric patients is scarce, especially of pre-school age. Methods: We retrospectively reviewed the medical records of all patients less than 6 years old who received intravenous lacosamide at our tertiary pediatric hospital. Data on dose, timing and order of administration was collected. Clinical and electrographic response was independently assessed with EEG interpretation blinded to time of administration. For adverse effects surveillance, heart rate was noted before and 1 hour after dose. Results: Eleven patients (8 boys), received lacosamide between 2013 and 2018. Mean age was 2 years (11 days – 5,3 years). Medical indications were: refractory status epilepticus (n=6), repetitive seizures (n=4), and inability to take oral lacosamide (n=1). On average, lacosamide was the fifth (1st-8th) IV antiepileptic drug administered 78 hours (SD 11 hours) after presentation. The most frequent dose was 5 mg/kg. Clinical response was confirmed in 7 patients, while electrographic response was proven in 3 patients. Seizure relapse at 24 hours was noted in 6 patients. No bradycardia occurred post-lacosamide. Conclusions: Although very safe, therapeutic response to lacosamide in young pediatric patients was inconclusive, mostly due to delay in administration, suboptimal dose, and high number of other IV antiepileptic drugs previously given.

Encephalopathy in Preterm Infants: Advances in Neuroprotection With Caffeine

With the improvement in neonatal rescue technology, the survival rate of critically ill preterm infants has substantially increased; however, the incidence of brain injury and sequelae in surviving preterm infants has concomitantly increased. Although the etiology and pathogenesis of preterm brain injury, and its prevention and treatment have been investigated in recent years, powerful and effective neuroprotective strategies are lacking. Caffeine is an emerging neuroprotective drug, and its benefits have been widely recognized; however, its effects depend on the dose of caffeine administered, the neurodevelopmental stage at the time of administration, and the duration of exposure. The main mechanisms of caffeine involve adenosine receptor antagonism, phosphodiesterase inhibition, calcium ion activation, and γ-aminobutyric acid receptor antagonism. Studies have shown that there are both direct and indirect beneficial effects of caffeine on the immature brain. Accordingly, this article briefly reviews the pharmacological characteristics of caffeine, its mechanism of action in the context of encephalopathy in premature infants, and its use in the neuroprotection of encephalopathy in this patient population.

Effect of metformin treatment and its time of administration on joint capsular fibrosis induced by mouse knee immobilization

Joint contracture leads to major patient discomfort. Metformin, one of the most extensively used oral drugs against type 2 diabetes has recently been found to suppress tissue fibrosis as well. However, its role in suppressing tissue fibrosis in joint contractures remains unknown. In this study, we examined the role of metformin treatment in suppressing joint capsular fibrosis and the most effective time of its administration. Joint capsular fibrosis was induced by immobilizing the knee joints of mice using splints and tapes. Metformin was administered intraperitoneally every alternate day after immobilization. Histological and immunohistochemical changes and expression of fibrosis-related genes were evaluated. Metformin treatment significantly suppressed fibrosis in joint capsules based on histological and immunohistochemical evaluation. Joint capsular tissue from metformin-treated mice also showed decreased expression of fibrosis-related genes. Early, but not late, metformin administration showed the same effect on fibrosis suppression in joint capsule as the whole treatment period. The expression of fibrosis-related genes was most suppressed in mice administered with metformin early. These studies demonstrated that metformin treatment can suppress joint capsular fibrosis and the most effective time to administer it is early after joint immobilization; a delay of more than 2 weeks of administration is less effective.

A-169 Remote Cognitive Screening: A Preliminary Study of Location Administration of the Boston Cognitive Assessment (BoCA)

Objective Digital, remote, cognitive assessment has become crucial for efficient screening of patients cognitive concerns. The Boston Cognitive Assessment (BoCA) is a brief, digital, global screening instrument that can be administered both in-office on a laptop, or remotely from patients’ homes. Potential differences in performance from completing the BoCA in-office versus completing it at home remain uninvestigated. As such, this study aimed to compared performances across these settings among demographically and cognitively matched patient samples. Method Data from 35 cognitively healthy participants who completed the BoCA (18 administered in-office; 17 remotely administered) were retroactively collected; groups were matched by age, education, gender, ethnicity, and global cognitive functioning based on their scores on a separate screening instrument. Overall BoCA scores (total = 30) as well as performance on the eight BoCA subscales (Immediate Recall, Delayed Recall, Verbal Reasoning, Visuospatial Reasoning, Executive Functions, Attention, Mental Math, and Orientation) were compared using nonparametric testing. Results A Contingency analysis and an independent samples Mann–Whitney U test confirmed the demographic and cognitive similarities between the two groups. Comparisons of BoCA scores revealed no differences in total scores or any of the BoCA subscales between those who completed the BoCA in-office and those who completed it remotely. Conclusion Results from the present study suggest that performance on the BoCA is not influenced by one’s environment at the time of administration. This further adds to the utility of the BoCA as a remote, self-administered, global screening instrument, and may support its adoption in settings where serial screening is indicated.

Use of hyaluronic acid preparations for treatment of osteoarthritis of major ligaments

The authors of the article analyzed the experience of domestic and foreign experts in the effectiveness of the use of HA preparations in the treatment of osteoarthritis of major ligaments. Background and Objective. To analyze the literature sources in order to determine the effectiveness of the use of HA preparations in the treatment of osteoarthritis of major ligaments. Materials and methods. Articles in specialized scientific journals and collections, Internet resource. Results. The analysis of literature sources determined the important role of HA preparations in the supplying and functioning of the articular cartilage. Researchers are inclined to believe that the ideal HA preparation should be as close as possible to the physiological HA of the synovial fluid of the joint. The developed domestic drug Arthro-Patch fully corresponds to these parameters. Conclusions. The use of modern injectable HA preparations is advisable at stages 1–3 of OA. Anti-inflammatory effect of HA preparations makes it possible to reduce the dose and time of administration of non-steroidal anti-inflammatory drugs and, as a consequence, reduce the risk of developing many adverse side effects of NSAIDs. The high level of safety of HA preparations, the absence of serious side effects during their long-term use determine their widespread use in the clinical practice of modern orthopedists.

Efficacy of tofacitinib as a «rescue therapy» in patients with severe ulcerative colitis

AIM: to evaluate the effectiveness of tofacitinib as a second line treatment.PATIENTS AND METHODS: the study included 12 patients, 4 (33.34%) males and 8 (66.66%) females. The median age was 41 ± 5 years. All patients admitted to the hospital with a severe flare-up of ulcerative colitis, which was the inclusion criterion in this study. Clinical manifestations, laboratory parameters, and colonoscopy were done at the time of administration of tofacitinib, on days 3 and 7, and after 12 weeks.RESULTS: a fast clinical response on 3 day of treatment, reduction in stool frequency, decrease blood in stool was noted in 10 (83.3%) patients. After 7 days from the start of TFCS therapy, all patients showed a decrease from severe activity to mild activity, as well as a decrease in inflammatory blood markers and hemoglobin levels. During the follow-up for 12 weeks, 100% of patients showed positive clinical and laboratory changes. In 10 (83.4%) patients, remission or maintenance of negligible minimal activity was noted.CONCLUSION: the results obtained show that the use of TFTB in hormone-resistant patients can be effective as a second line of “rescue therapy”.