Aseptic Measures Research Articles

Outcome of Conventional Trabeculectomy in Terms of Intraocular Pressure and Visual Acuity in Primary Open Angle Glaucoma

Purpose: To determine the outcomes of conventional trabeculectomy in terms of decrease in Intra Ocular Pressure (IOP) and improvement in visual acuity in patients of primary open glaucoma, coming to a tertiary care hospital.
 Study Design: Retrospective case series.
 Place and Duration of Study: Ophthalmology department of a tertiary care hospital from January 2017 to December 2018.
 Methods: Patients undergoing trabeculectomy for Primary open angle glaucoma were included. Patients with repeated trabeculectomy, failed argon laser trabeculoplasty, advance cataract, corneal opacities and absolute glaucoma were excluded. All the trabeculectomies were done under retrobulbar anaesthesia after taking all aseptic measures. Primary outcome measures were preoperative and postoperative visual acuity, intraocular pressure, number of antiglaucoma medications and failed or successful trabeculectomy.
 Results: Total 52 patients underwent trabeculectomy. There were 36 (69.2%) males and 16 (30.8%) females. Mean age was 56.73 years ± 10.9 SD. Mean preoperative IOP was 30.96 ± 6.71 mm Hg, post operatively IOP at 1 year it was 15.6 ± 4.2 mm Hg. P value was <.000. Mean number of antiglaucoma medications was 3.03 and 1.19, pre and post-operatively respectively (p value <.000). Improvement in visual acuity after trabeculectomy was seen in 32 (61.5%) patients. Complete Surgical success was seen in 28 (53.8%) and qualified success in 21 (40.4%) patients. Failed trabeculectomy was seen in 3 (5.8%) patients.
 Conclusion: Conventional trabeculectomy is effective in lowering IOP in primary open angle glaucoma patients. It maintains IOP within normal range with and without anti-glaucoma medications at 1 year follow-up. Trabeculectomy significantly reduces number of anti-glaucoma medications.
 Key Words: Intraocular pressure, Primary open angle glaucoma, Trabeculectomy.

Escherichia coli, a common constituent of benign prostate hyperplasia‐associated microbiota induces inflammation and DNA damage in prostate epithelial cells

The role of microbiota in the pathophysiology of benign prostate hyperplasia (BPH), especially in creating an inflammatory milieu may not be avoided. The major objectives of this study were to investigate the microbial composition of BPH tissues, its association with inflammation and check the effect of clinically isolated bacteria on prostate epithelial cells. The study includes 36 patients with a pathological diagnosis of BPH. Following strict aseptic measures, tissues were collected after transurethral resection of prostate, multiple pieces of the resected tissues were subjected to histopathological analysis, bacterial culture and genomic DNA extraction. Microbial composition was analyzed by culture and/or next-generation sequencing methods. Annotation of operational taxonomy unit has been done with an in-house algorithm. The extent of inflammation was scored through histological evaluation of tissue sections. The effect of clinical isolates on nuclear factor-κB (NF-κB) activity and induction of DNA-damage in the prostate epithelial cells were evaluated. Histopathological analysis of the BPH tissues showed the presence of inflammation in almost all the tissues with a varied level at different regions of the same tissue section and the level of overall inflammation was different from patients to patients. Microbial culture of tissue samples showed the presence of live bacteria in 55.5% (20 out of 36) of the patient tissues. Majority of the isolates were coagulase-positive Staphylococcus, E. coli and Micrococcus spp. Further, V3 16S rRNA sequencing of the DNA isolated from BPH tissues showed the presence of multiple bacteria and the most common phylum in the BPH tissues were found to be Proteobacteria, Actinobacteria, Firmicutes, and Bacteroidetes. The E. coli, isolated from one of the tissue was able to activate NF-κB and induce DNA damage in prostate epithelial cells. Phospho-histone γH2A.X staining confirmed the presence of cells with damaged DNA lesion in BPH tissues and also correlated with the severity of inflammation. Our study has shown that the BPH tissues do have a divergent microbial composition including the commonly found E. coli (phylum Proteobacteria), and these bacteria might contribute to the BPH-associated inflammation and/or tissue damage. The BPH-associated E. coli induced NF-κB signaling and DNA damage in prostate epithelial cells in vitro.

A CLINICAL STUDY TO EVALUATE THE EFFICACY OF KHADIRADI VARTI IN KARNINI YONI VYAPAD WITH SPECIAL REFERENCE TO CERVICAL EROSION

Objectives: Karnini Yoni Vyapad which is one among twenty Yoni Vyapads is a common problem of the females in the reproductive age group. Since the symptoms of Karnini Yoni Vyapad as explained in Sam-hitas has got similarity with cervical erosion in modern perspective so it has been taken into consideration in this study. This study aimed to assess the efficacy of the trial drug i.e. Khadiradi Varti in the treatment of cervical erosion. Method: 30 numbers of patients suffering from Karnini Yoni Vyapad (Cervical erosion) were selected from OPD and IPD and were treated with Khadiradi Varti per vaginally following all aseptic measures, once a day preferably at bedtime for 7 consecutive days after completion of menstrual cycle. Such 3 cy-cles were performed for each patient. Result: The trail drug have efficacy in reducing severity of signs and symptoms like degree of cervical erosion (Yoni Karnika), cervical odema (Yoni Soth), discharge per vagina (Yoni Srava), bleed on touch (Rakta Srava) associated with Karnini Yoni Yyapad without having any tox-icity or adverse effect on the body.

PATTERN AND BURDEN OF ANTIMICROBIAL RESISTANCE AMONG CAUSATIVE ORGANISMS OF SPONTANEOUS BACTERIAL PERITONITIS.

Background; Spontaneous bacterial peritonitis is a common bacterial infection in patients with cirrhosis and ascities with in-hospital mortality rates ranging from 20 to 30%. Early diagnosis and a prompt antibiotic therapy have considerably decreased the mortality rate and this study was done to determine drug resistance pattern among causative organisms of SBP. Material and Methods; All the cases (n = 183) of Cirrhosis of liver with ascities, fulfilling inclusion criteria were recruited from Department of Medicine Akhtar Saeed Trust Hospital Lahore and Nishtar Hospital, Multan. All selected patients were subjected to ascitic fluid tap, under aseptic measures by inserting a needle of 22 / 18 gauge in the left flank of abdomen. Ten ml of ascitic fluid was aspirated in a heparinised disposable syringe; which was immediately inoculated into blood culture bottle at bedside and send for bacterial culture and causative organisms was tested for their antibiotic drug resistance pattern. Data was entered and analyzed by computer program SPSS-18. Results; Of these 183 study cases, 103 (56.3%) were male patients while 80 (43.7%) were female patients. Mean age of our study cases was 51.73 ± 9.28 years. Previous history of use of antibiotics before 72 hours was noted in 103 (56.3%), anti – HCV was positive in 103 (56.3%) while HBs Ag was positive in 13.7% of our study cases. Among these study cases, E.coli was noted in 135 (73.8%), Staph. Aureus in 17.5% and Klebsiella was noted in 8.7%. Chloramphenicol was resistant in 24 (13.1%), ampicillin was resistant in 143 (78.1%), co – trimoxazole in 61.2%, ciprofloxacin in 55.7%, Ofloxacin in 56.3%, Cefotaxime was resistant in 78.1% and amoxicillin was resistant in 74.9%. Conclusion; High degree of drug resistance was observed among these strains in our study which points towards well directed efforts of our health policy makers to adopt certain guidelines regarding use of these drugs in our population. Our study results have indicated that E.coli was major causative organisms among patients with spontaneous bacterial peritonitis having cirrhosis of liver followed by staphylococcus aureus and klebsiella. Keywords; Cirrhosis, spontaneous bacterial peritonitis, E. coli. DOI: 10.7176/JMPB/67-07 Publication date: August 31 st 2020

P1349CATHETER RELATED BACTERAEMIA AND EFFECTIVENESS OF UNIVERSAL MEASURES: 11-YEAR PROSPECIVE STUDY

Abstract Background and Aims Tunnelled catheter-related bacteraemia (BRC) of the patient in chronic hemodialysis program results in high morbidity and mortality. Antibiotic catheter lock has been suggested to reduce the incidence of BRC in clinical trials. Aim: To demonstrate the effectiveness of universal aseptic measures in obtaining an optimal BRC rate in a long-term single-centre study. Method Design: Prospective cohort study, single-centre. Follow-up time: 11 years (2008-2018) Tunneled catheters: Optiflow, Hemostar, Hemosplit, Equistream, Hemoglide (Bard Access Systems, New Jersey, USA) and Palindrome (Covidien, - Medtronic, Mansfield, Massachusets, USA). Days / catheter analyzed: 207,320. Catheter placement: Ultrasound-guided interventional radiology equipment, with fluoroscopy and universal aseptic measures + 1 single dose of Vancomycin / cefazolin. Follow-up: Nursing and Nephrology and Infectious physicians. Universal aseptic measures. Heparin lock. BRC is considered to be the presence of a positive blood culture after discarding another focus and related to the negative catheter or blood culture with no other focus than the catheter. All available samples at the time of bacteraemia are analyzed: blood, sputum, urine, faeces, pleural fluid, peritoneal fluid, cerebrospinal fluid, exudates, smears etc, and their results. The BRC rate x 1000 days / catheter is evaluated Results Results BRC 2008 to 2018: 0.57, 0.47, 0.31, 0.1, 0.43, 0.37, 0.42, 0.16, 0.2, 0.18 and 0.04 respectively. The evaluated catheters, follow-up days, catheter-related bacteraemias, germ typing and treatment are analyzed: antibiotic vs. catheter removal in Table 1. Conclusion 1. The use of universal measures only, without the use in the antibiotics lock or anticoagulants other than heparin, can achieve a bacteraemia rate related to the optimal catheter, being cost / effective and avoiding possible resistance to antibiotics and side effects of other anticoagulant drugs. 2. Antibiotic sealing should be reserved for cases of difficult epidemiological control of BRC.

Role of intravitreal dexamethasone implant in HIV associated macular edema: A retrospective clinical trial

To investigate the role of intravitreal sustained release dexamethasone implant in AIDS associated macular edema.This hospital based retrospective interventional study (nonrandomized) was conducted in Malda Medical College, West Bengal, India from September 2017 to august 2019 where 18 eyes of 18 patients with HIV were included. After proper history taking and required investigations, intravitreal sustained release dexamethasone implant was injected to each patient in respective eye under topical anaesthesia with strict aseptic measures and utmost care. Institutional clearance and written informed consent from each patient were taken before the procedure. Best corrected visual acuity (BCVA) and intraocular pressure (IOP) measurement and central macular thickness (CMT) evaluation by spectral domain optical coherence tomography (SD-OCT) were performed at baseline and after 1 month, 3 months, 6 months of injection. The data obtained then were put for paired t test using SPSS software.All patients had shown improvement in terms of BCVA as well as reduction of central macular thickness (CMT). 12 patients had increased IOP at first visit for which topical anti glaucoma drugs were prescribed and on subsequent visits their IOP were under control. Intravitreal sustained release dexamethasone implant is a good option to tackle macular edema in HIV infected patients.

Antibiotic containing bone cement in prevention of hip and knee prosthetic joint infections: A systematic review and meta-analysis

BackgroundProsthetic joint infection (PJI) is the most serious total joint arthroplasty (TJA) complication despite several aseptic and antiseptic preventive measures. There is no clear evidence or even consensus, whether antibiotic-loaded bone cement (ALBC) should be used, in addition to systemic short-term routine antibiotic prophylaxis, to reduce the risk of PJI in primary TJA. We aimed to analyze the efficacy of ALBC for prevention of PJI in patients undergoing primary TJA. MethodsWe searched systematically for randomized controlled trials (RCTs) in PubMed, Scopus, Embase, Web of Science and Cochrane library. Two reviewers independently screened potentially eligible studies according to predefined selection criteria and assessed the risk of bias using a modified version of the Cochrane risk of bias tool. PJI was prespecified as the primary outcome of interest. The meta-analyses were based on risk ratios using random-effects model per default. For the purpose of sensitivity, the corresponding fixed effects model odds ratios were calculated with the use of the Peto method as well. To evaluate a potential difference in effect sizes using different types (subgroups) of antibiotics used in bone cement, and at different follow-up periods, we performed stratified meta-analyses. ResultsThirty-seven studies were eligible for the systematic review and qualitative synthesis, and 9 trials (6507 total joint arthroplasties) were included in this meta-analysis. Overall ALBC significantly reduced the risk of PJI following primary TJAs (RRs, 0.36; 95% CIs, 0.16 to 0.80; P = 0.01) with a moderate degree of inconsistency (I2 = 47%). Based on stratified meta-analyses the use of gentamicin appeared to have a better effect (P = 0.0005) in the total hip arthroplasty. Pooled data of different antibiotics used in knee arthroplasties showed a significant association of cefuroxime (RRs, 0.08; 95% CIs, 0.01 to 0.63; P = 0.02). Further, ALBCs significantly reduced the PJI at one and two years of follow-up (P = 0.03 and P = 0.005 respectively). ConclusionsThe evidence suggests that ALBCs are effective in reducing the PJI following primary TJA; i.e. between 20 and 84% reduced risk. However, the clear limitations of the available trial evidence highlight the need for joint-specific confirmatory trials, that will need to be designed as cluster-randomized trials of clinics in countries with well-functioning arthroplasty registries.The translational potential of this article: This meta-analysis highlights the prophylactic potential of ALBCs in lowering the risk of infection following primary hip or knee arthroplasties but emphasizes the need for more recent confirmatory trials.

Comparative gene expression analysis of Fas and related genes in preeclamptic and healthy women: A cross-sectional study.

BackgroundPreeclampsia is a hypertensive disorder of pregnancy affecting about 2-10% pregnancies worldwide. mRNA expression of tumor necrosis factor alpha (TNF-), Fas, and FasL have been reported to be altered in placental bed in preeclamptic pregnancies. We hypothesized that the expression of these genes is also altered in peripheral blood mononuclear cells (PBMCs) in preeclampsia.ObjectiveTo compare the expression of Fas receptor and related genes in PBMCs of preeclamptic and normotensive pregnant women.Materials and MethodsA cross-sectional comparative study comprising of 18 cases and 18 controls was designed. 5 ml of venous blood was drawn and collected considering aseptic measures. Buffy coat was separated by centrifugation and stored at -20°C. Favor Prep total RNA Isolation Kit (Favorgen, Taiwan) was used for RNA extraction. The mRNA expression of TNF-, Fas, and FasL was measured by real-time polymerase chain reaction in PBMCs in preeclamptic and normal pregnancies.ResultsA significant increase in mRNA expression of TNF-, Fas, and FasL (p 0.001) was observed in PBMCs of preeclamptic pregnancies compared to the control group (p 0.001). Moreover, a significant positive correlation was found between the TNF- mRNA expression and Fas and FasL (p 0.001).ConclusionThe results lead to the conclusion that mRNA expression of TNF-, Fas, and FasL in the maternal PBMCs is altered in preeclamptic pregnancies and might contribute to the pathogenesis of the disease.

Effect of incorporation of dried distillers grains with solubles (ddgs) in total mixed ration of magra lambs on blood parameters

The present experiment was conducted at ARC-CSWRI for thirteen weeks on Magra lambs of 3-4 months of age to observe the effect of incorporation of dried distillers grains with solubles (DDGS) in total mixed ration of magra lambs on blood parameters. The lambs were used in a randomized block design and divided into four groups of 5 lambs in each group (T1-T4). Blood samples were collected at monthly interval by puncturing jugular vein following aseptic measures. No significant effect of incorporation of dried distillers grain with solubles i.e. DDGS was observed at each month of experimental period and also on overall mean values of haemoglobin (Hb), packed cell volume, total erythrocyte count (TEC) and total leukocytes count (TLC). It was concluded that DDGS can be incorporated in lamb ration up to level of 15% without having any detrimental effect on health of lamb.

Contribution to improve dried meat (Kilishi) quality using an adapted hygrometer

It is a most for each actor in Niger’s food production and distribution chain bears responsibility to take the necessary steps to ensure that the products placed on the market do not pose a risk to the health of consumers. Traditional kilishi products in Niger have evolved from natural drying. This study was aimed to determine the relative humidity of the kilishi in contribution to improve its quality. Three varieties of kilishi (ja, fari and rumuzu) samples were analyzed, using an adapted hygrometer at ambient temperature. The results revealed that from the reading of adapted hygrometer 78±1.42% of relative humidity for the kilishi ja; 62±1.83% for kilishi rumuzu and 53±0.67% for kilishi fari. The kilishi ja level of humidity (78%) found was higher than the normal which is 60 to 65%. The relative humidity results indicated that the evaluation on the kilishi varieties was an indicator of degree of dryness leading to improve its quality. It is therefore recommended that strict aseptic measures and proper drying should be observed during the production of kilishi in order to reduce the microbial load to an acceptable level.

A prospective randomized control trial of ultrasound guided internal jugular venous cannulation: The short versus the long axis approach.

Objectives: To compare the first pass success rate between long and short axis approaches in ultrasound guided IJV cannulation. Study Design: Prospective randomized controlled study. Setting: Department of Anesthesia and Intensive Care, Jinnah Hospital, Lahore. Period: Between 3rd Mar, 2016 to 2nd Sep, 2016. Material & Method: One hundred and ten patients admitted in the ICU were included in this study. Internal jugular vein was visualized ultrasonographically. In group A patients, long-axis view was used, while in group B patients, short-axis view was used to pass the needle. Under aseptic measures, US probe was placed on the neck and IJV viewed with either approach. During needle advancement if the needle penetrates the vein in the first attempt and blood flush-back is viewed, it was labeled as 1st pass success. This first pass success rate was noted. Results: One hundred and ten patients (55 in each group) were included in the study. The mean age of the patients was found to be 33.89 ± 13.35 years in group A and 35.90 ± 14.10 years in group B. The primary outcome of the study was to compare 1st pass success rate in both groups. The first pass success rate was 74.5% in group B (short-axis) and 61.8% in group A (long-axis); independent sample test showed non-significant (P=0.219). There is no difference in the frequency of 1st pass success rate in short axis approach and long axis approach for Ultrasound-guided IJV cannulation. Conclusion: Ultrasound-guided internal jugular venous cannulation with both approaches i.e. short-axis view and long-axis view have no significant difference in terms of first pass and therefore are equally successful.

Spontaneous Bacterial Empyema in Cirrhotic patients with Hepatic hydrothorax.

Objectives: To determine the frequency of spontaneous bacterial empyema in cirrhotic patients with hepatic hydrothorax. Study Design: Descriptive cross sectional study. Setting: Conducted in gastroenterology unit at Isra University Hospital, Hyderabad. Periods: One year from April 2016 to March 2017. Material & Methods: Sample of 174 patients of Hepatic Hydrothorax was taken. Patients were of both gender and age ≥ 18 years, having diagnosed cirrhosis since last 5 years and currently having child class B & C severity were included. Hepatic hydrothorax was confirmed on ultrasound chest. After aseptic measures 50ml of pleural fluid was aspirated and sent to Isra University Hospital laboratory following the ultrasound guidelines. Spontaneous bacterial empyema was assessed as “polymorph nuclear cell count” more than 500 cells/mm3 or +ve culture with PMN cell count more than 250 cells/mm3 without parapneumonic effusion. All the data was recorded in the proforma. Results: The mean ± SD age of patients was 53.52 ± 5.52 years. Males were 60.92% while 39.08% were females. The frequency of spontaneous bacterial empyema was about 14.9%. Frequency of spontaneous bacterial empyema was little more in male gender than females (p value = 0.391), while it was significantly increased with increasing age as most common in age group of 61-65 years (p-value = 0.017). Conclusion: It was concluded that spontaneous bacterial empyema in cirrhosis patients was 14.9%.

Diagnosing Cervical Lesions Through LLETZ – A Reliable and Effective Tool

Background: Cervical dysplasia is the most common gynecological disorder of modern era. It initiates around the squamocolumnar junction of the cervix commonly due to the infection of human papilloma virus. Large loop excision of transitional zone is globally a standard procedure of choice both for diagnosing and treating cervical dysplasia. Pap smear is a fast and easy assessment tool for detecting cervical lesions, but it is relatively unreliable.
 Methodology: Fifty patients of age group 35 to 65 years patients having normal looking cervix with abnormal pap smear or suspicious looking cervix with or without abnormal pap smear, were selected for the study after informed consent. The procedure for LLTEZ was performed under strict aseptic measures in the procedural room and the biopsy specimen was sent for histopathological examination. The pathological findings were presented as percentages.
 Results: 66% cervical biopsy specimens were suggestive of chronic cervicitis and 24% samples were suggestive of chronic cervicitis with squamous metaplasia. Mild dysplasia in 4% samples, moderate and severe dysplasia were seen in 2% samples.
 Conclusion: LLETZ is an efficient procedure to deal with cervical dysplasia. It must be recommended for the work-up of uncertain gynecological presentations. The expertise of professionals must be improved through training to obtain maximum benefits.

BIOCHEMICAL AND CLINICAL EVALUATION OF CORRELATION OF PERIODONTITIS AND EARLY CAROTID ATHEROSCLEROSIS

Periodontal disease is a disease characterized by inflammation of the periodontal tissues caused by microorganisms in the oral cavity and affects approximately 90% of the world population. Losses in the alveolar bone and connective tissue are observed due to periodontal diseases, which may lead to tooth loss. In addition, periodontal disease has been associated with many systemic diseases such as coronary artery diseases, stroke, head and neck cancer, pregnancy complications and diabetes. Periodontal disease is affected by risk factors such as smoking and diabetes, similar to vascular diseases. Hence based on above findings the present study was planned for Biochemical and Clinical Evaluation of Correlation of Periodontitis and Early Carotid Atherosclerosis.
 The present study was planned in Department of Dentistry, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. In the present study 20 cases of the Generalized chronic Periodontitis were enrolled in the Group A as study group patients. And 20 cases of Periodontally healthy individuals were enrolled in Group B as control group patients for comparative evaluation. Under aseptic measures, venous blood samples were drawn by venipuncture in antecubital fossa using 5ml syringe and collected in a plain vacuum tubes and transported to clinical laboratory for lipid profile analysis. Both the groups were subjected for ultrasonography for the assessment of Carotid Intima-Media Thickness (IMT) and Lipid Profile.
 The data generated from the present study concluded that periodontal disease has association with early carotid atherosclerosis which is a risk factor for cardiovascular diseases .Thus oral health and systemic health are closely related and overall systemic health of an individual can be improved by maintaining a proper oral health regimen. It is important in terms of health policies that there is no need for an additional cost for this early diagnosis.
 Keywords: Periodontitis, Early Carotid Atherosclerosis, Heart disease, etc.

Effect of topical Vancomycin on consolidation of sternum surgical fracture in open-heart surgery

Introduction: The physiological process of sternum surgical fracture consolidation in patients undergoing cardiac surgery could be prolonged by the invasion of gram-positive saprophytic bacteria which perpetuates the local inflammatory process despite the standardized aseptic and antiseptic measures in cardiac surgery. In this regard, the topical application of Vancomycin can exert a positive effect and prevent the perpetuation of the local inflammatory process by the elimination of these bacteria which in turn reduces bone consolidation time.The purpose of the current study was to determine the effect of topical Vancomycin on sternum surgical fracture consolidation in patients undergoing to open-heart surgery. Materials and Methods: Patients who underwent open heart surgery were assigned into groups receiving the topical application of bone wax or Vancomycin mass in the spongy tissue exposed by surgical sternotomy, prior to sternal closure. The bone consolidation processes were assessed by two expert radiologists with simple chest computed tomography (CT) in the postoperative period (4, 8, and 12 weeks). Results: The study was conducted on 55 patients in Vancomycin (n=33) and bone wax group (n=19). The computerized axial tomography (CAT) scan revealed a higher number of patients with early bone consolidation (Medullar and bone continuity, and callus bone) in Vancomycin group, as compared to bone wax group (p values between 0.004-0.02 at 4 weeks and 0.01-0.06 at 8 weeks). However, no difference was observed at 12 weeks (P=0.09-0.11). Moreover, The magnitude effect of topical Vancomycin was high (>90%) at 3, 8, and 12 weeks of follow up, compared to the patients who received bone wax (<90%). Conclusion: The topical Vancomycin application had a positive effect on sternal surgical fracture and promotes an early bone consolidation in patients undergoing open-heart surgery.

Comparison of Irrigation with Povidone-Iodine Versus Normal Saline on Wound Infection After Open Appendectomy

Objective: Surgical site infections (SSIs) pose a continued problem to operating surgeons. It adds to the healthcare cost, increases morbidity and mortality and sometimes culminates in re-explorations. Rate of SSIs can be ameliorated by removing damaged or non-viable tissue, metabolic waste and wound exudates; this can be achieved by irrigation of surgical wound intraoperatively. Surgical wound irrigation can also be performed postoperatively. Even after giving prophylactic antibiotics and august aseptic measures, post-appendectomy wound infection remains soaring. The efficacy of povidone-io- dine on non-incised skin is well known but its application as an intraoperative irrigation solution in open surgical wounds is not a mundane practice. Likewise prophylactic irrigation with normal saline solution to prevent wound infection has also turned out to be effective in some studies. The objective of this study is to compare the percentage of superficial SSI post-appendectomy, with intraoperative irrigation of subcutaneous plane using 1% povidone-iodine solution versus normal saline.&#x0D; Methods: 200 cases of open appendectomy for acute appendicitis at Baqai Medical University, Kara- chi were randomly distributed into two arms. In group A, 0.9% Normal Saline was employed to irrigate subcutaneous tissue before skin closure while in group B irrigation with 1% diluted povidone-iodine solution was undertaken. The cases were assessed for infection in surgical wounds in line with Southampton wound grading system for five days after surgery and followed for thirty days.&#x0D; Results: Mean age of participants of this study was 18.65 years. There were 100 patients in both groups and the groups were not different statistically in terms of age, gender and operative findings. A total of 38 (19%) out of 200 patients had Southampton grade 2 and above, signifying wound infection. Out of these, 29 (29%) were from Group A and 9 (9%) from Group B (p=0.001).&#x0D; Conclusion: 1% diluted povidone-iodine irrigation of subcutaneous plane after appendectomy remark- ably lowers the rate of SSI when compared with normal saline irrigation.

Impact of BMI on serum uric acid levels in females in local population.

Body mass index is the fat content of body whereas hyperuricemia is the condition when serum uric acid level crosses the optimum normal level. Increase in BMI may influence serum uric acid. Objective: To find out the relationship of BMI with serum uric acid level in local population. Study Design: Cross sectional study. Setting: Lady Aitchison hospital Lahore. Period: March 2017- August 2017. Material and Methods: Written informed consent was taken prior to data collection. Detailed history was asked and weight in kilograms and height in meters was noted. Body mass index was calculated. Uric acid was measured by uricase method after taking 1 ml venous blood under aseptic measures. Results: Body mass index and serum uric acid of the subjects were compared with the standard values that were 24.99kg/m2 and 5.7mg/dl and statistical analysis showed a significant difference (p-0.023 and p-0.000) respectively. Simple linear regression revealed 0.391 units change in serum uric acid level with one unit change in BMI. Conclusion: Serum uric acid increased with increase in BMI.

Influence of serum estradiol on serum uric acid level in pre and postmenopausal women.

Background: Hyperuricemia develops when serum uric acid level exceeds the normal value. Estrogen may influence the level of serum uric acid. Postmenopausal females have a remarkable reduction in its level, so serum estradiol is studied in relation to serum uric acid levels in pre and post-menopausal women. Objective: To find out the relationship of serum Estradiol with serum uric acid level in premenopausal and postmenopausal women in local population. Study Design: Case control study. Setting: This study was conducted in Lady Aitchison Hospital Lahore. Period: March 2017- August 2017. Material and Methods: 134 females were enrolled in total and were grouped in to two. Group A comprised of premenopausal and Group B included postmenopausal females. After complete history and general physical examination, 5 ml venous blood sample under aseptic measures was taken. Serum uric acid was measured by enzymatic and serum estradiol by Enzyme-linked immunosorbent assay method. Results: The mean age of pre and postmenopausal women was 32 and 57 ± 7 years, with significantly lower in premenopause. The mean serum E2 was 91.86 ± 26.71 mg/dL in premenopause and 22.04 ± 9.28 mg/dL in postmenopause, with significantly lower mean in postmenopause. Mean serum uric acid was statistically higher in postmenopause that was 6.04 ± 0.58 mg/dL, when compared to premenopause that was 4.22 ± 0.90 mg/dL. Conclusion: Serum uric acid levels increased due to decreased serum estradiol in postmenopausal women as compared to premenopausal women.

Assessment of the quality of stored blood for transfusion at Mbarara Regional Referral Hospital, Southwestern Uganda.

Aim and objective: To assess the quality of blood stored for transfusion at Mbarara Regional Referral Hospital (MRRH) regarding bacterial contamination, malaria infection, and laboratory audit status.Materials and methods: Whole blood and packed red blood cells at MRRH were critically inspected for visual anomalies, and a portion of this blood was aseptically collected and analyzed for Plasmodium species and bacterial contamination using culture methods. For culture positive samples, drug susceptibility testing (DST) was done using the Kirby–Bauer disc diffusion method. An audit using Stepwise Laboratory quality Improvement Process Towards Accreditation (SLIPTA) quality checklist was conducted. The obtained data were analyzed as frequencies and proportions at 95% confidence interval (CI), and significance levels of relatedness were set at p-values<0.05.Results: Of the 202 samples analyzed, 6 (3%) had bacteria while 3 (1.5%) had Plasmodium falciparum trophozoites. The bacterial isolates were Staphylococcus aureus (N=4, 66.7%); Corynebacterium spp (N=1, 16.7%) and Micrococcus spp (N=1, 16.7%). Staphylococcus aureus showed sensitivity to chloramphenicol, oxacillin, amikacin, and gentamycin. Thirty (14.9%) of these units had visually detectable anomalies, and the laboratory audit score was 53.8%.Conclusion: The quality of some blood stored for transfusion at MRRH was inadequate, and the laboratory quality standard based on SLIPTA was low. Based on this, it is crucial to always insist on aseptic measures at all stages (phlebotomy, processing, transporting, and blood storage) and consider more assessment of the donor risk to minimize transfusion-transmitted malaria. It is plausible to standardize the hospital blood transfusion laboratory and revive hemovigilance by the hospital transfusion committee.

Healthcare acquired infections: malpractice and litigation issues.

Healthcare acquired infections (HAIs) represent a significant burden for hospitalized patients in terms of mortality, morbidity, length of stay and costs. Also cause medical liability and medical malpractice litigation. Specific keywords combinations were analitically searched in PubMed and Scopus databases. Publications concerning medical liability, medical malpractice and litigation issues were reviewed. The authors outlined the healthcare workers and healthcare settings mandatory duties in consideration of the Italian law. In case of infections occurred in hospital environment the patients must demonstrate the guilty nature of the physicians and healthcare settings, the existence of a harm and causal connection. Physicians and healthcare facilities defence is mainly based on demonstration that protocols and aseptic measures were adopted scrupulously applying the up to date scientific knowledge. HAI are a complex issue which need a multitask strategy and a surveillance system to control the phenomenon and help physicians and healthcare facilities to reduce malpractice litigation.