Days Of Postoperative Period Research Articles

Comparison of Postoperative Wound Infection in Controlled Diabetic and Non-Diabetic Patients in Elective Operations

Background: Diabetes mellitus (DM) is a systemic disease that alters the metabolism of blood sugar. Poorly controlled diabetes or hyperglycaemia is associated with an array of micro-vascular, macro-vascular, and neuropathic complications. There is a widely held belief that infections are usually more frequent and severe in diabetic patients. Diabetes prevalence is increasing in the developed & developing countries, and the appropriate management of patients with diabetes has become increasingly important for the prevention of hospital-acquired infections. Postoperative wound infection continues to be a major source of morbidity and mortality in developing countries despite recent advances in aseptic techniques. There is little information regarding postoperative wound infection in controlled diabetic patients undergoing elective operation. Objectives: The aim of our study was to evaluate the postoperative wound infection in controlled diabetic and non-diabetic patients in elective operations. Materials & method: This cross sectional comparative study was conducted in Department of Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, during the period of October 2011 to March 2012. A total seventy three patients with controlled diabetics and seventy three non-diabetics were selected. Inclusion criteria were patients undergoing clean and cleancontaminated elective operations. Un-controlled diabetes, patient undergoing contaminated and dirty operation, patient with tuberculosis, jaundice, uraemia, having cortico-steroids /chemoradiation and operated for malignancies were excluded. After preoperative preparation specific operation was done. All patients were followed up for 30 days of post operative period for development of any postoperative wound infection. All information recorded in data collection sheet. Data was processed and analysed with the help of computer program SPSS-16 and Microsoft excel. Quantitative data expressed as mean and standard deviation and qualitative data as frequency and percentage. Result: The patients of diabetic group [31 male, 42 female; mean age, 44.5 (SD 8.2) years] and non-diabetic group [40 male, 33 female; mean age, 43.1 (SD 9.4) years] were similar in age and sex (p>0.05 each). The rate of postoperative wound infection after elective abdominal surgery was 7.5% [in controlled diabetic group was 12.3% and that of non-diabetic group was 2.7% (p<0.05)] and the patients of diabetic group were 5.0 times more likely to develop wound infection as compared to that of non-diabetic group (OR=4.992; 95% of CI=1.040–23.971) in clean and clean contaminated elective abdominal surgery. The length of postoperative hospital stay was significantly more in diabetic group than that of non-diabetic group (8.2 (SD ± 2.9) vs 6.8 (SD ± 3.2) days; p<0.01). Conclusion: Postoperative wound infection was higher in controlled diabetic patients than that of non-diabetic. These results support the consideration of diabetes as an independent risk factor for SSIs after elective surgery. Continued efforts are needed to improve surgical outcomes for diabetic patients. J Dhaka Med Coll. 2022; 31(2) : 226-231

Systemic inflammatory response in cardiac surgery: possibilities of using colchicine

To evaluate manifestations of systemic inflammatory response (SIR) and the effect of the colchicine therapy on SIR severity in patients with ischemic heart disease (IHD) after coronary artery bypass grafting (CABG) with extracorporeal circulation (EC). This study included 100 patients aged 62+6.3 years with stable IHD and multivessel coronary atherosclerosis scheduled for CABG with EC. Patients of group 1 (n=50) were administered with a single dose of colchicine (Colchicum-Dispert) 500 µg 4 hours before surgery followed by 500 µg twice a day for 10 days after surgery. Patients of group 2 (n=50) received a standard treatment, including nonsteroid anti-inflammatory drugs after surgery. Severity of the inflammatory response was evaluated by measuring blood cytokines. In the postoperative period, patient of group 1 showed a tendency toward a lower incidence of pleurisy and heart rhythm disorders in the form of paroxysmal atrial fibrillation (AF) (p=0.18). Levels of the anti-inflammatory cytokines, interleukin-10 (IL-10) and interleukin-6 (IL-6), were significantly increased in both groups at 6 hours after surgery (p<0.05); at the same time, in group 1, IL-10 remained increased also at 10 days after surgery (р=0.0002). No significant time-related changes in the proinflammatory cytokines, tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β), were observed. At 3 days post-CABG, there were significant increases in tissue inhibitors of matrix metalloprotease 1 (TIMP-1) (р<0.0001) and matrix metalloproteinase 9 (MMP-9) (р<0.001); at the same time, patients of group 1 had lower MMP-9 concentrations than patients of group 2 (p<0.05). At 10 days of postoperative period, these values were comparable with the background values. Increases in neopterin compared to preoperative values were found in both groups on days 3 and 10 after surgery (р <0.0001). CABG with EC is associated with the activation of SIR. The colchicine therapy at a dose of 500 µg 4 hours prior to surgery and 500 µg twice a day for 10 days after surgery reduces manifestations of SIR, which is clinically evident as a tendency to reduced incidence of pleurisy and arrhythmias, and does not result in the development of serious complications. The dynamics of matrix metalloproteinases indicates that the colchicine treatment is promising for decreasing the risk of CHF progression and myocardial remodeling in patients with IHD.

Comparative study between ureter first approach and conventional open Anderson-Hynes pyeloplasty in paediatric patients: A prospective randomised study

Uretero-pelvic junction obstruction is the most common form of congenital anomaly of the kidney and urinary tract with an incidence of about 1/1.000-1.500 of births and the aetiology and pathogenesis of this anomaly are still unclear until now. This is a prospective randomized comparative study conducted from March 2022 to December 2022. Thirty children with uretero-pelvic junction obstruction were included and randomly divided into two groups according to a 1:1 ratio (computer-generated randomization, single blind). Fifteen cases (12 males and 3 female) were subjected to ureter first approach pyeloplasty, and another fifteen (9 males and 6 female) were subjected to conventional Anderson Hynes pyeloplasty. The mean age of all patients was 6.7 ± 5.4 years in ureter first approach group and 5.1 ± 4.3 years in conventional Anderson-Hynes pyeloplasty group. There were no significant differences between the two groups regarding age, gender, presentation, side, preoperative renogram and post-operative renogram. Also, there were no significant differences between the two groups regarding operative time (in first group 110.3 ± 12.4 and in the second group 111.2 ± 12.0 with p < 0.836), pre and post-operative complication rate. Two cases of urinary tract infections in the first group, one of them having fever, and four cases in the second group, two of them having fever (p < 0.651); four cases of loin pain in the first group and one case in the second group (p < 0.330); one case in the first group having pro- longed leakage of urine for 7 days in post-operative period (p < 0.309). However GFR and t 1⁄2 improved significantly after operation in both groups (p < 0.001). Ureter first approach is a simple and effective procedure in children with good short term outcomes and could be done safely especially for beginners and less expert surgeons. Finally, it can overcome the problem of long ureteric stricture that may be found intraoperatively because you can shift easily to a flap procedure and complete a tension free anastomosis.

Trace Element Status and Postoperative Morbidity After On-pump Coronary Artery Bypass Surgery.

Trace elements are essential micronutrients that take part in most antioxidant reactions in the body. In this study, we evaluated the levels of copper, chromium, manganese, selenium, magnesium, zinc, iron, and silicon in adult patients who undergone isolated on-pump coronary artery bypass with the occurrence of postoperative atrial fibrillation, transient renal injury, transient liver injury, and rate of wound infection; 51 adult patients (41 men, 10 women) underwent isolated coronary artery bypass grafting (CABG) under cardiopulmonary bypass. The mean age was 61,9 ± 8,0years (range 45-82years). Blood samples were collected preoperatively, postoperative first hour, postoperative first day, and fifth postoperative day for element analysis. Serum levels were determined by an Inductive Coupled Plasma Optical Emission Spectrometer (ICAP 6000). Serum copper, zinc, and selenium values, typically known as strong antioxidant elements in the body, decreased significantly during the first hour and first day of postoperative period compared to the preoperative period (p < 0.05). Also, postoperative atrial fibrillation, transient renal injury, transient liver injury, and rate of wound infection were observed to increase with the decrease in levels of trace elements (p < 0.05). The levels of these elements were observed to return to normal levels during the fifth postoperative day. The levels of trace elements decrease significantly after on-pump coronary artery bypass surgery. Our study results suggest that this could be one of the predisposing factors for increased postoperative atrial fibrillation, transient kidney injury, transient renal injury, and increased rate of wound infections for patients undergoing on-pump coronary artery bypass grafting.

Comparison of Logistic Euroscore with Euroscore II in predicting postoperative mortality in adult cardiac surgical patients

Background: Logistic Euroscore and Euroscore II are widely used in predicting perioperative mortality after cardiac surgery; however the data regarding the superiority of one over the other in predicting outcome regarding 30 days mortality in isolated coronary artery surgeries are not consistent. This study assessed the predictive accuracy of logistic Euroscore versus Euroscore II in determining 30 days mortality after isolated CABG surgery in a single cardiac center of Nepal.&#x0D; Methods: One hundred and forty-two patients scheduled for isolated coronary artery bypass surgery during the one-year period was taken for this prospective observational study. The predictive post-operative mortality was calculated using both of the scoring system. The actual mortality observed during the 30 day of postoperative period was recorded and the findings were compared with the predictive post-operative mortality according to the scoring systems by using area under the receiver operating characteristics curve (AUC).&#x0D; Results: One hundred and forty-two patients were enrolled in this study and average cross clamp time was 65.92 +/- 26.39 minutes and total cardiopulmonary bypass time was 102.90 +/- 37.32 minutes. The average hours of ventilator stay was 9.56 +/- 8.45 and total days of ICU stay was 4.96 +/- 2.00. The observed 30 day mortality was 2.11% (95% CI, 1.96-2.36%) which was slightly better predicted by ESL 2.40% (95% CI, 2.04-2.76%) in comparison to ES II 1.44% (95% CI, 1.22-1.66%). The AUC value was 0.917 (0.817-1.000) for ESL and 0.946 (0.887-1.000) for ES II in predicting 30 day postoperative mortality and were comparable.&#x0D; Conclusion: Both of the logistic Euroscore and Euroscore II are comparable to each other in predicting 30 day postoperative mortality after isolated CABG surgery.

Первый опыт имплантации интраокулярных линз модели RayOne Trifocal

Purpose. To study refractive result of the RayOne Trifocal intraocular lens (IOL) implantation (Rayner, UK). Material and methods. 32 patients (32 eyes) were selected for the RayOne Trifocal IOL implantation. All patients underwent standard preoperative ophthalmological examination. The IOL diopters were calculated using ZEISS IOL Master 700 (Carl Zeiss, Germany). In postoperative period, the achievement of target refraction (emmetropia) was assessed using autorefractor keratometry (Tomey Corp., Japan), as well as visometry for distance, at an intermediate distance (70 cm), and for near. Results. In vast majority of cases (22 eyes, 68 %), postoperative spherical equivalent within ±0.5 diopters (target refraction) was obtained; in 9 eyes (28 %) – weak myopic spherical equivalent, in one case – weak hyperopic equivalent. On the 1st day of postoperative period, uncorrected visual acuity for distance in vast majority of cases (22 eyes, 68 %) was 0.8–1.0, in 5 eyes (16 %) it was 0.5–0.7; in 5 eyes – 0.1–0.4 (16 %). The best corrected visual acuity in 12 eyes (38 %) was 0.7–0.8. At a distance of 70 cm, high visual acuity (0.8–1.0) was achieved in 26 eyes (81 %), 0.6 – in 6 eyes (19 %). Visual acuity for near vision without correction for most patients (28 eyes, 87 %) was 0.7–0.8, in 4 eyes (13 %) it corresponded to 0.1–0.4. Conclusion. The RayOne Trifocal diffractive IOL provides high visual acuity at all distances, according to our data, 68% for distance, 81% for intermediate distance, and 87% for near, which is consistent with literature data. Keywords: cataract, multifocal IOL, RayOne Trifocal.

INFLUENCE OF RESPIRATORY SYSTEM PROTECTION ON THE TREATMENT OF PATIENTS WITH CRANIOCEREBRAL TRAUMA

Introduction. Craniocerebral trauma (CCT) results in disorders of pharyngeal reflex, deglutition, breathing rhythm and frequency. All the mentioned conditions cause the development of respiratory complications. Whereas they become independent factors of negative therapeutic consequences in such category of patients.&#x0D; Aim of a paper. The research aims at evaluating protection/treatment possibilities of the respiratory system concerning the course of craniocerebral trauma in injured patients.&#x0D; Materials and methods. We examined 237 patients with CCT who underwent urgent surgical interventions in the form of a decompressive cranial trepanation and the removal of both subdural and epidural hematomata. All patients required prolonged mechanical ventilation of the lungs. The patients were retrospectively divided into two groups, namely: the first group (132 patients) – the patients with tracheostomy on the 5th-6th days of admission to the clinics of anesthesiology and intensive care; the second group (105 patients) – the patients with tracheostomy on the 1st-2nd days of hospitalization. Patients of both groups were not differentiated by gender, the severity of CCT and general condition. In addition to general clinical and biochemical blood markers, culturing of the secretion in the tracheostomy tube (at the moment of tracheostomy and further every 3-4 days), blood and urine were performed in all patients. Simultaneously we controlled the leucocyte count in the peripheral blood, number of immature forms, levels of CRP and procalcitonin. The evaluation of a neurological status of patients was carried out by the Glasgow and Richmond Agitation-Sedation Scale (RASS). The severity of CCT was visualized with the help of CT.&#x0D; Research results. Even at the moment of tracheostomy the frequency of colonization of tracheobronchial tree was significantly higher in the first group of patients compared to the second one. Such tendency was monitored in further stages as well. The phenomena of tracheobronchitis and pneumonia were detected more frequently in the group of patients with tracheostomy on the 5th-6th days of postoperative period in contrast to the patients with tracheostomy on the 1st-2nd days of postoperative period. Microorganisms of Enterobacteriaceae with the extended spectrum of ß-lactamase and non-fermenting Gram-negative bacteria were detected more frequently in the first group.&#x0D; Conclusion. Early tracheostomy in patients with CCT results in both the decrease in the frequency of positive culturing of secretions from the tracheobronchial tree and the reduction in a detection frequency of nosocomial pneumonia.

Treatment option for diaphragm dysfunction after cardiac surgery: a review and a clinical case

INTRODUCTION. Dysfunction of diaphragm postoperatively is associated with worsened quality of life and increased health care costs due to prolonged respiratory support and morbidity. After cardiac operations, dysfunction of diaphragm can take place in up to 10 % of patients but often remains underdiagnosed. At the same time, histologically revealed changes, such as muscle atrophy in the diaphragm, start within 12 hours of mechanical ventilation. The therapy of diaphragm weakness is not well established and has a limited efficacy. Current analytic review describes therapeutic option for treatment ventilator-induced diaphragm dysfunction with emphasis on electric neuromodulation of phrenic nerve. OBJECTIVE. To optimize respiratory function by bilateral electrostimulation of phrenic nerves on the neck level in patient with diaphragm dysfunction after cardiac operation. MATERIALS AND METHODS. 82-year-old female patient after elective aortic valve replacement was diagnosed with dysfunction of diaphragm and respiratory failure. These changes caused the weaning failure from respirator and led to prolonged ventilator support. On the 20, 22, 24 and 26 days of postoperative period we performed invasive bilateral phrenic nerve stimulation on the neck level for 10 minutes with ultrasound navigation. RESULTS. After electrical modulation of phrenic nerves, diaphragm excursion, detected by ultrasound, was improved. After four procedures, duration of spontaneous breathing trial increased from 1 to 12 hours. On postoperative day 30, the patient was successfully weaned from respiratory support and decannulated without recurrent respiratory failure. There were no any complications during procedure, it was well-tolerated and associated with emotional improvement. CONCLUSIONS. Phrenic nerve stimulation on the neck level can be a valuable option in selected patients with respiratory failure and difficulties with ventilator weaning.

The role of magnesium in the correction of postoperative hypocalcemia

Background. The postoperative hypoparathyroidism remains a specific complication in the thyroid surgery. The incidence of iatrogenic hypoparathyroidism ranges from 3.0 % to 31.5 %. The decrease in the level of parathyroid hormone leads to the launch of a cascade of the electrolyte changes. The standard methods for controlling and correcting hypoparathyroidism do not guarantee the prevention of hypocalcemiacases. The role of calcium and magnesium in the conduction of the nerve impulses along muscle fibers is well known. The study of the role of magnesium will enable further correction of the manifestations of postoperative hypoparathyroidism.Aim — to study a relationship between postoperative hypoparathyroidism, changes in calcium-magnesium metabolism and their clinical manifestations; to analyze the effects of hypomagnesemia on the clinical manifestations of hypocalcemia; to study the possibility of correcting calcium-magnesium metabolism in the postoperative period.Materials and methods. The study involved 145 patients operated for the thyroid diseases. The patients were divided into two groups. The main group (n = 73) included the patients who took magnesium medications in the preoperative period for 10—14 days at a dose of 1500—2000 mg/day. In the observation group (n = 72), the patients did not take the magnesium medications. Parameters of the parathyroid hormone, ionized calcium, and magnesium were measured in all patients in the preoperative period and on the first day of the postoperative period. The parathyroid hormones’levels on the first day of postoperative period were ranged into the “ranges”: 1) parathyroid hormone — ≤ 1 pg/ml, 2) parathyroid hormone — 1—5 pg/ml, 3) parathyroid hormone — 5—10 pg/ml, 4) parathyroid hormone — &gt; 10 pg/ml. The clinical manifestations of hypoparathyroidism were assessed on a scale: not pronounced, poorly pronounced, pronounced, sharply pronounced.Results. The correlations were found between the levels of the postoperative magnesium, ionized calcium and parathyroid hormone. In the main group, the number of the pronounced and sharply pronounced manifestations of hypocalcemia was observed in the parathyroid hormone range — ≤ 1 pg/ml. In the observation group, the largest number of the prono­unced and sharply pronounced clinical manifestations was recorded in the parathyroid hormone range — ≤ 1 pg/ml, parathyroid hormone — 1—5 pg/ml. In the main group, in comparison with the observation group, the total number of the clinical manifestations of hypocalcemia was lower.Conclusions. There were revealed the positive cor­rela­tions in the changes in the levels of the parathyroid hormone, ionized calcium and magnesium. It has been proven that uncorrected hypomagnesemia in the early postoperative period can be a predictor of the clinical manifestations of hypoparathyroidism. The correction of the serum magnesium levels in most patients reduces the clinical manifestations of hypocalcemia.

Effect of Low Triiodothyronine (T3) Hormone Levels on Atrial Fibrillation Development After Coronary Artery Bypass Surgery

Aim: Atrial fibrillation (AF) after coronary artery bypass surgery (CABG) is the most common type of arrhythmia and it causes serious morbidity. Low levels of triiodothyronine (T3) hormone are thought to be a strong determinative factor on poor prognosis of cardiac patients. This study was planned to investigate the effect of low levels of T3 on the development of AF after off-pump coronary artery bypass surgery (OPCAB) and conventional CABG surgery. Methods: The study was prospectively planned on 60 patients undergoing CABG surgery. Thirty of them were randomly selected among the patients undergoing OPCAB, and the other 30 were randomly selected among the patients undergoing conventional CABG surgery. Thyroid function profiles of all patients were evaluated before the operation and on the first day of postoperative period. Results: The average age of the patients was 58.7± 8. After the operation, 3 patients from each group, 6 patients in total, developed AF. Postoperatively measured TT3 levels of the patients who developed AF after the operation (0.39±0.09) were found to be significantly lower than the preoperatively measured TT3 levels (0.97± 0.06) (p=0.042). Moreover, postoperatively measured fT3 levels of the patients who developed AF after operation (1.58± 0.30) were found to be significantly lower than the preoperatively measured fT3 levels (2.95±0.37) ( p=0.001). However, by univariate logistic regression analysis, it was seen that the variables that were thought to be risk factors for AF were not significantly effective. Also, when the effects of the variables were examined together by multivariate regression analysis, no significant result was found.Conclusion: In our study, it was seen that low levels of thyroid hormone in patients undergoing OPCAB and conventional CABG surgery had no effect on AF development.

Effects of Dexamethasone on Post-dural Puncture Headache in Patients Undergoing Orthopedic Surgery

Background: The effect of Dexamethasone on Post-Dural Puncture Headache (PDPH) after spinal anesthesia has not been well elucidated. The aim of the current study was to evaluate the effect of prophylactic intravenous dexamethasone on the incidence and severity of PDPH in patients undergoing orthopedic surgery. Methods: This randomized, double-blind, placebo-controlled trial was carried out in patients undergoing orthopedic surgery. The subjects were randomly divided into a placebo (n=140) and a dexamethasone (n=140) group. During the surgery, the control group participants were injected 2cc of distilled water, and the dexamethasone group participants were injected 2cc (8mg) of dexamethasone as an infusion in the veins. The incidences of PDPH on the first, third and seventh postoperative days were studied. Data were analyzed using SPSS version 22. Results: A total of 280 patients with a mean age of 32.7 ± 11.0 years were studied. The incidence of PDPH on the first day of post-operative period was lower in the dexamethasone group than the control group (21 vs. 34, P&lt;0.05). This difference was disappeared on days 3 and 7. Nausea or vomiting occurred less in the dexamethasone group (9 vs. 26, P&lt;0.05). However, no statistically significant association was found between study groups and the incidence of back pain (P&gt;0.05). Conclusion: Although the frequency of PDPH was less in patients receiving dexamethasone, the incidence increased days after the operation and reached the level of the placebo group. We do not recommend prophylactic intravenous dexamethasone for the prevention of PDPH.

Does Skin Preparation Influence Surgical Site Infection in Laparotomy Wounds: Comparative Evaluation of Preoperative Skin Preparation With 4% Chlorhexidine With 5% Povidone Iodine in Laparotomy Wounds: A Prospective Trial

Introduction: Surgical site infection is a dangerous condition causing a heavy burden on the patient and social health system. Surgical site infections are among the most common hospital acquired infections comprising 14 to 16% of inpatient infections. There are various factors predisposing the infections and many of them are patient related or disease related. The use of pre-operative skin preparation by effective antiseptic plays an important role in reducing postoperative wound infections. There are several kinds of antiseptics available for preoperative skin preparation; however povidone iodine and spirit are commonly used in clinical practice. Materials and Methods: This study compared the incidence of surgical site infections within 7 days of postoperative period in laparotomy wounds prepared using 4% Chlorhexidine and those prepared with 5% Povidone iodine for pre-laparotomy skin preparation. Results: This study compared 128, 4% Chlorhexidine prepared patients and 109, 5% Povidone iodine prepared patients undergoing various elective n = 114 and emergency procedures n = 123. The overall SSI rates in 7 days in the whole group were 13.44 %. The SSI rates on the 4% Chlorhexidine group were 10.16% and 5% povidone iodine group were 17.27% and it was statically significant with a p value of p = 0.00413 showing significant reduction in the 4% Chlorhexidine group. The study also compared the SSI rates in elective and emergency procedures in both groups with significant difference in emergency procedures. More variables are also compared between the groups and results were analyzed. Conclusion: This study shows the use of Chlorhexidine 4% reduces the morbidity of one of the most common wound related complication in laparotomy patients in all categories of laparotomy wounds.

Ambulatory Robotic-Assisted Partial Nephrectomy: Safety and Feasibility Study

OBJECTIVETo evaluate the feasibility and safety of performing robotic-assisted laparoscopic partial nephrectomy (RAPN) as outpatient surgery in patients with renal masses. MATERIALS AND METHODSWe analyzed RAPN performed by a single surgeon at an academic medical center from July 2018 to June 2019 and identified those individual patients who were discharged on the same day. These cases were then compared to a concurrent inpatient RAPN group. Relationships with outcome analyzed using Fisher's exact test and Student's t test. RESULTSTwenty-three of 84 RAPNs (27.4%) were performed as ambulatory. Mean age was 57.4 years. Average tumor size was 2.24 cm. The mean total operative time was 99.4 minutes. Average estimated blood loss was 51.0 mL. When compared to the cohort of patients who stayed overnight, on multivariate analysis, the tumor size (2.24 ± 0.71 vs 3.65 ± 1.55 cm, P <0.001), and operative time (99.5 ± 25.1 vs 131.2 ± 30.8 minutes, P <0.001) were less in ambulatory cases. No differences were seen in regards to Charlson comorbidity index, age, gender, body mass index, estimated blood loss, or surgical approach. Within 90 days of postoperative period, the readmission rate for the entire cohort was 0. CONCLUSIONRAPN can be performed safely as ambulatory in select patients with comparable outcome without complication or hospital readmission.

REPARATION OF BONE TISSUE IN THE AREA OF OPEN FRACTURE CONSOLIDATION IN TUBULAR BONE IN LABORATORY ANIMALS. AN EXPERIMENTAL STUDY

Objective. Antibiotic prophylactics in surgery is a standard of medical care for many surgical interventions. It is “a very short course”: starts immediately before surgery and lasts no more than 24 hours after it. There were no any information found after a broad search on pathomorphology of consolidation zone in open fracture and morphometry of bone callus structures under various modalities of perioperative antibiotic prophylactics. Purpose. To find out reparation degree and inflammatory changes in bone tissue in the area of consolidation in open femoral fracture in experimental animals under various modalities of perioperative antibiotic prophylactics. Material and methods. 60 outbred male guinea pigs were taken into the experiment. The experimental animals were divided into 3 groups, 20 individuals in each. Animals from Group I, so-called “AB-1”, were given antibiotics 30 minutes before surgery and then for 8 hours after it during one day. Animals from Group II, so-called “AB-3” were administered antibacterial drug for 3 days of postoperative period. Guinea pigs from Group III (Controls) had no antibiotic therapy. The modeling of femur open fracture was performed according to the developed methodology for modeling and treatment of open fractures of tubular bones in experiment. Results. When comparing reparative processes in AB-1 and AB-3 groups, similar regeneration processes in femoral fracture were noted. They were accompanied by: formation of endostal and periosteal callus with abundantly vascularized connective tissue; formation of significant amount of newly formed bone trabeculae; insignificant presence of leukocytes in the lumen of bone marrow canal, what may be explained by peculiarities of postoperative management of laboratory animals. In the Control group, growth of newly formed bone trabeculae was less intensive ( less by 16.3%); there also were 2-fold increase in connective tissue volume and actively proliferating zones of cartilage tissue. Conclusion. Thus, findings of morphological examination indicate that in the experimental group with short 24-hour perioperative antibiotic prophylaxis, bone tissue consolidation had minimal inflammatory changes and better formation of new bone trabeculae.

Early complications in patients undergoing mitral valve replacement surgery: An observational study

Background: Rheumatic fever(RF) & Rheumatic Heart disease(RHD) present a problem in all parts of the world especially in developing countries. In India RHD accounts for 12%-65% hospital admissions related to cardiovascular disease. It is the most common cause of Mitral valve disease with associated morbidity and mortality. Mitral valve replacement (MVR) is the surgical treatment when conservative approach fails.Mitral stenosis(MS), Mitral regurgitation (MR) or both MS+MR are main indications for MVR. Material and Method: Despite a rise in the rate of success of total valve replacement, the procedure has been associated with complications inherent to prosthesis as well as to any intra cardiac procedure. Majority of authors have defined complications occuring within thirty days in post operative period as early complications. Observations and Results: In this observational study of 85 patients at a rural cardiac surgery center, who underwent MVR for Mitral valve disease with concomittant Maze-III procedure(modified) for the surgical ablation of Atrialfibrillation (AF) if present, the early complications observed were General complications( AF, Post operative excessive bleeding, haemolysis,Neurological-psychiatric-Thromboembolic complications, wound infection,respiratory complications, Renal complications,prolonged inotropic support& Mechanical ventillation, Prolonged hospital stay & early mortality and Prosthesis specific complications of Paravulvular regugitation( PVR), Obstruction to valve by thrombus,valve endocarditis. Conclusion: AF was the most common post operative complication observed in 24.7% patients,Acute delirium(psychosis) was seen in 21.17% patients,prolonged hospital stay(more than 10 days) was observed in 17.7% of patients, prolonged inotropic support was needed in 12.9% patients, pulmonary complications were observed in 10.5% patients. The rate for other isolated complications was less than 10% each. Overall mortality rate was 1.17%. Prosthetic Valve related complicaio.

Influence of operator's professional experience in the postoperative course after surgical extrac-tion of the impacted lower third molar: A pilot study.

BackgroundThird molars are present in 96.6% of humans, although they do not always erupt completely. Between 9.5% and 73% of them remain impacted. Surgical removal of impacted third molars is the most common practice in oral and maxillofacial surgery. This procedure results in traumatism and, consequently, the postoperative phase will involve symptomatology. It is uncommon to find studies that directly relate postoperative symptomatology and the operator’s experience. The aim of this study was to determine the differences regarding postoperative symp-tomatology in patients undergoing the bilateral extraction of lower impacted third molars and according to the operator’s experience. Material and MethodsA prospective cohort double-blind study was conducted in 50 healthy patients (100 molar extractions) to whom both lower third molars were removed by two dentists with different degree of professional experience. The extractions were randomly assigned with a split–mouth design. If an operator extracted the lower third molar on one side, the other operator extracted the contralateral one. The variables studied after four days of postoperative period were Pain (EVA scale), Inflammation and Trismus, in addition to intraoperative time and local anesthesia administered. ResultsStatistically significant differences were detected in the time of intervention and in trismus, since the most experienced operator always needed less time and caused higher degree of trismus. However, this does not entail more inflammation or pain in patients, so there are no relevant differences between operators with more or less experience (p>0.05). ConclusionsThe postoperative period is more favorable for the most experienced operator, although the results do not vary in a relevant manner between them. Key words:Preemptive analgesia, dental extraction, cyclooxygenases, real-time polymerase chain reaction.

Ozone Therapy as treatment for severe cases without good evolution in ophthalmology [abstract

PURPOSE: In ophthalmology many diseases lead to irreversible blindness, something that implies millions of dollars in care because people with these difficulties loose their autonomy, becoming dependent in all their everyday activities.&#x0D; This presentation will focus on clinical cases of the following pathologies treated with Ozone Therapy because all these were already being treated in a conventional way without signs of improvement. They are primary open-angle glaucoma, age-related macular degeneration, diabetic retinopathy, occlusion of the central retinal artery, facial paralysis and herpetic polyneuropathy associated with orbital apex syndrome.&#x0D; &#x0D; CASE PRESENTATION: As an example, a patient, 73 , female, insulin-dependent diabetes for 10 years, with primary open angle glaucoma, diabetic retinopathy with various laser photocoagulations, vitrectomies and intravitreal injections in both eyes (BE). Visual acuity (VA) of 20/200 in right eye (RE) and 20/100 in left eye (LE).&#x0D; Subjected to the facectomy in RE and with cataract in LE. The fundoscopy was stable in BE. The VA went to 20/200 on 1st day of postoperative period and remained stable until 21st day. After integrative treatment with Ozone Therapy the patient got a VA of 20/60-2 in RE and 20/40-2 in LE, restoring vision and improving her quality of life.&#x0D; Furthermore, she stopped to be insulin dependent, only having to take oral medication.&#x0D; &#x0D; CONCLUSION: The result shows that Ozone therapy should be a therapeutic tool to be associated with Ophthalmology because in many cases, including difficult treatment and evolution, it recovers visual acuity and re-establishes ocular physiology, promoting the maintenance of eye health and vision, contributing to the preservation of autonomy in the lives of patients.

A study of surgical site infections in a general practice hospital

Background: Surgical site infections (SSI), major contributor to increased morbidity, mortality and healthcare costs among surgical patients worldwide. This study evaluates the incidence of surgical site infections in abdominal surgeries.Methods: This prospective observational study was conducted at Siri hospital, Khammam after obtaining permission from the hospital ethics committee. A total of 250 patients of elective and emergency abdominal surgery were included and studied about surgical site infections and factors influencing it.Results: This study includes 250 patients with abdominal abnormalities. In this 48(19.2%) patients were recorded with surgical site infection. As the age increases SSI was also increases. ASA scores of III (5.6%) &amp; IV (8.0%) were associated with the increased SSI. These SSI were more common in intestinal obstruction with gangrene cases 7 (2.8%) and also in accidental trauma/injury cases 7 (2.8%). SSI can be noticed after 48 hour of infection and recorded up to 10 days of postoperative period. The surgical wound incidence was clean (14.6%), clean contaminated (29.2%), contaminated (20.8%) and dirty (35.4%) respectively. Major factors that influence the SSI were diabetes, obesity, pre-operative anti biotic usage, duration of surgery, emergency surgery and level of haemoglobin and albumin levels. The organisms isolated from SSI were E.coli (22.9%), Methicillin Resistant Staphylococcus aureus (18.7%), Proteus species (16.6%), Klebsiella species (16.6%), Pseudomonas aeruginosa (8.3%), Staphylococcus aureus (6.2%) and mixed bacterial infections (10.4%).Conclusions: Surgical site infections were more commonly seen in abdominal surgeries. SSI was higher in older people. Control of factors influencing and bacterial contamination decreases the incidence of SSI in abdominal surgeries.

Efficacy of Guided Imagery for Postoperative Symptoms, Sleep Quality, Anxiety, and Satisfaction Regarding Nursing Care: A Randomized Controlled Study

The purpose of this study was to determine the effects of perioperatively applied guided imagery on nausea, satisfaction, and anxiety. This is a prospective randomized controlled study. In addition to standard treatment and nursing care, guided imagery was applied to the intervention group once in the preoperative period, once on the first day of postoperative period, twice in the second and third days, for six times in total. Only standard treatment and nursing care were given to the patients of the control group. Anxiety and intensity of pain were significantly higher in the control group than the intervention group, and the level of satisfaction and sleep quality were lower in the control group than the intervention group. Results support that guided imagery can be useful in improving perianesthetic symptoms and can be a part of nursing care.

Perioperative water balance in patients with acute abdominal pathology in a liberal regime of infusion therapy.

In order to evaluate the effectiveness of the liberal regime of infusion therapy, we examined 50 patients with acute abdominal pathology considering the state of the water sectors of the body. We established that liberal regime of infusion causes hypervolemia and hyperhydration of peripheral tissues during the first 6 hours of the perioperative period, it retains a moderate deficit of hypovolemia and dehydratation from 1 to 14 day of observation and forms an increase in interstanial volume, causing its maximum edema from the 3d to 7th day of observation. These changes are combined with positive daily and cumulative water balances, which is reflected in a critical increase in the percentage of excess fluid from the 5th day of postoperative period.