Infection In Postoperative Period Research Articles

Short Term Outcomes of Head and Neck Oncology Surgery During Covid-19 Pandemic: Experience from a Tertiary Cancer Care Centre in North India.

With the entire world in the midst of COVID-19 pandemic, several health care facilities have stopped or delayed performing elective surgeries in order to cater to ever increasing number of COVID-19 patients. Moreover, there were initial reports of poor surgical outcomes in patients who underwent surgery and were found to be positive for COVID-19 infection in post-operative period. In this study, we have evaluated the short-term outcomes of head and neck oncology patients operated in our institute following a strict screening protocol and conducting COVID-19 testing by Reverse transcriptase polymerase chain reaction once the test was available. 68 patients operated between 1st April and 30th September, 2020 (COVID-19 era, study group) were compared with 59 patients operated during 1st October, 2019 to 31st March 2020 (Non COVID-19 era, control group). The comparison between the groups was done by measuring 30 days complication rate as defined by Dindo–Clavien classification. 10.3% of patients developed complications in study group as compared to 8.5% of patients in control group which was statistically non-significant (p = 0.7). Importantly, none of the patients developed any sign or symptom suggestive of COVID-19 infection in post-operative period in study group. Head and neck oncology related cancer procedures including complex reconstruction can safely be performed during COVID-19 era by proper screening and pre-operative testing for COVID-19. We also suggest use of N95 masks and face shields as bare minimum in order to ensure the safety of health care workers even after a negative COVID-19 report.

Comparative Study Between the effect of Skeletonized and Pedicled Internal Thoracic Artery on sternum healing in Patient Undergoing CABG

Background: Myocardial revascularization is performed preferentially with internal thoracic artery grafts. This study aimed to investigate sternal healing over time and the incidence of poor sternal healing and wound infection in patients undergoing coronary artery bypass graft (CABG) surgery using skeletonized internal thoracic artery. Objectives: (1) comparison of two surgical take-down techniques (skeletonizing vs. standard pedicle harvestation); (2) assessment of sternal healing and wound infection. Method: This study enrolled 50 patients (divided in two groups) who underwent isolated CABG using skeletonized internal thoracic artery (25 patients) and pedicled internal thoracic artery (25 patients) from December 2017 to August 2019. Postoperative assessment was performed on all patients for three months after surgery. In all patients, chest X-ray study was performed after surgery to assess sternal healing. Medical records were also retrospectively reviewed to identify perioperative variables associated with poor early sternal healing. Results: (1) After coronary grafting, assessment of sternum showed significant differences in healing between the two groups. (2) Diabetes mellitus as an independent predictor for superficial wound infection. (3) Pedicled procedure is an important factor associated with superficial wound infection in post-operative period. (4) Skeletonized procedure prolong the operation. (5) Pedicled procedure prolong the ICU and hospital stay.Conclusion: (1) Skeletonization of internal thoracic artery conduits lowers the risk of superficial and deep sternal wound infection in patients undergoing CABG with internal thoracic artery grafting. (2) Skeletonization of internal thoracic artery conduits prolong the operation time and require more surgical skills. (3) Skeletonization of ITA has better outcome.

Forecast Possibilities and Prophylaxis of Surgical Site Infections in TKA

Эндопротезирование коленных суставов (ЭКС) в последние годы занимает особое место среди достижений травматологии и ортопедии [3, 7, 10]. Вместе с тем, эта операция не всегда позволяет добиваться положительных результатов. Осложнения артропластики коленного сустава составляют от 2 до 27% среди всех случаев ЭКС [3, 5, 10, 11]. Структура негативных последствий артропластики коленного сустава (КС) неоднородна [5, 9, 11]. Значительную их часть составляют гнойно-воспалительные осложнения ЭКС [3, 7, 8].В современной отечественной и зарубежной литературе и на научных форумах разного уровня проводятся оживленные дискуссии по вопросам, касающимся улучшения результатов ЭКС. Вместе с тем, данные о возможностях прогнозирования и профилактики гнойно-воспалительных осложнений при артропластике суставов и данные о результатах оказания медицинской помощи при наличии инфекции области хирургического вмешательства (ИОХВ) после эндопротезирования суставов остаются противоречивыми [2, 4, 6]. В связи с этим, изучение вопросов прогнозирования и профилактики ИОХВ при эндопротезировании коленного сустава является актуальной темой медицинских научных исследований.Сохраняющийся риск развития гнойно-воспалительных осложнений при артропластике коленного сустава может быть расценен как побудительный мотив к разработке методик предоперационного планирования и подготовки, вариантов проведения хирургического вмешательства, а также способов ведения послеоперационного периода при эндопротезировании коленного сустава.ЦельНа основании определения факторов риска развития гнойных осложнений в зоне операции и выявления среди больных группы риска, а также разработки и применения алгоритма прогнозирования и профилактики инфекции области хирургического вмешательства улучшить результаты эндопротезирования коленных суставов

Utility of quantitative real time PCR in detection and monitoring of viral infections in post renal transplant recipients

BackgroundViral infections cause significant morbidity and mortality in post-transplant period. A highly sensitive and specific detection tool if used may help in early diagnosis and better management in these patients. The study aimed to assess the utility of quantitative real-time polymerase chain reaction (qRT-PCR) as a diagnostic and monitoring tool for viral infections in post renal transplant patients. MethodsA quantitative real-time polymerase chain reaction (qRT-PCR) was performed to detect EBV and CMV infection in 50 patients on 1st, 2nd, 3rd, and after 6 months of renal transplantation. ResultsCMV infection was found in 34%, EBV in 28% of recipients, and 17% showed dual infection. Viruses were detectable after the first month of transplantation followed by symptomatic infections within first three months of follow-up, with diarrhea being the commonest symptom. These patients were also at high risk for developing other infections. Anti-thymocyte globulin (ATG) induction was a definitive risk factor for CMV/EBV infection in post operative period. ConclusionRenal transplant patients frequently develop one or more viral infections at a time. Regular monitoring with qRT-PCR and prompt antiviral therapy with reduction in immunosuppression may be an ideal approach for management of these patients.

Groin hernia surgery in northern Ghana--humanitarian mission of Polish surgeons in Tamale.

Availability of surgical care in Africa is severely limited. This is due to the lack of surgeons and a small number of public hospitals. Only 25 out of 100,000 patients with inguinal hernia undergo a surgical treatment. As many as 65% of inguinal hernia repairs are performed urgently because of incarceration. Among patients with incarceration who do not reach the hospital there is recorded as many as 87 deaths per 100 cases. In order to improve the availability of treatment of inguinal hernia in Africa, humanitarian medical missions involving surgeons from Europe are organized. During regular visits to selected centers in Africa, they also carry out intensified treatment of patients and training of the local staff. The aim of the study was to present the experience of Polish surgeons from the humanitarian medical mission in Tamale in northern Ghana undertaken in fall of 2014. Surgical repair was performed in 87 patients (74 men - 85% and 13 women - 15%) between the ages of 26 to 70 years (mean 52.8 years; SD 10.3), who underwent a total of 98 inguinal hernia repairs under local anesthesia. Lichtenstein procedure was performed in 93 and Desarda technique in 5 patients. Patients reported the long-term presence of hernia symptoms - from one to 7 years (mean 3.4 years, SD 1.4). In most patients, hernia occurred more than 3 years earlier (61 patients; 70%). There were no intraoperative complications. All patients were discharged the next day after surgery. There was one wound infection in postoperative period which required mesh explantation. Inguinal hernia commonly found in Ghana is a major issue for the inefficient health care system. Humanitarian medical missions can help to improve the treatment results, as long as they are carried out periodically and allow for training of local personnel. Scarce equipment of medical facilities in Ghana is not a significant difficulty in performing the Lichtenstein repair under the local anesthesia.

Preoperative risk factors for mediastinitis after cardiac surgery: analysis of 2768 patients

Longitudinal median sternotomy is the most common surgical approach for access to heart disease treatment. The deep wound infections in postoperative period of cardiovascular surgery are a serious complication requiring high costs during treatment. Different studies have indicated some risk factors for the development of mediastinitis and preoperative variables are currently under investigation. The aim of this study is to identify the preoperative risk factors for postoperative development of mediastinitis in patients undergoing coronary artery bypass grafting and valve replacement. This observational study represents a cohort of 2768 consecutive operated patients. The period considered for analysis was from May 2007 to May 2009 and there were no exclusion criteria. Analysis was performed by univariate and multivariate logistic regression model of 38 preoperative variables. Thirty-five (1.3%) patients developed mediastinitis and 19 (0.7%) associated with osteomyelitis. The patient age average was 59.9 ± 13.5 years and the EuroSCORE of 4.5 ± 3.6. Hospital mortality was 42.8%. The multivariate analysis identified three variables as independent predictors of postoperative mediastinitis: intra-aortic balloon pump (OR 5.41, 95% CI [1.83 -16.01], P = 0.002), hemodialysis (OR 4.87, 95% CI [1.41 to 16.86], P = 0.012) and extracardiac vascular intervention (OR 4.39, 95% CI [1.64 to 11.76], P = 0.003). This study showed that necessity of preoperative hemodynamic support with intra-aortic balloon, hemodialysis, and extracardiac vascular intervention were risk factors for development of mediastinitis after cardiac surgery.

Variabilidade da frequência cardíaca e infecções pulmonares pós revascularização miocárdica

FUNDAMENTO: A variabilidade da frequência cardíaca (VFC) é um método diagnóstico não invasivo usado na avaliação da modulação autonômica do coração. A análise da VFC por métodos de dinâmica não linear no período pré-operatório da cirurgia de revascularização do miocárdio poderia ser preditora de morbidade no pós-operatório, como por exemplo, infecções pulmonares. OBJETIVO: Avaliar o comportamento da VFC pela dinâmica não linear, no período pré-operatório da cirurgia de revascularização do miocárdio e sua relação com a ocorrência de infecções pulmonares no período pós-operatório hospitalar. MÉTODOS: Foram avaliados 69 pacientes (média de idade de 58,6 ± 10,4 anos) com doença arterial coronariana e indicação eletiva de cirurgia de revascularização do miocárdio. Para quantificar a dinâmica não linear da VFC, foram realizadas: análise das flutuações depuradas de tendências (DFA), seus componentes de curto (α1) e longo (α2) prazos, entropia aproximada (-ApEn), expoente de Lyapunov (LE), e expoente de Hurst (HE) de séries temporais dos intervalos RR do ECG, captados com equipamento Polar S810i, na véspera da operação. RESULTADOS: Nos níveis de corte estipulado pela curva ROC, houve diferença significativa entre os grupos com e sem infecções pulmonares no pós-operatório de revascularização do miocárdio para a DFA total, entropia aproximada e expoente Lyapunov com p = 0, 0309, p = 0,0307 e p = 0,0006, respectivamente. CONCLUSÃO: Os métodos de dinâmica não linear, nos seus respectivos níveis de corte, permitiram diferenciar os casos que evoluíram com infecção pulmonar no pós-operatório de cirurgia de revascularização do miocárdio, sugerindo que, nesse grupo de pacientes, estes métodos podem ter caráter prognóstico.

Severe infections in postoperative period after pediatric cardiac operations - value of biochemical monitoring

Severe infections in postoperative period after pediatric cardiac operations - value of biochemical monitoring

Mini incision live donor nephrectomy: an optimal approach for the developing countries.

Laparoscopic donor nephrectomy (LD) is rapidly gaining popularity, however, this may not be affordable by donors in many developing countries because of its high cost. We describe our mini flank incision (MD) donor nephrectomy technique and its outcome. A 7-10-cm subcostal rib sparing transverse incision was given 2 cm lateral to the tip of the 12th rib, towards the lateral border of rectus muscle. All dissections were performed with help of long retractors and instruments, vessels were transfixed and cut. In last 45 cases, vessels were clipped with Liga or Weck clips. Donors and recipients outcome was analysed. From January 2000 to December 2002 a total of 148 patients underwent donor nephrectomy by mini incision technique. Mean patient age was 44.8 +/- 7.3 yr (range 20-70 yr). Nephrectomies were performed in 115 patients on the left side and in 33 cases on the right side. The mean incision length was 9.1 +/- 1.8 cm (range 7-10 cm). Mean operative time was 105 +/- 10.5 min (70-130 min). Mean analgesic (Tramadol) requirement was 205 +/- 52 mg; postoperative hospital stay was 2.2 +/- 0.5 d. Twelve per cent patients developed fever and 4% had superficial wound infection in postoperative period. Three patients required blood transfusion. Mean convalescence period was 22 +/- 2.8 d. Extrapleural, extraperitoneal, subcostal mini incisions live donor nephrectomy is a relatively safe procedure with low morbidity. This technique has a shorter hospital stay, early convalescence and better cosmesis. It is cost-effective and is an ideal substitute for the developing country.

Antifungal Prophylaxis During the Early Postoperative Period of Lung Transplantation

Fungal infections occur frequently in lung transplant patients, with the highest risk being in the early postoperative period (the initial hospitalization after lung transplantation). Aspergillus is responsible for more than half of all fungal infections, and Aspergillus has even been considered a contraindication for lung transplantation because of its difficult therapy and frequently fatal outcome. The aim of this article is to evaluate the success of an antifungal prophylaxis protocol to prevent fungal infection in the immediate postoperative period in lung transplant recipients. From March 1994 to March 1997, we performed 52 lung transplants in 31 men and 21 women who received antifungal prophylaxis with fluconazole, 400 mg/d, and aerosolized amphotericin B, 0.6 mg/kg/d, during the postoperative period. The mean (+/- SD) postoperative period duration was 49 +/- 27.5 days. No fungal infections were observed during this period, and all patients provided negative cultures. We also found no toxicity related to antifungal drugs. The dose of cyclosporine was easily adjusted in every recipient according to blood levels so that effective immunosuppression was not compromised. In our study, the removal of the lungs and antifungal prophylaxis with fluconazole and aerosolized amphotericin B prevented fungal infection in the postoperative period in all 52 lung transplant recipients.

Primary obstructive megaureter

Twenty-three children with primary obstructive mega-ureters presented between 1978 and 1988 to the Princess Margaret Hospital for Children in Perth. Twenty-eight ureters were treated. Urinary infections were the presenting feature in 14 children. The obstructive segment was transvesically excised. Histopathologic examination of the distal, intramural ureter showed fibromuscular disarray with a relative increase in fibrous tissue and reduction of musculature in all specimens. Twenty-two ureters were tapered by excision and all 28 were reimplanted using an antireflux technique. Seventeen children were followed for an average of 3 years. Seven children showed renal growth, reduction in ureteric size by greater than 2 cm, improvement in glomerular filtration rate by more than 10%, no obstruction on reflux, and no infections in postoperative period. Four children showed all the above but suffered one or more infections after the operation. Of the remaining 6 children, 3 had postoperative obstruction and 3 had vesicoureteric reflux.