Wound Infection Research Articles

Curcumin-Loaded Nanocomposite Hydrogel Dressings for Promoting Infected Wound Healing and Tissue Regeneration

Curcumin-Loaded Nanocomposite Hydrogel Dressings for Promoting Infected Wound Healing and Tissue Regeneration

Multifunctional hydrogel based on polyvinyl alcohol/chitosan/metal polyphenols for facilitating acute and infected wound healing

Multifunctional hydrogel based on polyvinyl alcohol/chitosan/metal polyphenols for facilitating acute and infected wound healing

Gellan gum-based multifunctional hydrogel with enduring sterilization and ROS scavenging for infected wound healing

The progression of severe skin injury healing can be easily impeded by bacterial infections and the resultant overproduction of reactive oxygen species (ROS) within the wound microenvironment. In this study, we developed a multifunctional antibacterial hydrogel by integrating gallium ion-tannic acid and polydopamine particles into gellan gum via a facile heat-cooling process. By harnessing the synergistic effects of polydopamine for short-term photothermal therapy and gallium ion for long-term chemotherapy, the hydrogel obtained shows outstanding antibacterial activities. Sustained release of gallium ion and tannic acid ensures a prolonged sterilization along with ROS-scavenging benefits. Moreover, this hydrogel demonstrates superior cytocompatibility, hemostatic properties, as well as capabilities including promoting cell migration, and adsorption to bacterial cells and toxin. The therapeutic efficacy of the hydrogel was validated using a mouse model of MRSA-induced cutaneous infections. Overall, this work introduces a straightforward yet highly efficient multifunctional hydrogel platform that combines synergetic antibacterial actions, ROS scavenging, and hemostasis to enhance the healing of bacteria-associated wounds.

WITHDRAWN: Natural outer membrane vesicles from Serratia marcescens for inherent and biocompatible anti-microbial photodynamic therapy

It is a common pursuit to create an efficient photodynamic therapy (PDT), as a potential alternative to antibiotics. In this research, we first discovered and acquired the natural outer membrane vesicles (OMVs) from Serratia marcescens for effective photodynamic inactivation of both bacteria and fungi. The native OMVs was prepared from the culture media of S. marcescens, which inherently contained a photosensitizer named prodigiosin (PG). The negatively-charged, green-emitting OMVs exhibited improved water-solubility and increased singlet oxygen generation, as compared to free PG, resulting in notably enhanced antibacterial PDT effect towards microbes with appealing biosafety in vitro. Upon binding to the microbial cells through hydrophobic interaction, OMVs enriched PG in the microbic cells, destroying cell membrane structure and DNA and causing protein leakage under light irradiation, leading to microbial cell death. More importantly, OMVs could notably enhance infected wound healing and antibacterial effectiveness with satisfactory biocompatibility in mice. Collectively, the naturally-occurring PG-containing OMVs offers a novel modality for effective antimicrobial PDT, benefiting the treatment of microbial infection in clinic.

Glucose and pH dual-responsive hydrogels with antibacterial, reactive oxygen species scavenging, and angiogenesis properties for promoting the healing of infected diabetic foot ulcers

The healing process of diabetic foot ulcers is challenging due to the presence of a complex and severe inflammatory microenvironment, characterized by hyperglycemia, low pH, susceptibility to infection, vascular dysfunction, and over-expression of reactive oxygen species (ROS), which can potentially lead to amputation or even mortality. Herein, a glucose and pH dual-responsive hydrogel was designed and prepared by crosslinking phenylboronic acid-grafted quaternary chitosan (QF, 4 wt%) with dopamine-grafted oxidized hyaluronic acid (OD, 5 wt%) through phenylboronation, schiff-base reaction, and other techniques. The multifunctional QO/@PV@AB7 hydrogel was prepared by incorporating pravastatin-loaded chitosan nanoparticles (CSNPs@PV, 2 mg/mL) and antimicrobial peptide AMP-AB7 loaded silica nanoparticles (SiO2NPs@AB7, 0.5 mg/mL). The results demonstrate that the QO/@PV@AB7 hydrogel exhibits good responsiveness to acidic conditions and high glucose levels, while effectively scavenging various types of ROS. Moreover, it exerted protective effects against oxidative stress on cells, enhanced HUVECs viability, and promoted angiogenesis. Notably, the QO/@PV@AB7 hydrogel displayed potent antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli. Additionally, in an MRSA-infected rat model of diabetic foot wounds, administration of the QO/@PV@AB7 hydrogel led to increased secretion of pro-angiogenic factors such as vascular endothelial nitric oxide synthase (eNOS), vascular endothelial-generating factor (VEGF), and endothelial cell adhesion molecule (CD31). Furthermore, the hydrogel significantly reduced the levels of inflammatory factors such as interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), while simultaneously increasing the levels of anti-inflammatory cytokines such as interleukin-10 (IL-10). The findings suggest that multifunctional hydrogels incorporating PV@CSNPs and SiO2NPs@AB7 demonstrate promising potential as a therapeutic approach for the treatment of diabetic foot. Statement of SignificanceHere, a glucose and pH dual-responsive QO/@PV@AB7 hydrogel with antimicrobial and angiogenesis-promoting properties was developed for the treatment of infected wounds in diabetic feet. Our findings demonstrate that the proposed hydrogel exhibits good responsiveness, effectively scavenges various types of reactive oxygen species (DPPH, O2-, -OH, and ABTS+), provides protection against oxidative stress, enhances HUVECs cell viability, and promotes angiogenesis. Notably, it also demonstrates potent antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli. Additionally, in vivo experiments demonstrated that the hydrogel exhibited accelerated wound healing in MRSA-infected diabetic foot ulcers, with a reduction of four days compared to the control group.

Choice of Empirical Treatment in Patients With Wound Infection

Objective: We aimed to determine the distribution of infectious agents in wound culture specimens, their resistance rates, and to evaluate empirical treatment choices in wound infections. Methods: Wound culture results of adult patients between 2016-2020 were retrospectively investigated. Determination of bacteria and antibiotic sensitivity tests were done using conventional methods and automatized systems. Results: A total of 2576 wound specimens were sent, and significant bacterial growth was detected in 1254 (48.7%). Most frequently isolated agent was Escherichia coli (E.coli) (24.2%), followed by Staphylococcus aureus (S.aureus) (16.8%). The highest rate of resistance in Enterobacterales species was against amoxicillin-clavulanate (AMC), except Proteus mirabilis. Antibiotics that Enterobacterales species were most sensitive were amikacin and carbapenems, while it was trimethoprim – sulfamethoxazole (TMP-SXT) for Acinetobacter baumannii, and amikacin for Pseudomonas aeruginosa. The highest rate of resistance in S.aureus strains was against penicillin, with a methicillin resistance rate of 22.9%, while no resistance was found against vancomycin. Conclusion: Initial treatment in wound infections is empirical, and the range of treatment is narrowed when results of culture and sensitivity tests are obtained. Clindamycin, AMC, TMP – SXT and ciprofloxacin seem to be appropriate for outpatients, while TMP-SXT or vancomycin for gram-positive cocci, and TMP-SXT and amikacin combination for gram – negatives, and carbapenems as a last resort.

Diagnoses Bacterial Wound Infection and Detection of Some Immune Parameters in its

This study aims to diagnoses bacterial wound infection and to estimate the serum levels of TLR-3, CXCL8, TGF-β1, IL-8, IL-17 and IL-22 in wound patients. This study had been included 140 samples (blood and swab) obtained from patients found in Baquba-Teaching Hospital from 15/ 6 /2023 to 20 /3 /2024. Swab samples taken from wound were culture on the blood agar and MacConkey agar, and then Bacteria diagnoses was done by using an automatic VITEK 2 system. The serum levels of immune parameters done by ELISA. The results shown that sixty isolates were grow in culture, the results indicated of 38(63.3%) isolates of gram-negative bacteria, represented by: 12 (20%) isolates E. coli, 18 (30%) Pseudomonas aeruginosa, 6 (10%) Protus spp., 2 (3.3%) Acinetobacter spp. the results indicated of 22 (36.6%) isolates of gram-positive bacteria, represented by: 16 (26.6%) isolates Staphylococcus aureus, 4 (6.6 %) another Staphylococcus spp., 2 (3.3%) Enterococcus spp. The study also shown the a increase in the concentration of TLR-3 , CXCL8 , IL-2 , IL-17 and IL-22 in the serum of bacterial patients compared with the healthy, Where the results of the current study show decreases in the concentration of TGF-β1 among compared with healthy. In conclusion, it was discovered that the infection of bacteria in wound infection was lower in females than males. Pseudomonas aeruginosa and S. aureus were found to be the highly isolated bacteria wound infection, with increases levels of TLR-3, CXCL8, IL-17 and IL-22 in serum in patients and decreases level of TGF-β1 in serum of patients.

PURULENT-NECROTIC COMPLICATIONS AFTER AMPUTATION OF THE LOWER EXTREMITIES: ISSUES OF TREATMENT AND PREVENTION

Transfemoral amputation of a limb performed by a patient with obliterating atherosclerosis with irreversible ischemia is a difficult, traumatic operation and is accompanied by high mortality. High mortality after amputation of a limb at the hip level is associated with the severity of the general condition of patients and complications of the postoperative period. As our studies have shown, the most common complication after limb amputation is an infection of the femoral stump wound, its development is directly related to metabolic disorders in patients, a decrease in the immune status, ischemia of the stump tissues and foci of secondary infection. The clinical picture of infection of the femoral stump wound is variable. It depends, first, on the patient's general condition, the process's spread, the trophism of the stump tissues, and the nature of the microflora. Improving the treatment results of patients who have undergone limb amputation is possible by performing all the necessary preventive measures regarding ischemia and stump infection in the prescribed volume and the development of infectious complications, as well as treatment by the requirements of modern purulent surgery.

Evaluation of the Relationship Between Bacterial Infection and Immunological Factors with Diabetic Foot Ulcer

Diabetes represent a chronic disorder that involve the decline in the levels of insulin produced by the pancreas due to many genetic and environmental factors. The disease involves the elevation of blood sugar in the circulation which may lead to vascular, neurological, ocular and renal complications. In addition, diabetic patients tend to develop ulceration due to wound infection swiftly in the lower limbs due to the reduce in the neurological sensation as well as to elevated sugar circulation which may greatly provoke wound infection and diabetic foot ulcerations. The current study aimed at isolation of the common causes of bacterial infection associated with diabetic foot ulcer as well as the assessment of IL-17 and IL-18 and in those patients and in control healthy group. The present study was conducted in Salah Aldeen province during the period from 1st of November 2023 to 15th of May 2024 and included 150 patients with diabetic foot infection who attended Salah-Alden Hospitals: (Tikrit Teaching Hospital, Balad General Hospital and private surgery clinics). Swabs and whole blood from patients with diabetic foot ulcer were taken and submitted to routine culture and identification of the causative bacterial infection followed by biochemical identification and antibiotics susceptibility test for the isolated microbe. The serum specimens from those positive bacterial isolates were submitted for IL17 and IL-18 ELISA assessment. IL-17, significant elevation P<0.05 of this cytokine was recorded in diabetic patients with foot ulcer with mean 21.94 pg/ml compared to control group. In the same way significant increase of IL-18 (P<0.05) was noted in diabetic patients with foot ulcer with mean 347.15 pg/ml in comparison to control group. In conclusion, diabetic foot ulceration is the result of in controlled elevation of blood glucose and bacterial infection with various pathogens can complicate the scenario, and the significant elevation of IL17 and IL18 in those patients can insight the role played by these cytokines in signaling the immune to recruit cellular and humoral response.

TROCAR SITE CLOSURE WITH OMENTAL PLUG INSERTION IN LAPAROSCOPIC BARIATRIC OPERATIONS: EFFICACY, SAFETY, AND OUTCOMES

Introduction:Trocar site herniation (TSH) remains a significant complication following laparoscopic bariatric surgery. Conventional closure techniques often prove challenging and may lead to inadequate closure, increasing the risk of TSH. This study aimed to evaluate the effectiveness and safety of a novel omental plug technique for closing trocar sites in laparoscopic bariatric surgery. Methodology:A retrospective study included 256 patients who underwent laparoscopic bariatric surgery (LSG, OAGB, or RYGB) between 2019 and 2023 at Armed Forces Hospital, Taif, Saudi Arabia. We used an innovative omental plug technique to close trocar sites ≥10mm. The primary outcome was the incidence of TSH within 12 months postoperatively, assessed clinically and with an ultrasonography examination. Secondary outcomes included wound infections, seroma formation, and reoperation for trocar site complications. Results:We observed no cases of TSH, indicating significant efficacy in preventing this complication. Other postoperative complications were minimal, with only one case (0.4%) of a superficial wound infection. Conclusion:In laparoscopic bariatric surgery, the omental plug technique demonstrated promising results in preventing TSH and reducing postoperative complications. Its ease of use, safety profile, and potential biological advantages suggest it may be a valuable alternative to traditional fascial closure methods. We warrant future larger, multicentric studies with longer follow-up to confirm these findings.

Efficacy of B-Lynch Compression Suture for Control of Primary Post-Partum Hemorrhage

OBJECTIVES This study aimed to evaluate the efficiency of the B-Lynch compression suture for primary post-partum hemorrhage control. METHODOLOGY It is a prospective cross-sectional study performed for two years, i.e., 1 November 2021 to 31 October 2023, at the Department of Obstetrics and Gynaecology in a tertiary care hospital. This study included 65 study cases out of 23,964 with primary post-partum hemorrhage (PPH) due to uterine atony during cesarean delivery not responding to pharmacological treatment and was managed by applying B-Lynch compression sutures. The amount of blood loss, demographic characteristics, birth weight of babies, causative factors, and other related complications were studied in such selected cases. RESULTSB-Lynch compression suture presented a success rate of 97% in the present study. 52% had blood loss of 1000-1500ml, 29% had loss between 1501-2000ml and 18% had 2001-2500ml blood loss. 6% had wound gaping, 10.7% had a fever, and 8% had more than seven days stay in hospital, and wound infections were noted. CONCLUSION Our study concluded that the B-Lynch compression suture had a success rate of 97% in the management of primary post-partum hemorrhage, with few post-operative complications. The current research demonstrates the efficacy of B-Lynch as a lifesaving, easy, effectual technique that avoids hysterectomy and thus avoids heavy blood loss.

Distribution of TEM and SHV Genes in ESBL-Producing Klebsiella pneumoniae Strains Isolated From Various Clinical Samples in Al-Basrah Province, Iraq

Klebsiella pneumonia is an opportunistic pathogen causes several diseases including sepsis, pneumonia, and wound infections. Antimicrobial resistance (AMR) in MDR K.pneumonia carrying genes for extended-spectrum β-lactams (ESBLs) has been considered a risk for health problems around the world, which has greatly limited treatment options. The current study relied on n=26 Klebsiella pneumoniae isolates that were previously isolated by the studies of master’s student “Intithar Mahdi Mozan" between October 2022 and December 2022,the samples were collected from three hospitals in Al-Basrah province,Iraq. K. pneumoniae isolates reactivated and re-identified by cultivating isolates on MacConkey agar and Klebsiella pneumoniae chromogenic media and then re-identified K. pneumoniae isolates through diagnostic gene 16S rDNA by PCR technique, the results revealed that all n= 26 isolates of K. pneumoniae had a molecular weight of approximately 130 bp at a 100%. Double disk approximation test (DAM) was used to detected produced extended-spectrum β-lactams (ESBLs), the result of current study was showed positive results for the ESBLs. Extended-spectrum β-lactamses (ESBLs) genes was detected by using three specific primers: blaTEM, blaSHV and, blaCTX-M. Out of n=26 K. pneumoniae isolates results was shown the 23 (88.46%) K. pneumoniae isolates had gave positive results for the blaTEM gene. While 3 (11.538%) K. pneumoniae isolates revealed negative results for blaTEM gene. On other hand results were shown that only 5 (19.23%) K. pneumoniae isolates had positive results for blaSHV gene and 21 (80.769%) K. pneumoniae isolates had negative results for the blaSHV gene. Also the results shown the 5(19.23%)K. pneumoniae isolates had positive results for blaTEM and blaSHV genes.

Antibacterial cationic porous organic polymer coatings via an adsorption-contact-photodynamic inactivation strategy for treatment of drug-resistant bacteria

Although photodynamic therapy (PDT) has great potential for treating severely infected wounds, it is restricted by the short lifetime, limited diffusion distance of reactive oxygen species (ROS), and incomplete contact with bacteria. Herein, we report a novel nanosized ionic porous organic polymer (TPAPy-IPOP) based on the triphenylamine (TPA) moiety. Strong electron-deficient cationic groups were introduced into TPA to construct the donor–acceptor (D–A) system, in which the photoelectric effect of TPAPy-IPOP was greatly enhanced, and it was easily excited to produce ROS under irradiation with visible light. The introduction of cations not only facilitated bacterial adsorption by TPAPy-IPOP via electrostatic attraction, which was more conducive to killing bacteria by ROS, but also inactivated bacteria by the cations directly. The nanosized TPAPy-IPOP remained suspended in water for several months and could be sprayed onto various substrates to form a durable coating with excellent antibacterial properties. The in vivo results proved that the silk fibroin/polyvinyl alcohol non-woven fabric (SF/PVA) coated with TPAPy-IPOP could create and maintain a sterile microenvironment at a wound site. The rapid reduction in inflammation resulting from its bactericidal action accelerated the wound healing rate. Collectively, this design is expected to offer a generalizable approach for developing novel antibacterial therapeutic photosensitizers, especially for infected wound treatment.

Combining Multiple Spectroscopic Techniques to Reveal the Effects of Staphylococcus aureus Infection on Human Bone Tissues.

Osteomyelitis (OM) and periprosthetic joint infections (PJIs) are major public health concerns in Western countries due to increased life expectancy. Infections usually occur due to bacterial spread through fractures, implants, or blood-borne transmission. The pathogens trigger an inflammatory response that hinders bone tissue regeneration. Treatment requires surgical intervention, which involves the precise removal of infected tissue, wound cleansing, and local and systemic antibiotic administration. Staphylococcus aureus (SA) is one of the most common pathogens causing infection-induced OM and PJIs. It forms antimicrobial-resistant biofilms and is frequently found in healthcare settings. In this proof-of-concept, we present an approach based on multiple spectroscopic techniques aimed at investigating the effects of SA infection on bone tissue, as well as identifying specific markers useful to detect early bacterial colonization on the tissue surface. A cross-section of a human femoral diaphysis, with negative-culture results, was divided into three parts, and the cortical and trabecular regions were separated from each other. Two portions of each bone tissue type were infected with SA for one and seven days, respectively. Multiple techniques were used to investigate the impact of the infection on bone tissue, Brillouin-Raman microspectroscopy and attenuated total reflection Fourier transform infrared spectroscopy were employed to assess and develop a new noninvasive diagnostic method to detect SA by targeting the bone of the host. The results indicate that exposure to SA infection significantly alters the bone structure, especially in the case of the trabecular type, even after just one day. Moreover, Raman spectral markers of the tissue damage were identified, indicating that this technique can detect the effect of the pathogens' presence in bone biopsies and pave the way for potential application during surgery, due to its nondestructive and contactless nature.

Analyzing the Role of Mechanical Bowel Preparation on Surgical Outcomes in Colorectal Surgery

Despite improved postoperative recovery from the use of minimally invasive procedures and enhanced recovery after surgery protocols in recent decades, colectomy is still associated with morbidity. Surgical site infections range from trivial wound infections to potentially deadly colonic anastomotic leaks. Objectives: To compare the outcome results regarding postoperative complications of Mechanical Bowel Preparation and Non-Medical Bowel Preparation groups in elective colorectal surgery at a Tertiary Care Hospital in Peshawar, Pakistan. Methods: The research was a quasi-experimental study. In this study, 210 patients were included; they were divided into 2 groups: Mechanical Bowel Preparation Group and the Non-Mechanical Bowel Preparation Group. Data were collected through electronic health records. The data were analysed using SPSS software version 26.0. Descriptive statistics, such as the Chi-Square test, were applied to the results. Results: There was no statistically significant difference regarding the surgical outcomes and the demographics between the Mechanical Bowel Preparation and Mechanical Bowel Preparation groups. The escalation of the surgical site infection looked lower when the Mechanical Bowel Preparation was not in use i.e 20 (19.05%) in the Mechanical Bowel Preparation group and 14 (13.33%) in the Non-Mechanical Bowel Preparation group, but it did not seem to be, statistically significant; p-value=0.261014. The anastomotic leak rates and intra-abdominal collection rates do not differ significantly between the two groups; p>0.05. Conclusions: It was concluded that there was no statistical significance between the groups of mechanical bowel preparation and non-mechanical bowel preparation concerning surgical site infections, anastomotic leakages, and other colorectal surgery complications.

A Study of the Characteristics and Properties of P. aeruginosa Isolated from Different Sources and their Resistance to Antibiotics

Pseudomonas aeruginosa, a common opportunistic bacterium, is a major source of human surface infections. Infections with these bacteria are difficult to cure and cause significant economic implications. Objectives The current study looked at the antibiotic resistance patterns of P. aeruginosa isolated from burns, wound swabs, and urinary tract infections that were referred to Iraq Hospitals' emergency health care units. From October 2022 to May 2023, 180 swabs were collected from burn and wound patients (110 burns, 67 wounds, and 3 urinary tract infections) of both sexes, (80) males and (100) females, aged 1-72 years, at Baghdad government hospitals: Ghazi Al-Hariri Hospital, Central Laboratories, Specialized Burns Hospital, and Yarmouk Hospital. Results:(180) diagnostic swabs from patients with burns and wound infections of both sexes, (80) males and (100) females, aged 1–72 years. The current study found 25(31.25) more P. aeruginosa positive cases in males than females, with 29(29) out of 54 positive cases. The study discovered that the age group 21-30 years had the highest rate of bacterial infection, followed by the age groups 11-20 and 1-10, with 11 (20.37%), 10 (18.51%), and 10 (18.51%), respectively. According to the current study's findings, the antibiotics Amikacin, Gentamicin, Ceftazidime, Cefepime, Netilmicin, and Tobramycin showed the highest resistance rates (81.4%, 81.4%, 79.6%, 72.2%, 74%, and 79.6%, respectively).The test findings showed that 52 isolates (96%) produced pyrocyanin and hemolysins. Bacterial colonies were white to gray with a sticky feel. All isolates exhibited β-hemolysis.Alkaline protease production All isolates exhibited a translucent halo surrounding the bacterial colonies.Lipase production All isolates exhibited a hazy halo surrounding the development zone of P.aeruginosa colonies. The current study discovered that the antibiotics Amikacin, Gentamicin, Ceftazidime, Cefepime, Netilmicin, and Tobramycin were the most resistant in cases of burn and wound patients, as well as urinary tract infections in Iraq.

Reconstructive interventions on bile ducts in patients with benign obstructive jaundice

Aim. To evaluate immediate and long-term results of surgical reconstruction of the biliary system in various types of benign obstructive jaundice.Materials and methods. The study enrolled 110 patients with choledocholithiasis, iatrogenic biliary strictures, common bile duct strictures, as well as strictures of biliodigestive and biliobiliary anastomoses. Patients were divided into 3 groups. Group 1 included 43 patients with multiple choledocholithiasis and bile duct dilatation >15 mm. Group 2 enrolled 35 patients with multiple choledocholithiasis and hepaticolithiasis who were intraoperatively diagnosed with stricture, injury, or pressure ulcers of the common bile duct wall. Group 3 included 32 patients with cicatricial and iatrogenic biliary strictures. The immediate and long-term results of surgical treatment were compared.Results. In group 1, the survival rate comprised 89.4%, the average duration of surgery amounted to 137 minutes, complications involved wound infection, bile leakage, bile peritonitis. In group 2, the survival rate accounted for 91.4%, the average duration of surgery comprised 192 minutes; strictures of biliodigestive anastomosis were detected in the remote period, and reconstructive surgeries were performed. Group 3 revealed the survival rate of 100%, the average duration of surgery of 215 minutes, and no complications in the long term.Conclusion. The diameter of the common bile duct, its wall changes, size of gallstones, signs of cholangitis, patency of the bile papilla, and localization of biliary stricture determine the surgical tactics, when performing biliary reconstruction in patients with non-cancerous obstructive jaundice. In case minimally invasive surgery is found impossible under conditions of multiple choledocholithiasis, common bile duct diameter >15 mm, and preservation of its wall, choledocholithotomy with Kerr drainage is considered to be optimal. In case of damage to the CBD wall and patency of the bile papilla, preference shall be given to hepaticoenterostomy. Bile duct reconstruction with stent drainage is indicated for treatment of cicatricial and iatrogenic biliary strictures.

USE OF PROPHYLACTIC ANTIBIOTICS IN PATIENTS UNDERGOING CAESAREAN SECTION AT CUT MEUTIA GENERAL HOSPITAL, NORTH ACEH 2021-2022

Caesarean section is a surgical procedure to remove the fetus through an incision in the lining of the abdomen and uterus. Cesarean delivery is performed by considering clinical signs of the mother and fetus, such as placenta previa, abnormal location of the fetus, as well as different signs that may endanger the existence of the mother or embryo. According to the World Health Organization (WHO), the number of cesarean deliveries has increased, which is directly relative to the increase in the contamination rate of surgical wound infection (ILO). Prophylactic antibiotics are one of the prevention of surgical wound infection. The research method used is retrospective descriptive. The sampling technique in this research uses non-probability sampling, namely total sampling. The aftereffects of this review show that the use of prophylactic antibiotics in caesarean section patients, namely ceftriaxone 51.2% and cefotaxime 48.8%, the use of prophylactic antibiotics at the Cut Meutia Aceh General Hospital based on ASHP, the use of antibiotics ceftriaxone, cefotaxime, and reponem is 100% inappropriate and based on PPRA RSU Cut Meutia which is 100% compliant. The aftereffects of this study presumed that the utilization of anti-toxins based on ASHP is not appropriate and based on PPRA Cut Meutia Hospital is appropriate.

Outcomes of Retro Colic Retro Pyloric Roux En Y Hepaticojejunostomy In Biliary Reconstruction

OBJECTIVES To assess the effectiveness of retro pyloric Roux-En-Y Hepaticojejunostomy in cases of choledochal cysts and bile duct injuries to reduce complications, such as delayed gastric emptying and acute cholangitis. METHODOLOGY This retrospective cohort study was conducted in the surgical C unit of Hayatabad Medical Complex, Peshawar (January 2019 - December 2022). This study included 37 patients treated for bile duct injuries and choledochal cysts. All patients had an ASA III or above, aged 5 to 36 years. Amongst the 35 patients, 21 patients underwent surgery for choledochal cysts, while 14 patients were treated for bile duct injuries. Patients with type 1choledochal cysts were admitted through OPD after getting diagnosed by ultrasound abdomen and, in some cases, MRCP. RESULTSOut of 36 patients, 23 (63.71%) presented with type I choledochal cysts, while 14 (40%) exhibited bile duct injuries (BDI). Among the 14 BDI cases, 57.14% underwent open cholecystectomy, 42.85% underwent laparoscopic cholecystectomy, and 5.71% received immediate repair during the primary surgery. Conversely, 8.57% of patients with CBD ligation underwent exploration on the 3rd postoperative day upon early detection of the injury. Among the patients diagnosed with BDI after the 7th postoperative day, 25.71% underwent delayed repair at three months. Postoperatively, patients were authorized for fluid consumption within 24-48 hours. Moreover, 4 (11.42%) patients developed a fever of approximately 100°F, managed with intravenous Paracetamol in 2 (5.71%) cases. Patients also presented with subsequent wound infections, which were treated on an outpatient basis through oral antibiotics and wound dressing. CONCLUSION The Retropyloric Roux-en-Y hepaticojejunostomy is a modified biliary reconstruction procedure with minimal morbidity and better outcomes than traditional methods. It reduces complications like delayed gastric emptying and acute cholangitis. We recommend its frequent use for biliary reconstruction when appropriate.

Assessing the Safety of Mesh Repair in Strangulated Groin Hernias: A Systematic Review and Meta-Analysis.

The use of mesh in emergency repair of complicated groin hernias has been a subject of discussion for decades. While it is now generally accepted that mesh could safely be used in incarcerated (irreducible) and obstructed hernias (without strangulation), with wound infection rates comparable to suture repairs, the use of mesh in strangulated hernias involving bowel resection is still controversial. The aim of this study, therefore, was to analyse the safety of mesh use in strangulated hernias with ischaemic bowel at the time of surgery.A literature search was carried out using relevant keywords. The study was conducted in accordance with the Preferred Reporting Items forSystematic Reviewsand Meta-Analyses (PRISMA) 2020 framework anddata analysis was done using the Review Manager version 5.4 (The Cochrane Collaboration, Oxford, UK) meta-analysis software.Seven studies comprising 1,159 patients who had emergency surgery for strangulated groin hernias were analysed. A pooled random effect meta-analysis did not show any significant difference in the surgical site infection rate (odds ratio (OR) = 0.88, 95% confidence interval (CI) = 0.39-1.96, p = 0.75), seroma formation (OR = 3.39; 95% CI = 0.70-16.43; p = 0.13), and hernia recurrence (OR = 0.33; CI = 0.05-2.22; p = 0.26) between the two groups. The long-held concern that mesh could not be safely used in strangulated groin hernias has not been validated by the results obtained from this systematic review and meta-analysis. However, more randomised controlled trials in this clinical area would need to be carried out to further validate the results of this study.