Pressurized Irrigation Research Articles

Development of System Dynamics for Holistic Conceptualization of Water Resources Problems Using Grounded Theory: A Case Study of the Zayandehrud River Basin

System dynamics is one of the modeling methods that has become popular in water resources modeling in recent years due to its ability to consider various aspects of the system. The first step in developing a dynamic system model is to develop “dynamic hypotheses” or causal loop diagrams (CLDs). This step poses some challenges as follows: a wide range of knowledge is required to develop these hypotheses; the affecting and affected components in each field are not predetermined; modelers develop the CLDs based on their assumptions. These challenges may exclude the main affecting components on the system in the models. The present study aims to address these challenges through the development of dynamic hypotheses using the grounded theory approach. The grounded theory provides a holistic and comprehensive view of the system through a systematic qualitative process. Therefore, to demonstrate the effectiveness of this method, the proposed process was implemented in the Zayandehrud basin as one of the most complex basins in Iran. After developing the hypotheses, their accuracy was ensured by providing quantitative data. It is noteworthy that the proposed method has proved satisfactory in showing the main problems of the natural and human system in the Zayandehrud basin and the connection between these problems. Moreover, the main problems in socioeconomic system of Zayandehrud basin, which have been less studied in previous researches, include: population growth, immigration, rising per capita water consumption, growth of the industrial and agricultural sector, improper development of pressurized irrigation systems, changing the water allocation to an unfair pattern, and rising unemployment.

Effect of Nozzles design on the performance of Impact Sprinklers in sprinkler irrigation system

Water is limited resource. This is considered to be one of the main challenges for future water policy. Saving water and energy is a requirement to ensure the viability of pressurized irrigation systems. Designing and optimizing sprinkler irrigation systems are mainly based on achieving appropriate hydraulic performance. Spray nozzles being very often a critical component in determining the final quality of the product or the sprinkler irrigation efficiency process. The engineering design factors of sprinkler affect sprinkler system performance. So, this study focuses on some engineering design factors (three different nozzle characteristics (1, 2 and 3) and operating pressures from 150 to 250 kPa), comparing with designed nozzle (No 4) to improve brass impact sprinkler performance. This study sited on Giza region at National Laboratory for testing the components of irrigation networks and field drainage, Agricultural Engineering Research Institute AEnRI, Agricultural Research Center ARC. The result of Christiansen uniformity coefficient CU indicated that designed nozzle No 4 achieving good performance according to American society of Agricultural and Biological Engineers ASABE 2001 starting with operating pressure 150 kPa 74.05 % while nozzle No 3 starting with 175 kPa achieved 75.23 %. Also it was found that nozzle No 4 increasing flow rate by 43.48 %, precipitation rate by 19.92 %, rotation speed by 24.96 %, decreasing coverage radius by 28.38 % and the jet breaks up sufficiently to achieve an adequate water distribution pattern and obtained good droplet size comparing with nozzle No 3. It was found that sprinkler layouts 9m Х 9m overlapping achieved acceptable uniformity at operating pressure 150 kPa. Also the result indicated that nozzle No 4 saved operating time ratio by 26.87 % and decreased over minimum application targeted irrigation depth by 66.7 % at the same overlapping distances and at the same operating pressure 150 kPa.

The role of normal saline irrigation versus povidon iodine of surgical wound in decreasing the rate of surgical site infection in perforated appendicitis

Background: Surgical site infection is most common complication after appendectomy especially in patients with perforated appendicitis.Aim: To assess the role of irrigation of the surgical wound with normal saline in comparison with povidon iodine soaking on the rate of surgical site infection after appendectomy for perforated appendicitis. Methods: This is a prospective randomized study which was carried out in department of surgery at baquba teaching hospital for 116 patients with perforated appendicitis operated on. The study took one year (April 1-2013 to march 31-2014). The patients were divided into two groups: Group A: Surgical wounds washed with normal saline.Group B: Surgical wound washed with povidon iodine.Results: This study have found that 9(15.5%) out of 58 patients developed surgical site infection in group A and 20(34.4%) out of 58 patients develop surgical site infection in group B(p value=0.0320),suggesting that the normal saline is more effective than povidon iodine stacking for surgical site infection of perforated appendicitis with statistically significant results.Conclusions: The syringe pressure irrigation of the surgical wound with normal saline after appendectomy contributes significantly in decreasing the incidence of postoperative surgical site infection in perforated appendicitis.

IMPROVING THE MANAGEMENT OF WASTEWATER REUSE TO IRRIGATE LANDSCAPE

This study aimed to measure the effect of treated wastewater on the performance of pressure irrigation network components and compare it with domestic water. The experiments were conducted in Eastown and Lake View sites in the Fifth Settlement - New Cairo, at N = 30° 01' 14.4, E = 31° 51' 60.9 and N = 30° 02' 22, E = 31° 44' 31.3, respectively, and the experiments were done in (2019). The area under investigation was 155 m², divided into three plots (5×5 m) for spray irrigation, there areas were planted with turf grass (passpalm 10), and three plots (5×2 m) for drip irrigation, there areas were planted with shrubs (Lantana camara nana) and trees (Calistemon viminalis). By irrigation with two types of water: treated wastewater and domestic water with the use of two types of filters in the Lake View site (a screen filter and a sandy filter) and the use of one type of filters in the Eastown site, which is screen filter. The washing process was carried out manually and automatically. The results showed significant effects on the components of the network and on the general appearance of the vitality and shape of the cultivated surfaces. The most important results obtained were: • Emission uniformity for drip system in Lake View site, was higher when using automatic operation with treated wastewater by (5 and 6%) for on-line dripper and built-in dripper, respectively, than manual operation, while, in Eastown site emission uniformity was higher when using automatic operation with treated wastewater by (2.3 and 4.9 %) for on-line dripper and built-in dripper, respectively, than manual operation. • Distribution uniformity for spray system was higher when using automatic operation with treated wastewater by (5 and 5.1%) in Lake View site and Eastown site, respectively, than manual operation. • Clogging ratio in Lake View site by using manual operation with treated wastewater was (40 and 48%) for on-line dripper and built-in dripper, respectively. Clogging ratio using automatic operation was (20 and 25%) for on-line dripper and built-in dripper, respectively, while, in Eastown site by using manual operation with treated wastewater was (34.5 and 44.7%) for on-line dripper and built-in dripper, respectively, and by using automatic operation was (18.75 and 22%) for online dripper and built-in dripper, respectively. It was higher with manual operation than automatic operation and higher with treated wastewater than domestic water. • The concentration of total suspended solids was less by (93.6 and 97.9%) with manual and automatic operations, respectively in Lake View site, while, it was less by (50 and 60%) with manual and automatic operations, respectively, in Eastown site. • The turf quality index (color, density, ground cover) gave the highest degree when using treated wastewater with automatic operation, which is due to the nutrients in treated wastewater. • It is preferable to use sand filters before the mesh filters with treated wastewater to reduce the percentage of clogging with impurities instead of using only mesh filters.

Planned behavior and social capital: Understanding farmers’ behavior toward pressurized irrigation technologies

Water scarcity is becoming a major challenge worldwide. The agricultural sector, as a main user of freshwater, may significantly increase its water use efficiency by promoting water saving strategies. This paper proposes a socio-psychological model that builds upon the Theory of Planned Behavior and social capital variables to examine how psychological constructs and their interaction with the environment and farmers’ backgrounds influence the switch from traditional to pressurized irrigation. Considering temporal precedence, we measured farmers’ intention to adopt irrigation technologies, and one year later their actual behavior. We used a structural equation model and estimated marginal effects for direct and indirect relations. The results show that actual adoption is affected directly by intention, and the effect of subjective norms, perceived control, and attitudes on adoption are mediated through intention. Social pressure exerts a strong influence on farmers, particularly in comparison to their own attitudes. Social capital triggers the adoption of pressurized irrigation by increasing social pressure and strengthening farmers’ perceived self-confidence.

IMPROVING THE MANAGEMENT OF WASTEWATER REUSE TO IRRIGATE LANDSCAPE.

This study aimed to measure the effect of treated wastewater on the performance of pressure irrigation network components and compare it with domestic water. The experiments were conducted in Eastown and Lake View sites in the Fifth Settlement - New Cairo, at N = 30° 01' 14.4", E = 31° 51' 60.9" and N = 30° 02' 22", E = 31° 44' 31.3", respectively, and the experiments were done in (2019). The area under investigation was 155 m², divided into three plots (5×5 m) for spray irrigation, there areas were planted with turf grass (passpalm 10), and three plots (5×2 m) for drip irrigation, there areas were planted with shrubs (Lantana camara nana) and trees (Calistemon viminalis). By irrigation with two types of water: treated wastewater and domestic water with the use of two types of filters in the Lake View site (a screen filter and a sandy filter) and the use of one type of filters in the Eastown site, which is screen filter. The washing process was carried out manually and automatically. The results showed significant effects on the components of the network and on the general appearance of the vitality and shape of the cultivated surfaces. The most important results obtained were:• Emission uniformity for drip system in Lake View site, was higher when using automatic operation with treated wastewater by (5 and 6%) for on-line dripper and built-in dripper, respectively, than manual operation, while, in Eastown site emission uniformity was higher when using automatic operation with treated wastewater by (2.3 and 4.9 %) for on-line dripper and built-in dripper, respectively, than manual operation. • Distribution uniformity for spray system was higher when using automatic operation with treated wastewater by (5 and 5.1%) in Lake View site and Eastown site, respectively, than manual operation.• Clogging ratio in Lake View site by using manual operation with treated wastewater was (40 and 48%) for on-line dripper and built-in dripper, respectively. Clogging ratio using automatic operation was (20 and 25%) for on-line dripper and built-in dripper, respectively, while, in Eastown site by using manual operation with treated wastewater was (34.5 and 44.7%) for on-line dripper and built-in dripper, respectively, and by using automatic operation was (18.75 and 22%) for on-line dripper and built-in dripper, respectively. It was higher with manual operation than automatic operation and higher with treated wastewater than domestic water.• The concentration of total suspended solids was less by (93.6 and 97.9%) with manual and automatic operations, respectively in Lake View site, while, it was less by (50 and 60%) with manual and automatic operations, respectively, in Eastown site.• The turf quality index (color, density, ground cover) gave the highest degree when using treated wastewater with automatic operation, which is due to the nutrients in treated wastewater.• It is preferable to use sand filters before the mesh filters with treated wastewater to reduce the percentage of clogging with impurities instead of using only mesh filters.

A global analysis of irrigation scheme water supplies in relation to requirements

The performance of irrigation schemes around the world has been below expectations. The assessment of irrigation performance is an essential step towards improving agricultural water use. One of the primary performance indicators is the relative irrigation supply (RIS, the ratio between the amount of water delivered and the crop net irrigation requirements). This study presents a worldwide analysis of irrigation scheme performance by evaluating key attributes that influence the RIS. The analysis was based on a review of reports and scientific papers that yielded 264 cases belonging to 25 countries in six world regions. The database was subjected to two types of statistical analysis: k-means clustering and analysis of covariance (ANCOVA). The cluster grouped irrigation schemes which were characterized by low RIS and advanced irrigation technology. The ANCOVA showed that the RIS co-varied significantly with the variation in precipitation, delivery schedule, on-farm irrigation systems, distribution network, and region, but not with the crop. The ANCOVA also showed that modern pressurized on-farm irrigation systems and on-demand distribution systems significantly improve RIS. The ANCOVA general linear model had a good capacity to predict RIS with a coefficient of determination of R2 = 0.83.

Relevance of intravesical pressures during transurethral procedures

Endourology has undergone fundamental changes over the last 2decades. Maintaining low intrarenal pressure (IRP) during upper urinary tract procedures is an established concept. However, researchers have not yet studied the concept of reduced intravesical pressures (IVPs) during transurethral (TUR) surgery as thoroughly. Low IVP is supposed to decrease complications as fluid retention, TUR syndrome, and incidence of fever. The study aims to give an overview of the contemporarily existing concepts and specify the term of low IVP to avoid TUR-related complications and optimize TUR-related results. A literature search was performed using PubMed, restricted to original English-written articles, including animal, artificial model, and human studies. Different keywords were transurethral resection, transurethral enucleation, transurethral vaporization, pressure, fluid absorption, and TUR syndrome. Analyzed mean IVPs during TUR vary between 11 and 35 cmH2O but are mostly kept below 30 cmH2O. Mean maximum IVPs during TUR range from 20 to 55 cmH2O. Maximum IVPs seem to be lower when surgeons utilize continuous flow resection, and irrigation pressures are kept low. The results demonstrate a strong correlation between IVP levels and fluid absorption. IVP increase remains a neglected predictor of transurethral procedure complications, and endourologists should consider its intraoperative monitoring. Further research is necessary to quantify generated pressures and introduce means of controlling them.

Precision surface irrigation with conjunctive water use

The Indus Basin Irrigation System is characterized as a gravity surface irrigation system, with minimal on-line or off-line storage and limited distribution control. An important characteristic is the limited water availability. On field irrigation within the Indus Basin Irrigation System is almost entirely using surface irrigation and only very few farms adopting pressurized irrigation systems. The objective of the warabandi management system that characterizes the Indus Basin Irrigation System is to distribute the limited available water as equitably as possible. This research evaluates surface irrigation under furrow and border strip irrigation using canal water and groundwater conjunctively. This paper presents results from a numerical model and field observations, to examine the precision surface irrigation paradigm within the water supply constraints imposed by the warabandi system of the Indus Basin Irrigation System. We conclude that laser grading within the IBIS is achievable at a modest cost and effort. Our findings suggest that the improved laser-graded profile persists for at least three crop seasons. Furrow irrigation can attain a high performance using either available canal or groundwater with low quarter distribution uniformity and low quarter application efficiency as performance indicators. Border irrigation can also attain a high performance provided irrigation is changed to fortnightly. Model predictions of advance curve and low quarter distribution uniformity are compared to field observations and in-situ measurement.

Three Thousand Cases of Office Hysteroscopy: See and Treat an Indian Experience.

Assessment of feasibility of office hysteroscopy in Indian setting. Retrospective study design. Tertiary care centre: Galaxy care Hospital, Pune, India. Three thousand consecutive women undergoing office hysteroscopy between 2012 and May 2018. Office hysteroscopy 2200 cases (2012-2017) with Bettocchi 2.9 scope and Hamou endomat. Eight hundred cases (2017-2018) with Bettocchi 1.9 scope and EASI. Normal saline was used as distension medium. With Hamou endomat, settings have drip rate of 200ml/min with irrigation pressure of 75mmHg and suction bar 0.15. With EASI, settings were for Bettocchi 4 (1.9mm) and Bettocchi 5 (2.9mm) scope with 45mmHg. Hysteroscopies were carried out by an experienced operator trained in office hysteroscopy. All hysteroscopies were done in early proliferative phase (4th-11th day). Success, failure and complication rates. Hysteroscopies were successfully performed in nearly 98.66% of cases with 4 patients requiring a two-step procedure due to > 3cm pathology. One thousand eight hundred eight (62.2%) were diagnostic hysteroscopies, while operative hysteroscopies were performed in one thousand one hundred twenty (37.8%). One patient (1/3000) had a vasovagal attack. In outpatient setting, counselling the patient for office hysteroscopy played an important role to overcome pain and anxiety, in addition to low pressure, continuous flow irrigation and vaginoscopic approach. Traditional resectoscopic surgeries should be reserved for challenging cases (i.e. endometrial ablation) or for certain pathologies (myomas > 2.0cm, broad-base, large-size polyps). Recent advances in technique and instrumentation facilitate this approach and might encourage greater adoption by the gynaecology community. With the right approach, technique and setup, office hysteroscopy is feasible with favourable outcomes.

EVALUATION OF SOME CHEMICAL-INJECTION EQUIPMENT WITH PRESSURIZED IRRIGATION SYSTEMS

The aim of this research is to evaluate hydraulic performance of prevailing chemical injection equipment used with pressurized irrigation systems including; (1) By-pass pressure differential tank, (2) With suction pipe of irrigation pump, (3) Separate electric centrifugal pump, and (4) Venturi, to help in selecting an appropriate chemical injector according to field and operating conditions.The mainresults in this study can be summarized in the following: *The average of injection rates were: 190, 380, 1000, and 1175 for venturi, by-pass differential tank, with suction pipe of irrigation pump, and separate electric centrifugal pump respectively, at pressure drop or irrigation pressure of 100 kPa. * The average uniformity of injection rate ranged from 94.8 to 99% during fertigation time for prevailing equipment under study . * Economical verification of the feasibility of using chemical injectorsis discussed according to different field conditions.

Debridement Efficiency Of Different Irrigating Protocols In Truss Cavity Access Preparation

Minimal invasive dentistry and endodontic technological revolution used in endodontic treatment enable the application of conservative endodontic access(CEC)cavity to minimize tooth structure removal.This study examined the cleanliness of CEC.Methods:Eighty sound extracted upper first premolar divided into 4groups (n=20)according to the irrigation protocol G1:Conventional method with Irriflex irrigating needle;G2: ENDOVAC negative pressure irrigation system;G3: PUI with ED62 irrigation ultrasonic tip;G4: Er,Cr:YSGG Laser SWEEPS Mode. CEC done under high magnification.After instrumentation with M3ProGold rotary file to size 35/0.04 taper and irriganted, specimens examined under SEM, and cleanliness of pulp chamber and root canal walls at coronal,middle,apical third was measured. Data were measured, tabulated and statistically analyzed by ANOVA and t-student test (P

SUVDAN FOYDALANISH REJASINI AMALGA OSHIRISH TARTIBLARI, TADBIRLARI HAMDA SUVDAN FOYDALANISH KOEFFITSIENTI

If we look at the existing irrigation methods used today in the country, then they are divided into: ground, rainfall, underground or underground, drip and spray. Basically, they are transferred to the irrigation field in two forms: through gravity and pressure irrigation systems. Naturally, a gravity irrigation system is economically more expensive than a low pressure irrigation system. However, from a performance appraisal stand point, pressure irrigation methods are less efficient and have serious disadvantages

Water and Energy Demand Management in Pressurized Irrigation Networks

Minimizing energy expenditure is one of the main purposes of the managers of pressurized irrigation systems. From the energy consumption standpoint, they can reduce energy consumption by supplying a constant flow into the system (a scheme different from urban water pressurized networks in which water demands depend on users). Managers can keep energy demands (opening and closing valves) while meeting pressure restrictions. We developed a computer application in MATLAB containing a genetic algorithm to find the best moment to open and to close valves to minimize an objective function which measures the differences between the objective and the real injected flows. We tested this program in the pressurized irrigation network of the San Vicente Campus, University of Alicante (Southeast Spain) and we calculated the water and energy balance (from the later and present irrigation network) and the carbon credits not emitted to the atmosphere.

Comparison of automated irrigation systems using an in vitro ureteroscopy model.

ABSTRACTIntroduction:Two automated irrigation systems have been released for use during endoscopic procedures such as ureteroscopy: the Cogentix RocaFlow® (CRF) and Thermedx FluidSmart® (TFS). Accurate pressure control using automated systems may help providers maintain irrigation pressures within a safe range while also providing clear visualization. Our objective was to directly compare these systems based on their pressure accuracy, pressure-flow relationships, and fluid heating capabilities in order to help providers better utilize the temperature and pressure settings of each system.Materials and Methods:An in vitro ureteroscopy model was used for testing, consisting of a short semirigid ureteroscope (6/7, 5F, 31cm Wolf 425612) connected to a continuous digital pressure transducer (Meriam m1550). Each system pressure output and flow-rate, via 100mL beaker filling time, was measured using multiple trials at pressure settings between 30 and 300mmHg. Output fluid temperature was monitored using a digital thermometer (Omega DP25-TH).Results:The pressure output of both systems exceeded the desired setting across the entire tested range, a difference of 15.7±2.4mmHg for the TFS compared to 5.2±1.5mmHg for the CRF (p <0.0001). Related to this finding, the TFS also had slightly higher flow rates across all trials (7±2mL/min). Temperature testing revealed a similar maximum temperature of 34.0°C with both systems, however, the TFS peaked after only 8 minutes and started to plateau as early as 4-5 minutes into the test, while the CRF took over 18 minutes to reach a similar peak.Conclusions:Our in vitro ureteroscopy testing found that the CRF system had better pressure accuracy than the TFS system but with noticeably slower fluid heating capabilities. Each system provided steady irrigation at safe pressures within their expected operating parameters with small differences in performance that should not limit their ability to provide steady irrigation at safe pressures.

The alternative model to predict adoption behavior of agricultural technologies

Appropriate and accurate management of water resources and agricultural irrigation plays an important role in preventing the water and food crisis worldwide especially in arid developing countries. Application of modern irrigation technologies and methods is the main issue in the optimal use of water. This goal would not be happened without considering the adoption process of the end users. Analysis of pressurized irrigation technology adoption models was the main purpose of current study. This research was accomplished based on survey method using questionnaire for data collection. All of the farmers of Abadeh county in Iran was the research population which 418 of them were selected using stratified random sampling as research sample. The face validity and reliability of the questionnaire were confirmed by a panel of specialists as well as doing a pilot study out of the main research (r = 0.74–0.92), respectively. Discriminant analysis was used to determine the predictive power of different adoption models of pressurized irrigation including task-technology fit, communicative-learning and integrative models in grouping of farmers in the two categories of adopters and non-adopters. The findings indicated that integrative model has a higher ability to classify adopters and non-adopters of pressurized irrigation with better accuracy and desirability in comparison with each of the other two models, separately. Task-technology fit and communicative learning models had low power in determining the pressurized irrigation users. Integrative model includes the factors of the two previous models as well as considering the social participation and environmental responsibility in discriminant function which could better classify the adopters and non-adopters of the technology.

Continuous monitoring of intrapelvic pressure during flexible ureteroscopy using a sensor wire: a pilot study.

To evaluate the feasibility of measuring the intrapelvic pressure (IPP) during f-URS with a wire including a pressure sensor and to assess IPP profiles during the procedure. Patients undergoing f-URS for stone disease were recruited. A wire with pressure sensor was placed in the renal cavities to measure IPP. For these cases, either no ureteral access sheath (UAS) or 10/12 or 12/14-Fr UASs were used according to surgeon discretion. Irrigation was ensured by a combination of a continuous pressure generator set at 80 cmH2O and a hand-assisted irrigation system providing on-demand forced irrigation to provide proper visibility. Pressures were monitored in real time and recorded for analysis. Four patients undergoing five f-URS were included. IPP monitoring was successful in all patients. Mean baseline IPP was 6 cmH2O. During f-URS with only the endoscope in the renal cavities and irrigation pressure set at 80 cmH2O without any forced irrigation, the mean IPP was 63 cmH2O. Mean IPP during laser lithotripsy with the use of on-demand forced irrigation was 115.3 cmH2O. The maximum pressure peaks recorded during this therapeutic period using forced irrigation ranged from 289.3 to 436.9 cmH2O. High IPP levels may be achieved during f-URS with on-demand irrigation systems. The impact of these high pressures on the risk of complications and long-term consequences still need to be evaluated adequately. But, in this preliminary pilot study, IPP could be reliably and conveniently monitored and recorded using a wire with a digital pressure sensor.

The effect of different irrigation treatments on yield and water productivity of Arachis Hypogaea L. under semi‐arid conditions in Iran

AbstractThe aim of this study was to assess the impacts of varied irrigation regimes on the yield, irrigation water productivity (IWP) and crop water productivity (CWP) of Arachis hypogaea L. under pressurized irrigation in the south‐west of Iran (Hamidiyeh, Khuzestan Province, Iran). The test was performed in a split‐plot pattern. The main treatments were three irrigation frequencies (Fs) based on varied levels of cumulative pan evaporation (CPE) amounts (F1: 35 mm; F2: 60 mm; F3: 85 mm of CPE). The subtreatments were seven irrigation water levels (Is) (I1 = 60%, I2 = 85%, I3 = 100%, I4 = 135% (of actual evapotranspiration (ETc)), I5 = PRZD60, I6 = PRZD85 and I7 = PRZD100 treatments) with four replications. The partial root‐zone drying (PRZD) treatments received 60, 85 and 100% of the actual evapotranspiration (ETc), respectively, from replacing laterals. Crops were planted on 1 June 2017 and 1 June 2018. The results indicated that the F2I4 treatment in both years showed the greatest peanut yield (PY). Moreover, in order to avoid greater PY loss the PRZD method was a proper and favourable option compared with traditional deficit irrigation (DI). However, PY declined by an average of 11.1 and 3.4% compared to the F2I4 treatment in 2017 and 2018, respectively, but the F2I7 treatment had about 16.3 and 16.1% lower water value than the F2I4 treatment. PRZD treatments (I5 and I6) have effective amended PY than deficit irrigation treatments (I1 and I2) in both growing seasons, whereas these treatments received the same amount of moisture for all Fs (F1, F2 and F3). In the end, crop water productivity and IWP amounts also declined with rising irrigation frequency. © 2020 John Wiley &amp; Sons, Ltd.

Management of colonic fistulas in patients with infected pancreatic necrosis being treated with a step-up approach

BackgroundColonic fistula is a potentially fatal complication in acute necrotizing pancreatitis (ANP), especially in patients with infected pancreatic necrosis (IPN). The aim of this study was to evaluate the feasibility of a step-up approach including percutaneous catheter drainage (PCD) and continuous negative pressure irrigation (CNPI) in a group of patients with colonic fistula. MethodsA retrospective review of a prospectively collected data was performed. Data were extracted for patients complicated by colonic fistula from January 2010 to January 2017. ResultsA total of 1750 patients were admitted with ANP during the study period. Of these patients, 711 (41%) developed IPN and colonic fistula was present in 132 (19%). A step-up approach was adopted for all patients, with 47% avoiding surgery. The mortality in patients requiring surgery (37%) was higher than that in patients managed non-surgically (19%) constituting an overall mortality rate of 29%. In patients managed conservatively, 92% had spontaneous closure of the fistula. ConclusionColonic fistula is not a rare complication in ANP occurring in 19% of patients with IPN in the current study. A step-up approach was effective and safe in managing colonic fistula and surgery could be obviated in nearly half of the patients.

The Effect of Irrigation Fluid on Periprosthetic Joint Infection in Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis.

IntroductionRates of osteoarthritis and total joint arthroplasty (TJA) are on the rise globally. Periprosthetic joint infection (PJI) is the most devastating complication of TJA. A number of different intraoperative interventions have been proposed in an effort to reduce infection rates, including antibiotic cements, local antibiotic powder, and various irrigation solutions. The evidence on the importance of irrigation solutions is limited but has gained prominence recently, including the publication of a large randomized controlled trial (RCT). Thus, the purpose of this study was to evaluate the effectiveness of various irrigation solutions and pressures at reducing the rates of PJI.MethodsA systematic review was performed using the electronic databases MEDLINE, Embase, and Web of Science. All records were screened in duplicate. Data collected included basic study characteristics, the details of the intervention and comparison solutions, if applicable, and rates of superficial and deep infection. A meta-analysis of comparative studies was performed to assess for consistency and potential direction of effect. ResultsA total of ten studies were included, of which one was an RCT, eight were retrospective cohorts, and one was a case series. In total, there were 29,630 TJAs in 29,596 patients. The mean age ranged from 61 to 80 years. Six studies compared povidone-iodine (Betadine®) to normal saline, two studies compared chlorhexidine to saline, one study compared “triple prophylaxis” to standard practice, and one study used gentamicin but had no comparison group. The pooled risk ratio for deep infection in studies using Betadine® compared to saline was 0.62 (95% confidence interval [CI]: 0.33-1.19), while for chlorhexidine it was 0.74 (95%CI: 0.33-1.65).DiscussionCurrent evidence on the relative efficacy of irrigating solutions as prophylaxis for infection following TJA remains inconclusive. Imprecision of estimates vindicates the need for a definitive trial to further inform their use in surgical practice. ConclusionAntiseptic irrigation during TJA with solutions (Betadine®, chlorhexidine) may decrease PJI risk in patients undergoing primary and revision total hip and knee arthroplasties. Wide confidence intervals and heterogeneity among studies, however, render conclusions untrustworthy. Well-conducted RCTs are very much needed to help further investigate this issue.