Prophylactic Usage Research Articles

Antibiotic Prescribing Regimen and Resistance Awareness Among Eastern Libyan Dentists

Background: The frequent use of antibiotics in dentistry for prophylaxis and treatment has contributed to a significant global public health issue: antibiotic resistance. Aim: This research aims to evaluate the patterns in the prescription of antibiotics and their prophylactic usage in treating systemic conditions. Additionally, it investigates the awareness as well as adherence to guidelines for antibiotic prescription, as well as the awareness of antibiotic resistance among dentists with advanced degrees and postgraduate (AD) qualifications, and those with bachelor’s Degrees (BD) in the eastern region of Libya. Materials and Methods: This cross-sectional study employed a questionnaire to gather data from a representative sample of 130 Libyan dentists in the eastern region (including Benghazi, Almarj, Albayda, Derna and Tobruk cities). Results: Most of the antibiotics prescribed by dentists were amoxicillin with clavulanic acid followed by amoxicillin alone, and both participant groups were adherent to the recommendations for prescribing antibiotics with statistically significant variation between the two groups. Conclusion: This study revealed a tendency to overprescribe and utilize antibiotics for particular dental diseases. The majority of dentists were aware of resistance to antibiotics and adhering to the antibiotic prescription guidelines, the participants acknowledged the recommended use of antibiotics as a preventive strategy for systemic conditions.

Factors of mild and moderate course of COVID-19 in non-immunized persons

Severity of COVID-19 is known to be related to various factors. The aim of the study was to perform comparative analysis of the features associated with mild and moderate course of infection caused by the SARS-CoV-2 virus in the absence of immunization against a new coronavirus infection, and looking for opportunities of binary classification. We performed the analysis of clinical and laboratory data of 59 medical staff members who had a mild (group No. 1), or moderate (group No. 2) forms of COVID-19. The results were analyzed using STATISTICA and GraphPad Prism programs. We have found that the patients with moderate course of the disease were 12% older, which numerically corresponded to a difference of 5 years (p = 0.019). Males were 1.5 times more likely to have a moderate course of the disease (p = 0.000). A part of respondents used non-specific immunoprophylactic agents. It was found that the intake of cholecalciferol, riamilovir/triazaverin did not affect the severity of disease, and the usage of human recombinant interferon alpha-2b in order to prevent SARS-CoV-2 virus infection was associated with subsequent mild course of COVID-19 (p = 0.000). More severe clinical course of COVID-19 was associated with simultaneous usage of several nonspecific immunoprophylactic agents, in particular, ascorbic acid, zinc compounds, umifenovir hydrochloride monohydrate (p = 0.000). Higher body mass index was also associated with a severe course of the disease (p = 0.034). The analysis showed that the issue of binary classification for the patients with mild and moderate COVID-19 in the absence of vaccination may be resolved (recognition accuracy is 90.9%, p 0.0001). The risk of moderate COVID-19 in non-immunized individuals is influenced by advanced age, gender factor, increased body mass index, presence of hypertension (70% hazard increase), as well as simultaneous use of several non-specific immunoprophylactic agents to prevent infection. Presence of allergic reactions and frequency of seasonal acute respiratory viral infections do not affect the severity of COVID-19. Prophylactic usage of human recombinant IFNa-2b is associated with milder course of infection caused by the SARS-CoV-2 virus.

Role of nonsteroidal anti-inflammatory drugs on change in macular volume postcataract surgery in diabetic eyes: A retrospective comparative study.

Diabetic eyes suffer from variety of complications including macular edema. Cataract surgery is the most commonly done procedure throughout the world and majority would be diabetics. As pseudophakic-cystoid macular edema (CME) is a known complication following cataract surgery, our study concentrated on finding the role of prophylactic topical nonsteroidal anti-inflammatory drugs (NSAIDs) on change in total macular volume (TMV) postcataract surgery in diabetic eyes. To evaluate the role of NSAIDs on change in TMV postcataract surgery in diabetic eyes. Retrospective comparative study. Data were collected from the medical records department of our institute constituting diabetics undergoing cataract surgery from June-2021 to February-2022. Eighty diabetic eyes were divided into two groups: one group were given topical nepafenac drops and another who were not given. Demographic details, diabetic retinopathy stage, preoperative optical coherence tomography (OCT), and postoperative day (POD) 7, day 28, and 3 months OCT were collected. Statistical analysis was done to compare the change in TMV between both the groups. Student's t-test and Chi-squared/Fisher's exact test were employed to find statistically significant differences between the two groups using SPSS-22.0 software. In our study, the mean age in the group with nepafenac was 60.93 ± 5.86 years and 31 (77.5%) had moderate nonproliferative diabetic retinopathy (NPDR), and in the group without nepafenac, the mean age was 58.53 ± 7.41 years and 30 (75%) had moderate NPDR. Majority of the individuals in the study group were known diabetic for 2-5 years. Change in TMV at POD 3 months among two groups was not statistically significant; P = 0.758 (P < 0.05-significant). Our study concluded that topical-NSAIDs played no role in postoperative period following cataract surgery with respect to change in TMV in diabetic eyes. Thus, prophylactic usage of topical-NSAIDs can be a burden on patient as it has no role in prevention of pseudophakic-CME in those with the duration of diabetes mellitus <5 years and with mild-to-moderate NPDR.

Biofunctional lipid nanoparticles for precision treatment and prophylaxis of bacterial infections.

The lack of bacterial-targeting function in antibiotics and their prophylactic usage have caused overuse of antibiotics, which lead to antibiotic resistance and inevitable long-term toxicity. To overcome these issues, we develop neutrophil-bacterial hybrid cell membrane vesicle (HMV)-coated biofunctional lipid nanoparticles (LNP@HMVs), which are designed to transport antibiotics specifically to bacterial cells at the infection site for the effective treatment and prophylaxis of bacterial infection. The dual targeting ability of HMVs to inflammatory vascular endothelial cells and homologous Gram-negative bacterial cells results in targeted accumulation of LNP@HMVs in the site of infections. LNP@HMVs loaded with the antibiotic norfloxacin not only exhibit enhanced activity against planktonic bacteria and bacterial biofilms in vitro but also achieve potent therapeutic efficacy in treating both systemic infection and lung infection. Furthermore, LNP@HMVs trigger the activation of specific humoral and cellular immunity to prevent bacterial infection. Together, LNP@HMVs provide a promising strategy to effectively treat and prevent bacterial infection.

Computational Approaches Molecular Docking and MD Simulation Establishes the Potential COVID-19 Main Protease Inhibitors from Natural Products

Aim: COVID-19 was classified as a pandemic by the World Health Organization (WHO) on March 11, 2020. No reliable cure, however, was found. To prevent viral replication, complementary therapy with antiviral and antimalarial medications were used. However, due to their synthetic origin, they have a lot of side effects. To overcome this bane natural origin drugs were repositioned. Background: As repositioned drugs do not undergo a pro-long process of pre-clinical trial, hence, they play an excellent role in the spillover of pathogens. The main protease (6LU7) enzyme found in severe acute respiratory syndrome coronavirus-2 (SAR-CoV-2) is essential for viral replication. Thus, it acts as a hotspot in drug discovery. Objective: A molecular docking computational approach was used to determine the ability of the binding contract between the selected 3D-models of COVID-19 protease target and proposed natural compounds pristimerin, amazoquinone, kendomycin, celastrol, 20-epi-isoguesterinol, phenanthrenequinone, taxodione, maytenoquinone, hippeastrine, ammothamnine, 28-hydroxy isoiguesterin, hemanthamine, alisol-B, stigmasterol, β-pinene,and β-sitosterol through Autodock v.1.5.6 software. Method: The present study is designed to perform in-silico studies using molecular docking (Autodock tool v.1.5.6), Discovery Studio 2017 R2 client, Patch dock, SWISS-ADME prediction, and molecular simulation (Desmond simulation package of Schrodinger) between 6LU7 and natural origin compounds. Result: The results of docking study performed between 6LU7 and compounds pristimerin, amazoquinone, kendomycin, celastrol, 20-epi-isoguesterinol, phenanthrenequinone, taxodione, maytenoquinone, hippeastrine, ammothamnine, 28-hydroxy isoiguesterin, hemanthamine, alisol-B, stigmasterol, β-pinene, and β-sitosterol, showed binding energy as -9.68, -7.34, -5.34, -4.63, -4.24, -4.13, -4.08, -3.85, -3.83, -3.7, -3.6, -3.57, -3.54, -3.39, -3.18, and -3.03 Kcal/mol, respectively. It can be shown that the Pristimerin-6LU7 protein complex was maintained throughout the simulation since the ligand RMSDs varied with a maximum value of 4.2Å during the first 10 ns, followed by more stable interactions for the remaining time of the simulation. Conclusion: The goal of the current work was to find inhibitors for both prophylactic and therapeutic usage in COVID-19 patients.

Assessing the effectiveness of gabapentin in paclitaxel-induced arthralgia, myalgia, and neuropathic pain: An observational, cohort study.

Arthralgia, myalgia, and neuropathic pain are the most common side effects observed due to paclitaxel chemotherapy. The aim of this study was to investigate the prophylactic role, maintenance, remission, and re-occurrence of arthralgia, myalgia, and neuropathic pain post-gabapentin therapy. This study was conducted in the Department of Oncology, Dhiraj Hospital, Vadodara with a sample of 51 patients. Newly detected cancer patients who observed arthralgia, myalgia, and neuropathic pain due to paclitaxel were taken and a baseline pain assessment was done using the Common Terminology Criteria for Adverse Events (CTCAE) and painDETECT questionnaire. Gabapentin was given in the first cycle after symptoms appeared and prophylactic treatment was given in the subsequent three cycles and evaluation of pain was done post-gabapentin therapy to assess the symptomatic as well as prophylactic effect. At baseline, neuropathic pain score was 22.7 ± 3.6 which reduced to 0.01 ± 0.14 on subsequent follow-ups. Grade 2 arthralgia, myalgia, and neuropathic pain were more observed at baseline which reduces to Grade 0 in the third cycle. The difference in baseline and post-gabapentin therapy was statistically analyzed by conducting t-test which showed p-value <0.00001 and t-value was less than -2 which indicated a statistically significant result. This study shows that gabapentin reduces neuropathic pain. Prophylactic usage of gabapentin was highly effective at bringing about quick pain relief when compared to symptomatic treatment. In further follow-ups, it was noted that gabapentin maintained the impact throughout the cycles.

Investigating antimicrobial-resistant bacteria from exotic domestic birds - a One Health concern.

Antimicrobial resistance is a natural mechanism in microorganisms, making the treatment of infections more complex in human and veterinary medicine. Global exotic and ornamental bird markets have significantly increased, and the close relationship between pets and humans makes exploring the potential role of these birds as vectors for the spread of antimicrobial-resistant bacteria imperative. This study aimed to use culture-dependent methods to investigate cloacal bacteria and the presence of antibiotic-resistant bacteria in four breeding stocks of ornamental birds. Cloacal swab samples were collected from 53 birds (canaries = 32, cockatiels = 17, and budgies = 4) and used for culturing and isolating facultative anaerobic and/or obligatory aerobic Gram-positive and Gram-negative bacteria. The antimicrobial susceptibility profile of each isolate was determined by the disk diffusion method. Thirty-four isolates were obtained, most of which belonged to the Staphylococcus genus. Bacterial richness was higher in canaries and in one of the breeding stockings, where Gram-negative bacteria were more abundant than in the others. In addition, canaries exhibited a predominance of resistant isolates, particularly multidrug-resistant strains, probably due to prophylactic antimicrobial usage. Most Gram-negative bacteria were resistant to at least one drug tested. A vancomycin-resistant Enterococcus faecalis strain was isolated. Most Staphylococcus strains were resistant to gentamycin, followed by penicillin. Eight strains were cefoxitin-resistant, including oxacillin-resistant S. epidermidis, in which the mecA gene was detected. Understanding the prevalence of resistance in avian species is crucial in the collaborative pursuit of maintaining antibiotic effectiveness and strengthening public health defense against emerging infectious risks.

Antimicrobial agent usage patterns and their role in preventing surgical site infections at a tertiary care teaching hospital: A comprehensive study

Background: Surgical site infections (SSIs) present a formidable challenge in contemporary healthcare, impacting patient well-being and contributing to escalating healthcare costs. The judicious utilization of antimicrobial agents is paramount in effectively combating SSIs. This study, conducted at a Tertiary Care Teaching Hospital in Kerala, seeks to unravel the intricate patterns of antimicrobial agent usage within the General Surgery Department over 10 months. Aims and Objectives: The primary aim is to thoroughly examine antimicrobial agent patterns within the General Surgery Department, focusing specifically on patients undergoing surgical procedures. The study aims to assess the appropriateness of antimicrobial agent usage, encompassing the choice for prophylactic purposes, timing of pre-operative dosing, the occurrence of intraoperative dosing, and the selection appropriateness for post-operative prophylaxis. Materials and Methods: Crafted for robust analysis, the study included 150 cases, implementing specific inclusion and exclusion criteria to ensure data quality. The emphasis was placed on patients undergoing surgical procedures, focusing on prophylactic antimicrobial use. Data collection involved meticulously evaluating appropriateness across critical parameters, including the choice of prophylactic antimicrobial agent, pre-operative dosing timing, intraoperative dosing, and selection appropriateness for post-operative prophylaxis. Results: Analysis of 150 cases provided valuable insights into the age and gender distribution, predominantly within the 41–60 age groups. Prevalent surgical procedures, such as hernia and appendicitis, underscored the necessity for tailored antimicrobial protocols. Cephalosporins emerged as the dominant class, raising concerns about potential overuse and resistance. Pre-exposure prophylactic antibiotics, predominantly cephalosporins, were administered in 88 cases. Post-exposure prophylaxis mirrored this trend, necessitating a critical evaluation of antibiotic selection and duration. Detailed analysis of cephalosporin pre- and post-exposure prophylaxis identified prevalent choices such as Cefotaxime and Cefoperazone + Sulbactam, emphasizing the importance of scrutinizing cephalosporin selection. Conclusion: This study furnishes valuable insights into the appropriateness of antimicrobial agent usage for preventing SSIs, serving as a model for analogous healthcare settings. It underscores the significance of local antibiotic stewardship, guideline adherence, and the ongoing commitment to optimizing prophylactic antimicrobial usage for ensuring patient safety and advancing healthcare quality amidst evolving challenges.

Evaluating the Effectiveness of Prophylactic Pharmacological Agents in Preventing Surgical Site Infections amongst Saudi Adults: A Cross-sectional Study

Abstract Introduction: Surgical site infections (SSIs) are a significant concern in medical surgery, impacting patient outcomes and healthcare costs. Despite advances in surgical techniques and infection control practices, SSIs remain prevalent in post-operative care. Prophylactic pharmacological agents, particularly antibiotics, have become critical in preventing these infections. This study, set in Saudi Arabia, aims to assess the utilisation patterns of these agents, evaluate their effectiveness in preventing SSIs amongst adults and identify adherence gaps to prophylactic guidelines. This research addresses the literature gap on regional variations in prophylactic practices and their outcomes. Methods: Employing a cross-sectional design, this study targeted adult patients undergoing surgery in Saudi hospitals. The study included adults aged 18 and above who underwent surgical procedures involving prophylactic pharmacology, excluding patients with pre-existing infections or on long-term antibiotic therapy. The data were collected using structured questionnaires and hospital records, focusing on patient demographics, surgical details and prophylactic agent usage. Data analysis involved SPSS software, using descriptive statistics and Chi-squared tests, with significance set at P &lt; 0.05. Results: The study’s key findings include a significant number of participants observing positive outcomes with the use of prophylactic agents. Most participants were satisfied with their surgical procedures and believed in the significant contribution of prophylactic agents to reducing SSI. The study also highlighted that patient characteristics and institutional policies influence the utilisation and efficacy of these agents. Conclusion: This study illuminates the use and effectiveness of prophylactic pharmacological agents in preventing SSIs amongst Saudi adults, revealing variations in their utilisation and impact. The findings underscore the need for tailored prophylactic strategies and adherence to guidelines. These insights open new avenues for research, particularly in personalised prophylactic protocols and educational interventions. The study enriches the understanding of SSI prevention and advocates for re-evaluation and expansion of current practices and guidelines in this area.

Assessment of hospitalizations and cytopenia events among patients with extensive stage small cell lung cancer (ES-SCLC) receiving chemotherapy with trilaciclib.

531 Background: Prior studies have reported that that nearly 75% of patients receiving chemotherapy for small cell lung cancer present a hospitalization associated with myelosuppression. Trilaciclib is a myeloprotective agent indicated for use prior to chemotherapy in ES-SCLC. Given the relative recency in trilaciclib approval (2/12/2021), this study assessed real-world outcomes associated with trilaciclib among patients with ES-SCLC. Methods: This study was a retrospective analysis of adult ES-SCLC patients diagnosed between 2020 and 2023 using the 100% Medicare Fee-for-Service and MORE2 Registry claims databases. Eligible patients met literature-based criteria for ES-SCLC using International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes, received platinum/etoposide- or topotecan-based chemotherapy regimens after diagnosis, and were continuously enrolled ≥ 30 days preceding and following chemotherapy initiation. Patients were categorized into 2 mutually exclusive cohorts: 1) trilaciclib administered at chemotherapy initiation and with no granulocyte colony stimulating factor (G-CSF) received during chemotherapy, and 2) no trilaciclib administered during chemotherapy. Chi-square tests and student’s t-tests were used to assess statistically significant differences between groups on cytopenia events (based on the appearance of an ICD-10 diagnosis code) and all-cause hospitalizations during the post-index period. Data use agreements prohibit reporting of categorical outcomes of &lt; 11 patients. Results: 132 trilaciclib (mean age 70.6, male 50.8%) and 12,305 non-trilaciclib patients (age 68.0, male 48.2%) were eligible for the study; median follow-up was 202 days. Compared to the non-trilaciclib cohort, patients receiving trilaciclib had a lower rate of hospitalizations per patient per month during follow-up (0.14±0.25 vs. 0.19±0.27; p &lt;0.001). Within 90 days post-chemotherapy initiation, trilaciclib was associated with lower rates of hospitalization (21.2% vs. 32.4%; p &lt;0.01) and febrile neutropenia (&lt; 3% vs. 5.7%, p=0.01). Anemia (44.7% vs. 52.6%, p=0.07), neutropenia (9.1% vs. 14.9%, p=0.06) and thrombocytopenia (5.3% vs. 8.4%, p=0.2) were numerically lower for trilaciclib patients in the 90-day post-index period. Results were similar when the non-trilaciclib group was stratified by prophylactic G-CSF usage. Conclusions: This real-world study demonstrated that receiving trilaciclib prior to chemotherapy treatment was associated with a lower rates of hospitalizations and cytopenia events, suggesting trilaciclib may prevent adverse events associated with treatment for ES-SCLC.

Role of onion extract in preventing abnormal scarring in scald injury

It has been suggested that using an onion extract and silicone derivative can stop aberrant scarring. In order to prevent aberrant post-burn scars, our study showed the prophylactic usage of silicone derivative and onion extract gel. Along with silicone-based treatments, onion extract or capelin has received attention recently as a potential contributor to scarring. According to various studies, onion extract itself may help with wound healing and may help avoid new scars. Patients evaluated their level of pain and itching at each visit, and surgeons used the Vancouver Scar Scale to assess the scarring process. Ratings for pain and itchiness in patients applying onion extract gel. No side effects were reported by any patients. Gel made from onion extract is secure and useful for avoiding unnatural burn scars.

The potential of non-traditional walnut shells waste for the production of antioxidant reach extracts intended for the food industry

Phenolic compounds extracted from walnut shells are potentially good natural sources of antioxidants for the food industry and have numerous health benefits. Walnuts have more antioxidant capacity than any other nut because the shell is primarily composed of lignin, a strong source of phenols. Studies demonstrated that lignin characterizes the shell strength level and is a source of antioxidants due to its chemical composition. In the current study, an extract obtained by extraction with a hydroalcoholic solvent of various concentrations from a walnut shell was investigated. The results of this study have proven that walnut shell extract contains the main sources of mineral elements and vitamins, which are of great importance. According to the biological value, this extract contains essential amino acids for the body. The high content of quercetin and catechin shows the antioxidant activity of the extract. In the present article, the authors disclose methods for obtaining an experimental batch of a prophylactic product based on walnut shells and give the product a technological characteristic. Consequently, a product was developed for prophylactic usage of 10 ml per 100 ml of water and must be taken 1-2 times a day for 21 days. The required product amount was calculated from the daily intake of vitamins, minerals, and flavonoids.

Current Trends in Antifungal Prophylaxis for High-Risk Neonates in Neonatal Intensive Care Units in India: A Nationwide Survey.

Background Prophylactic antifungals are often used in high-risk babies in neonatal intensive care units (NICUs) to reduce invasive fungal infections (IFIs). However, existing guidelines regarding prophylactic antifungal usage do not clearly define the high-risk population. This study aimed to assess the practices related to prophylactic antifungal use in NICUs in India. Methods For this cross-sectional study, an online structured questionnaire was completed by neonatologists who worked in level 3 NICUs in 12 states in India during the period June 2022 to August 2022. Results Data from 151 NICUs were analyzed. 71.7% of respondents were from private hospitals, and 28.3% were from government hospitals. Nearly one-fourth of the units (28.5%) used antifungal prophylaxis in all extremely low birth weight (ELBW) babies, while another one-fourth (25.8%) used a case-based approach. The remaining NICUs (45.7%) did not use prophylactic antifungals. Among the users, the preferred antifungal was fluconazole; 3 mg/kg and 6 mg/kg were the dosage regimens used. The commonly used interval for administering fluconazole was 72 hours (69.2% of units). The intravenous route was the preferred route of administration (84.1%). Factors that influenced the non-users were the low incidence of fungal infections in their NICUs and concern about the development of resistance. It was noted that the users felt strongly about the need for further recommendations from pediatric societies and more studies on the efficacy of antifungals. Conclusion There is considerable variation in the use of prophylactic antifungals across NICUs in India. Among the users, uniformity in the choice of antifungal and interval of administration was observed. Further recommendations from pediatric societies, including the definitions of neonates at-risk of fungal infections, are required to ensure consistency in practice and help clinicians decide whether or not to use prophylactic antifungals.

Intracameral Drug Delivery: A Review of Agents, Indications, and Outcomes.

An intracameral (IC) injection directly delivers the drug into the anterior chamber of the eye. This targeted drug delivery technique overcomes the ocular barriers and offers a high therapeutic concentration of medication at the desired site and consequently better clinical outcomes. IC drug delivery is a safe and effective modality with many advantages over topical delivery. These include excellent bioavailability, reduced systemic risk, and minimal ocular toxicity. Agents delivered via IC injection have shown promising results against infection, inflammation, ocular hypertension, and neovascularization. Current literature shows that IC antibiotics, including cefuroxime, vancomycin, and moxifloxacin, are routinely used for prophylaxis of endophthalmitis. Other drugs available for IC use are steroids, anesthetics, mydriatics, miotics, antivascular endothelial growth factor, antiglaucoma, and alkylating agents. Introduction of sustained-release devices containing dexamethasone or Bimatoprost in anterior chamber via IC route has the potential in treating ocular inflammation and raised intraocular pressure. The complications such as hemorrhagic occlusive retinal vasculitis and toxic anterior segment syndrome have been documented with IC prophylaxis but are rare. In this review, we provide an overview of available IC drugs, their pharmacokinetics, the spectrum of activity, dosage and preparation, prophylactic and therapeutic usage, clinical efficacy, and safety profiles.

Fish health knowledge, management practices and prophylactic health products usage in aquaculture systems in Kenya

ABSTRACT This study assessed knowledge in fish health, management practices and usage of prophylactic health products (PHPs) in pond and cage aquaculture systems in Kenya. Data were collected using semi-structured questionnaires in 220 fish farms randomly selected from six counties, which were previously recorded to be producing high quantities of cultured fish in the country. Prophylactic health products used for fish health management in the farms surveyed were mainly water and soil treatment compounds, disinfectants, antibiotics, and probiotics. Among the farmers surveyed, only 11.9% of the pond fish farms sought advice on fish health issues from specialists compared to 59.3% in the cage culture systems. Thirty-seven percent of cage culture farmers were aware of probiotics and their benefits compared to 5.7% of the pond farmers. The study concluded that knowledge of fish health management practices by fish farmers is still inadequate and there is a need to train fish farmers and fisheries staff to build their capacity on fish health and management.

Critically appraised paper: For women at risk of breast cancer-related lymphoedema, prophylactic compression sleeve usage reduces and delays arm swelling.

Critically appraised paper: For women at risk of breast cancer-related lymphoedema, prophylactic compression sleeve usage reduces and delays arm swelling.

Critically appraised paper: For women at high risk of breast cancer-related lymphoedema, prophylactic compression sleeve usage reduces and delays occurrence of arm swelling [commentary

Critically appraised paper: For women at high risk of breast cancer-related lymphoedema, prophylactic compression sleeve usage reduces and delays occurrence of arm swelling [commentary

Antiemetic effect of intravenous palonosetron and ondansetron for the prevention of postoperative nausea and vomiting following laparoscopic surgeries under general anaesthesia, a randomised observational study

Post-operative nausea and vomiting(PONV) is one of the common complications in patients undergoing laparoscopic surgeries under general anaesthesia. This study compares efficacy of prophylactic palonosetron and ondansetron in the prevention of PONV. After obtaining the approval of institutional ethical committee, a prospective randomised study was conducted on 60 patients belonging to American Society of Anaesthesiologists Grade I and II, patients of either sex, aged between 18 to 60 years, fulfilling the inclusion criteria were divided into two groups receiving inj. ondansetron 8 milligrams i.v. or inj. palonosetron 75 micrograms i.v. Incidence of PONV and need of rescue antiemetic was recorded post operatively. Data were evaluated statistically using Graph Pad Prism computer software version 6.04.It was found that inj. palonosetron 75mcg i.v. was more efficient in the prevention of PONV and required lesser rescue antiemetic when compared inj. ondansetron 8mg i.v. At conclusion of the study it was found that the prophylactic usage of inj. palonosetron 75 mcg i.v. is more effective than inj. ondansetron 8mg i.v. in the prevention of PONV in patients undergoing laparoscopic surgery (p value &lt; 0.05).

423 Effectiveness of prophylactic negative pressure wound therapy after caesarean section in reducing superficial surgical site infection – a case-control study

Introduction and aims of the study: The increasing number of caesarean sections worldwide1 makes impaired healing of wounds after the procedure a frequent problem. Assessed risk of surgical site infections (SSI) is about 2-15% and 90% of them are superficial SSI. 2 Closed incision Negative Pressure Wound Therapy (NPWT) is a method under evaluation mainly in obese women undergoing caesarean deliveries with discrepant results. From the ones stating that NWPT vacuum dressings are efficient3 to the ones claiming that prophylactic usage in obese women did not reduce the incidence of SSIs. 4 The aim of the study was to evaluate wound healing outcomes in high-risk patients after caesarean section treated with and without the use of NPWT. Methods: In 2019 we prepared a list of identifiable risk factors of inappropriate wound healing. When a patient history confirmed at least 3 risk factors, we used prophylactic NPWT for 5 days (V.A.C. dressing). Patients data were retrospectively analysed. Group 1 were patients with NPWT from 2020 to march of 2021. A control group was created from patients data from the same time frame (hospital database), matching the intervention group for age, BMI and risk factors of SSIs. Outcomes assessed were the presence of wound complications, need for antibiotic therapy, readmission to hospital, length of stay and additional surgical procedures. Results: Patients in both the intervention group (n=21) and control group (n=6323) were included to the study. There was only one inappropriate wound healing in the intervention group. Moreover, usage of VAC was connected with shorter hospital stay, with no readmission to hospital and fewer antibiotic therapies and additional surgical procedures in comparison to control group. Conclusion: Closed incision NWPT is effective way of SSIs prophylaxis when proper qualification to intervention. More studies are needed, especially prospective ones, with the bigger study sample.

Impact of antimicrobial stewardship intervention in clean and clean-contaminated surgical procedures at a Vietnamese national hospital.

We investigated the characteristics of prophylactic antimicrobial use in clean and clean-contaminated surgical procedures and assessed the efficacy of a prophylactic antimicrobial stewardship intervention at Thong Nhat Hospital, Ho Chi Minh City, Vietnam. A cross-sectional study was conducted on 354 patients who underwent either clean or clean-contaminated surgical procedures at Thong Nhat Hospital. Eligible patients were classified with respect to three periods of intervention from 2017 to 2020. Data collection included surgical procedures, patient characteristics, and prophylactic antimicrobial usage. We determined the efficacy of antimicrobial stewardship intervention based on comparisons among the primary outcome (the appropriateness of prophylactic antimicrobials) and secondary outcomes (postoperative antimicrobial prophylaxis (AP) prolongation, length of postoperative hospital stay, and cost of antimicrobials). The mean age of patients in periods 1, 2, and 3 was 54.5 ± 16.6, 50.2 ± 16.5, and 52.8 ± 17.3years, respectively, with an overall male/female ratio of 1.1/1. No significant differences were detected in basic patient characteristics during the three periods. Majority of the surgical procedures were clean (56%-59%) and scheduled (85%-86%). Prophylactic antimicrobial stewardship intervention enhanced AP appropriateness (by 12.7%, 12.7%, and 39.0% in periods 1, 2, and 3, respectively, p < 0.001), decreased postoperative prophylactic antimicrobial duration [3.0 (0-6), 1.5 (0-5), and 0.0 (0-1) days, respectively, p < 0.001], and reduced average antimicrobial expenses (p < 0.001). The prophylactic antimicrobial stewardship interventions introduced at Thong Nhat Hospital had several positive impacts on the appropriateness of prophylactic antimicrobial use and treatment costs.