International Journal of Surgery Open最新文献

Background

Apneic oxygenation using a nasal cannula is used to deliver oxygen continuously during the apneic period of endotracheal intubation to prevent desaturation. Pre-oxygenation using face mask alone technique may be insufficient to provide a safe apnea period in pediatric patients who are at high risk for rapid desaturation compared to added apneic oxygenation. This study compared the efficacy of apneic oxygenation with a face mask (AO) versus a face mask alone (FMA) pre-oxygenation to prevent desaturation during endotracheal intubation in elective pediatric surgical patients.

Methods

A prospective cohort study was conducted on two equal groups of elective pediatric patients observed in either use of apneic oxygenation with a face mask (AO) or face mask alone(FMA) pre-oxygenation during endotracheal intubation at the study hospital from early December 2021 to late March 2022. The data were collected using a structured questionnaire. The primary outcome variable was the desaturation SpO₂ (<94%) observed during endotracheal intubation. The categorical data were analyzed using a χ2-test. Parametric data were analyzed using an independent t-test or one-way ANOVA as appropriate with a 95% CI and a p-value of < 0.05 was considered statistically significant. The Bonferroni post hoc analysis was employed to test the significance of means between the groups.

Results

The mean desaturation level was (SpO₂ = 95.74 ± 2.99) in apneic oxygenation with face-mask group and (SpO₂ = 93.96 ± 3.74) in the face-mask alone group(p = 0.006) with medium effect size (Cohan's d = 0.06). A one-way ANOVA showed a statistically significant difference in the mean (±SD) of desaturation level with the number of attempts at endotracheal intubation within the groups (P = 0.005). The Bonferroni pairwise comparison within groups, showed that the mean (±SD) desaturation level during endotracheal intubation for the participant with >2 attempts is significantly lower than for participants with only 1 attempt (p-value = 0.004).

Conclusion and recommendation

A continuous administration of apneic oxygenation (5-l/min) by nasal cannula during endotracheal intubation significantly reduced desaturation in pediatrics. We recommend the use of apneic oxygenation (AO) in pediatrics during intubation time.

Cholera has globally affected the world since the 19th century, resulting in numerous cases and deaths throughout time. In Pakistan, while Cholera had always been a threat to the country's public health, the recent monsoon floods have exacerbated the situation. With high incidence of the disease, health care facilities are overburdened and inaccessible. Due to destruction of infrastructure and houses in the country, Pakistan's health care services and WASH services are inadequate. This further leads to increased disease prevalence and transmission of Cholera. Despite global funding being carried out to alleviate economic struggles, Pakistan also requires disease surveillance, rapid treatment provision and widespread awareness to manage Cholera.

Background and aim

Surgical extraction of the impacted lower third molar is one of the most common surgical procedures in dentistry. Postoperative pain usually reaches its intensity 12 h after the procedure and adversely affects the patient's quality of life for many days. Chamomile anti-inflammatory and pain-relieving properties have been introduced in the medical literature. The present study aimed to investigate the efficacy of chamomile gel in reducing postoperative pain and symptoms after impacted lower third molar surgeries.

Materials and methods

This study was a triple-blinded placebo-controlled randomised clinical trial with a split-mouth crossover design. The study included 70 impacted lower third molars in 35 patients (13 males and 22 females) with a mean age of 22.29 (±3.00) years. Participants’ extraction sides were randomly allocated into the study groups. Each participant was enrolled twice, i.e., into the study and control groups with a washout period of 3 weeks between the two surgeries. Postoperative pain, need for analgesics, symptoms severity (PoSSe), and wound healing were evaluated.

Results

Gingival healing was significantly better in chamomile group compared to control group (P < 0.001). There were no significant differences in post-extraction alveolar osteitis between chamomile and control group (P = 0.314). VAS results showed significant differences in mean pain scores, with significant decrease in chamomile groups (P < 0.05). Moreover, analgesic consumption was significantly higher in placebo group (P < 0.05). Mean PoSSe scores were 16.8 (±9.4) in the chamomile group, versus 41.1 (±9.9) in the control.

Conclusions

Within the limitations of the present study, it was concluded that intra-socket application of chamomile gel might effectively improve healing, and reduce pain levels, postoperative symptoms severity, and analgesics consumption after surgical extraction of impacted lower third molars.

Background

Pulmonary aspiration of gastric contents is a rare but catastrophic cause of anesthesia related morbidity and mortality of surgical patients. The risk of pulmonary aspiration is high in surgical patient due to multiple factors. The aim of this study was to assess the practice of aspiration prevention and prophylaxis usage for patients prior to surgery.

Method

A cross-sectional study was conducted from 10 April 2022 to 20 April 2022. Data were collected by the direct observation and patient interview. The standards were directly changed in to questionnaire form with two integral components ‘yes’ and ‘no”. Data were entered and analyzed using statistical package of social sciences (SPSS) version 20.

Result

A total of 200 surgical patients were included with a response rate of 100%. Preoperative information provision to elective surgical patients on fasting requirements and the reason for them in advance of their procedures was implemented in 63% of the patients. The verification of fasting requirement was provided in 94% of elective patients. About 62.5% of elective surgical patients received gastrointestinal stimulants preoperatively. Metoclopromide was administered for 94% of emergency patients.

Conclusion and recommendation

The practice of preoperative fasting and administration of prophylactic agents for pulmonary aspiration is quite limited in our setup. Moreover, adherence to the recommendations of American Society of Anesthesiologist (ASA) and European Society of Anesthesiologist (ESA) was also suboptimal. We strongly recommend clinicians to use appropriate prophylactic agent to the right patient and adherence of the clinician to the local guideline on prevention of pulmonary aspiration.

Introduction

The significance of androgen receptor (AR) expression in bladder cancer is the focus of current research. This study aimed to assess the significance of AR expression in bladder urothelial carcinoma.

Methods

A total of 206 cases of urothelial carcinoma of the urinary bladder were reviewed and immunohistochemical staining for AR was performed. The histological score was calculated as the product of the staining intensity and percentage of cells with positive nuclear staining. The staining results were correlated with demographic parameters, tumor grade, and detrusor muscle invasion status.

Results

Seventy-eight percent (n = 161) of cases tested positive for AR expression. AR was significantly overexpressed in non-muscle-invasive tumors (p = 0.042). Moreover, A higher AR expression was associated with increased disease-free survival (p = 0.019). However, AR expression was not significantly associated with cancer-specific survival, patient sex, or tumor grade (0.359, 0.747, and 0.867, respectively). AR expression is inversely related to muscle invasion and recurrence in bladder cancer.

Conclusion

The results of this study support those of several reports worldwide. Further molecular studies are required to elucidate the role of androgens in bladder cancer pathogenesis and therapy.

Introduction

Surgical site infection (SSI) is the commonest form of hospital acquired infection in sub-Saharan Africa, associated with increased morbidity and mortality. This study was aimed at determining the incidence and outcomes of surgical site infection following emergency laparotomy during the COVID -19 pandemic in a low resource setting.

Methods

This was a retrospective single Centre cohort of patients that had emergency laparotomy between July 2021–June 2022 (COVID period) and July 2018–June 2019 (pre-COVID period). Analysis was done using SPSS version 22 in which SSI rates were compared between the two periods using the chi squared test. Mortality, re-operation rates and length of hospital stay were also compared.

Results

Of the 453 patient files included in analysis, 244 (53.9%) were for the COVID period, while 209 (46.1%) were for the pre COVID period. The incidence of SSI was insignificantly higher in the COVID period (17.6% versus 16.7%; P = 0.901). Mortality was also insignificantly higher in the SSI group (3.8% versus 3.5%; P = 0.745). Presence of surgical site infection increased the risk for re-operation (P < 0.001) and prolonged hospital stay (P < 0.001).

Conclusion

Since the incidence and outcomes of surgical site infection appear not to have changed following the pandemic, the same measures that were previously used to prevent SSI could still be effective even during the pandemic if followed appropriately and combined with the COVID specific peri-operative care recommendations.

Laparoscopic surgery has become the standard for almost every surgical procedure; the benefits include faster recovery, less pain, and less risk of surgical site infection. Nonetheless, it demands technical knowledge and a high degree of experience from the surgical team to provide patients with the adequate treatment they need. Any variation of the normal anatomy, like situs inversus, can pose a challenge to the surgical team and will need more creativity to perform any surgery accurately and without complications.

We present two situs inversus patients who needed surgical intervention due to cholelithiasis and acute appendicitis. After careful preoperative planning and modifications in the surgical technique, the patients underwent full recovery.