Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Cyclosporine causes no hearing defect in paediatric patients with nephrotic syndrome

Objective: We aimed to evaluate the ototoxicity of cyclosporine A (CsA) in children with nephrotic syndrome (NS).Design: Data of paediatric patients with NS followed in paediatric nephrology department were evaluated retrospectively, and hearing functions were evaluated by pure tone audiometry (PTA) and transient evoked otoacoustic emissions (TEOAEs). Age, gender, type of NS, duration and cumulative doses of immunosuppressives were noted.Study sample: The patients who had received CsA (n: 16) and immunosuppressives other than CsA (n: 13) for at least 6 months formed two patient groups and healthy cases formed a control group (n: 20). Children with known previous hearing defect, inner ear trauma or surgery, recurrent otitis media and those using hearing aid were excluded.Results: Gender, age at first clinical presentation, laboratory tests and number of relapses were similar between the groups. No hearing loss was defined in PTA at frequencies of 250, 500, 1000, 2000, 4000 and 8000Hz. The results of TEOAEs were similar between the groups and compatible with normal hearing.Conclusions: CsA is not responsible for permanent sensorineural hearing loss in children with NS, and there is no sufficient evidence to consider routine hearing assessment in children with NS treated with CsA

Control of active faults and sea level changes on the distribution of shallow gas accumulations and gas-related seismic structures along the central branch of the North Anatolian Fault, southern Marmara shelf, Turkey

Detailed reviews of multichannel seismic reflection, sparker, chirp and multibeam data that were collected on the southern Marmara Sea shelf revealed various shallow gas indicators and related sedimentary structures, including enhanced reflections, seismic chimneys, acoustic blanking, bright spots, pockmarks, mound-like features and seeps. Seismic attribute analyses were applied to characterise the existence of gas-bearing sediments. The distribution of shallow gas indicators provides important insights into their origin and the geological factors that control them. Prominent gas accumulations and seeps are observed along the profiles that cross the branches of the central segment of the North Anatolian Fault Zone, which indicates that the gas seeps are controlled by active faulting. This indicates that the faults act as conduits through the sedimentary column. The dense occurrences of gas directly off the river mouths along the shallow bays provide clues about the organic-rich carbon content of the sediments and biogenic methane generation. In some areas, the gas-related acoustic anomalies are mostly located in the upper sediments below the marine unit, which indicates that the gas emissions in these areas were terminated as a result of the increased overburden pressure after the Holocene sea level rise and the deposition of the marine unit

Development of a medication adherence scale for familial Mediterranean fever (MASIF) in a cohort of Turkish children

Objective. To develop and assess the validity and reliability of an adherence scale concerning medical treatment in paediatric FMF patients. Methods. The Medication Adherence Scale in FMF Patients (MASIF) is a 18-item questionnaire that evaluates adherence to medication in four domains. Validation of the instrument was accomplished in paediatric FMF patients (aged 2-18 years) under medication at least for 6 months. The first step was to build up the scale through qualitative approach (with interviews using semi-structured questions). Validation analyses included assessment of feasibility, face and content validity; construct validity, internal consistency and test-retest reliability. Results. One hundred and fifty patients with FMF were enrolled in the study. The mean age of the patients was 11.11±4.02 years and 48.7% of them were male. The MASIF was found to be feasible and valid for both face and content. It correlated with the Morisky Medication Adherence Scale as a gold standard thereby demonstrating good construct validity (r=0.515, p < 0.001). Assessment of content validity identified four subscales. The internal consistency, Cronbach's alpha was 0.728. There was a positive and significant correlation between test and retest scores (r=0.843; p < 0.001). Also, a significant correlation between parents' and children's reports (r=0.781, p < 0.001). Conclusion. Based on these results, the use of this scale to assess and follow up the adherence to treatment in paediatric FMF patients under medical treatment is recommended. © Clinical and Experimental Rheumatology 2015