Incidence of Port Site Infection After Laparoscopic Cholecystectomy: Our Experience at Hayatabad Medical Complex

OBJECTIVES This study aimed to assess the factors that affect post-laparoscopic cholecystectomies PSI and determine which characteristics can be changed to prevent PSI in a trial to maximize the benefits of laparoscopic surgery.METHODOLOGY The study included all patients who experienced port site infection following laparoscopic cholecystectomy. All patients received Inj Ceftriaxone 1gm pre-operatively & then twice a day postoperatively for 03 days. In all operations, the gallbladder is removed from the epigastric port without using a retrieval bag by skilled surgeons employing four-port methods and reusable equipment. Most patients had the sub-hepatic tube drain placed and were discharged the day after surgery.RESULTSAcute cholecystitis was the most common operative finding with port-site infection, i.e. 6(42.8%), second being empyema that was seen in 3(21.4%) patients, 2(14.3%) patients had bad adhesions, mucocele in 2(14.3%) patients and thick walled gall bladder with stones was found in 1(7.1%) patients respectively, indicating that the relationship between infection and acute cholecystitis is significant. Regarding the spills of bile, stones, or pus, 3(21.4%) patients had infections despite there being no spillage, while 11(78.6%) patients developed an infection while the spillage happened during their procedures. The p-value was 0.0001, meaning that the spillage might be considered a risk factor for the development of port site infection.CONCLUSIONThe spilling of bile, stones, or pus, the port of gallbladder removal, and acute cholecystitis are all strongly associated with port site infection. Given that Mycobacterium tuberculosis may be the source of chronic deep surgical site infections, more care should be exercised. The majority of PSIs are superficial and more prevalent in men

Withering timings affect the total free amino acids and mineral contents of tea leaves during black tea manufacturing

AbstractThe aim of the present study was to investigate the effect of withering timings (i.e. 0, 21, 22, 23 and 24h) on the moisture, total free amino acids, ash, essential and toxic mineral element contents of tea (Camellia sinensis L.) leaves during black tea manufacturing. Moisture, ash, Na, P, Mg, Cu, Zn, Mn, Al, Ni and Pb contents were significantly (P<0.05) affected by withering, whereas non-significant (P>0.05) results were noted for total free amino acids, K, Fe and Cd contents. The highest moisture content (76.4%) was examined in fresh leaves that progressively decreased to 63.8% in 24h withering. Total free amino acid contents gradually increased up to 23h and then decreased. Ash, P, Cu, Zn and Mn contents showed an increasing trend with withering time. Conversely, significantly lowered amounts of Na (162.5mg/kg) and Mg (803mg/kg) were recorded in tea leaves after 24h withering. Among the toxic elements, Al, Ni and Pb contents were progressively increased over withering time. It was concluded that tea is a potential source of essential chemical constituents and during processing proper care should be taken to produce high quality black tea

Cytotoxicity, Morphology and Chemical Composition of Two Luting Cements: An in Vitro Study

Objective: To assess the cytotoxicity, surface morphology, elemental compositions and chemical characterization of two commonly used luting cement. Material and Methods: The two luting types of cement used were Elite Cement® and Hy-Bond Resiglass®. Freshly mixed (n=6) and set form (n=6) of each cement was placed in medium to obtain extracts. The extract from each sample was exposed to L929 mouse fibroblasts (1x104cells/well). Alamar Blue Assay assessed cell viability. Surface morphology and elemental composition were evaluated using scanning electron microscopy and energy dispersive spectroscopy. The chemical characterization was performed by Fourier Transform Infrared Spectroscopy. One-way ANOVA and post-hoc Tukey analysis were conducted to assess results. Results: Hy-Bond Resiglass® was the more cytotoxic of the two types of cement in both freshly mixed (68.10 +5.16; p&lt;0.05) and set state (87.58 +4.86; p&lt;0.05), compared to Elite Cement® both freshly mixed (77.01 +5.45; p&lt;0.05) and set state (89.39 +5.66; p&lt;0.05). Scanning electron microscopy revealed a more irregular and porous structure in Hy-Bond Resiglass® compared to Elite Cement®. Similarly, intense peaks of aluminium, tungsten and fluorine were observed in energy dispersive spectroscopy in Hy-Bond Resiglass. Conclusion: All these three elements (aluminium, tungsten and fluorine) have cytotoxic potential. The Fourier transform infrared spectroscopy revealed the presence of hydroxyethyl methacrylate in Hy-Bond Resiglass®, which has a cytotoxic potential

The Karachi intracranial stenosis study (KISS) Protocol: an urban multicenter case-control investigation reporting the clinical, radiologic and biochemical associations of intracranial stenosis in Pakistan.

Background: Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner. Methods/Design: The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due to intracranial stenosis and compare them to those with stroke due to other etiologies as well as to unaffected individuals. We plan to recruit 200 patients with stroke due to intracranial stenosis and two control groups each of 150 matched individuals. The first set of controls will include patients with ischemic stroke that is due to other atherosclerotic mechanisms specifically lacunar and cardioembolic strokes. The second group will consist of stroke free individuals. Standardized interviews will be conducted to determine demographic, medical, social, and behavioral variables along with baseline medications. Mandatory procedures for inclusion in the study are clinical confirmation of stroke by a healthcare professional within 72 hours of onset, 12 lead electrocardiogram, and neuroimaging. In addition, lipid profile, serum glucose, creatinine and HbA1C will be measured in all participants. Ancillary tests will include carotid ultrasound, transcranial doppler and magnetic resonance or computed tomography angiogram to rule out concurrent carotid disease. Echocardiogram and other additional investigations will be performed at these centers at the discretion of the regional physicians. Discussion: The results of this study will help inform locally relevant clinical guidelines and effective public health and individual interventions

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention