Comparison of surgical site infection after skin closure by prolene or staples in bilateral simultaneous knee arthroplasty patients: A parallel design randomized controlled trial protocol

Introduction: Knee arthroplasty also known as the total knee replacement is an orthopedic surgical procedure done to resurface the knee that has been severely damaged by arthritis. After the completion of the surgical procedure, the skin closure is done. The optimal goal of skin closure after the procedure is to promote rapid healing and an acceptable cosmetic result while minimizing the risk of infection. Skin closure after knee arthroplasty is done by using either of the two widely used sutures i.e., polypropylene (Prolene) sutures or the skin staple sutures. There are no standard guidelines as which type of the suture should be used. The present study aims to compare the incidence of surgical site infections (superficial and deep) for Prolene vs staple sutures in the bilateral knee arthroplasty patients within 6 weeks for superficial and within 90 days for deep infection.Methods: This study will be conducted as an open blinded, parallel design, equivalence randomized controlled trial. The patients would be selected and randomized in 1:1 ratio to receive either of the two interventions i.e., Prolene or Staples. Patients undergoing unilateral or staged total knee replacement (TKR) were excluded.Analysis: The normality assessment will be done using Shapiro Wilk test. Cox proportional hazard regression will be used to check the univariate and multi-variable associations of independent variables with the outcome. Both intention to treat analysis and per protocol analysis would be performed.Ethics and dissemination: All the required approvals will be taken from the ethical review committee. Informed consent will be taken form the patient to enroll him/her in the study. Results of the study will be disseminated to the study participants, public health and clinical professionals and would also be published in a reputable international journal.The trial is registered at clinicaltrials.gov and UIN of the registry is NCT04492852.Highlights: Post-operative surgical site infections and complications are a major concern nowadays.Skin staples are not widely used as compared to Prolene because they are expensive and not easily available in every hospital.There are no standard guidelines as which type of the suture should be used.The type of sutures is being selected on the orders and wishes of the surgeon at the time of skin closure

Gum chewing, added to conventional feeding, reduces risk of post-operative ileus after elective hip and knee arthroplasty procedures in elderly population: A protocol for a parallel design, open-label, randomized controlled trial

Introduction: Postoperative ileus (poi) is defined as a temporary cessation of bowel movement after a surgical procedure. Cessation of bowel movement not only leads to disturbing constipation but also may lead to nausea, loss of appetite, and food intolerance. Literature reports sham feeding (gum-chewing) effect as an increase in chewing and saliva which enhances the gastric emptying and overall motility of gut as a cephalic phase of digestion. Therefore, we aim to assess the effect of adding gum-chewing to the conventional postoperative feeding regimen on restoring postoperative bowel function and length of stay in hospital of patients undergoing elective hip arthroplasty.Methods and analysis: This is a single-center, open-label, parallel design, superiority randomized-controlled trial with 2 treatment arms. The primary and secondary outcomes will be the time interval in hours from the end of surgery until the passage of flatus and the time interval in hours from the end of surgery until the passage of stool. Statistical analysis will be done using STATA software. Length of stay will be calculated by Kaplan-Meier analysis, with unadjusted comparison of groups by Mantel-Cox log rank test. Risk ratios for the time-to-become ileus free and time-to-discharge from hospital will be calculated by Cox regression modeling. P value as 0.05 or less will be taken as significant.Ethics and dissemination: This protocol is exempted from Ethical review at this stage however all the required approvals will be taken from the ethical review committee before starting the study. Informed consent will be taken form the patient to enroll him/her in the study. Results of the study will be disseminated to the study participants, public health, and clinical professionals. The results would also be published in a reputable international journal.Trial registration: This trial is registered on clinicaltrials.gov with ID: NCT04489875.Highlights: Cessation of bowel movement not only leads to disturbing constipation but also may lead to nausea, loss of appetite, and food intolerance.These patients tend to have more pain scores and dissatisfaction with the surgical management and team.The sham feeding (gum-chewing) effect causes an increase in chewing and saliva formation and therefore enhances the gastric emptying and overall motility of gut as a cephalic phase of digestion even in non-gastro or colorectal surgeries.We hypothesize that there is an association between gum chewing and the relief from postoperative ileus in hip arthroplasty patients

Proportion and determination of medication adherence failure among patients after coronary artery bypass grafting at a tertiary care hospital in Karachi, Pakistan: An analytical cross sectional study

Medication adherence failure worldwide. It adds burden on The primary objective of this associated with it. (MAP) after coronary artery bypass grafting is the major issue the healthcare system and results in the poor health outcomes. study is to estimate the proportion of MAF, and the factors Aim: The aim of this study was to determine the proportion of medication adherence failu !he associated factors among the coronary artery bypass grafting patients re and Alaterials and Methods: This study was a hospital based cross-sectional study. A sample of (n-60) patients was obtained from the consulting clinics after at least 3 months of CABG, using a consecutive sampling technique. The adult patients undergoing elective isolated CABG at Aga Khan University Hospital were included. The study was conducted from June till September 2019. The medication adherence failure (outcome) was assessed using the Morisky scale 8. The data collected comprised of the patient\u27s demographics, family history of diseases, co the number of medications and the severity of symptoms. The data was analyzed Using the cox proportional algorithm. Results: The mean age of the participants was 5 9.9(±10.1) and (86.6%) were males. In 33.3% of the individuals the medication adherence failure was present with forgetting to take medi the frequently reported reason (48.3%). cations Multivariable regression analysis showed that the factors associated with the MAF include NYHA functional\u27 class (PR-0.02, 95% C1=-0.0005 - 1.01), Education Up to Matric (PR--4.49, 95% CI=-1.15 - 17.58), Intermediate (PR=8.44, 95% CI= 2.002 - 35.64), Age (PR-0.93, 95% C1--0.88 - 0.97) and number of medications (PR=1.17, 95% C1=-1.04 - 1.32). onclusion: Our study that the prevalence of MAF is associated with the low education level, greater number of medications and younger age. increasing the medication adherence will help in preventing the complications and repeat coronary procedures. Furthermore, appropriate interventions could be planned to address the behaviors related to taking medications

Frequency of early initiation of breastfeeding among women in Thatta, Sindh and factors associated with it: A secondary data analysis

Introduction: It is recommended by the World Health Organization to initiate breastfeeding within first hour of birth. In recent time, many efforts are being taken by international and national stakeholders to promote mothers to initiate early breastfeeding. However, only 42% of newborns in South Asia and 45% of newborns in world are put to breastfeeding within first hour of birth. The aim of this study was to determine the prevalence of early initiation of breastfeeding and factors associated with it in rural areas of Sindh, Pakistan. Methodology: The data for this study were extracted from the survey related to Exclusive breastfeeding among women in Thatta, 2019. Survey was implemented in areas of Thatta registered in Maternal and Neonatal Health Registry (MNHR). MNHR is a population-based study for low- and middle-income countries (LMICs) to assess pregnancy related outcomes. About 397 women with complete information on timing of initiation of breastfeeding were used in the analysis. Results: The early initiation of breastfeeding to their newborn baby i.e. within first hour of the birth, were found in 20.4% of mothers. Factors associated with early initiation of breastfeeding include adequate knowledge (AOR=3.63, 95% CI= 1.99-6.59), place of delivery AOR=2.66  (95% CI=1.51-4.67), gestational age of baby (AOR= 1.89, 95% CI=1.10-3.24) and Age of mother (AOR=1.07, 95% CI=1.02-1.13). Conclusion: Providing counselling and health education for mother before, during and after the pregnancy are important to motivate mothers to initiate breastfeeding early and continue exclusive breastfeeding for recommended period i.e. 6 months