Wound infection in gynecologic surgery.

OBJECTIVE: We sought to determine the wound infection rate among patients undergoing elective gynecologic surgery at a single tertiary care center and to determine the predictive value of various factors that contribute to infection. We further investigated the adequacy of hospital records in documenting infection rates as well as the timing of presentation of wound infections. METHODS: The records of 115 patients undergoing elective gynecologic surgery at our institution were reviewed. Patients were further subdivided based on route of surgery. We analyzed the importance of antibiotic prophylaxis, route of surgery, smoking, diabetes, and body mass index (BMI). RESULTS: The overall wound infection rate was 12.17% with no significant difference in the subgroups by route of surgery. Overall, antibiotic prophylaxis significantly decreased infection rates (P = 0.0118), but the route of surgery, BMI, smoking, and diabetes were not significant predictors of infection. Only one case of infection was detected during the initial hospital stay (6.1%). Fifty percent of the patients with infection required readmission, and of these 35.7% required an additional surgical procedure. The average length of hospital stay was 2.4 days longer in patients with infection. CONCLUSIONS: Antibiotic prophylaxis has a role in the management of patients undergoing abdominal gynecologic surgery. In today's environment of cost containment, an increased hospital stay and the added likelihood of additional surgical intervention associated with wound infection are important targets for prevention. Most patients with wound infection were diagnosed after discharge from the hospital. In our population, among whom transportation problems and remote residence are prevalent, strategies for infection surveillance should be integral to discharge planning

Prevalence of depression and anxiety in type 2 diabetes mellitus patients in tertiary care hospital

Background: The prevalence of depression and anxiety in diabetes is considerably higher than normal population and found to have a negative impact on diabetes. Objective of the study was to assess the prevalence of depression and anxiety and to identify their associated risk factors among people with type 2 diabetes mellitus.Methods: Descriptive study was done in Endocrine and medicine outpatient Department of Vijaya Hospital in Belagavi, South India. Total 384 patients with type 2 diabetes mellitus were interviewed for depression and anxiety by administering the Hospital Anxiety and Depression Scale (HADS).Results: Of the total 384 patients surveyed, depression and anxiety were found in 32.56%. (95%CI 27.8-37.2%) and 37.76% (95% CI 33.1-42.9%) respectively. In Multiple Logistic regression analysis age, unmarried, religion, duration of type II diabetes and type of treatment were significantly associated with depression symptoms, Anxiety symptoms were associated with age, Qualification, Occupation, Religion, Duration and type of treatment.Conclusions: This study found a high prevalence of depression and anxiety in patients with Type 2 DM. Therefore, the care of individuals with type 2 Diabetes Mellitus (DM) should include the screening and possible treatment of depression and anxiety in order to achieve and sustain treatment goals

Optimal timing of chemotherapy and cystectomy

Radical cystectomy with pelvic lymphadenectomy is the standard treatment for muscle-invasive bladder cancer. However, the high recurrence rates and high death rate from metastases after radical cystectomy for locally advanced bladder cancer emphasize the high risk of occult distant disease. To improve patient survival, multimodal therapy whereby chemotherapy and surgery are used in concert with each other is necessary. The preponderance of data suggests that neoadjuvant chemotherapy offers patients a clear - albeit small - survival advantage, whereas the data for adjuvant chemotherapy are less convincing. Currently, trials to improve the results of such neoadjuvant therapy using biologic targets in conjunction with cytotoxic regimens are under way

Simulation of IRNSS Navigation Payload Operations for End to End Payload Testing

Fault free operations of space vehicles have always been a challenging task. Every space mission requires stringent qualification process on ground for qualification of the space vehicle for mission operations. This paper deals with the simulation of IRNSS navigation payload operations on ground for end to end payload testing and qualification of the payload for broadcast of IRNSS navigation parameters. IRNSS is an emerging Indian regional navigation satellite system for providing the satellite based navigation service over India and neighboring region. The system is optimally designed for its space and ground segment to provide the best in class navigation service. The space segment comprises of 7 satellites with 4 satellites in geo-synchronous orbit and 3 in geo-stationary orbit. The navigation payload on-board every IRNSS spacecraft comprises of navigation signal generation unit, atomic clocks and ranging subsystems. For every IRNSS spacecraft, a series of tests are carried out during different phases of spacecraft integration and testing. The core elements of IRNSS navigation operations such as IRNSS navigation software, payload test receiver, atomic clocks and telecommand and telemetry subsystem all participate in simulation and end to end testing of navigation payload. This paper describes in detail the simulation of various mission scenarios with respect to navigation payload operations considering different phases of satellite operations, subsystems involved and environment. The simulation has been key to successful operations of IRNSS 1A and IRNSS 1B which are operational in IRNSS space segment. Keywords: IRNSS, Navigation, payload, simulatio

Do health systems delay the treatment of poor children? A qualitative study of child deaths in rural Tanzania.

Child mortality remains one of the major public-health problems in Tanzania. Delays in receiving and accessing adequate care contribute to these high rates. The literature on public health often focuses on the role of mothers in delaying treatment, suggesting that they contact the health system too late and that they prefer to treat their children at home, a perspective often echoed by health workers. Using the three-delay methodology, this study focus on the third phase of the model, exploring the delays experienced in receiving adequate care when mothers with a sick child contact a health-care facility. The overall objective is to analyse specific structural factors embedded in everyday practices at health facilities in a district in Tanzania which cause delays in the treatment of poor children and to discuss possible changes to institutions and social technologies. The study is based on qualitative fieldwork, including in-depth interviews with sixteen mothers who have lost a child, case studies in which patients were followed through the health system, and observations of more than a hundred consultations at all three levels of the health-care system. Data analysis took the form of thematic analysis. Focusing on the third phase of the three-delay model, four main obstacles have been identified: confusions over payment, inadequate referral systems, the inefficient organization of health services and the culture of communication. These impediments strike the poorest segment of the mothers particularly hard. It is argued that these delaying factors function as 'technologies of social exclusion', as they are embedded in the everyday practices of the health facilities in systematic ways. The interviews, case studies and observations show that it is especially families with low social and cultural capital that experience delays after having contacted the health-care system. Reductions of the various types of uncertainty concerning payment, improved referral practices and improved communication between health staff and patients would reduce some of the delays within health facilities, which might feedback positively into the other two phases of delay

Intravesical rAd-IFNα/Syn3 for Patients With High-Grade, Bacillus Calmette-Guerin-Refractory or Relapsed Non-Muscle-Invasive Bladder Cancer: A Phase II Randomized Study.

Purpose Many patients with high-risk non-muscle-invasive bladder cancer (NMIBC) are either refractory to bacillus Calmette-Guerin (BCG) treatment or may experience disease relapse. We assessed the efficacy and safety of recombinant adenovirus interferon alfa with Syn3 (rAd-IFNα/Syn3), a replication-deficient recombinant adenovirus gene transfer vector, for patients with high-grade (HG) BCG-refractory or relapsed NMIBC. Methods In this open-label, multicenter (n = 13), parallel-arm, phase II study ( ClinicalTrials.gov identifier: NCT01687244), 43 patients with HG BCG-refractory or relapsed NMIBC received intravesical rAd-IFNα/Syn3 (randomly assigned 1:1 to 1 × 10(11) viral particles (vp)/mL or 3 × 10(11) vp/mL). Patients who responded at months 3, 6, and 9 were retreated at months 4, 7, and 10. The primary end point was 12-month HG recurrence-free survival (RFS). All patients who received at least one dose were included in efficacy and safety analyses. Results Forty patients received rAd-IFNα/Syn3 (1 × 10(11) vp/mL, n = 21; 3 × 10(11) vp/mL, n = 19) between November 5, 2012, and April 8, 2015. Fourteen patients (35.0%; 90% CI, 22.6% to 49.2%) remained free of HG recurrence 12 months after initial treatment. Comparable 12-month HG RFS was noted for both doses. Of these 14 patients, two experienced recurrence at 21 and 28 months, respectively, after treatment initiation, and one died as a result of an upper tract tumor at 17 months without a recurrence. rAd-IFNα/Syn3 was well tolerated; no grade four or five adverse events (AEs) occurred, and no patient discontinued treatment because of an adverse event. The most frequently reported drug-related AEs were micturition urgency (n = 16; 40%), dysuria (n = 16; 40%), fatigue (n = 13; 32.5%), pollakiuria (n = 11; 28%), and hematuria and nocturia (n = 10 each; 25%). Conclusion rAd-IFNα/Syn3 was well tolerated. It demonstrated promising efficacy for patients with HG NMIBC after BCG therapy who were unable or unwilling to undergo radical cystectomy