6 research outputs found
Nonabsorbable Antibiotics Reduce Bacterial and Endotoxin Translocation in Hepatectomised Rats
There is increasing evidence that septic complications, occurring after major hepatectomies, may be caused by gram negative bacteria, translocating from the gut. We investigated in rats, the effect of extended hepatectomy on the structure and morphology of the intestinal mucosa as well as on the translocation of intestinal bacteria and endotoxins. We also examined the effect of nonabsorbable antibiotics on reducing the intestinal flora and consequently the phenomenon of translocation by administering neomycin sulphate and cefazoline. Hepatectomy was found to increase translocation, while administration of nonabsorbable antibiotics decreased it significantly. In addition, hepatectomy increased the aerobic cecal bacterial population, which normalised in the group receiving antibiotics. Among the histological parameters evaluated, villus height demonstrated a significant reduction after hepatectomy, while the number of villi per cm and the number of mitoses per crypt, remained unchanged. Our results indicate that administration of nonabsorbable antibiotics presents a positive effect on bacterial and endotoxin translocation after extended hepatectomy, and this may be related to reduction of colonic bacterial load as an intraluminal effect of antibiotics
Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism
Background
It is generally assumed by practitioners and guideline authors that
combined modalities (methods of treatment) are more effective than
single modalities in preventing venous thromboembolism (VTE), defined as
deep vein thrombosis (DVT) or pulmonary embolism (PE), or both. This is
the second update of the review first published in 2008.
Objectives
The aim of this review was to assess the efficacy of combined
intermittent pneumatic leg compression (IPC) and pharmacological
prophylaxis compared to single modalities in preventing VTE.
Search methods
The Cochrane Vascular Information Specialist searched the Cochrane
Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, and
AMED databases, and World Health Organization International Clinical
Trials Registry Platform and ClinicalTrials.gov trials registers to 18
January 2021. We searched the reference lists of relevant articles for
additional studies.
Selection criteria
We included randomised controlled trials (RCTs) or controlled clinical
trials (CCTs) of combined IPC and pharmacological interventions used to
prevent VTE compared to either intervention individually.
Data collection and analysis
We independently selected studies, applied Cochrane’s risk of bias toot,
and extracted data. We resolved disagreements by discussion. We
performed fixed-effect model meta-analyses with odds ratios (ORs) and
95% confidence intervals (Cis). We used a random-effects model when
there was heterogeneity. We assessed the certainty of the evidence using
GRADE. The outcomes of interest were PE, DVT, bleeding and major
bleeding.
Main results
We included a total of 34 studies involving 14,931 participants, mainly
undergoing surgery or admitted with trauma. Twenty-five studies were
RCTs (12,672 participants) and nine were CCTs (2259 participants).
Overall, the risk of bias was mostly unclear or high. We used GRADE to
assess the certainty of the evidence and this was downgraded due to the
risk of bias, imprecision or indirectness.
The addition of pharmacological prophylaxis to IPC compared with IPC
alone reduced the incidence of symptomatic PE from 1.34% (34/2530) in
the IPC group to 0.65% (19/2932) in the combined group (OR 0.51, 95%
CI 0.29 to 0.91; 19 studies, 5462 participants, lowcertainty evidence).
The incidence of DVT was 3.81% in the IPC group and 2.03% in the
combined group showing a reduced incidence of DVT in favour of the
combined group (OR 0.51, 95% CI 0.36 to 0.72; 18 studies, 5394
participants, low-certainty evidence). The addition of pharmacological
prophylaxis to IPC, however, increased the risk of any bleeding compared
to IPC alone: 0.95% (22/2304) in the IPC group and 5.88% (137/2330) in
the combined group (OR 6.02, 95% CI 3.88 to 9.35; 13 studies, 4634
participants, very low-certainty evidence). Major bleeding followed a
similar pattern: 0.34% (7/2054) in the IPC group compared to 2.21%
(46/2079) in the combined group (OR 5.77, 95% CI 2.81 to 11.83; 12
studies, 4133 participants, very tow-certainty evidence).
Tests for subgroup differences between orthopaedic and non-orthopaedic
surgery participants were not possible for PE incidence as no PE events
were reported in the orthopaedic subgroup. No difference was detected
between orthopaedic and non-orthopaedic surgery participants for DVT
incidence (test for subgroup difference P= 0.19).
The use of combined IPC and pharmacological prophylaxis modalities
compared with pharmacological prophylaxis alone reduced the incidence of
PE from 1.84% (61/3318) in the pharmacological prophylaxis group to
0.91% (31/3419) in the combined group (OR 0.46, 95% CI 0.30 to 0.71;
15 studies, 6737 participants, low-certainty evidence). The incidence of
DVT was 9.28% (288/3105) in the pharmacological prophylaxis group and
5.48% (167/3046) in the combined group (OR 0.38, 95% CI 0.21 to 0.70;
17 studies; 6151 participants, high-certainty evidence). Increased
bleeding side effects were not observed for IPC when it was added to
anticoagulation (any bleeding: OR 0.87, 95% CI 0.56 to 1.35, 6 studies,
1314 participants, very low-certainty evidence; major bleeding: OR 1.21,
95% CI 0.35 to 4.18, 5 studies, 908 participants, very low-certainty
evidence).
No difference was detected between the orthopaedic and non-orthopaedic
surgery participants for PE incidence (test for subgroup difference P =
0.82) or for DVT incidence (test for subgroup difference P = 0.69).
Authors’ conclusions
Evidence suggests that combining IPC with pharmacological prophylaxis,
compared to IPC alone reduces the incidence of both PE and DVT
(low-certainty evidence). Combining IPC with pharmacological
prophylaxis, compared to pharmacological prophylaxis alone, reduces the
incidence of both PE (low-certainty evidence) and DVT (high-certainty
evidence). We downgraded due to risk of bias in study methodology and
imprecision. Very low-certainty evidence suggests that the addition of
pharmacological prophylaxis to IPC increased the risk of bleeding
compared to IPC alone, a side effect not observed when IPC is added to
pharmacological prophylaxis (very lowcertainty evidence), as expected
for a physical method of thromboprophylaxis. The certainty of the
evidence for bleeding was downgraded to very low due to risk of bias in
study methodology, imprecision and indirectness. The results of this
update agree with current guideline recommendations, which support the
use of combined modalities in hospitalised people (limited to those with
trauma or undergoing surgery) at risk of developing VTE. More studies on
the role of combined modalities in VIE prevention are needed to provide
evidence for specific patient groups and to increase our certainty in
the evidence
Dataset of the vascular e-Learning during the COVID-19 pandemic (EL-COVID) survey
10.1016/j.dib.2021.107442Data in Brief38107442
Vascular e-Learning During the COVID-19 Pandemic: The EL-COVID Survey
10.1016/j.avsg.2021.08.001Annals of Vascular Surger