Predictors and Evaluation of Surgical Wound Complications in Elective Abdominal Surgeries

INTRODUCTION: Surgical wound infection is a common cause of concern for a surgeon. The goal of an operative procedure is an early and complication free recovery. Post-operative pain, nausea, vomiting are common but some patients develop short and long term complications like fever, wound infection, wound dehiscence, anastomosis disruption, adhesive bowel obstruction, incisional hernia, etc. such complications are more frequently seen after emergency surgeries, but they do occur in elective procedures also, which is a matter of concern. Wound infection, wound dehiscence and incisional hernia remain challenging problems. Preoperative antibiotic prophylaxis, effective and persistent skin antisepsis, avoidance of contamination and better surgical skills are most effective methods to reduce complications. Depending on operative conditions, wound infection rates vary from 2.8% to 40%. AIM AND OBJECTIVES: To analyze various factors that may predict the surgical wound complication following elective abdominal surgeries and to evaluate the occurrence of various surgical wound complications. METHODOLOGY: For the study, demographic details of patients, results of investigations and details of surgical procedures were documented. Patients were followed up during postoperative period and at monthly interval for 6 months. Occurrence of complications like wound discharge, sinus, fistula, wound dehiscence and incisional hernia was noted. If pus was present, it is subjected to culture and sensitivity. All the above collected data will be analyzed and conclusions will be derived through statistical analysis using Mann-Whitney U test for continuous variables and Chi-square test for categoric variables. Patients will be called up one month after discharge and follow up will be done. RESULTS: Overall the complications occurred in 19 patients out of 120 patients who were followed for 6 months. This constituted a rate of 15.83% and all complications were infection of wound site and were superficial SSIs. The most common complication was seroma formation postoperatively which was sent for pus culture and sensitivity and results were evaluated. All 19 patients developed seroma from day 2 and it was more on day 3. One patient developed incisional hernia on POD 30 and one more developed burst abdomen on POD 10. Preoperatively hemoglobin and albumin had found to be a good predictor of wound complication. Preoperative serum urea and creatinine had no role in predicting wound complication after surgery. Hernioplasty had relatively high rate of infection

A study on correlation of adverse reactions with changes in biochemical, haematological and procedural parameters in plateletpheresis donors

BACKGROUND: Plateletpheresis helps in collection of platelets from a single donor, thus reducing the donor frequency exposure and the risk of TTIs to the patient in need of platelet transfusions. There is a slow transition from voluntary whole blood collection to apheresis collections with more focus towards quality of platelet concentrate. In a developing country like India, since there is a constant demand for blood and its components, it is important to maintain a good donor safety profile and encourage an increase in repeat voluntary plateletpheresis donations. AIM OF THE STUDY: The aim of the study was to correlate the adverse reactions with changes in biochemical, haematological and procedural parameters in Plateletpheresis donors. MATERIALS & METHODS: The study was conducted on 63 plateletpheresis donors over a period of one year (July 2016 – August 2017) using Haemonetics MCS+ cell separator. Prophylactic calcium supplementation was given to all the donors and were divided into two groups -Oral Ca2+ group (n=32) & IV Ca2+ group (n=31). The adverse events during the procedure were recorded and classified according to their nature. The pre and post procedure haematological and biochemical parameters along with procedural parameters from the donors were assessed with the aid of automated cell counter and biochemical analyser. RESULTS: A total of 47.6% (n=30) adverse events were recorded in 63 plateletpheresis donors, of which 41.3% (n=26) were due to mild citrate toxicity followed by vasovagal reaction (4.8%; n=3) and haematoma formation (1.6%; n=1). All adverse events were observed in the oral Ca2+ group and were mild in nature. There was a statistically significant post procedure drop in haemoglobin and platelet count (p < 0.05). Also, similar post procedure drop of S.Ionised Ca2+ levels in the Oral Ca2+ group was observed while there was a significant increase in post procedure S.Ionised Ca2+ in the IV Ca2+ group (p<0.05). The pre-procedure platelet count correlated positively with platelet yield (r=0.288; p<0.05) and negatively with duration (r = -0.396; p <0.05) and number of cycles (r = - 0.399; p <0.05). CONCLUSION: Donor adverse reactions affect voluntary blood donor recruitment strategies. Prophylactic administration of intravenous calcium resulted in better bioavailability of serum ionised calcium with absence of adverse reactions, maintenance of lab parameters within normal range and better donor comfort. Further, if oral prophylactic calcium supplementation is preferred, administration of 2-3 tablets of calcium (0.969 g of total Ca2+) most often prevents manifestations of mild citrate toxicity. However, it is imperative to conduct more studies with larger number of donors to observe donor adverse reactions specific to our population

Morphological Analysis of the Human Internal Iliac Artery in South Indian Population

Objectives: The accidental hemorrhage is common due to erroneous interpretation of the variant arteries during surgical procedures, hence the present study has been undertaken with reference to its morphological significance. The objectives were to examine the level of origin, length and the branching pattern of the human internal iliac artery in South Indian population. Methods: The study included 60 human bisected pelvises irrespective of their side and sex. The specimens were collected from the anatomy laboratory and were fixed with the formalin. The branching patterns were studied and demonstrated as per the guidelines of Adachi. Results: The origin of internal iliac artery was at the level of S1 vertebra in majority (58.3%) of the cases. The average length of internal iliac artery was 37 ± 4.62 mm (range, 13-54 mm). The type I pattern of the internal iliac artery was most common (83.5%) followed by types III and II. The type IV and V pattern of adachi were not observed. Conclusions: The results of this study were different from those reported by others and may be because of racial and geographical variations. Prior knowledge of the anatomical variations is beneficial for the vascular surgeons ligating the internal iliac artery or its branches and the radiologists interpreting angiograms of the pelvic region

Factors determining poor prognosis in scorpion sting in coastal Andhra Pradesh

Introduction: Scorpion stings are a major public health problem and a common emergency in India and other tropical countries. In India, red scorpions are more prevalent, and their venom is more likely to cause cardiovascular complications and mortality. Objective: There are very few studies regarding predictors of poor prognosis. Hence, this study was designed which aimed to identify these factors. Materials and Methods: In this hospital-based, prospective study, children admitted to scorpion sting between December 2009 and November 2010 were included. Relevant information was collected and analyzed. Results: Scorpion stings account for 1 in every 36 admissions. Maximum cases were in 0-3 and 7-9 years age groups with mean of 6.78 years. Red scorpion stings were more common and are associated with more severe presentations. There was considerable variation in sting-prazosin interval (SPI) ranging from 2 to 28 h. If the child’s age was below 6 years, red scorpion sting and SPI &gt;8 h were very significantly associated with a higher incidence of complications such as peripheral circulatory failure, congestive cardiac failure, myocarditis, and acute pulmonary edema. Conclusion: Younger age, red scorpion, and delay in administration of prazosin are predictors of poor prognosis in scorpion stings in children, a common and fatal medical emergency in India

Microbiological Hazard Identification and Exposure Assessment of Poultry Products Sold in Various Localities of Hyderabad, India

A study was carried out to identify microbiological hazards and assess their exposure associated with consumption of poultry based street food served in different localities of Hyderabad. The study indicated that chicken 65, chicken fried rice, chicken noodles, chicken Manchuria and chilly chicken are the most common recipes. A process flow diagram was developed to identify critical control points in the food item. After analysis of the samples at each level of preparation, it was observed that rice and noodles were kept at room temperature for about 5-6 hrs which was a critical control point. A total of 376 samples including chicken fried rice, chicken noodles, boiled noodles and boiled rice were collected from circle 1, 2, 3, 4, 5, 6, and 7 of Greater Hyderabad municipal corporation (GHMC) and analyzed for microbiological examination. The most prevalent pathogenic bacteria isolated were S. aureus (3.4 log 10 cfu/g) and B. cereus (3.4 log 10 cfu/g). Salmonella spp. was present in salads (3.2 log 10 cfu/g) and hand washings of the food handler (3.5 log 10 cfu/g). Salmonella contamination was found in salads served along with chicken fried rice and chicken noodles than in the food

Soft Computing and Artificial Intelligence Techniques for Intrusion Detection System

The rapid development of computer networks and mostly of the Internet has created many stability and security problems such as intrusions on computer and network systems. Further the dependency of companies and government agencies is increasing on their computer networks and the significance of protecting these systems from attacks is serious because a single intrusion can cause a heavy loss or the consistency of network becomes insecure. During recent years number of intrusions has dramatically increased. Therefore it is very important to prevent such intrusions. The hindrance of such intrusions is entirely dependent on their detection that is a key part of any security tool such as Intrusion Detection System (IDS), Intrusion Prevention System (IPS), Adaptive Security Alliance (ASA), checkpoints and firewalls. Hence accurate detection of network attack is imperative. A variety of intrusion detection approaches are available but the main problem is their performance, which can be enhanced by increasing the detection rates and reducing false positives. Keywords: IDS, Soft Computing, ANN, Genetic Algorith

QoS Constrained Optimal Sink and Relay Placement in Planned Wireless Sensor Networks

We are given a set of sensors at given locations, a set of potential locations for placing base stations (BSs, or sinks), and another set of potential locations for placing wireless relay nodes. There is a cost for placing a BS and a cost for placing a relay. The problem we consider is to select a set of BS locations, a set of relay locations, and an association of sensor nodes with the selected BS locations, so that number of hops in the path from each sensor to its BS is bounded by hmax, and among all such feasible networks, the cost of the selected network is the minimum. The hop count bound suffices to ensure a certain probability of the data being delivered to the BS within a given maximum delay under a light traffic model. We observe that the problem is NP-Hard, and is hard to even approximate within a constant factor. For this problem, we propose a polynomial time approximation algorithm (SmartSelect) based on a relay placement algorithm proposed in our earlier work, along with a modification of the greedy algorithm for weighted set cover. We have analyzed the worst case approximation guarantee for this algorithm. We have also proposed a polynomial time heuristic to improve upon the solution provided by SmartSelect. Our numerical results demonstrate that the algorithms provide good quality solutions using very little computation time in various randomly generated network scenarios