Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Analysis of the costs of treating dry socket

© 2015 Faculty of Medicine in Niš. Clinic of Dentistry in Niš. All rights reserved. Background: Dry socket is a disturbance in the healing of tooth extraction, characterized by the absence of blood clot and persistence of intense pain. The aim of this study was to determine the costs of treating dry socket, as in Serbia, until now, there has been no adequate estimation of the expenses and cost structure for treating patients with dry socket. Material and Methods: The costs of treating dry socket were analyzed on the sample of 455 adults with confirmed diagnosis of dry socket. All the patients were treated at the Oral Surgery Department, Institute of Dental Medicine in Kragujevac, during 2012. Direct costs per patient, concerning the acquisition of medicines and medical supplies, as well as medical services, were recorded in accordance with the Blue Code Book of the National Health Insurance Fund. Results: Out of total 12.652 teeth extracted, 455 patients (3.6%) were diagnosed with dry socket. Total direct cost for treating dry socket in 2012 was 1.298,58 ± 468.93 RSD per patient, of which 1.065,16 RSD ± 394.49 RSD (82.02%) was the total price of the service and 1. 298,58 ± 468.93 RSD (17.98%) was spent on dental supplies. Conclusion: The actual cost of treating dry socket in Serbia shows that there is a need for the implementation of the relevant preventive measures. Global economic crisis, worsens the constant lack of available resources in dental healthcare services. Dry socket, as one of the most frequent post-extraction complications, although quite harmless in terms of clinical prognosis represents substantial economic loss for Serbia

A naturally arising broad and potent CD4-binding site antibody with low somatic mutation

The induction of broadly neutralizing antibodies (bNAbs) is a potential strategy for a vaccine against HIV-1. However, most bNAbs exhibit features such as unusually high somatic hypermutation, including insertions and deletions, which make their induction challenging. VRC01-class bNAbs not only exhibit extraordinary breadth and potency but also rank among the most highly somatically mutated bNAbs. Here, we describe a VRC01-class antibody isolated from a viremic controller, BG24, that is much less mutated than most relatives of its class while achieving comparable breadth and potency. A 3.8-angstrom x-ray crystal structure of a BG24-BG505 Env trimer complex revealed conserved contacts at the gp120 interface characteristic of the VRC01-class Abs, despite lacking common CDR3 sequence motifs. The existence of moderately mutated CD4-binding site (CD4bs) bNAbs such as BG24 provides a simpler blueprint for CD4bs antibody induction by a vaccine, raising the prospect that such an induction might be feasible with a germline-targeting approach