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

Qualidade das informações sobre aleitamento materno e alimentação complementar em sites brasileiros de profissionais de saúde disponíveis na internet The quality of information on maternal breast feeding and complementary feeding on Brazilian internet sites available for health professionals

OBJETIVOS: analisar as informações de sites da internet sobre o aleitamento materno e alimentação complementar de acordo com a adequação às recomendações do Ministério da Saúde do Brasil. MÉTODOS: realizado estudo transversal, com amostra de 103 sites de profissionais de saúde. Analisaram-se informações sobre aleitamento materno (AM) e alimentação complementar (AC). As informações foram quantificadas e analisadas qualitativamente. RESULTADOS: as recomendações relativas ao AM foram: exclusivo até 6º mês (64,1%); sem água e chá (31,1%); duração de dois anos ou mais (36,9%); e não utilizar mamadeira e chupeta (33%). Para a AC foi utilizada a terminologia desmame (30,1%), recomendada a introdução alimentar no 6º mês (47,9%), introdução da primeira papa com fruta (11,6%) ou suco (9,7%); e a oferta de sopa (14,6%) como refeição. Na análise qualitativa, entre as informações incorretas, constavam recomendações de consumo de carne no 12º mês, horários regulares para refeições, introdução de alimentos no 7º mês e consumo de leite de vaca no 6º mês. CONCLUSÕES: a maior parte das informações sobre aleitamento materno está de acordo com o preconizado pelo Ministério da Saúde, mas são insuficientes para estimular a prática do aleitamento materno. Já as informações sobre alimentação complementar na sua maioria divergem do recomendado.<br>OBJECTIVES: to analyze the information available on internet sites regarding maternal breast feeding and complementary feeding according to the recommendations of the Brazilian Ministry of Health. METHODS: a cross-sectional study was carried out using a sample of 103 sites for professional healthcare workers. Information was analyzed on maternal breast feeding (MB) and complementary feeding (CF). The information was quantified and analyzed qualitatively. RESULTS: the recommendations for MB were: that it should be exclusive up to the 6th month of life (64.1%); that no water or tea should be added (31.1%); that it should last for two years or more (36.9%); and that bottles and/or pacifiers should not be used (33%). For CF, the term weaning was used (30.1%), it was recommended that solid feeding begin in the 6th month of life (47.9%), involving fruit pulp (11.6%) or juice (9.7%); and soup (14.6%). According to the qualitative analysis, incorrect information included recommending the consumption of meat in the 12th month of life, regular meals, the introduction of solid food in the 7th month and the consumption of cow's milk in the 6th month. CONCLUSIONS: most of the information on breast feeding accords with the advice of the Brazilian Ministry of Health, but is not sufficient to encourage breast feeding. The information on complementary feeding mostly diverges from the official recommendations

Stem Cell Therapy for Diabetic Foot Ulcers

Diabetic foot ulcers (DFU) are chronic wounds that are notoriously difficult to heal, thus leading to an exaggerated amputation rate in the diabetic population. Stem cells, through their inherent ability to secrete pro-healing cytokines/growth factors and cellular differentiation capabilities, are a promising regenerative approach to assist in wound healing for DFU patients. This chapter will focus on the underlying pathologic wound healing in the diabetic phenotype and the promising regenerative effects of stem cell treatments as adjuncts to wound healing for DFU. It will also detail the differing types of stem cells with their respective therapeutic effects, stem cell delivery systems for DFU treatment, and the future of stem cell therapies