The effect of intra-wound vancomycin powder application in reducing surgical site infections after total hip arthroplasty

Post-operative total hip arthroplasty surgical wound infections are associated with substantial morbidity, mortality, and economic burden. Intra-wound vancomycin powder application may prevent infections after hip surgery. The objectives of this study is to answer the question as to whether the application of 2 gram intra-wound vancomycin powder In patients undergoing total hip arthroplasty, lead to reduced rates of postoperative surgical site infections or not? From April 2013, 125 patients had consent prior to their hip surgery. These 125 patients had total hip arthtoplasty by three different surgeons at Imam Hossein hospital. All patients received either 2 grams of IV Cefazolin one hour prior to the incision or 1 gram of IV Vancomycin one hour prior to the incision in patient with a Penicillin allergy. Near the end of the procedure, the wound was thoroughly irrigated with normal saline. for All patients befor surgical wound closure 2 gram of Vancomycin powder was poured into the wound. Postoperatively, patients continued on intravenous antibiotics for twenty-four hours. All patients underwent routine postoperative surgical care including physical therapy, routine radiographs, and routine managment of pain medications. Laboratory tests include Hb , BUN, Cr and electrolits were done before surgery and postoperatively after 48 hours and 7 days. All patients were discharged within the first 3 days after surgery and follow-up at weeks 2 and 4 and one year after surgery was performed. During the course of follow up that has ranged from one months to one year, sixteen of patients experienced surgical site infection. 10 patients were lost to follow up. No allergic reactions or adverse outcomes were reported from the use of 2 gram of Vancomycin powder prior to closure. Although intra-wound application of Vancomycin is known to minimize infections in spinal surgery little previous studies reported if Vancomycin application will reduce surgical site infection in hip surgeries. This study demonstrates that intra-wound application of Vancomycin reduces surgical site infection in total hip arthroplasty without any adverse complications

The 64-Multislice Computed Tomogram Averts Misdiagnosis of an Anomalous Origin of the Left Main Coronary Artery

A 38-year-old woman was discovered to have a systolic murmur for an unrelated complaint. Transesophageal echocardiography showed no atrial or ventricular septal defects, but multiple large collateral vessels in inter-ventricular septum. The origin of left coronary artery was not seen at the expected site on the aortic root. The 64-multislice computed tomography confirmed the diagnosis of an anomalous origin of the left coronary artery from the pulmonary artery. Left coronary artery was revascularized with a saphenous vein graft with an uneventful recovery

ACL reconstruction using bone-patella tendon-bone autograft: Press-fit technique vs. interference screw fixation

Purpose: The gold standard in ACL reconstructions has been the bone-patellar tendon-bone autograft fixed with interference screws. This prospective, randomized clinical trial aimed to compare two methods of fixation for BPTB grafts: press-fit fixation vs. interference screw, over a 12-month follow-up interval. Methods: 158 patients with an average age of 29.8 years, between 2011 and 2012, were treated for torn ACL. 82 patients underwent reconstruction with BPTB autograft with a press fit fixation technique, and in 76 cases an interference screw was used. At the time of final follow-up, 71 patients in press-fit group and 65 patients in interference screw group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion, IKDC score and complications. Results: At 12-month follow-up, 59 (83 ) and 55 (85 ) in press-fit and screw group, respectively had good-to-excellent IKDC score (p > 0.05). The mean laxity assessed using a KT-1000 arthrometer improved to 2.7 and 2.5 mm in press-fit and screw group, respectively. Regarding Lachman and pivot shift test, there was a statistically significant improvement in the integrity of the ACL in both the groups, but no significant differences was noted between groups. There were no significant differences in terms of femur circumference difference, effusion, knee range of motion, pain and complications. Conclusions: The press-fit technique is an efficient procedure. Its outcome was comparable with the interference screw group. Furthermore it has unlimited bone-to-bone healing, no need for removal of hardware, ease for revision and cost effectiveness. © 2014 Springer-Verlag

ESSAYS IN OIL PRICE SHOCKS AND MACROECONOMICS OF OIL EXPORTING COUNTRIES

The central issue that this dissertation tries to address is the relationship between oil price shocks and the macroeconomics of oil exporting countries. For all those who had a chance to live in an oil exporting countries, it is evident that oil revenue plays a major role to induce ups and downs in economy and also in politics. I tried to address this phenomenon in the first chapter in which the relationship between oil price shocks and business cycles is investigated. In the first chapter it is shown that in some oil exporting countries like Kuwait, Venezuela and Libya, the impact of oil price shock is conditional on the cycle of the economy. An oil price shock has different effect when the economy is in boom than when it is in bust. Iran is not included in the sample of countries of this chapter since exogenous radical political events like revolution, persistent war, sanction, short term civil war and so on, makes the performance of the economy too volatile to be able to fit its data with regime switching models. This approach works well when changes are smooth. Therefore, I analyzed the case of Iran in a separate chapter through the VAR and SVECM framework. This paper examines the well-known Dutch disease hypothesis for the case of Iran. The result of second chapter partially contradict the prediction of this hypothesis since it is shown that positive oil price shock has permanent positive effect on GDP which is consistent with the finding of Esfahani, Mohades and Pesaran (2009). Success of populist candidate in presidential election in Iran and Venezuela motivated the writing of the first paper. This paper explores the relationship between quality of institution and the composition of government budget. It shows that when the quality of institution is low, majority of constituency prefer direct transfer rather than public spending on necessary and productive public goods, although investment in public goods is a prerequisite for development. But when the quality of institution is high, voters choose public investment. That is the cause of the difference in the public choice of two countries: Norway and Venezuela. This is in line with the finding of the literature on political economy of oil. Therefore, all three chapters although are different in method and content but concern a central issue which is the role of oil in the economy of oil exporting countries

Vitamin C in prevention of atrial fibrillation after coronary artery bypass graft: double blind randomized clinical trial

Background: Atrial fibrillation is the most common arrhythmia after cardiac surgery. Vitamin C as an antioxidant has an important role in reducing the incidence of postop-erative atrial fibrillation. The present study aimed at administrating vitamin C as a way to reduce the incidence of post-CABG atrial fibrillation. Methods: In this double-blind, parallel clinical trial, 170 patients with coronary artery disease who underwent CABG surgery, by using a table of random numbers are di-vided into intervention and control groups to receive placebo or vitamin C. The clinical and surgical characteristics of the patients in the two groups were similar. The interven-tion group received 2 mg of vitamin C intravenously, the night before surgery. This drug followed by 500 mg, twice a day for five days after surgery. On the other hand patients in the control group received placebo (normal saline intravenously). After operation two groups were compared regarding Important outcomes such as postoperative arrhythmia, ICU stay and hospital stay. Results: One hundred eighteen men and fifty two women with a mean age of 59.1±9.8 years were enrolled in the study in two vitamin C and placebo groups (each consisting of 85 patients). The incidence of postoperative atrial fibrillation was 12.9% in the vita-min C group and 29.4% in the control group (P=0.009). ICU stay in the vitamin C group were 2.5±1.4 days versus 3.0±1.6 days in controls (P=0.035) and hospital stay in the vitamin C group were 6.6±1.5 days versus 8.2±2.3 days in controls (P<0.001). Conclusion: Vitamin C is relatively safe, inexpensive, well tolerated and has a low complication. According to the 44% reduction in the incidence of atrial fibrillation in vitamin C patients undergoing coronary artery bypass grafting surgery, this drug can be prescribed as a prophylaxis for prevention of post-CABG atrial fibrillation

Effect of Peer Education before Coronary Artery Bypass Graft on Post Discharge Quality of Life

Abstract Background: Promoting quality of life after Coronary Artery Bypass Graft (CABG) is necessary in order to control the risk factors and reducing the probability of patient readmission. This study was conducted to determine the effect of peer education on patients’ quality of life after coronary artery bypass graft. Materials and Methods: In this clinical trial, two patients with previous coronary artery bypass surgery were trained as peer educators. The patients who were candidate for surgery were systematically allocated to trial or control groups. Before the surgery, both groups received the post CABG self-care in the ward. The trial group (n=40) was taught by the peers, while the control group (n=40) received the routine teaching by the nurses. The quality of life was assessed before, one month and two months after discharging using the SF12 questionnaire. Multivariate Analysis of Variances (MANOVA) was recruited to analyze the data. Results: In the trial group, the mean quality of life scores before the surgery, one month and two month after discharging were 31.82±4.90, 28.06±3.83 and 35.82± 4.96, respectively. In the control group, the scores were 25.58±4.21, 29.31±4.03, and 31.56±6.91. The results indicated significant differences between the groups (p<0.001, F= 13.52). In the peer educated group, the mean scores of quality of life were higher than the control group. Conclusion: The CABG patients᾽ quality of life was significantly higher in the patients who received peer education in comparison with the control group. It seems that peer education may contribute in the patients᾽ self care and promoting their quality of life