Using different surgical techniques and ideas to reduce post-operative adhesion formation: a systematic review and meta-analysis

Adhesion development is the most common sequelae of intra-abdominal and pelvic surgery. Using a good surgical technique is advocated as a first step in preventing adhesions. However, the evidence for different surgical techniques to reduce adhesion formation needs confirmation. This review contributed to the growing knowledge pool by elucidating factors that potentially predispose to the development of adhesions. A literature search was performed using the PubMed database for all relevant English language articles and were reviewed with particular attention to predisposing factors to post-operative adhesion development. In addition, the reference lists of each article were reviewed to identify additional relevant articles. Various factors have been shown to directly increase the risk of post-operative adhesion development; namely, certain genetic polymorphisms in the interleukin-1 receptor antagonist, increased estrogen exposure, and endometriosis. There were 28 papers with 27 studies included for a systematic review. Of these, 17 studies were eligible for meta-analysis and 11 for qualitative assessment only. None of the techniques that were compared significantly reduced the incidence of adhesive small bowel obstruction. In a small low-quality trial, the pregnancy rate increased after subserous fixation of suture knots. However, the incidence of adhesions was lower after laparoscopic compared with open surgery (relative risk (RR): 0.14; 95% confidence interval (CI): 0.03-0.61) and when the peritoneum was not closed (RR: 0.36; 95% CI: 0.21-0.63). None of the specific techniques that were compared reduced the two main adhesion-related clinical outcomes, small bowel obstruction and infertility

Occurrence and risk factors of Vitamin D deficiency in Indian children living with HIV – A case–control study

Background: Vitamin D deficiency (VDD) is highly prevalent in healthy individuals. Studies suggest that Vitamin D plays an important role in immune system. Objective: The objective of this study was to assess the frequency of VDD in Indian children living with HIV (CLHIV) and to find out the risk factors associated with it. Materials and Methods: It was a cross-sectional comparative study conducted in a tertiary care teaching hospital of North India. A total of 52 CLHIV were enrolled consecutively from the pediatric HIV center and an equal number of age- and sex-matched controls were enrolled from the pediatric outpatient department. Serum Vitamin D levels of cases and controls were assessed and compared. Various risk factors, both classical (age, sex, sunlight exposure, average dietary intake of calcium, and Vitamin D) and disease related (WHO and immunological stage, duration, and regimen of treatment), were evaluated for VDD in CLHIV. Results: The prevalence of VDD in cases and controls was 69.23% and 19.23%, respectively (p<0.001). The mean serum Vitamin D level of the cases (18.24±11.2 ng/dL) was significantly lower than that of controls (31.58±17.31 ng/dL) (p<0.001). The risk factor that predicted the occurrence VDD in CLHIV was a poor intake of Vitamin D. Conclusion: CLHIV are more prone to VDD; hence, there is a need to regularly evaluate, supplement, and monitor for Vitamin D status in these children

Preventing respiratory viral transmission in long-term care: Knowledge, attitudes, and practices of healthcare personnel

OBJECTIVETo examine knowledge and attitudes about influenza vaccination and infection prevention practices among healthcare personnel (HCP) in a long-term-care (LTC) setting.DESIGNKnowledge, attitudes, and practices (KAP) survey.SETTINGAn LTC facility in St Louis, Missouri.PARTICIPANTSAll HCP working at the LTC facility were eligible to participate, regardless of department or position. Of 170 full- and part-time HCP working at the facility, 73 completed the survey, a 42.9% response rate.RESULTSMost HCP agreed that respiratory viral infections were serious and that hand hygiene and face mask use were protective. However, only 46% could describe the correct transmission-based precautions for an influenza patient. Correctly answering infection prevention knowledge questions did not vary by years of experience but did vary for HCP with more direct patient contact versus less patient contact. Furthermore, 42% of respondents reported working while sick, and 56% reported that their coworkers did. In addition, 54% reported that facility policies made staying home while ill difficult. Some respondents expressed concerns about the safety (22%) and effectiveness (27%) of the influenza vaccine, and 28% of respondents stated that they would not get the influenza vaccine if it was not required.CONCLUSIONSThis survey of staff in an LTC facility identified several areas for policy improvement, particularly sick leave, as well as potential targets for interventions to improve infection prevention knowledge and to address HCP concerns about influenza vaccination to improve HCP vaccination rates in LTCs.Infect Control Hosp Epidemiol 2017;38:1449–1456</jats:sec

Local Anesthetic Systemic Toxicity

Local anesthetics are used very often in medicine and dentistry. They have few adverse effects, but the increased use of these drugs has resulted in a higher incidence of local and systemic anesthetic toxicity (LAST). From the initial symptoms to the deleterious effects on cardiac and the central nervous system, LAST is an important consequence of which we should be aware. LAST is known since the introduction and use of local anesthetics; it was originally associated with seizures and respiratory failure. However, in the 1970s, side effects on the heart were also identified, as the fatal cardiac toxicity associated with bupivacaine was discovered in healthy patients. Prevention and safe administration of regional anesthesia remains primary factors in the avoidance of the toxicity of these drugs. When a patient has LAST, treatment should be started immediately to reduce seizures. If there is cardiac arrest, follow ACLS guidelines. Intravenous lipids improve cardiac conduction, contractility and coronary perfusion by removing liposoluble local anesthetic from cardiac tissue

Chronic pelvic pain in women: comparative study between ultrasonography and laparoscopy as diagnostic tool

Background: Chronic pelvic pain is a major cause of morbidity among the reproductive age group women. The study on patients of chronic pelvic pain aimed to compare the diagnostic accuracy of ultrasonography and laparoscopy in these patientsMethods: The study was conducted on 100 patients of chronic pelvic pain attending the gynaecology outdoor and were subjected to thorough clinical examination followed by ultrasonography and laparoscopic examination.Results: Maximum number of cases of chronic pelvic pain belonged to 25-30 years, were parous with mean duration of pain of 15.2 months. The most common complaint was vaginal discharge (70%) followed by menstrual irregularity. On clinical examination, pelvic tenderness was observed in majority (60%) of cases. USG examination showed chronic pelvic inflammatory disease in 43% cases followed by myoma (8%), ovarian cyst (5%), endometriosis (6%), pelvic congestion (5%) and no abnormal pathology in 25% cases. On laparoscopic examination, chronic pelvic inflammatory disease was present in 47% cases followed by endometriosis (11%), pelvic congestion (8%), myoma (8%), adhesions (7%) while 13% cases showed normal findings.Conclusions: Laparoscopy is more effective than ultrasonography as a diagnostic tool in patients of chronic pelvic pain.

Child Drawing: A Projective Tool for Dental Anxiety Assessment

INTRODUCTION: Assessment of child’s anxiety is important in order to determine the success of dental treatment. Drawing, a nonverbal, self-report, projective and non-invasive technique may prove be helpful and needs to be explored in order to access anxiety in children requiring dental treatment.AIM: To investigate the applicability of children’s drawings as an indicator to measure their level of anxiety.MATERIALS &amp; METHOD: A cross-sectional study was conducted in a total of hundred children between age group of 4-6 years. Children were asked to draw dental operatory on A4 sheet and colour it with basic set of 12 colours. The drawing was scored using Child Drawing: Hospital (projective scale) scale and the results were compared with pulse oximeter readings (physiological parameter) and Venham Picture Test scorings.RESULTS: Child Drawing: Hospital scale scoring had a positive correlation with pulse oximeter reading (involuntary) (p-value = 0.125) and a negative correlation with Venham picture test (p-value = 0.140).CONCLUSION: Drawing may be statistically significant projective tool significant to assess child anxiety in dental setting

Topographic Distribution of Carious Lesion on Young Permanent Mandibular Molars and Its Relation to Periapical Index Score of Apical Periodontitis: A Radiographic Analysis

INTRODUCTION: Caries in young permanent teeth progress rapidly resulting in early pulp involvement which further progresses into loss of mineralized tissue and severe periapical pathologies. The Periapical Index scoring system (PAI) proposed by Ørstavik et al. in 1986 is an invaluable diagnostic tool used to evaluate periapical lesion extent and severity by 2D digital intraoral periapical radiographic analysis with minimal radiation exposure and hence treatment planning.AIM: To evaluate the relationship of the surface distribution of caries in young permanent molars, pulpal involvement and periapical index (PAI) score with respect to individual root forming young permanent mandibular molars. MATERIALS AND METHOD: In this retrospective single-centre study, 100 pulpally involved carious young permanent mandibular molars were included, selected from the departmental records between August 2018-2019. Topographic distribution of caries and radiographic analysis (using PAI) was evaluated to see the effect of anatomical site of caries, individual anatomical form of root, and extent &amp; severity of apical periodontitis developed.RESULT: No significant correlation between the site of caries involvement and PAI score was observed. PAI score for distal roots was higher(PAI&gt; 2) as compared to mesial root for pulpally involved carious young permanent first molars (p-value mesial root-0.576 , distal root-0.591)CONCLUSION: PAI score is independent of the topographic distribution of caries and no correlation was observed. Periapical radiolucency does not depend on caries distribution, either it is mesial, distal or occlusal

To evaluate the efficacy and safety of single dose intravenous iron carboxymaltose verses multidose iron sucrose in post-partum cases of severe iron deficiency anemia

Background: Iron deficiency is the most common nutritional deficiency worldwide. Anemia is the most common treatable, direct/indirect cause of maternal and neonatal morbidity and mortality in developing countries like India.Methods: 100 cases with iron deficiency anemia in post-partum patient were selected from postpartum wards and assigned in two groups of 50 each. In group A iron carboxymaltose injection administered by intravenous infusion up to a maximum single dose of 20 ml of iron carboxymaltose injection (1000 mg of iron). In group B Iron sucrose was given as 200mg elemental iron (2 ampules of 5 ml) in 100ml of 0.9% normal saline infusion over 1 5 min alternate days up to 5 days. All patients were monitored for rise in hemoglobin level and any adverse effect at 2 weeks, 4 weeks, 8 weeks and 12 weeks of iron therapy.Results: In group A mean Hemoglobin level rise is 3.95 g/dl and in group B it is 3.32 g/dl at 4 weeks of initial therapy. In group A 100% cases achieved target hemoglobin at 12 weeks after therapy while in group B 98% cases achieved target hemoglobin at 12 weeks after therapy. In group A 12% cases have grade 1 adverse reaction while in group B 20% cases have adverse reaction.Conclusions: Administration of intravenous iron has a good clinical result, with minimum adverse reactions. Thus we can conclude that intravenous ferric carboxymaltose therapy is safe, convenient, more effective and faster acting than intravenous iron sucrose for treatment of severe iron deficiency anemia in postpartum patient