Comparative study of vacuum-assisted closure therapy versus vacuum-assisted closure therapy supplemented with vitamin C in compound wound healing

Background: It is imperative for early and precise management of the compound wound for preventing further complication and delaying definitive management. As we all know superiority of vacuum assisted closure (VAC) therapy in wound management over any other method, but adding vitamin C has been shown to accelerate wound healing, reducing hospital stay, and cost of management and prevention of delaying definitive management of wound due to some conspicuous property of vitamin C that serve as superior adjuvant in wound healing. Methods: A case series of 40 patients who have been inflicted with compound wounds with most following road traffic accidents. We then categorised patients and tried to observe any difference in rate of satisfactorily healing of wound with 20 patients put on VAC therapy alone and other 20 patients put on VAC therapy supplemented with vit C. Results: Patients who were undergoing VAC dressing and supplemented with vitamin C, not only portrayed a better result of wound healing but also reduced the amount of vacuum dressing sittings. Conclusions: It was observed that, in general, patients who were undergoing VAC dressing and supplemented with vitamin C, not only portrayed a better result of wound healing but also reduced amount of vacuum dressing sittings, improved rate of granulation tissue, reduced hospital stay, early definitive fixation of associated fracture and skin grafting and showed superior outcomes in terms of better tissue recovery

A prospective study of the functional outcome of 3 stitch technique in a compound humerus shaft fracture

Background: Intramedullary nailing of compound shaft humerus fractures has been an innovative and surgically friendly technique to deal with extensive soft tissue injury that impedes open reduction and internal fixation. The purpose of this article is to highlight the minimally invasive technique of intramedullary humerus nailing to prevent the perioperative and postoperative complications encountered. A 1 year follow up of all the patients have shown functionally excellent results and good surgical outcome. Methods: We have conducted this prospective study from Jan 2020 to Jan 2022 at DR. D.Y. Patil medical college and hospital. Informed consent from each patient was taken explaining the methods of study and probable complications.  By this 3-stitch technique we have treated 25 adult patients sustaining post traumatic compound humerus shaft fractures by Antegrade humerus nailing. We have included compound injury upto type 3A (Gustilo-Anderson classification). Results: Out of the 25 patients, 23 patients showed functionally excellent outcomes with good compliance to rehabilitation protocol but 2 patients had delayed wound healing of which 1 patient had undergone VAC therapy, which later healed well after a period of 2-3 weeks with sequential dry dressings. None have gone into nonunion. Conclusions: Our study suggests that the 3-stitch technique is a good alternative method compared to external fixators and other various surgical techniques and yields good results with lesser complications and better cosmetic outcomes in compound injuries

Um guia prático sobre a anatomia do rinencéfalo

Pathology of the rhinencephalon has been a subject of interest in the fields of neurodegenerative diseases, trauma, epilepsy and other neurological conditions. Most of what is known about the human rhinencephalon comes from comparative anatomy studies in other mammals and histological studies in primates. Functional imaging studies can provide new and important insight into the function of the rhinencephalon in humans but have limited spatial resolution, limiting its contribution to the study of the anatomy of the human rhinencephalon. In this study we aim to provide a brief and objective review of the anatomy of this important and often overlooked area of the nervous system744329336As patologias do rinencéfalo tem sido assunto de interesse para os estudiosos das doenças neurodegenerativas, do traumatismo cranio-encefálico, epilepsia e outras doenças neurológicas. A maior parte do conhecimento sobre a anatomia do rinencéfalo vem de estudos de anatomia comparativa com outros mamíferos e estudos histológicos em primatas. Estudos de imagem funcional, apesar de proporcionarem informações úteis e interessantes a respeito do funcionamento do rinencéfalo em humanos, sofrem de resolução espacial limitada, e portanto contribuem de maneira restrita ao estudo dos limites das áreas anatômicas. Neste artigo buscamos proporcionar ao neurologista e neurocientista interessado uma revisão prática e objetiva da anatomia desta área importante e muitas vezes esquecida do sistema nervos

New Record of Ariomma brevimanum (Klunzinger, 1884) (Perciformes: Ariommatidae) from Indian Waters

Nine specimens (584–670 mm standard length) of Ariomma brevimanum (Klunzinger 1884) were collected from the Cochin Fishing Harbour (south-eastern Arabian Sea) in 2016. Morphometric and meristic parameters, along with the DNA barcoding confirmed the identity of the specimens. The majority of the proportional morphometric measurement and meristic counts were concurrent with the previous description of A. brevimanus: body elongated (depth at first dorsal and second dorsal fin origin was about 22.8–25.2% and 22.0–22.7%of the standard length respectively); first dorsal fin with XI spine and second dorsal fin with I spine and 15 rays; anal fin with II spine and 15 rays; pectoral fin with 22–24 rays; scales large, cycloid, thin and deciduous; lateral line with 52–55 pored scales; pre-dorsal scale patch extending to about the hind margin of the eye; pre-opercular margin angular; horizontal eye diameter 18–22% of head length; gill rakers, 30–32 on first gill arch. In the present study, the partial sequences of the mitochondrial COI gene of A. brevimanum were generated. The analysis using the sequences of the COI gene produced a phylogenetic tree considering the maximum likelihood tree showed distinct clustering among species of Ariomma and revealed an identical phylogenetic relationship. The present study represents the first record for Indian waters, as well as the south-eastern Arabian Sea record of this species

Effect of Nano-Silica on the Physical, Mechanical and Thermal Properties of the Natural Rubber Latex Modified Concrete

The preparation and properties of latex modified concrete (LMC), nano silica modified concrete (nSMC) and silica-latex modified concrete (SLMC) have been investigated in this study. Properties like compressive strength, tensile strength, flexural strength, thermal characteristics and water absorption have been evaluated. The 7-day compressive strength has increased 37% (30.15 N/mm2) after the inclusion of nano silica and latex. The composite has showed considerable improvements in splitting tensile strength (3.24 N/mm2), flexural strength (6.05 N/mm2) and thermal conductivity, while it lowered the water absorption rate. The property increase has been attributed to the pore filling and pozzolanic activity of nano silica and densification of matrix by natural rubber latex and nano silica. The results of this study have suggested that the addition of nano silica and latex could be a relevant technique toward conventional concrete as a key material along with energy efficient construction and building technology

Effect of Nano-Silica on the Physical, Mechanical and Thermal Properties of the Natural Rubber Latex Modified Concrete

452-457The preparation and properties of latex modified concrete (LMC), nano silica modified concrete (nSMC) and silica-latex modified concrete (SLMC) have been investigated in this study. Properties like compressive strength, tensile strength, flexural strength, thermal characteristics and water absorption have been evaluated. The 7-day compressive strength has increased 37% (30.15 N/mm2) after the inclusion of nano silica and latex. The composite has showed considerable improvements in splitting tensile strength (3.24 N/mm2), flexural strength (6.05 N/mm2) and thermal conductivity, while it lowered the water absorption rate. The property increase has been attributed to the pore filling and pozzolanic activity of nano silica and densification of matrix by natural rubber latex and nano silica. The results of this study have suggested that the addition of nano silica and latex could be a relevant technique toward conventional concrete as a key material along with energy efficient construction and building technology

Role of random biopsies in surveillance of dysplasia in ulcerative colitis patients with high risk of colorectal cancer

Background/AimsRecent data suggest that the incidence of ulcerative colitis (UC) related colorectal cancer (CRC) in India is similar to that of West. The optimum method for surveillance is still a debate. Surveillance with random biopsies has been the standard of care, but is a tedious process. We therefore undertook this study to assess the yield of random biopsy in dysplasia surveillance.MethodsBetween March 2014 and July 2015, patients of UC attending the Inflammatory Bowel Disease clinic at the All India Institute of Medical Sciences with high risk factors for CRC like duration of disease >15 years and pancolitis, family history of CRC, primary sclerosing cholangitis underwent surveillance colonoscopy for dysplasia. Four quadrant random biopsies at 10 cm intervals were taken (33 biopsies). Two pathologists examined specimens for dysplasia, and the yield of dysplasia was calculated.ResultsTwenty-eight patients were included. Twenty-six of these had pancolitis with a duration of disease greater than 15 years, and two patients had associated primary sclerosing cholangis. No patient had a family history of CRC. The mean age at onset of disease was 28.89±8.73 years and the duration of disease was 19.00±8.78 years. Eighteen patients (64.28%) were males. A total of 924 biopsies were taken. None of the biopsies revealed any evidence of dysplasia, and 7/924 (0.7%) were indefinite for dysplasia.ConclusionsRandom biopsy for surveillance in longstanding extensive colitis has a low yield for dysplasia and does not suffice for screening. Newer techniques such as chromoendoscopy-guided biopsies need greater adoption

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication