A study to assess the effectiveness of a self-instructional module on prevention and control of nosocomial infection in terms of knowledge and practice among staff nurses working in surgical unit of the Civil hospital, Ahmadabad

Background: Nosocomial infection is also called as 'Hospital Acquired- Infection’. It can be defined as an infection whose development is favoured by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff. The nosocomial infection rate is alarming and is estimated at about 30-35 percent of all hospital admissions. Many lives are lost because of the spread of infections in hospitals. Nosocomial infections are important contributors for morbidity and mortality. They became more important public health problem with increasing economic and human impact. Aims and objective: To assess the knowledge and practice of the staff nurses working in surgical unit of civil hospital Ahmedabad before and after the administration of self-instruction module on prevention of control of nosocomial infection (HAIs). To find co-relation between pre-test knowledge and post-test knowledge. Material and Methods: This study was conducted using the quasi experimental research approach and research design used was one group pre and post test.30 staff nurses working in surgical unit of civil hospital Ahmedabad are selected by convenient sampling method. Collection tool used on staff nurse was structured knowledge questionnaire and observational checklist Results: findings revealed that majority of sample (46.66%) were in the age between 21 to 30 years. According to qualification highest percentages (43.33%) belong to G.N.M. Majority had experience between 5 to 7 years (30%). Study findings revealed that the knowledge score of the sample show marked increase as seen in the post-test score of the experimental group indicates that the self-instructional module was effective in improving the knowledge and practice of the samples.  Key words:  Nosocomial infection, Prevention, control, staff nurs

A study of efficacy of subcision, micro-needling and carbon dioxide fractional laser for treatment of acne scars

Background: Acne vulgaris is one of the most common skin problem encountered in adolescents. Complication of acne may lead to scar formation. Types of acne scars are atrophic scars (ice pick, rolling scars and box scar), hypertrophic scar and keloidal scar. Multiple modalities for treating acne scars are chemical peeling, derma roller, subcision, punch excision, cryoroller, CROSS (chemical reconstruction of skin scars), fractional lasers, etc. This study is to study the efficacy of derma roller, subcision and CO2 fractional laser in acne scar and complications associated with them.Methods: Total 45 patients with grade 2, 3 and 4 atrophic acne scar (Goodman and Baron grading system) were enrolled in the study and randomly assigned in three groups of 15 patients each. Group A: Derma roller, Group B: Subcision, Group C: CO2 fractional laser. 3 sittings at 28 days interval were done in each group. Evaluation was done by standardized digital photography pre-procedure and at each sitting. Physician’s evaluation was done in terms of excellent, good, fair, poor improvement or worsening. Patient’s self-evaluates as excellent, good, fair, poor improvement or worsening.Results: According to physicians evaluation at the end of 3 sittings excellent response was seen in 20% (n=3), 13.33% (n=2), 6.67% (n=1) in group B, group C, group A respectively. According to self-evaluation by patient at the end of 3 sittings, overall, 44.44% (n=20) patients showed an excellent response (score of 8-10).Conclusions: Time tested procedures; like subcision if done adequately and properly have excellent response and is comparable to newer and costly treatment like CO2 fractional laser.

A comparative study of treatment modalities in female androgenetic alopecia

Background: Androgenetic alopecia (AGA) occurs in both men and women. It is characterized by progressive loss of hair from the scalp in a defined pattern. The aim of the study was to analyse and assess the efficacy of treatment modalities in female androgenetic alopecia (AGA) and assess the side effects, level of stress, associated family history and past history of any medical illness in these patients.Methods: 60 female patients between 18-50 years of age were randomly divided into 2 groups, with 30 cases in each. The first group (Group A), received only topical 2% minoxidil, applied in the form of a 1 ml solution at an interval of 12 hours and the second group (Group B), received combination of 2% minoxidil and platelet rich plasma (PRP) therapy injections every 15 days for 2 months and then every monthly for 4 months. Patients were evaluated every 2 months for a period of 6 months based on patient and physician assessment of clinical improvement, photographic evidence and type of hair growth. Side effects during the treatment period were observed for.Results: 70% (n=42) of patients were in the age group 18-30 years. 56.67% (n=34) had alopecia of Ludwig pattern type 2. Hypothyroidism was the major associated medical illness seen in 20% (n=20) of patients. Family history was seen in 46.66% (n=28). 73.33% (n=44) had stress in the range of 5-7 on a visual analogue scale (VAS) of 10. Excellent improvement was observed in 33.33% of patients of Group A (Minoxidil only), and in 60% (n=36) of patients of Group B (Minoxidil + PRP). Pruritis was the most common side effect seen in 13.33% (n=8) patients.Conclusions: Non-invasive management for AGA is a safe, effective and promising tool for hair growth. It offers better patient compliance, less side effects and only topical anesthesia is required. Multimodality approach in the treatment of hair loss gives excellent response, which is seen in our study as combination therapy (2% minoxidil with PRP) is more effective than topical minoxidil alone

Maternal and perinatal outcome in instrumental vaginal deliveries over 5 years: a retrospective study

Background: Due to fear of trauma and less skill, use of instrumental vaginal delivery (IVD) is decreasing every year and incidence of caesarean section is increasing. Caesarean section is a major surgery associated with increased morbidity and mortality. This study evaluates the incidence of instrumental vaginal delivery and associated maternal and perinatal outcome. Methods: This observational retrospective study was carried out in full term antenatal patients in labour with vertex presentation who had undergone operative vaginal deliveries during the study period from January 2017 to December 2021 at G.C.S. Hospital. Data were obtained from the hospital records and analysed which included the age, parity, incidence, indication, the APGAR scores of the babies and complications in the patient. Results: Incidence of instrumental deliveries was found to be 1.98%. Most common indications for IVD were prolonged second stage of labour followed by foetal distress and post-dated pregnancy. Most common maternal complication was perineal tears and most common perinatal complication was neonatal intensive care unit (NICU) admission. Conclusions: The decision to proceed with an operative vaginal delivery when a spontaneous vaginal delivery is not possible must be based upon maternal and foetal factors. Most common maternal complications were perineal tears, cervical tears, episiotomy extension, vaginal laceration and atonic postpartum hemorrhage (PPH). Most common neonatal complications were NICU admission most commonly for neonatal hyperbilirubinemia.

Genetic drivers of heterogeneity in type 2 diabetes pathophysiology.

Type 2 diabetes (T2D) is a heterogeneous disease that develops through diverse pathophysiological processes1,2 and molecular mechanisms that are often specific to cell type3,4. Here, to characterize the genetic contribution to these processes across ancestry groups, we aggregate genome-wide association study data from 2,535,601 individuals (39.7% not of European ancestry), including 428,452 cases of T2D. We identify 1,289 independent association signals at genome-wide significance (P < 5 × 10-8) that map to 611 loci, of which 145 loci are, to our knowledge, previously unreported. We define eight non-overlapping clusters of T2D signals that are characterized by distinct profiles of cardiometabolic trait associations. These clusters are differentially enriched for cell-type-specific regions of open chromatin, including pancreatic islets, adipocytes, endothelial cells and enteroendocrine cells. We build cluster-specific partitioned polygenic scores5 in a further 279,552 individuals of diverse ancestry, including 30,288 cases of T2D, and test their association with T2D-related vascular outcomes. Cluster-specific partitioned polygenic scores are associated with coronary artery disease, peripheral artery disease and end-stage diabetic nephropathy across ancestry groups, highlighting the importance of obesity-related processes in the development of vascular outcomes. Our findings show the value of integrating multi-ancestry genome-wide association study data with single-cell epigenomics to disentangle the aetiological heterogeneity that drives the development and progression of T2D. This might offer a route to optimize global access to genetically informed diabetes care

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p&lt;00001), age 70 years or older versus younger than 70 years (230 [165-322], p&lt;00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p&lt;00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research