Pre-operative bladder irrigation with 1% Povidone iodine in reducing open prostatectomy surgical site infection (SSI) at university teaching hospital, Lusaka

Purpose: The aim of the study is to assess the effectiveness of using preoperative bladder irrigation with 1% povidone iodine in reducing post transvesical prostatectomy surgical site infections. Study design: This was a prospective randomized cohort study with blinding of patients and outcome adjudicator regarding group assignments.Methodology: One hundred and thirty patients were recruited from the waiting list of Urology unit II in the department of surgery during the period between July 2011 to December 2012. The non-probability convenience sampling technique was used. Any consenting patient who presented to the department of surgery for open prostatectomy and fulfills the inclusion criteria was selected. The patients were randomly allocated to each of the two groups. Each group had 65 patients. Patients in the study group had their bladder irrigated with 1% 50cc povidoneiodine which was drained upon opening the bladder followed by enucleating the adenomatous prostate gland. Hemostasis was ensured and a 3 way Foley's catheter inserted via the urethral into the bladder and ballooned appropriately for draining and irrigation. The bladder was sutured in 2 layers using 0 or 1 chromic catgut. In the control group povidone-iodine was not used. Both groups received pre-operative antibiotics 30 minutes before incision and post-operative for 5 days. Pre-operative, intraoperative and post-operative data were collected on a standardized data collection forms. Post-operative irrigation was done for 9 to 12 days after which the catheter was removed as an outpatient. Patients were followed up in the urological clinic at 1 week, 2weeks and at 4 weeks post-operatively to assess whether they had developed surgical site infections according to CDC guidelines. Data was analyzed using SPSS version 16.Results: The patients mean age was 71.1 in the control group and 71.4 in the study group with no statistically significant difference (t=0.318; p=0.75; df=126.89). The overall surgical infection rate was 16.2%. In the control group 15 out of 65 patients (23.1%) developed SSIs. While in the study group 6 out of 65 patients (9.2%) developed SSIs. The difference in the rates of SSI between the two groups was statistically significant (÷²; p<0.05; df=126.89) Escherichia coli was the most predominant organism 13/37 (35%), streptococcus 7/37 (18.9), Citrobacter koseri 5/37 (13.5%), Klebsiella sp 4/37 (10.8%). Escherichia coli, Streptococcus and Citrobacter were sensitive to ciprofloxacin; Pantoea agglomerans was sensitive to ceftazidime while Staphylococcus coagulase was sensitive to imipenem. Enterobacter cloace was resistant to all antibiotics used.Conclusion: The study found that irrigating the bladder with 1% povidone-iodine resulted in significant reduction in post prostatectomy surgical site infection, Escherichia coli as the most common causative organism, reduced morbidity and post-operative hospital stay in the povidone iodine group.Key words: Benign prostatic hyperplasia, transvesical prostatectomy, povidone iodine, surgical site infections

Effect of electrodeposition current density on the microstructure and magnetic properties of nickel-cobalt-molybdenum alloy powders

Nanostructured nickel-cobalt-molybdenum alloy powders were electrodeposited from an ammonium sulfate bath. The powders mostly consist of an amorphous phase and a very small amount of nanocrystals with an mean size of less than 3 nm. An increase in deposition current density increases the amorphous phase percentage, the density of chaotically distributed dislocations and internal microstrains in the powders, while decreasing the mean nanocrystal size. The temperature range over which the structural relaxation of the powders deposited at higher current densities occurs is shifted towards lower temperatures. A change in relative magnetic permeability during structural relaxation is higher in powders deposited at higher current densities. Powder crystallization takes place at temperatures above 700oC. The formation of the stable crystal structure causes a decrease in relative magnetic permeability

Immunological and technical considerations in application of alginate-based microencapsulation systems

Islets encapsulated in immunoprotective microcapsules are being proposed as an alternative for insulin therapy for treatment of type 1 diabetes. Many materials for producing microcapsules have been proposed but only alginate does currently qualify as ready for clinical application. However, many different alginate-based capsule systems do exist. A pitfall in the field is that these systems are applied without a targeted strategy with varying degrees of success as a consequence. In the current review the different properties of alginate-based systems are reviewed in view of future application in humans. The use of allogeneic and xenogeneic islet sources are discussed with acknowledging the different degrees of immune protection the encapsulation system should supply. Also issues such as oxygen supply and the role of danger associated molecular patterns (DAMPS) in immune activation are being reviewed.A common property of the encapsulation systems is that alginates for medical application should have an extreme high degree of purity and lack pathogen-associated molecular patterns (PAMPs) to avoid activation of the recipient’s immune system. Up to now, non-inflammatory alginates are only produced on a lab-scale and are not yet commercially available. This is a major pitfall on the route to human application. Also the lack of predictive pre-clinical models is a burden. The principle differences between relevant innate and adaptive immune responses in humans and other species are reviewed. Especially the extreme differences between the immune system of non-human primates and humans are cumbersome as non-human primates may not be predictive of the immune responses in humans, as opposed to the popular belief of regulatory agencies. Current insight is that although the technology is versatile major research efforts are required for identifying the mechanical, immunological and physico-chemical requirements for successful human application

A Scalable Middleware Solution for Advanced Wide Area Web Services

To alleviate scalability problems in the Web, many researchers concentrate on how to incorporate advanced caching and replication techniques. Many solutions incorporate object-based techniques. In particular, Web resources are considered as distributed objects offering a well-defined interface. We argue that most proposals ignore two important aspects. First, there is little discussion on what kind of coherence should be provided. Proposing specific caching or replication solutions makes sense only if we know what coherence model they should implement. Second, most proposals treat all Web resources alike. Such a one-size-fits-all approach will never work in a wide-area system. We propose a solution in which Web resources are encapsulated in physically distributed shared objects. Each object should encapsulate not only state and operations, but also the policy by which its state is distributed, cached, replicated, migrated, etc

Association of acute Babesia canis infection and serum lipid, lipoprotein, and apoprotein concentrations in dogs

Background Babesia canis infection induces a marked acute phase response (APR) that might be associated with alteration in lipid and lipoprotein metabolism and disease prognosis. Hypothesis Dogs with B. canis-induced APR develop dyslipidemia with altered lipoprotein concentration and morphology. Animals Twenty-nine client-owned dogs with acute B. canis infection and 10 clinically healthy control dogs. Methods Observational cross-sectional study. Serum amyloid A (SAA) was measured using ELISA. Cholesterol, phospholipids, and triglycerides were determined biochemically. Lipoproteins were separated using agarose gel electrophoresis. Lipoprotein diameter was assessed by polyacrylamide gradient gel electrophoresis; correlation with ApoA-1 (radioimmunoassay) and SAA was determined. Results Dogs with B. canis infection had a marked APR (median SAA, 168.3 mu g/mL; range, 98.1-716.2 mu g/mL) compared with controls (3.2 mu g/mL, 2.0-4.2 mu g/mL) (P < .001). Dogs with B. canis infection had significantly lower median cholesterol (4.79 mmol/L, 1.89-7.64 mmol/L versus 6.15 mmol/L, 4.2-7.4 mmol/L) (P = .02), phospholipid (4.64 mmol/L, 2.6-6.6 mmol/L versus 5.72 mmol/L, 4.68-7.0 mmol/L) (P = .02), and alpha-lipoproteins (77.5%, 27.7%-93.5% versus 89.2%, 75.1%-93.5%) (P = .04), and higher ApoA-1 (1.36 U, 0.8-2.56 U versus 0.95 U, 0.73-1.54 U) concentrations (P = .02). Serum amyloid A correlated with high-density lipoproteins (HDLs) diameter (rho = .43; P = .03) and ApoA-1 (rho = .63, P < .001). Conclusions and Clinical Importance Major changes associated with B. canis-induced APR in dogs are related to concentration, composition, and morphology of HDL particles pointing to an altered reverse cholesterol transport. Parallel ApoA-1 and SAA concentration increase is a unique still unexplained pathophysiological finding

Low-energy excitations in the three-dimensional random-field Ising model

The random-field Ising model (RFIM), one of the basic models for quenched disorder, can be studied numerically with the help of efficient ground-state algorithms. In this study, we extend these algorithm by various methods in order to analyze low-energy excitations for the three-dimensional RFIM with Gaussian distributed disorder that appear in the form of clusters of connected spins. We analyze several properties of these clusters. Our results support the validity of the droplet-model description for the RFIM.Comment: 10 pages, 9 figure