Management of complex surgical wounds of the back: identifying an evidence-based approach

Background@#Postoperative dehiscence and surgical site infection after spinal surgery can carry serious morbidity. Multidisciplinary involvement of plastic surgery is essential to minimizing morbidity and achieving definitive closure. However, a standardized approach is lacking. The aim of this study was to identify effective reconstructive interventions for the basis of an evidence-based management protocol. @*Methods@#A retrospective review was performed at a single tertiary institution for 45 patients who required 53 reconstruction procedures with plastic surgery for wounds secondary to spinal surgery from 2010 to 2019. Statistical analysis was performed for demographics, comorbidities, and treatment methods. Primary outcomes were postoperative complications, including dehiscence, seroma, and infection. The secondary outcome was time to healing. @*Results@#The overall complication rate was 32%, with dehiscence occurring in 17%, seroma in 15% and infection in 11% of cases. Median follow-up was 10 months (interquartile range, 4–23). Use of antibiotic beads did not affect rate of infection occurrence after wound closure (P=0.146). Use of incisional negative pressure wound therapy (iNPWT) was significant for reduced time to healing (P=0.001). Patients treated without iNPWT healed at median of 67.5 days while the patients who received iNPWT healed in 33 days. Demographics and comorbidities between these two groups were similar. @*Conclusions@#This data provides groundwork for an evidence-based approach to soft tissue reconstruction and management of dehiscence after spinal surgery. Timely involvement of plastic surgery in high-risk patients and utilization of evidence-based interventions such as iNPWT are essential for improving outcomes in this population.

Pathogenesis of minimal change nephrotic syndrome: an immunological concept / 소아과

Idiopathic nephrotic syndrome (INS) in children is characterized by massive proteinuria and hypoalbuminemia. Minimal change nephrotic syndrome (MCNS) is the most common form of INS in children. The pathogenesis of MCNS still remains unclear, however, several hypotheses have been recently proposed. For several decades, MCNS has been considered a T-cell disorder, which causes the impairment of the glomerular filtration barrier with the release of different circulating factors. Increased levels of several cytokines are also suggested. Recently, a "two-hit" theory was proposed that included the induction of CD80 (B7-1) and regulatory T-cell (Treg) dysfunction, with or without impaired autoregulatory functions of the podocyte. In contrast to the well-established involvement of T cells, the role of B cells has not been clearly identified. However, B-cell biology has recently gained more attention, because rituximab (a monoclonal antibody directed against CD20-bearing cells) demonstrated a very good therapeutic response in the treatment of childhood and adult MCNS. Here, we discuss recent insights into the pathogenesis of MCNS in children.

Epidemiological evaluation and outcome of pure abdominal trauma victims who underwent surgical exploratory laparotomy

Objective: The aim of this study was to evaluate the epidemiological profile, surgical treatment, andoutcome of patients suffering from pure abdominal injuries who underwent exploratory laparotomy in the emergency department of Aswan University Hospital, Egypt

Patients and methods: This was an evaluation and assessment of observational and descriptive study with prospective approach through interviews of 80 patients with pure abdominal trauma who were subjected to surgical treatment in the form of exploratory laparotomy and evaluation of their medical records

Results: The most affected individuals were male patients younger than 49 years, most of them withlow educational level and single. There was a predominance of trauma in the rural areasthat mostly occurred at night time and evening. Blunt trauma was the most common type of abdominal trauma, and road traffic accidents were the most frequent mechanism of trauma.The upper abdomen was the most affected region. Pain was the most common presenting symptom, and the spleen was the most affected organ. The hospital stay ranged from 1 to11 days. Most patients were discharged with permanent sequelae; there were six deaths

Conclusion: Blunt trauma was the most common type of abdominal injury. Road traffic accidents were themost common mechanism of blunt trauma, and stab wounds were the most common type of penetrating injuries. A number of risk factors were identified in this study, which include the type of abdominal trauma, presence of chronic diseases, delay in early transport from the siteof trauma to the emergency department, and age of patient. Despite the magnitude of traumas,the outcome was satisfactory

Effects of Interleukin-13 and Montelukast on the Expression of Zonula Occludens-1 in Human Podocytes

PURPOSE: The aim of this study was to investigate whether pathologic changes in zonula occludens-1 (ZO-1) are induced by interleukin-13 (IL-13) in the experimental minimal-change nephrotic syndrome (MCNS) model and to determine whether montelukast, a leukotriene receptor antagonist, has an effect on ZO-1 restoration in cultured human podocytes. MATERIALS AND METHODS: Human podocytes cultured on bovine serum albumin-coated plates were treated with different doses of IL-13 and montelukast and then examined for distribution using confocal microscopy and for ZO-1 protein levels using Western blotting. RESULTS: ZO-1 was internalized and shown to accumulate in the cytoplasm of human podocytes in an IL-13 dose-dependent manner. High doses (50 and 100 ng/mL) of IL-13 decreased the levels of ZO-1 protein at 12 and 24 h (both p<0.01; n=3), which were significantly reversed by a high dose (0.5 microM) montelukast treatment (p<0.01; n=3). CONCLUSION: Our results suggest that IL-13 alters the expression of ZO-1, and such alterations in the content and distribution of ZO-1 may be relevant in the pathogenesis of proteinuria in the MCNS model.

Effects of Interleukin-13 and Montelukast on the Expression of Zonula Occludens-1 in Human Podocytes

PURPOSE: The aim of this study was to investigate whether pathologic changes in zonula occludens-1 (ZO-1) are induced by interleukin-13 (IL-13) in the experimental minimal-change nephrotic syndrome (MCNS) model and to determine whether montelukast, a leukotriene receptor antagonist, has an effect on ZO-1 restoration in cultured human podocytes. MATERIALS AND METHODS: Human podocytes cultured on bovine serum albumin-coated plates were treated with different doses of IL-13 and montelukast and then examined for distribution using confocal microscopy and for ZO-1 protein levels using Western blotting. RESULTS: ZO-1 was internalized and shown to accumulate in the cytoplasm of human podocytes in an IL-13 dose-dependent manner. High doses (50 and 100 ng/mL) of IL-13 decreased the levels of ZO-1 protein at 12 and 24 h (both p<0.01; n=3), which were significantly reversed by a high dose (0.5 microM) montelukast treatment (p<0.01; n=3). CONCLUSION: Our results suggest that IL-13 alters the expression of ZO-1, and such alterations in the content and distribution of ZO-1 may be relevant in the pathogenesis of proteinuria in the MCNS model.

Current concepts of the podocyte in nephrotic syndrome

Nephrotic syndrome is a disorder of the glomerular filtration barrier, and central to the filtration mechanism of the glomerular filtration barrier is the podocyte. We are starting to better understand how this cell, with its unique architectural features, fulfils its exact filtration properties. The multiprotein complex between adjacent podocyte foot processes, the slit diaphragm, is essential to the control of the actin cytoskeleton and cell morphology. Many of the proteins within the slit diaphragm, including nephrin, podocin, transient receptor potential-6 channel, and alpha-actinin-4, have been identified via genetic studies of inherited nephrotic syndromes. Signaling from slit diaphragm proteins to the actin cytoskeleton is mediated via the Rho GTPases. These are thought to be involved in the control of podocyte motility, which has been postulated as a focus of proteinuric pathways. Nephrotic syndrome is currently treated with immunosuppressive therapy, with significant adverse effects. These therapies may work in nephrotic syndrome due to specific effects on the podocytes. This review aims to describe our current understanding of the cellular pathways and molecules within the podocyte relevant to nephrotic syndrome and its treatment. With our current knowledge of the cellular biology of the podocyte, there is much hope for targeted therapies for nephrotic syndromes.

Halophilic (aerobic) bacterial growth rate of mangrove ecosystem.

Mangroves are woody specialized trees of tropics and are valuable flora contributing to economical, ecological, scientific and cultural resources. They thrive in salty environments like coastal regions and are aid towards disaster management facing the onslaught of giant waves such as Tsunami. Analysis of mangrove soil on the banks of the Adyar river, behind the Theosophical society campus, Adyar, Chennai, India, gave a startling revelation of microorganisms that can tolerate different salinity ranges. Previous studies in Pichavaram delta, have reported bacterial isolates such as nitrogen fixing bacteria, halophiles and several others. However their efficiency in the growth of mangrove forest has been studied to a lesser extent. The present study has been designed and formulated to estimate halophilic(aerobic) bacterial load from mangroves soil sample based on depth and salinity of the soil and further the efficiency if any of these isolates in the growth of mangroves. Results have been correlated and a cohesive conclusion reached for further intensive research. This study throws light on the ecology of the bacterial population in the coastal marine environment inhabited by mangroves and its possible role in disaster mitigation.

Outcomes of laparoscopic cholecystectomy during the first admission of acute biliary pancreatitis

Biliary stones are the leading cause of acute pancreatitis. Although cholecystectomy and selective endoscopic retrograde cholangiography [ERC] comprise the current treatment in patients with acute biliary pancreatitis [ABP], the time of intervention is still controversial. The aim of the study is to evaluate the policy of laparoscopic cholecystectomy for patients with ABP during the initial admission. The study was carried out in the period November 2004- October 2006. Thirty patients with ABP were subjected to laparoscopic cholecystectomy during the index admission after clinical and biochemical resolution of the attack. The severity of the disease was assessed using Ranson' criteria; 3 or less indicates mild pancreatitis, while more than 3 is considered severe pancreatitis. ERC and endoscopic sphincterotomy [ES] are used on a selective basis pre- and post-operatively. Standard 4- ports technique was used; timing for surgery, operative difficulty, conversion rate, post-operative morbidity and mortality were evaluated. A total of 30 patients with the diagnosis of ABP were included in this study. Twenty-five patients [83.3%] were categorized as having mild pancreatitis [Ranson' criteria 3]. All patients were managed conservatively and underwent laparoscopic cholecystectomy after clinical and biochemical resolution of the attack on the same hospital admission. The time from admission to the operating room ranged from 3-8 days [median 5.1] in mild pancreatitis, while in severe pancreatitis; it ranged from 7-28 days [median 20.2]. ERC and ES were performed on selective basis for 6 patients pre-operatively and in 2 patients post-operatively [26.6%]. Magnetic resonance cholangiopancreatography [MRCP] was also done on selective basis to clear the anatomy of the region of ampulla of Vater in 4 patients [13.3%] for whom ultrasound [US] was not decisive. Laparoscopic cholecystectomy was feasible in spite of edema, inflammation and adhesion. The rates of conversion, morbidity and mortality were 6.6%, 33.3% and 3.3%, respectively. Definitive treatment of ABP can be accomplished effectively and safely by cholecystectomy following clinical and biochemical improvement with acceptable morbidity and mortality during the same admission

Community-based screening for pre-hypertension among military active duty personnel

The majority of hypertension cases are asymptomatic and, therefore, goes unrecognized and untreated, leading to a high risk of coronary artery diseases, heart failure, renal failure, and cardiovascular diseases. The purpose of this study was to determine the prevalence of both pre-hypertension and hypertension and risk factors associated with newly diagnosed Saudi military active duty service personnel. Community-based screening of 1238 Saudi military active duty service personnel was conducted during the period September - December 2007 at six randomly selected out of a total of 15 military units of Taif region, Western of Saudi Arabia. Screening tools included self-administrated questionnaire, general physical examination, anthropometric measurements, and assessment of blood pressure. All participants were Saudi males. Their age ranged from 19-56 years old with mean +/- SD of 37.2 +/- 7.02. By applying the Joint National Committee on prevention, detection, evaluation, and treatment of high hypertension [JNC-7] criteria, 214 [17.3%] were considered pre-hypertensive. Multivariate logistic regression analysis showed that obesity as measured by body mass index [OR=2.71, Cl:1.39-5.28], positive family history [OR=1.46, Cl:1.03-2.06], ever smoking [OR=1.45, Cl:1.05-2.02], and increased waist circumference [OR=1.04, Cl:1.02-1.06] were the significant predictors of workplace newly diagnosed hypertension among military active duty personnel. Pre-hypertension is a common hidden problem and it predicts the development of frank hypertension. Findings of the current study support the recommendation of lifestyle modification for pre-hypertension patients. However, further prospective studied are required to determine the role of pharmacotherapy in pre-hypertension

Human leukocyte antigen typing in Iraqi multiple sclerosis patients

To assess the relative frequency of human leukocyte antigen [HLA] class I and class II in Iraqi multiple sclerosis [MS] patients, and to ascertain whether they offer any etiologic or protective role. We conducted this study in the Baghdad MS Clinic and Teaching Laboratory Institute, Medical City, Baghdad Teaching Hospital, Baghdad, Iraq from March to July 2004. We enrolled 44 randomly selected MS patients and 69 healthy unrelated age- and sex-matched controls. We carried out HLA class I and class II typing on both groups using the microlymphocytotoxicity test. The HLA class I typing revealed no consistent association between MS and HLA-A and -Cw, while HLA-B5 and -B44 were found to possibly be risk factors for MS with odds ratio [OR] of 10.2 for -B5 and 4.4 for -B44. The HLA-B35 may form a protective factor with OR of 0.1. The HLA class II typing revealed an etiologic risk for HLA-DR4 [OR=10.3] and a protective effect for HLA-DR2 [OR=0.3] and -DR7 [OR=0.2], and etiologic effect for -DQ1 [OR=3.3] and -DQ3 [OR=3]. The HLA DR4 carries the strongest association with MS in Iraqi patients. This study adds to the well-known diversity of HLA-allelic association of MS in different populations, and emphasizes the complexity of genetic susceptibility to MS

Relationship of ABO blood group in patients with oral cancers

Present study was designed to find the association of ABO blood groups with oral cancers. In this study 50 diagnosed cases of oral cancers and 50 healthy controls were selected. ABO blood grouping, complete blood examination was performed in all these subjects. Out of 50 patients 16 were blood group A, 11 group 'B', 8 group 'AB' and 15 belong to group 'O' as compared to controls who were, 14, 15, 3, 18 for blood groups A, B, AB and O respectively. Conclusions: No relationship is found between Oral Cancers and ABO Blood groups

Complications of streptokinase during infusion in acute myocardial infarction

Myocardial infarction is one of the most common causes of death worldwide. The cornerstone of therapy is thrombolytic therapy. Coronary thrombolysis helps restore coronary patency, preserves left ventricular function and improves survival. The most common thrombolytic agent used is streptokinase. But thrombolytic therapy is at times associated with some complications. This comparative study was aimed to find out the complications occurring during streptokinase infusion in patients presenting with acute myocardial infarction in Mayo Hospital, Lahore. Two hundred patients with definite diagnosis of acute myocardial infraction, who presented to East Medical Ward, Mayo Hospital, Lahore, were included in this study. All patients presenting with AMI were considered for SK therapy. Those who were actually given SK constituted the SK group and those who were not fit for SK, but otherwise SK was indicated, constituted the control group. In SK group 100 patients were given standard t reatment of acute myocardial infarction including streptokinase. In control group 100 patients were given standard treatment of acute myocardial infarction except streptokinase due to non-eligibility. Patients with typical chest pain of at least 30 minutes duration, serial ECG changes and serial cardiac enzyme changes were entered in the study. Comparative / interventional Post SK changes in blood pressure were significant [p= 0.011]. There was post SK hypotension in 48 [24%] and post SK hypertension in 20 [10%] patients. Allergic reaction was present in 4 [2%] only [p=0.044]. Arrhythmias were significantly less prominent in SK group [p=0.000]. Post SK bleeding occurred in 3 [1.5%] only [p=0.082]. 37 patients died [18.5%] in total, out of which 5 [2.55] patients died in SK group and 32 in control group [p=0.000]. CVA occurred in 1 SK group patient only, which was found to be hemorrhagic on CT scan [p= 0.31]. Early administration of SK lowers in-hospital mortality [p= 0.00 0]. Major complications during SK therapy are Hypotension [p= 0.011], Arrhythmias [p= 0.000], Allergic reactions [p= 0.044]

Frequency of atrial fibrillation in mitral stenosis and its correlation with left atrial size

Chronic rheumatic heart disease is much the commonest cause of mitral stenosis. Incidence of rheumatic MS parallels that of acute rheumatic fever. Atrial fibrillation usually develops in the presence of pre-existing ECG evidence of left atrial enlargement and is related to the size of the chamber, the extend of fibrosis of the left atrial myocardium, the duration of the atriomegaly and the age of the patient. Descriptive. Mayo Hospital, Lahore and Punjab Institute of Cardiology, Lahore. Convenient. 129 consecutive cases of predominant mitral stenosis. 112 cases included in the final workup. The frequency of AF in MS in this study was calculated as 25.9%. The correlation between AF and left atrial size was significant [p = 0.000]. This was plotted on the scattergram [Figure No. 1], which shows a steep rise in the frequency of AF beyond a left atrial size of 70 mm. Frequency of AF in patients with MS is 25.9%. The correlation between AF in MS and left atrial size is significant [p = 0.000]

Relationship of secretor status in patients with oral cancers

Present study was designed to find the association of secretor status with oral cancers. In this study 50 diagnosed cases of oral cancers and 50 healthy controls were selected. Secretor status on saliva sample was performed in all these subjects. 39 [78%] subjects were secretors and 11 [22%] were non secretors in control group. 28 [56%] patients with oral cancers were secretors and 22 [44%] were non secretors. Oral cancer was found to be associated with non-secretor status