Oral hygiene for improving surgical outcomes: A systematic review and meta-analysis

INTRODUCTION@#Nosocomial infections such as surgical site infections (SSI) and postoperative pneumonia significantly contribute to a patient’s morbidity and mortality. This systematic review and meta-analysis evaluate the effectiveness of oral hygiene programs in reducing the incidence of nosocomial infections and related postoperative complications among all surgical patients. @*METHODS@#The systematic review and meta-analysis were conducted in line with the Cochrane Handbook for Systematic Reviews of Interventions. Medline and the Cochrane controlled trials (CENTRAL) databases were searched. Two review authors independently selected the trials and extracted the outcome data. The risk of bias of each included study was assessed independently by two review authors using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis was performed when more than one trial reported the same outcome for the same comparison. @*RESULTS@#29 systematic reviews and 59 randomized controlled trials were included in the review. Thirty-two trials compared chlorhexidine with placebo, 7 trials povidone iodine with placebo, 7 trials topical antibiotics with placebo, 1 trial essential oils with placebo, 3 trials other agents with placebo, and 5 trials toothbrushing with no toothbrushing. Five trials compared one agent with another agent, and 1 trial compared dosings and frequencies of chlorhexidine use. Chlorhexidine was associated with a reduced risk of nosocomial infection, nosocomial pneumonia, ventilator-associated pneumonia (VAP), and shorter hosptial stay, and no significant impact on surgical site infection rates, ventilator days and mortality. Povidone iodine did not show any significant benefit on reducing VAP rates, ventilator days, ICU days, or mortality when compared against placebo. Hexetidine,when compared with placebo showed similar incidences of VAP. Topical oral antibiotics did not provide significant reduction on VAP rates, ventilator days, ICU days and mortality rates, compared with placebo.@*CONCLUSION@#Oral hygiene offers benefits in terms of lower rates of nosocomial infection, nosocomial pneumonia, ventilator-associated pneumonia, surgical site infection, shorter ICU stay, less ventilator days and lower oral colonization / colony counts.

Ten-year review of patients with resected esophagogastric junction adenocarcinoma in the Philippine General Hospital

OBJECTIVE@#To describe the clinicopathologic profile, management, and outcomes of patients with esophagogastric junction (EGJ) adenocarcinoma in the local setting.@*METHODS@#Data was obtained from patients who had curative surgery for EGJ adenocarcinoma from 2004–2013 in the Philippine General Hospital. We used student's T-tests, analysis of variance, chi-squared and Fisher’s exact tests for comparisons and Cohen’s kappa index for correlation. A P value of less than or equal to 0.05 was considered significant.@*RESULTS@#We included 88 patients (81.2% male) with mean age of 55.2 years. Eight percent were clinical Siewert type I; 23.9% were type II; 15.9% were type III; and majority (52.3%) were unknown type. Surgical approach and resection differed across the Siewert types (P<0.000). Thoracoabdominal approach (72.7%) and distal esophagectomy with total gastrectomy (77.3%) were the most common procedures. Many had at least pathologic T3 (80.6%), N2 (54.5%), and stage III (68.2%) disease. Neoadjuvant and adjuvant chemotherapy was given in 1.2% (1/82) and 48.6% (18/37), respectively. In-hospital morbidity was 40%; mortality was 4.5%; 1-year disease-free survival rate was 69.4%; and overall survival rate was 76.5%. Correlation was fair between preoperative and pathologic Siewert type (P=0.003) and poor between clinical and pathologic stage (P=0.115). Patients with recurrence had higher pathologic lymph nodes (P=0.029) and more advanced stage (P=0.022).@*CONCLUSION@#EGJ adenocarcinomas were locally advanced and had poor outcomes. Surgery should be individualized and multimodality approach considered.

Bile acid homeostasis in female mice deficient in

Bile acids (BAs) are amphipathic molecules important for metabolism of cholesterol, absorption of lipids and lipid soluble vitamins, bile flow, and regulation of gut microbiome. There are over 30 different BA species known to exist in humans and mice, which are endogenous modulators of at least 6 different membrane or nuclear receptors. This diversity of ligands and receptors play important roles in health and disease; however, the full functions of each individual BA