Factors associated with increased lactate levels in cardiac surgeries: scoping review / Factores relacionados a la elevación del nivel de lactato en cirugías cardíacas: revisión de ámbito / Fatores associados à elevação do nível de lactato em cirurgias cardíacas: revisão de escopo

ABSTRACT Objectives: to map the factors associated with increased lactate levels in the postoperative period of cardiac surgery using extracorporeal circulation. Methods: this is a scoping review carried out in December 2022, across ten data sources. It was prepared in accordance with the recommendations of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta Analyses Extension for Scoping Reviews checklist. Results: the most recurrent findings in studies regarding the factors responsible for the increase in lactate were: tissue hypoperfusion, cardiopulmonary bypass time and use of vasoactive drugs. In 95% of studies, increased lactate was related to increased patient mortality. Conclusions: discussing the causes of possible complications in cardiac surgery patients is important for preparing the team and preventing complications, in addition to ensuring quality recovery.

RESUMEN Objetivos: mapear los factores relacionados a la elevación del nivel de lactato en el posoperatorio de cirugía cardíaca con uso de circulación extracorporea. Métodos: se trata de una revisión de ámbito realizada en diciembre de 2022, en diez fuentes de datos. Fue elaborada conforme las recomendaciones del Instituto Joanna Briggs y del checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Resultados: los hallados más recurrentes en los estudios sobre los factores responsables por el aumento del lactato fueron: hipoperfusión tisular, tiempo de circulación extracorporea y uso de fármacos vasoactivos. En 95% de los estudios, el aumento del lactato se relacionó al aumento de la mortalidad de los pacientes. Conclusiones: discutir sobre las causas de posibles complicaciones en pacientes de cirugía cardíaca se hace importante para el preparo del equipo y prevención de intercurrencias, además garantizar recuperación de calidad.

RESUMO Objetivos: mapear os fatores associados à elevação do nível de lactato no pós-operatório de cirurgia cardíaca com uso de circulação extracorpórea. Métodos: trata-se de uma revisão de escopo realizada em dezembro de 2022, em dez fontes de dados. Foi elaborada conforme as recomendações do Instituto Joanna Briggs e do checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Resultados: os achados mais recorrentes nos estudos a respeito dos fatores responsáveis pelo aumento do lactato foram: hipoperfusão tecidual, tempo de circulação extracorpórea e uso de fármacos vasoativos. Em 95% dos estudos, o aumento do lactato relacionou-se ao aumento da mortalidade dos pacientes. Conclusões: discutir sobre as causas de possíveis complicações em pacientes de cirurgia cardíaca faz-se importante para o preparo da equipe e prevenção de intercorrências, além de garantir recuperação de qualidade.

A Structured Pre- and Post-Operative Voice Therapy Program for Benign Vocal Fold Lesions

Benign vocal fold lesions (BVFLs) are acquired structural anomalies of the vocal folds, and these are primarily a result of vocal abuse or phonotrauma. Phonotraumatic lesions are not generally regarded as recurrent, provided that appropriate behavioral changes are made after resolution or surgical removal. Voice therapy plays a crucial role in this aspect. The aim of this article is to propose a structured pre- and post-operative voice therapy program for patients undergoing surgical intervention for BVFLs. Voice therapy post-surgery has been proven to reduce the rate of recurrence in BVFLs. Having a standard treatment protocol is a useful tool for the therapist, particularly one without extensive voice training.

Las lesiones benignas de los pliegues vocales (LBPV) son anomalías estructurales adquiridas de los pliegues vocales, y son principalmente el resultado de un abuso vocal o fonotrauma. Las lesiones fonotraumáticas generalmente no se consideran recurrentes, siempre que se realicen cambios apropiados en el comportamiento después de la resolución o la excisión quirúrgica. La terapia vocal juega un papel crucial en este aspecto. El objetivo de este artículo es proponer un programa estructurado de terapia de voz pre y postoperatorio para pacientes que son expuestos a una intervención quirúrgica para LBPV. Se ha demostrado que la terapia de voz después de la cirugía reduce la tasa de recurrencia en LBPV. Tener un protocolo de tratamiento estándar es una herramienta útil para el terapeuta, particularmente uno sin un entrenamiento extenso en patología de la voz.

Prescription audit in post-operative patients of Dr. B. R. Ambedkar Medical College and Hospital, Bengaluru

Background: Prescribing drugs are an important skill which needs to be continuously assessed and refined accordingly. Many drugs especially antimicrobials and fixed dose combinations that maybe irrational are being prescribed. Hence, this study was undertaken to analyze the rational prescribing guidelines in post-operative patients which will help doctors to update their knowledge and improve their attitude toward selecting cost effective treatment. Aim and Objectives: The aims of this study were as follows: (i) To evaluate prevailing prescription trends and (ii) to evaluate rationality of prescriptions in post-operative cases of surgery, orthopedics, obstetrics, and gynecology (OBG), and Otorhinolaryngology (ORL) departments. Materials and Methods: A prospective observational study was conducted in post-operative wards of departments of surgery, orthopedics, ORL, and OBG of Dr. B. R. Ambedkar Medical College and Hospital, Bengaluru. The study duration was 15 months from December 2018 to March 2020 with a sample size of 2000. Results: In the present study, female preponderance (54.4%) was seen. Majority of the drugs (77.3%) were prescribed under brand name. The most common group of drugs prescribed was non-steroidal anti-inflammatory drugs (135%) and the antibiotic was Cephalosporins (77.5%). As per the World Health Organization (WHO) core prescribing indicators, 6.25 were the average drugs per prescription. Conclusion: According to the WHO core prescribing indicators, polypharmacy was observed and prescribing by generic name was also less. However, there was no irrational use of antibiotics in post-operative cases in our study which reduces the chances of development of antibiotic resistance. Practice of prescribing drugs from the essential drugs list (EDL) was less. The study suggests incorporating educative initiative, development of drug policy, and an EDL-based hospital formulary to ensure rational use of medicines.

Inkk Trial - Intraoperative ketamine for perioperative pain management following total knee endoprosthetic replacement in oncology: a double-blinded randomized trial

Abstract Background There has been a growing interest in the use of ketamine following orthopedic surgeries. We hypothesized that low dose intravenous ketamine during surgery would help in mobilization following total knee replacement (TKR) in oncology patients as assessed by the timed to up and go (TUG) test at 72 hours post-surgery. Our secondary objectives were to compare the opioid requirement at the end of 72 hours, pain scores, satisfaction with pain management, adverse effects, range of joint movement achieved in the post-operative period and the functional recovery at the end of 1 month. Methods After the ethics commitee approval, registration of the trial with the Clinical Trial Registry - India (CTRI), and informed consent, this double-blinded trial was conducted. Using computer generated randomization chart, an independent team randomized the patients into ketamine group which received at induction, a ketamine bolus dose of 0.5 mg.kg-1 before the incision followed by 10 µg.kg-1min-1 infusion which was maintained intraoperatively till skin closure and the saline group received an equivalent volume of saline. Postoperatively, patient controlled morphine pumps were attached and the pain score with morphine usage were recorded for 72 hours. The TUG tests and range of motion were assessed by the physiotherapists until 72 hours. Results Fifty-two patients were enrolled in the trial. Demographics were comparable. No significant intraoperative hemodynamic changes and post-operative adverse events were noted between the groups. A decrease in the TUG test, along with decreased opioid usage with a better range of movements was noted in the ketamine group, but this was not statistically significant. Day of discharge, patient satisfaction score, and functional recovery assessed by Oxford Knee Score (OKS) were comparable between the groups. Conclusion In conclusion, low dose intraoperative ketamine infusion does not provide clinical benefit in perioperative pain management and postoperative rehabilitation following total knee endoprosthetic replacement in oncology.

Percepções de pacientes sobre recuperação cirúrgica retardada: validação do diagnóstico de enfermagem / Percepciones de pacientes sobre recuperación quirúrgica retardada: validación del diagnóstico de enfermería / Perceptions of patients on delayed surgical recovery: validation of the nursing diagnosis

RESUMO Objetivo: validar qualitativamente o diagnóstico de enfermagem Recuperação Cirúrgica Retardada, a partir das percepções de pacientes. Método: estudo qualitativo, realizado com 20 pacientes de hospital de referência com seis dias ou mais de pós-operatório. Realizou-se entrevista semiestruturada como técnica de coleta de dados e, para análise de dados, procedeu-se ao método da análise de conteúdo temática. Resultados: obtiveram três categorias: Descrição das características definidoras e fatores relacionados a partir do relato dos pacientes; Percepção sobre a recuperação cirúrgica; e Repercussões do retardo da recuperação cirúrgica na vida, na saúde e no bem-estar dos pacientes. Considerações finais: as percepções dos pacientes estiveram intimamente ligadas ao tempo de pós-operatório e prolongamento da internação, o que corrobora a definição do diagnóstico Recuperação Cirúrgica Retardada. Investigações qualitativas auxiliam na compreensão da experiência do paciente quanto ao fenômeno do diagnóstico e situa o cuidado centrado na pessoa. Pode, ainda, auxiliar no delineamento de intervenções de enfermagem assertivas para o alcance da recuperação plena.

RESUMEN Objetivo: validar cualitativamente el diagnóstico de enfermería Recuperación Quirúrgica Retardada, a partir de las percepciones de pacientes. Método: estudio cualitativo, realizado con 20 pacientes de hospital de referencia con seis días o más de postoperatorio. Se realizó entrevista semiestructurada como técnica de recolección de datos y, para análisis de datos, se procedió al método del análisis de contenido temático. Resultados: obtuvieron tres categorías: Descripción de las características definitorias y factores relacionados a partir del relato de los pacientes; Percepción sobre la recuperación quirúrgica; y Repercusiones del retardo de la recuperación quirúrgica en la vida, en la salud y en el bienestar de los pacientes. Consideraciones finales: las percepciones de los pacientes estuvieron íntimamente conectadas al tiempo de postoperatorio y la prolongación de la internación, lo que corrobora la definición del diagnóstico Recuperación Quirúrgica Retardada. Investigaciones cualitativas ayudan en la comprensión de la experiencia del paciente en cuanto al fenómeno del diagnóstico y ubican el cuidado centrado en la persona. Pueden, además, ayudar en la definición de intervenciones de enfermería asertivas para el alcance de la recuperación plena.

ABSTRACT Objective: to qualitatively validate the nursing diagnosis Delayed surgical recovery based on patients' perceptions. Method: a qualitative study was conducted with 20 patients from a reference hospital six days or more after surgery. A semi-structured interview was conducted as the data collection technique, and the thematic content analysis method was used for data analysis. Results: three categories were obtained: Description of the defining characteristics and related factors based on the patients' statements, Perception of surgical recovery, and Repercussions of delayed surgical recovery on the patients' lives, health, and well-being. Final considerations: the patients' perceptions were closely linked to the postoperative period and length of stay, which corroborates the definition of Delayed surgical recovery. Qualitative investigations help to understand the patient's experience regarding the diagnosis phenomenon and situate person-centered care. It can also help design assertive nursing interventions to achieve full recovery.

Application of ultrasound shear wave elastography in the prediction of clinically relevant post-operative pancreatic fistula after pancreatectomy: a prospective study / 中华超声影像学杂志

Objective:To quantitatively evaluate the stiffness of pancreatic parenchyma and lesions by virtual touch tissue imaging and quantification (VTIQ) technique, and to investigate the potential usefulness of ultrasound shear wave elastography (SWE) in the prediction of clinically relevant post-operative pancreatic fistula (CR-POPF) after pancreatectomy.Methods:Patients who scheduled to receive pancreatectomy were prospectively enrolled in Zhongshan Hospital, Fudan University from March 2021 to December 2021. VTIQ assessment was applied to patients within one week before the scheduled surgery to make quantitative SWE evaluation of target tissue. The SWV values of body part pancreatic parenchyma and lesions were measured and recorded. The palpation stiffness of pancreas was qualitatively evaluated during the operation by the surgeon.CR-POPF was diagnosed according to 2016 International Study Group of Pancreatic Fistula (ISGPF) standard.Grade B/C pancreatic fistula was defined as CR-POPF positive. Recognized peri-operative risk factors of CR-POPF were analyzed. ROC curve analysis was used to evaluate the diagnostic efficacy of SWV value in predicting CR-POPF.Results:A total of 72 patients were finally enrolled in this study, including 47 (65.3%, 47/72) patients who received pancreaticoduodenectomy (PD) and 25 (34.7%, 25/72) patients who underwent distal pancreatectomy. CR-POPF occurred in 22 (30.6%, 22/72) patients after pancreatectomy. The SWV value of body part pancreatic parenchyma was significant lower in CR-POPF positive group than in CR-POPF negative group ( P<0.001). There was no significant difference in lesion SWV value between CR-POPF positive and negative groups ( P=0.664). Besides, the palpation stiffness was no difference between the two groups ( P=0.689). Taking SWV value of pancreatic parenchyma >1.16 m/s as a cut-off value for predicting CR-POPF, the area under the ROC curve (AUROC) was 0.816 with 0.760 of sensitivity, 0.634 of specificity, 67.5% of positive predictive value and 72.5% of negative predictive value, respectively. Conclusions:The VTIQ method may improve the objectivity and accuracy of CR-POPF prediction via pre-operative, non-invasive and quantitative evaluation of pancreatic stiffness, which has potential value in clinical applications.

Analgesic effect and safety of using an epidural analgesia pump versus an intravenous analgesia pump for uterine artery embolization in the treatment of uterine fibroids / 中国基层医药

Objective:To investigate the analgesic effect and safety of using an epidural analgesia pump versus an intravenous analgesia pump for uterine artery embolization in the treatment of uterine fibroids. Methods:Fifty patients with uterine fibroids undergoing uterine artery embolization admitted to The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2019 to December 2021 were included in this study. They were divided into an observation group and a control group ( n = 25/group). Patients in the observation group used an epidural analgesia pump for pain relief, while patients in the control group used an intravenous analgesia pump for pain relief. At 1, 6, 12, and 24 hours after surgery, pain severity was compared between the two groups using the Visual Analogue Scale. Comfort level was compared between the two groups using the Bruggemann Comfort scale. Before and after surgery, respiratory rate, heart rate, blood pressure, and adverse reactions were compared between the two groups. Results:At 1 hour after surgery, the Visual Analogue Scale score in the observation group was significantly lower than that in the control group [3.00 (2.00, 5.50) vs. 7.00 (6.00, 8.00), Z = -3.84, P < 0.05]. At 6, 12, and 24 hours after surgery, there was a significant difference in the Visual Analogue Scale score between the two groups (all P > 0.05). Within 24 hours after surgery, the use of opioid analgesics in the observation group was less than that in the control group [16.00% (4/25) vs. 88.00% (22/25), χ2 = 25.96, P < 0.001]. At 1 hour after surgery, the Bruggemann Comfort Scale score in the observation group was significantly higher than that in the control group [0.00 (0.00, 0.50) vs. 0.00 (0.00, 0.00), Z = 2.08, P < 0.05]. At 6, 12, and 24 hours after surgery, there was no significant difference in the Bruggemann Comfort Scale score between the two groups (all P > 0.05). After surgery, heart rate was significantly decreased in each group compared with before surgery (both P < 0.05). There were no significant differences in respiratory rate and mean arterial pressure between the two groups before and after surgery (both P > 0.05). There were no significant differences in the incidences of postoperative nausea, vomiting, and fever between the two groups (all P > 0.05). Conclusion:The epidural analgesia pump used for uterine artery embolization in the treatment of uterine fibroids has a better analgesic effect and provides more comfort and is safer than the intravenous analgesia pump. The former is worthy of clinical promotion.

Study on the effect of ultrasound intermediate frequency acupoint drug guiding technology on the recovery of gastrointestinal function in patients undergoing lumbar spine surgery / 中国医师进修杂志

Objective:To observe the effects of ultrasound intermediate frequency acupoint targeted drug guiding technology on the recovery of gastrointestinal function and serum gastrin levels in elderly patients after lumbar spine surgery under general anesthesia.Methods:This study used prospective research methods.A total of 90 elderly patients undergoing lumbar spine surgery after general anesthesia in the orthopaedic ward of Beijing Geriatrics Hospital from June 2019 to June 2021 were randomly divided into blank control group, drug control group, and drug-guided treatment group, with 30 cases each group. After the operation, no intervention was given to the blank control group, the drug control group received oral mosapride citrate tablets, the drug-guided treatment group used the D patch to guide the medicine at the two acupoints of Zusanli and Zhongwan with ultrasound medium frequency guided medicine instrument for 1 week each. The serum gastrin levels of the patients in each group were detected 1 d before operation, 3 d after operation, and 1 week after operation, and the time of first exhaust and first defecation after operation were recorded.Results:The results showed that the level of serum gastrin preoperativein the three groups was not significantly different ( P>0.05). On the third day after operation, the levelof serum gastrin in the drug guide treatment group, drug control group and blank control group were lower than those at 1 d before operation: (66.51 ± 5.34) ng/L vs. (69.36 ± 6.50) ng/L, (58.34 ± 5.71) ng/L vs. (68.75 ± 5.13) ng/L, (55.76 ± 6.23) ng/L vs. (70.20 ± 6.71) ng/L, the differences were statistically significant ( P<0.05), and showed a decreasing trend in turn. Among them, the level of serum gastrin in the drug guide treatment group was higher than that in the drug control group and blank control group, the difference was statistically significant ( P<0.05). One week after operation, the level of serum gastrin in the three groups increased compared with the third day after operation ( P<0.05), and the drug guiding treatment group was higher than the drug control group and the blank control group: (72.38 ± 6.78) ng/L vs. (67.15 ± 6.27) ng/L, (63.52 ± 5.38) ng/L, the differences were statistically significant ( P<0.05). The time of first exhaust and defecation after the operation of the three groups of patients, the drug-guided treatment group was significantly shorter than the drug control group and the blank control group: (15.25 ± 3.10) h vs. (20.38 ± 4.21) h and (28.52 ± 3.69) h, (24.14 ± 3.53) h vs. (36.15 ± 3.54) h and (49.51 ± 4.37) h, the differences were statistically significant ( P<0.05). Conclusions:Ultrasound intermediate frequency acupoint drug guiding technology can increase the patient′s serum gastrin level and promote the recovery of gastrointestinal function in elderly patients with lumbar spine surgery after general anesthesia.

Clinical efficacy of neoadjuvant chemotherapy combined with radical surgery for elderly patients with locally advanced gastric cancer / 中华普通外科杂志

Objective:To evaluate the safety and feasibility of neoadjuvant chemotherapy (NACT) combined with radical surgery for elderly patients with locally advanced gastric cancer (LAGC).Methods:One hundred and fourty eight patients with LAGC after NACT and gastrectomy between 2012 and 2020 were retrospectively reviewed. They were divided into two groups: (1) <65 years old (111 cases) and (2) ≥65 years old (37 cases) and their clinicopathological and prognostic data were compared.Results:There was no significant difference between the two groups in the incidence of hematological complications such as anemia ( χ2=0.235, P=0.628), leukopenia ( χ2=0.613, P=0.434), neutropenia ( χ2=0.011, P=0.918) and thrombocytopenia ( χ2=0.253, P=0.615) and non-hematological complications such as nausea ( χ2=0.092, P=0.762), vomiting ( χ2=0.166, P=0.683), diarrhea ( χ2=0.015, P=0.902) and mucositis ( χ2=0.199, P=0.766) due to NACT. There were no statistical differences between the older patients and the younger in operation duration ( t=0.270, P=0.604), intraoperative bleeding ( t=1.140, P=0.250) and R 0 resection rate ( χ2=0.105, P=0.750). The incidence of postoperative complications was 25.2% and 37.8% in the younger patients and the olders ( χ2=2.172, P=0.141). Pleural effusion ( χ2=7.007, P=0.008) and pulmonary infection ( χ2=10.204, P=0.001) was significantly higher in the older patients than in the youngers. The 3-year progression-free survival rate ( t=0.494, P=0.482) and 3-year overall survival rate ( t=0.013, P=0.908) were comparable between the two groups. Conclusions:NACT combined with radical surgery is safe and effective in elderly patients with LAGC, except for higher perioperative pulmonary-related complications.

Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial / 中西医结合学报

BACKGROUND@#Treatment duration of wrist-ankle acupuncture (WAA) is uncertain for post-thyroidectomy pain relief.@*OBJECTIVE@#This study evaluated the effect of different WAA treatment duration on post-operative pain relief and other discomforts associated with thyroidectomy.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTION@#This randomized controlled trial was conducted at a single research site in Guangzhou, China. A total of 132 patients receiving thyroidectomy were randomly divided into the control group (sham WAA, 30 min) and three intervention groups (group 1: WAA, 30 min; group 2: WAA, 45 min; group 3: WAA, 60 min), with group allocation ratio of 1:1:1:1. Acupuncture was administered within 1 hour of leaving the operating room.@*OUTCOMES AND MEASURES@#Primary outcome was patients' pain at the surgical site assessed by visual analogue scale (VAS) at the moment after acupuncture treatment (post-intervention). Secondary outcomes included the patients' pain VAS scores at 6, 12, 24, 48 and 72 h after the thyroidectomy, the 40-item Quality of Recovery (QoR-40) score, the grade of post-operative nausea and vomiting (PONV), and the use of additional analgesic therapy.@*RESULTS@#The adjusted mean difference (AMD) in VAS scores from baseline to post-intervention in group 1 was -0.89 (95% confidence interval [CI], -1.02 to -0.76). The decrease in VAS score at post-intervention was statistically significant in group 1 compared to the control group (AMD, -0.43; 95% CI, -0.58 to -0.28; P < 0.001), and in groups 2 and 3 compared to group 1 (group 2 vs group 1: AMD, -0.65; 95% CI, -0.81 to -0.48; P < 0.001; group 3 vs group 1: AMD, -0.66; 95% CI, -0.86 to -0.47; P < 0.001). The VAS scores in the four groups converged beyond 24 h after the operation. Fewer patients in group 2 and group 3 experienced PONV in the first 24 h after operation. No statistical differences were measured in QoR-40 score and the number of patients with additional analgesic therapy.@*CONCLUSION@#Compared with the 30 min intervention, WAA treatment with longer needle retention time (45 or 60 min) had an advantage in pain relief within 6 h after surgery. WAA's analgesic effect lasted for 6-12 h post-operatively. Please cite this article as: Han XR, Yue W, Chen HC, He W, Luo JH, Chen SX, Liu N, Yang M. Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial. J Integr Med. 2023; 21(2): 168-175.

Application value of laparoscopic pancreatic tumor enucleation / 中华消化外科杂志

Objective:To investigate the application value of laparoscopic pancreatic tumor enucleation (LapEN).Methods:The retrospective and descriptive study was conducted. The clinical data of 47 patients who underwent LapEN in Second Hospital of Hebei Medical University from September 2016 to June 2022 were collected. There were 18 males and 29 females, aged (49±12)years. Observa-tion indicators: (1) surgical situations; (2) postoperative complications; (3) postoperative recovery; (4) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers. Results:(1) Surgical situations. All 47 patients underwent LapEN successfully, with the operation time as (135±19)minutes and the volume of intraoperative blood loss as 100(50,100)mL. (2) Postoperative complications. Of the 47 patients, there were 12 patients with postoperative pancreatic fistula, 3 patients with postoperative abdominal infection, 1 case with postoperative hemorrhage, 1 case with postoperative gastric emptying disorder. (3) Postoperative recovery. Of the 47 patients, there were 13 cases with pancreatic solid pseudopapillary neoplasm, 12 cases with insulinoma, 11 cases with pancreatic serous cystadenoma, 7 cases with pancreatic intraductal papillary mucinous neoplasm (branched type), 4 cases with pancreatic mucinous cyst-adenoma. The tumor diameter of 47 patients was 1.9(1.6,2.3)cm and all patients with R 0 resection. There was no patient with perioperative death in the 47 patients. The postoperative duration of hospital stay and total hospital expenses of 47 patients was (13±4)days and (6.8±1.2) ten thousand yuan, respectively. (4) Follow-up. All 47 patients were followed up for 14(range, 8?18)months. None of the 47 patients had new onset diabetes or situations required postoperative exocrine replacement therapy, and no patient died. Conclusion:LapEN is safe and feasible for patients with pancreatic benign tumor or low potential malignancy.

Urological, vascular, and infectious implications of kidney transplant: a single-center experience / Complicaciones urológicas, vasculares e infecciosas del trasplante renal: experiencia en un solo centro

Introduction: Kidney transplant has improved in the last decades due to new technologies and surgical techniques. However, there are still multiple complications associated with this procedure, which can affect the function and viability of the kidney graft. Our aim was to describe the incidence of urological, vascular, and infectious complications in the 1st month after the procedure. Methods: A cross-sectional and retrospective study was carried out. Records of all patients who underwent kidney transplant from 2007 to 2017 were reviewed and data of demographic and surgical variables as well as information of vascular, urological, and infectious complications during the 1st post-operative month were registered and analyzed. Results: A total of 243 patients that required kidney transplant were assessed. The most common chronic kidney disease etiologies were: idiopathic (25.5%), glomerulopathies (24.7%), and hypertension (23.5%). Seventy patients (28.8%) presented a complication, of which 31 were urological, 27 were infectious, and 12 were vascular. In each category, the most frequent complications were the perirenal hematoma, the urinary tract infection, and renal artery stenosis, respectively. Conclusions: The prevalence of complications found in our center is similar to that reported in the literature and it is significant. It is important for medical personnel to be aware of this data to have a high level of suspicion and make an active search, as an early diagnosis and treatment of these pathologies are crucial to avoid graft loss

Introducción: El trasplante renal ha mejorado en las últimas décadas gracias a las nuevas tecnologías y técnicas quirúrgicas. Sin embargo, aún existen múltiples complicaciones asociadas a este procedimiento, que pueden afectar la función y viabilidad del injerto renal. Nuestro objetivo fue describir la incidencia de complicaciones urológicas, vasculares e infecciosas en el primer mes tras el procedimiento. Métodos: Se realizó un estudio retrospectivo de corte transversal. Se revisaron los expedientes de todos los pacientes que se sometieron a trasplante renal desde 2007 hasta 2017 y se registraron y analizaron datos de variables demográficas y quirúrgicas, así como información de complicaciones vasculares, urológicas e infecciosas durante el primer mes postoperatorio. Resultados: Se evaluaron un total de 243 pacientes que requirieron trasplante renal. Las etiologías de enfermedad renal crónica (ERC) más frecuentes fueron: idiopática (25,5%), glomerulopatías (24,7%) e hipertensión arterial (23,5%). 70 pacientes (28,8%) presentaron alguna complicación, de los cuales 31 fueron urológicos, 27 infecciosos y 12 vasculares. En cada categoría las complicaciones más frecuentes fueron el hematoma perirrenal, la infección del tracto urinario y la estenosis de la arteria renal respectivamente. Conclusiones: La prevalencia de complicaciones encontrada en nuestro centro es similar a la reportada en la literatura y es significativa. Es importante que el personal médico conozca estos datos para tener un alto nivel de sospecha y realizar una búsqueda activa, ya que el diagnóstico y tratamiento precoz de estas patologías es fundamental para evitar la pérdida del injerto.

A COMPARATIVE STUDY BETWEEN CAUDAL ROPIVACAINE AND ROPIVACAINE PLUS DEXAMETHASONE FOR INFRAUMBILICAL SURGERY IN PEDIATRIC PATIENTS

Background: Caudal block is one of the most popular regional block in children with high success rate for infra-umbilical surgeries. Among local anaesthetics ropivacaine provides a greater margin of safety, less motor blockade, less neurological and cardiac toxicity and similar duration of analgesia compared to bupivacaine. Addition of dexamethasone as an additive to local anesthesia decreases the postoperative rescue analgesia consumption.This study was designed to compare the effectiveness of intra-operative and postoperative analgesia on adding dexamethasone to 0.15% ropivacaine with 0.15%ropvacaine given alone. A prospective double blinded Materials: randomised controlled study was conducted consisting of 60 patients undergoing infra-umbilical surgeries under general anesthesia with Caudal block. Patients were randomised into two groups. Group A received 0.15% Inj.ropivacaine 1.5ml/kg with 1ml normal saline and Group B received 0.15% Inj.Ropivacaine 1.5ml/kg with 0.1mg/kg Inj.dexamethasone in caudal block Mean FLACC pain score was comparable and statistically not signi?cant (P=0.083) in both groups upto 30min Results: postoperatively. At 60min mean pain score in group A was 0.30 ± 0.54 and in group B was 0 (P=0.005) which was statistically signi?cant. In group A 40%(12) patients required rescue analgesia whereas in group B only 10%(3) patients required analgesia(P= 0.007) Patients remained hemodynamically stable throughout the procedure. After 60min Conclusion: postoperatively FLACC score was signi?cantly higher in group A as compared to group B. It concludes that addition of dexamethasone signi?cantly reduced postoperative pain and need for rescue analgesia without any side effects.

Pattern of analgesic use for post-operative pain relief among adult surgical patients in a tertiary care hospital

Background: Post-operative pain is an acute pain which if not adequately managed may lead to morbidity and complications. It can be controlled effectively by analgesics. It is essential to choose an analgesic with good efficacy and safety profile to avoid drug-related complications. Aims and Objectives: This study aims (i) to study the pattern of analgesic use for postoperative pain; (ii) to study the efficacy of the analgesic prescribed for post-operative pain; and (iii) to study the safety of the analgesics used for post-operative pain. Materials and Methods: A prospective observational study was conducted for 3 months period. The pattern of analgesic use for post-operative pain was studied in 110 patients. The influence of sociodemographic factors, surgery related factors on pain assessment score, and patient satisfaction score was assessed. The safety profile of analgesics used was studied. Results: Post-operative was seen equally in both the genders and mean age of patients was 41 years. Diclofenac was the most common analgesic prescribed and intramuscular route was most commonly used. About 64% of patients were satisfied with their treatment and 94.55% of patients did not encounter any adverse effects. However, there was no association between various factors and pain assessment score and patient satisfaction score. Conclusion: Post-operative pain can be effectively managed by non-opioid analgesics like diclofenac which provide cost-effective treatment. Analgesic for post-operative pain should be chosen judiciously by considering patient-related and surgery-related factors for better post-operative pain management and to prevent post-operative complications.

Evaluation of cautery in manual small-incision cataract surgery

Purpose: Manual small-incision cataract surgery (MSICS) has a major role in tackling cataract blindness in our country. Cauterization of sclera is one of the important steps performed in MSICS to have bloodless field during surgery. Only few studies have addressed the effect of cautery on post?operative astigmatism. The present study is designed to evaluate the effect of cautery on surgically induced astigmatism in Indian patients. Methods: The study was designed as a prospective randomized trial conducted in a tertiary health care institution over a period of 2 years. A total of 150 eyes were randomized into two groups. The study group (Group 1, n = 75) underwent MSICS with cauterization using wetfield bipolar cautery with 4 amperes power. In the control group (Group 2, n = 75), no cauterization was performed. Surgically induced astigmatism was calculated using Naesers polar value method and compared between these two groups up to 60 days post?operatively. Results: Data from 150 eyes were available for evaluation. The net post?operative astigmatic value was 1.01 � 0.21, 1.04 � 0.19, and 1.03 � 0.22 D on the 1st, 7th, and 30th post?operative days, respectively, showing a stable trend in patients undergoing cauterization. In Group 2, the net post?operative astigmatic values observed were 0.47 � 0.11 D, 0.54 � 0.10, and 0.54 � 0.09 D on the 1st, 7th, and 30th post-operative days, respectively. The mean value of surgically induced astigmatism at 2 months post?operatively with and without cautery was 0.60 � 0.20 D at 90� and 0.47 � 0.10 D at 90�. The difference was not statistically significant (P = 0.08). Conclusion: The results of this study show that the use of cautery in MSICS is not associated with a higher surgically induced post?operative astigmatism. The magnitude of surgically induced astigmatism decreases with time.

A drug utilization study in post-operative patients of obstetrics and gynecology of a tertiary care teaching hospital

Background: After any kind of surgery, many drugs are prescribed for prevention of infection, analgesic purpose, nausea, vomiting, gastritis and to maintain the hemodynamic status. Drug utilization studies are conducted for a variety of reasons, including consumption, off-label use, medication errors, misuse, and treatment dynamics. It is done to identify the problems associated and help the prescribers to optimize resource allocation and utilization. Aim and Objectives: This study was conducted with the objective to reconnoiter the utilization pattern of various medications in obstetrics and gynecological post-operative cases for assessment of various medications prescribed, their route of administration, their duration of use, and the World Health Organization (WHO) core drug indicators. Materials and Methods: This was a Prospective Observational study conducted after obtaining approval from the Institutional Ethics Committee. Data were collected from patients case sheets during the period of April 2019 to June 2019, in the post-operative wards of obstetrics and gynecology department using a structured pro forma. Results: A total of 100 patients were prescribed with different medications such as antimicrobials, analgesics antacids, with an average of 7.48 drugs per encounter. Injectable drug encounters was up to 92 %. Antimicrobials were prescribed upto 88 %) and the most common being metronidazole which was prescribed to 80% of patients. The most common analgesic prescribed was diclofenac for 73% of patients. Out of 41 different types of drugs prescribed, 45 (45%) were prescribed by their generic name and 91 (91%) were from the Essential Medicines WHO Model List (2021). Conclusions: The present study provides a valuable insight about the overall pattern of drugs prescribed in postoperative patients in the obstetrics and gynecology unit of a tertiary care hospital. Though only one half of the medications prescribed were by the generic name, a very good proportion of medications were prescribed from the Essential Medicine List. This report is mainly intended to be a step in the wider assessment of safety and efficacy of drugs prescribed in post-operative wards.

Efficacy of port-site infiltration with ropivacaine alone versus ropivacaine with fentanyl for postoperative analgesia in patients undergoing laparoscopic procedures

Background and aims: Wound infiltration as a pre-emptive measure to relieve post-operative pain is a common practice following laparoscopic procedures. The addition of adjuvants like opioids to local anesthetics can facilitate the prolongation of postoperative analgesia. Our primary aim was to compare the analgesic efficacy of peri-portal infiltration of Ropivacaine alone versus Ropivacaine with Fentanyl in patients undergoing laparoscopic operations. Methods: The study was conducted on 80 ASA physical status I and II patients, aged 18 to 65 years, undergoing surgical procedures under general anesthesia. Group R was infiltrated with Ropivacaine (0.5%) (18ml+2ml saline) while in Group RF, Ropivacaine(18ml) with Fentanyl 2ml (100礸)] was infiltrated around ports, before wound closure. At the end of the surgery, one of our study drug solutions was infiltrated, to which the patient as well as the assessor were blinded. Postoperative pain was assessed by the VAS (visual analog scale) score. Injection Tramadol 100mg was given as a rescue analgesic if the VAS score was ? 3. Student抯 t-test and Fischer抯 exact test were applied for continuous and categorical variables; Kruskal Wallis and Mann Whitney U test for nonparametric data. The entire statistical analysis was done using STATA 13[ STATA CORP. TEXAS, USA] software. Results: The mean duration of analgesia was significantly longer in group RF, with a requirement of fewer doses of rescue analgesics, compared to group R. Conclusion: The addition of Fentanyl to Ropivacaine for periportal infiltration was found to be superior to Ropivacaine alone in providing effective postoperative analgesia as well as reducing the requirement of rescue analgesics.

EVALUATION OF CARDIAC SPECIFIC MARKER CARDIAC TROPONIN I AFTER CORONARY BYPASS SURGERY

Background: Cardiac troponin I (cTnI) is reported to be very specific formyocardial cell damage without cross reactivity with skeletal muscle isoform.Evaluation of cTnI after CABG will be useful as an early marker of excessivepost operative myocardial damage when a specific therapeutic intervention canstill be efficient and improve outcome.Methodology: The study comprised of 50 patients who undergo Coronary arterybypass surgery at V.S group of Hospital. Blood sample were taken after 12 hour (T12) and 24 hour ( T24 ) of post CABG. The sample were analysed for cTnI.Results: Our results show that Troponin I levels after 2 hours, 12 hours and 24hours in patients who had better outcome after CABG was 9.2 ng/ml, 13.9 ng/mland 10.9 ng/ml respectively. Whereas, Troponin I levels after 2 hours, 12 hoursand 24 hours in patients who had adverse outcome like death of patients afterCABG was 10.6 ng/ml, 38.7 ng/ml and 28.9 ng/ml respectively.Conclusion: Routine measurement of cardiac troponin levels after cardiactroponin can identify group of patients at increased risk of complications ordeath.

Effect of Anti?Platelet Therapy on Peri?Operative Blood Loss in Patients Undergoing Off?Pump Coronary Artery Bypass Grafting

Purpose:The purpose of this study was to review the effect of the pre?operative use of clopidogrel and aspirin on peri?operative bleeding, blood product transfusion, and resource utilization after coronary artery bypass grafting (CABG). Materials and Methods: A total of 1200 patients who underwent off?pump CABG (OPCABG) between 2010 and 2012 were retrospectively studied. Patients were divided into three groups: group 1: discontinued aspirin and clopidogrel 6 days prior to surgery (n = 468), group 2: discontinued both drugs 3 to 5 days prior to surgery (n = 621), and group 3: discontinued both drugs 2 days prior to surgery (n = 111). The bleeding pattern and blood product transfusion were studied and compared between the groups. Patients having history of other drugs affecting the coagulation profile, other organ dysfunction, on?pump CABG, and the combined procedure were excluded from the study. Results: Group 2 patients had a higher rate of bleeding and a reduced mean value of hemoglobin (Hb) as compared to other groups. The same results were seen in blood and blood product transfusion. Patients of group 2 and group 3 were associated with higher blood loss in terms of drainage at 12 and 24 hours. Post?operatively, this was statistically significant. Re?exploration was statisitically significant in group 3 patients (9.01%) than in group 2 (2.58%) and group 1 (1.07%) patients. Conclusion: The pre?operative use of clopidogrel and aspirin in patients undergoing OPCABG showed limited clinical benefits; however, its use significantly increased the risk of bleeding and blood transfusion, thus increasing morbidity and resource utilization. Hence, clopidogrel and aspirin should be stopped at least 6 days prior to surgery.

Drug utilization study in post-operative cases of obstetrics and gynecology department in a tertiary care hospital

Background: After any surgery, drugs are prescribed for analgesia, prevention of infection, nausea, vomiting, and to maintain the hemodynamic status. Drug utilization studies identify the associated problems and aid prescribers to optimize resource allocation and utilization. Aim and Objectives: This study was done to explore the utilization pattern of medications in obstetrics and gynecology post-operative cases for assessment of the following: (1) Various medications prescribed, (2) their route of administration, (3) duration of usage, and (4) the World Health Organization (WHO) core drug indicators. Materials and Methods: A retrospective observational case-sheet based study was conducted after obtaining approval from the Institutional Ethics Committee. Data were collected from case sheets dated May 1, 2018, to October 31, 2018, in the obstetrics and gynecology department using a structured pro format. Results: A total of 240 patients (247 encounters) were prescribed antimicrobials, analgesics, antacids, and intravenous (IV) fluids with an average of 7.25 drugs per encounter. Injectable drug was prescribed to 222 (89.88%) patients. Antimicrobials were prescribed to 168 patients (68.01%); most common being metronidazole which was prescribed to 120 patients (48.58%). Diclofenac was prescribed to 232 patients (93.93%) and Ranitidine to 239 patients (96.76%); these were the most commonly prescribed analgesic and antacid, respectively. Out of 68 different types of drugs prescribed, 16 (23.53%) were prescribed by their generic name and 51 (75%) were from the Essential Medicines WHO Model List (EML) (2015). Conclusions: Antimicrobials were moderately used in management of post-operative cases. Although only about a quarter of medications were prescribed by generic name, nearly three-fourths were from EML.