RESUMEN
Background: Ultrasound guided measurement of optic nerve sheath diameter (ONSD) is an emerging non invasive bedside tool that is being used to detect raised intracranial pressure (ICP) in patients with traumatic brain injury(TBI). Early detection of raised ICP can guide in the timely management of such patients with raised ICP due to TBI. Methods: A prospective, observational, open labelled study planned with a 30 patients of TBI of both genders, aged between 18 to 70 years. ONSD readings were taken 3 times a day for three days from the time of admission with portable SonoSite ultrasound machine. Data was expressed as mean ±standard deviation. Values were compared using T test and P value was calculated. Results: Highest reading recorded in patients with GCS <8 was 6.26±0.73 in comparison to 5.38±0.56 (p=0.001) in patients with GCS >8. Highest reading of ONSD correlating with a positive CT finding at admission was 6.22±.81 and was 5.46±.57 (p=0.006) in patients with negative findings on CT. ROC curve with average cut off of 6 mm correlated with positive CT findings with sensitivity of 80%, specificity of 70% and negative predictive value of 87% was found. Conclusions: Ultrasound-guided ONSD monitoring shows promise for diagnosing intracranial hypertension in traumatic brain injury. Correlations with CT, GCS, and outcomes emphasize its clinical relevance, warranting further validatio.
RESUMEN
Background: Mechanical bowel preparation for colorectal surgeries is thought to clear the bowel lumen of stool, thus decreasing intraluminal pressure of hard, potentially impacting stool and reduce ischemia at the new anastomosis. This reduces the dreaded complication of organ space surgical site infection (SSI) that leads to anastomotic leak which is most commonly seen in colorectal surgeries. Oral antibiotic preparation is thought to reduce the bacterial concentration of colonic mucosa which is thought to further bring down the incidence of organ space SSI in colorectal surgery. Aim of this study was to evaluate the role of oral antibiotics given preoperatively as an adjunct to mechanical bowel preparation and intravenous antibiotics, in reducing SSI in colorectal surgeries. Methods: Comparative study of 60 cases of colorectal surgery divided into two equal groups (group A-patients who received oral antibiotic preparations (OABP) with mechanical bowel preparations (MBPs) and ivAb preoperatively (oral antibiotic preparation and mechanical bowel preparation +intravenous antibiotic) versus group B-patients who only received MBP and ivAb preoperatively. Outcomes of SSI results were compared. Results: Incidence of SSI in group A was 16% whereas it was 40% in group B. Incidence of anastomotic leak in group A was 3.3% and in group B was 13.3%. E. coli was found in the pus culture of 60% cases of SSI in study groups whereas S. aureus was found to be the causative organism in rest of the cases that developed SSI. Conclusions: The study supports the use of OABP as an adjunct to MBP and ivAb preoperatively in colorectal surgery for the prevention of SSI and its related complications.
RESUMEN
Background: Mechanical bowel preparation for colorectal surgeries is thought to clear the bowel lumen of stool, thus decreasing intraluminal pressure of hard, potentially impacting stool and reduce ischemia at the new anastomosis. This reduces the dreaded complication of organ space surgical site infection (SSI) that leads to anastomotic leak which is most commonly seen in colorectal surgeries. Oral antibiotic preparation is thought to reduce the bacterial concentration of colonic mucosa which is thought to further bring down the incidence of organ space SSI in colorectal surgery. Aim of this study was to evaluate the role of oral antibiotics given preoperatively as an adjunct to mechanical bowel preparation and intravenous antibiotics, in reducing SSI in colorectal surgeries. Methods: Comparative study of 60 cases of colorectal surgery divided into two equal groups (group A-patients who received oral antibiotic preparations (OABP) with mechanical bowel preparations (MBPs) and ivAb preoperatively (oral antibiotic preparation and mechanical bowel preparation +intravenous antibiotic) versus group B-patients who only received MBP and ivAb preoperatively. Outcomes of SSI results were compared. Results: Incidence of SSI in group A was 16% whereas it was 40% in group B. Incidence of anastomotic leak in group A was 3.3% and in group B was 13.3%. E. coli was found in the pus culture of 60% cases of SSI in study groups whereas S. aureus was found to be the causative organism in rest of the cases that developed SSI. Conclusions: The study supports the use of OABP as an adjunct to MBP and ivAb preoperatively in colorectal surgery for the prevention of SSI and its related complications.