Tratamiento quirúrgico de la endocarditis mediante cirugía mínimamente invasiva / Surgical treatment of endocarditis using minimally invasive surgery

Resumen Objetivo: Describir la experiencia del Hospital Universitario San Vicente Fundación en el manejo quirúrgico de la endocarditis por técnica mínimamente invasiva (MICS). Metodología: Estudio descriptivo, longitudinal, con toma retrospectiva de pacientes intervenidos por MICS para cirugía valvular con diagnóstico de endocarditis infecciosa entre enero de 2012 y agosto de 2015 en el Hospital Universitario San Vicente Fundación, Medellín. Resultados: En 44 meses fueron llevados a cirugía por endocarditis 15 pacientes, el 93,3% de sexo masculino, edad promedio de 46,2 años, el 40% en clase funcional III y IV (clasificación de la New York Heart Association), 2 pacientes con embolización cerebral; 1 paciente requirió manejo hibrido coronario. Se realizaron 6 plastias y 8 reemplazos valvulares, con compromiso valvular mitral en 46,6%. El tiempo de circulación extracorpórea fue de 103 minutos. El promedio de elementos sanguíneos transfundido fue de 2,5 unidades de glóbulos rojos. No hubo casos de muerte en los primeros 30 días postoperatorios. No se reportaron infecciones del sitio quirúrgico, accidentes cerebrovasculares, fibrilación auricular ni marcapasos definitivo, así como tampoco reintervención por sangrado. Conclusiones: La cirugía valvular por minitoracotomía anterior derecha para el manejo de la endocarditis, es un procedimiento seguro y con buenos resultados en nuestro centro; además reafirma las ventajas de la cirugía mínimamente invasiva.

Abstract Objective: To describe the experience of the Hospital Universitario San Vicente Fundación in the surgical management of endocarditis using a minimally invasive technique. Methodology: A descriptive, longitudinal study was conducted on a retrospective sample of patients intervened for valve surgery using a minimally invasive technique. The patients were diagnosed with infectious endocarditis between January 2012 and August 2015 in the Hospital Universitario San Vicente Fundación, Medellin. Results: A total of 15 patients had surgery due to endocarditis in the 44 months of the study. Most of them (93.3%) were male. The mean age was 46.2 years, and 40% were in functional Class III and IV (New York Heart Association classification). Two patients had cerebral embolisation, and one patient, 2 patients required hybrid coronary management. A total of 6 grafts and 8 valve replacements were performed, with mitral valve involvement in 46.6%. The mean extracorporeal circulation time was 103 minutes. The mean blood products transfused was 2.5 units of blood cells. There were no deaths in the first 30 days after the surgery. There were no reports of infections at the surgical site, cerebrovascular accidents, atrial fibrillation or definite pacemakers. Neither were there were any re-interventions due to bleeding. Conclusions: Valve surgery using a right anterior mini-thoracotomy for the management of endocarditis, is a safe procedures with good outcomes in this hospital. It also re-affirms the advantages of minimally invasive surgery.

Tongue metastasis as an initial manifestation of distant metastasis in oesophageal adenocarcinoma

Metastasis to the head and neck region from primary is rarest manifestation. Lung and breast carcinomas are the commonest malignancies to metastasize to the head and neck region. Oesophageal adenocarcinoma with metastasis to the oral cavity is a rarest presentation and is associated with dismal prognosis. Only few related case reports have been published so far. Her-in we report a case of 55 years old male who underwent radical oesophagectomy for adenocarcinoma of lower oesophagus twelve months back, now presented with hard mass in the right margin of tongue which was suspected as primary tongue carcinoma; subsequently was confirmed as metastatic oesophageal adenocarcinoma following excision. Two months after tongue excision, patient died of progressive metastatic disease

Sublingual Immunotherapy in Allergic Rhinitis: Efficacy, Safety, Adherence and Guidelines

Allergic rhinitis (AR) is a globally increasing health problem affecting the quality of life. Specific immunotherapy is an available causal treatment changing the basic allergic mechanisms of the disease. Over one hundred years, subcutaneous immunotherapy (SCIT) was developed and proved its efficacy but many adverse effects were recorded including anaphylaxis. In 1986, sublingual immunotherapy (SLIT) was introduced as an alternative solution to solve this problem. Our study aims to discuss SLIT from the points of efficacy, safety, adherence and guidelines developed. A literature search was conducted in Medline/PubMed and the Cochrane Library in January 2013 using the keywords "allergic rhinitis, sublingual immunotherapy, efficacy, safety, compliance, adherence, guidelines." All types of publications were included. We augmented our study by searching the reference lists of identified reviews. SLIT has been established in many guidelines as an evidence-based effective treatment in AR with safer profile than SCIT. The meta-analyses confirmed its efficacy and showed a significant reduction in both symptoms and medication scores. The most common recorded adverse effects were minor local effects in the mouth, gastrointestinal reactions with few cases of anaphylaxis and no fatality. Adherence is more favorable for SLIT mainly because it is safe, noninvasive and easily taken at home. We support the call to conduct large multi-centric studies to gain more statistical power and overcome the problem of heterogeneity observed in the meta-analyses.

Use of Candida rugosa lipase immobilized on sepabeads for the amyl caprylate synthesis: batch and fluidized bed reactor study

Lipase from Candida rugosa was covalently immobilized on Sepabeads EC-EP for application for amyl caprylate synthesis in an organic solvent system. Several solvents were tested in terms of biocatalyst stability and the best result was obtained with isooctane. The lipase-catalyzed esterification in the selected system was performed in batch and fluidized bed reactor systems. The influence of several important reaction parameters including temperature, initial water content, enzyme loading, acid/alcohol molar ratio, and time of addition of molecular sieves is carefully analyzed by means of an experimental design. Almost complete conversion (> 99 percent) of the substrate to ester could be performed in a batch reactor system, using lipase loading as low as 37 mg g-1 dry support and in a relatively short time (24 hrs) at 37°C, when high initial substrate molar ratio of 2.2 is used. Kinetics in a fluidized bed reactor system seems to still have a slightly better profile than in the batch system (90.2 percent yields after 14 hrs). The fluidized bed reactor operated for up 70 hrs almost with no loss in productivity, implying that the proposed process and the immobilized system could provide a promising approach for the amyl caprylate synthesis at the industrial scale.

PEFR and FEF25-75 in type 2 diabetes mellitus and their relationships with its duration.

Background: Diabetes mellitus is a major public health problem with increasing incidence worldwide and long term complications of various organs including lungs. The magnitude of the complications of this disease is related to its duration. Objective: To observe PEFR and FEF25-75 in type 2 diabetic male and their relationship with duration of the disease. Methods: This cross sectional study was carried out in the Department of Physiology, BSMMU, Dhaka, from 1st July 2007 to 30th June 2008 on 60 type 2 diabetic, non smoker, male of 40-60 years old. For comparison, 30 age, BMI and socioeconomic status matched apparently healthy non diabetic subjects were also studied. Based on the duration of disease, diabetic patients were divided into B1 (5-10 years) and B2 (10-20 years). PEFR and FEF25-75 of all the subjects were measured by an electronic spirometer. Data were analyzed by One way ANOVA, Unpaired Student’s ‘t’ and Pearson’s correlation coefficient tests. Results: The mean percentage of predicted values of PEFR and FEF25-75 in non diabetic male were within normal ranges. But, both the parameters were significantly (p<0.001) lower in both the groups of type 2 diabetic male compared to those of non diabetic male. Again, the PEFR and FEF25-75 were lower in the patients of longer duration compared to those of shorter duration but the differences were not significant. However, PEFR was negatively correlated and FEF25-75 was positively correlated with shorter duration of diabetes and the relationships were nonsignificant. On the other hand, both the parameters were negatively correlated with longer duration of diabetes while only PEFR showed significant (p<0.01) relationship. Conclusion: The PEFR and FEF25-75 may be lower in type 2 diabetic male, which are inversely related to the duration of the disease.

Epidemiology, clinical screening and early management of developmental dysplasia of the hip in sulaimani city center

there is no screening program in our area, no reliable data on incidence, associated risk factors and effects of early management of DDH, and after 30 years of entering ultrasound in the management of DDH, still plain radiographs are in use. to observe effectiveness of early diagnosis and treatment of DDH using clinical screening and ultrasound-based management system, cross-sectional observational study Methods: 1521 neonates in their first week of age attended the birth office for vaccination from 1[st] June to 31[st] July 2009, Ortolani and Barlow method used for clinical screening followed by filling a questionnaire to evaluate risk factor association. Ultrasound used for classification of hips [using Grafs method] followed by treatment in the first three months of age using Pavlik harness splint as a treatment method. 65.8 per 1000 live birth have DDH, twice common in female, 50% bilateral, ultrasound in the first week shows values of [0, 109, 20, and 3] and at 3 months [124, 5, 3, and 0] values for Graf [Ula, Ilc and D, lll and IV] respectively. Treatment rate with Pavlik harness splint were 17.5% with success rate of 82.5% without open reductions of the hip, finally to have 97.8% normal hips [Graf I] at the end of this study with treatment. In DDH, early diagnosis and treatment through clinical screening and ultrasound-based management is effective

Reações cutâneas secundárias ao uso dos inibidores do receptor de fator de crescimento epidérmico: relato de dois casos / Cutaneous reactions due to the use of epidermal growth factor receptor inhibitors: two case reports

O aumento da expressão de receptores do fator de crescimento epidérmico (EGFR) está envolvido no estímulo ao crescimento tumoral. Seus inibidores demonstraram eficácia no tratamento de neoplasias de cabeça e pescoço, cólon e pulmão.A inibição do EGFR pode determinar reações cutâneas em mais de 50 por cento dos pacientes. Em geral, são reversíveis, mas, quando graves, limitam o uso da droga. Lesões papulopustulosas em face e tronco são as mais comuns, além de xerose, alterações ungueais e dos pelos. A intensidade da toxicidade cutânea tem relação direta com a resposta antitumoral. Uma abordagem dermatológica adequada é essencial para dar continuidade à terapia contra o câncer de forma satisfatória.

An increase in the expression of epidermal growth factor receptors (EGFR) is involved in the stimulation of tumor development. EGFR inhibitors have shown efficacy in the treatment of neoplasms of the head, neck, colon and lung. EGFR when inhibited can cause cutaneous reactions in more than 50 percent of the patients. They are usually reversible, but when severe, limit the use of the drug. Papulopustulars lesions in the face and upper torso are the most common, as well as xerosis, hair and nail changes. There is a direct relationship between the degree of cutaneous toxicity and the antitumoral response. An adequate dermatologic approach is necessary for an effective therapy against cancer.

Scope of growth factor in cancer patients

The growth factors [GFs] act at different stages of stem cell proliferation. Among them the most important ones found of clinical use are erythropoietin [EPO], granulocyte-colony stimulating factor [G-CSF], granulocyte macrophagecolony stimulating factor [GM-CSF], and thrombopoietin [TPO]. Their concomitant use makes treatment with chemotherapy or radiotherapy easier and cost-effective, with fewer side effects and better quality of life in highly selected patients. This is a review article

Usefulness of antibiotics for prevention of post-operative wound infection

A randomized trial was conducted in the Surgical Unit of Khyber Hospital, Peshawar to evaluate the role of prophylactic use of antibiotics in preventing post-operative wound infection among surgical patients. The study was intended as a pilot project, which might suggest the need fur further investigation or at least offer some evidence for or against the routine prophylactic use of antibiotics. A group of 95 patients of varying age and socio-economic background, who were operated upon by surgeons of comparable experience, were carefully studied and followed upto five weeks post-operatively. Among the study group, which received antibiotics during post-operative period 15% developed wound infection, whereas in control group which did not receive any antibiotic only 6% developed wound infection. This study failed to demonstrate any benefit which may cuni pensate for the discomfort, expenses and possible dangers associated with the prophylatic use of antibiotics following most surgical procedures