Modulation Agents of Wound Healing in Ocular Surgeries

@#Wound healing is a complex process that includes haemostasis and inflammation, followed by a proliferation period and repair and finally remodelling. Ocular surgeries, particularly in glaucoma cases, aim at minimal fibrosis to preserve the function of trabeculectomy as an alternative pathway for aqueous drainage. Hence, it is important to find an agent to modulate the wound healing process. This review presents compilation of wound modulation agents that have been tested in vitro, in vivo, or clinically on patients undergoing ocular surgeries, particularly for glaucoma. We identified agents into four groups, mostly for glaucoma filtration operations: anti-metabolites, anti-growth factors, mechanical barriers and rho kinases. The effect of these agents is highlighted in this review. In conclusion, despite recognized drawbacks of antimetabolites, they are still regarded as the gold standard and the most efficient treatment as anti-scarring agents use in ocular surgeries. More studies are needed to inquire agents that efficient yet has minimal adverse effects both in short and long term.

A comparison of pre- and post-operative outcomes in living donors undergoing transperitoneal laparoscopic nephrectomy and open nephrectomy: a retrospective single-center study

ABSTRACT BACKGROUND: Kidney transplantation is often regarded as the preferred therapy for end-stage renal disease. Several surgical procedures have been developed to reduce postoperative donor complications, while maintaining kidney quality. OBJECTIVE: This study aimed to compare the preoperative and postoperative outcomes of living kidney donors who underwent either transperitoneal laparoscopic nephrectomy or open nephrectomy. DESIGN AND SETTING: Retrospective study conducted in Istanbul, Turkey. METHODS: Fifty-five living-related kidney donors underwent nephrectomy and were retrospectively divided into two groups: 21 donors who underwent open nephrectomy (Group 1) and 34 donors who underwent transperitoneal laparoscopic nephrectomy (Group 2). RESULTS: In comparison to the donors who underwent open nephrectomy, those who underwent transperitoneal laparoscopic nephrectomy had significantly shorter postoperative hospital stays (2.3 ± 0.2 versus 3.8 ± 0.8 days, P = 0.003), duration of urinary catheterization (1.2 ± 0.8 days versus 2.0 ± 0.7 days, P = 0.0001), operating times (210 ± 27 minutes versus 185 ± 24 minutes, P = 0.02), and less blood loss (86 ml versus 142 ml, P = 0.048). There was no statistically significant difference between the two groups with regard to the estimated blood transfusion and warm ischemia time. The preoperative week, first postoperative week, and 1-month postoperative serum creatinine levels were comparable between the groups. CONCLUSIONS: Laparoscopic donor nephrectomy can be safely performed at centers with expertise in laparoscopic surgery. Laparoscopic donor nephrectomy has better outcomes than open donor nephrectomy in terms of length of hospital stay, duration of urinary catheterization, operating time, and blood loss.

Complicaciones de cirugía de Whipple en un paciente pediátrico con tumor pseudopapilar de páncreas / Complications of Whipple procedure in a pediatric patient with pseudopapillary tumor of the pancreas

Las neoplasias de páncreas son una entidad poco frecuente en pediatría; el tumor pseudopapilar de páncreas (TSP) es el más comúnmente diagnosticado. Habitualmente, se localizan en la cabeza del páncreas. La cirugía de Whipple o pancreatoduodenectomía es la técnica elegida para el tratamiento de los tumores benignos o malignos de páncreas. Si bien la mortalidad conocida ha descendido en los últimos años, debido a la mayor experiencia de los cirujanos y al mejor cuidado pre- y posoperatorio, la morbilidad se ha mantenido elevada secundaria a las complicaciones asociadas. Dentro de estas se destacan retardo en el vaciamiento gástrico, colecciones intraabdominales, fístula pancreática, reestenosis del sitio quirúrgico y hemorragia pospancreatectomía. Se presenta el caso clínico de una niña de 13 años con diagnóstico de TSP que recibió tratamiento quirúrgico efectivo desde el punto de vista oncológico, pero que requirió una internación prolongada secundaria a las complicaciones quirúrgicas.

Pancreatic neoplasms are rare in pediatrics; the pseudopapillary tumor (PPT) of the pancreas is the most common. PPTs of the pancreas are usually located in the head of the pancreas. A pancreaticoduodenectomy or Whipple procedure is the technique of choice for the treatment of benign or malignant pancreatic tumors. Although mortality for this cause has decreased in recent years, due to the greater experience of surgeons and improved pre- and postoperative care, morbidity has remained high secondary to associated complications. These include delayed gastric emptying, intra-abdominal collections, pancreatic fistula, surgical site restenosis, and post-pancreatectomy hemorrhage. Here we describe the clinical case of a 13-year-old girl diagnosed with PPT of the pancreas who underwent an effective surgery in terms of cancer treatment, but who required a prolonged hospitalization secondary to surgical complications.

Salud y discapacidad en niñas y niños argentinos con cardiopatías congénitas complejas operadas. Resultados a los dos años de vida / Health and disability in Argentine children with complex congenital heart disease undergoing surgery. Outcomes at 2 years of life

Introducción. Las cardiopatías congénitas complejas son las malformaciones más frecuentes con una importante carga de morbimortalidad. Se busca conocer el estado de salud y discapacidad de niños operados en un hospital de tercer nivel. Población y métodos. Fueron evaluados en las áreas de crecimiento, neurodesarrollo y discapacidad 84 pacientes entre 21 y 39 meses de edad operados con circulación extracorpórea durante el primer año de vida. Resultados. La mayoría de los niños crece por debajo del percentil 50 en los tres parámetros, con mayor compromiso en aquellos con síndrome genético asociado. La frecuencia de discapacidad fue del 55 %. En el grupo con CC aislada, la gravedad de la cardiopatía y el examen neurológico patológico al alta se asociaron con discapacidad (p = 0,047 y p = 0,03). Contar solo con cobertura de salud pública se asocia a un menor acceso a intervenciones oportunas (p = 0,02). Conclusiones. Cerca de la mitad de los pacientes evoluciona con discapacidad moderada-grave. Es competencia del equipo de salud conocer las morbilidades más allá del aspecto cardiovascular y los factores de riesgo. Las barreras en el acceso a las intervenciones adecuadas advierten a los profesionales sobre la relevancia de buscar estrategias para vencerlas y lograr el máximo potencial de desarrollo de los pacientes.

Introduction. Complex congenital heart defects are the most frequent malformations and entail a significant burden of disease. The objective of this study was to determine the health status and disability of children who underwent surgery at a tertiary care hospital. Population and methods. A total of 84 patients aged 21 to 39 months who had a surgery with extracorporeal circulation during their first year of life were assessed in terms of growth, neurodevelopment, and disability. Results. In most children, growth was below the 50th percentile in all 3 parameters, and greater involvement was observed in those with an associated genetic disorder. The frequency of disability was 55%. In the group with isolated congenital heart disease, the severity of disease and a pathological neurological examination at discharge were associated with disability (p = 0.047 and p = 0.03). Having only public health coverage was associated with less access to timely interventions (p = 0.02). Conclusions. Nearly half of the patients develop moderate-severe disability. Being aware of morbidities beyond the cardiovascular aspect and risk factors is part of the health care team's scope. Barriers in access to appropriate interventions caution health care providers of the relevance of seeking strategies to overcome them and achieve the maximum development potential of patients.

Evaluation of Anaesthetic Challenges in Primary Cleft Lip and Palate Surgeries in a Single Center Study

Background: One of the most prevalent congenital malformations and the most frequent craniofacial defects in children is cleft lip and palate. The aim of the study was to investigate the anaesthetic procedures employed and to determine the challenges and postoperative complications associated with cleft lip and palate surgery. Material & Methods: A retrospective review of the anaesthetic procedures carried out from January 2022 to December 2022 at the Dhaka Dental College and Hospital. The hospital records were reviewed in order to learn about every occurrence of orofacial cleft surgery. In this study, a total number of 120 cases were reviewed. Results: Among 120 cases, 53 (44.2%) of the patients were female and 67 (55.8%) were male. The bulk of patients came after their first year of life. About 54(45%) of them were younger than five years old. 68(56.67%) underwent cleft lip surgery, 37(30.83%) for cleft palate surgery and rest 15(12.5%) patients under went for combined cleft lip and cleft palate surgeries. Upper Respiratory Tract Infection (URTI) was reported as the most common pre-existing morbidity. Bronchospasm was the main intraoperative complications occurred in 8 (6.67%) of the cases with URTI. After surgey 6(5%) patients experienced bleeding, 3(2.5%) patients needed to be reintubated. In addition, 2 (1.67%) instances had trouble controlling their pain, only 1(0.83%) patient had trouble swallowing and 1(0.83%) recovered slowly. Conclusion: Anaesthesia for surgical repair of cleft lip or palate in children is challenging. After a thorough preoperative evaluation, a trained anaesthesiologist should administer anaesthesia under strict supervision to minimize postoperative complications.

Delayed-onset unilateral facial paralysis after mastoidectomy: A case report

Objective@#To discuss the case of a 36-year-old man who presented with left unilateral facial paralysis 11 days after mastoidectomy.@*Methods@#Design: Case Report Setting: Tertiary Government Training Hospital Patient: One@*Results@#A 36-year-old man with recurrent left ear discharge of 30 years duration underwent left canal wall-down mastoidectomy and was discharged well after 3 days. On follow up after 8 more days, he was noted to have House Brackmann IV left facial paralysis. Following 5 days methylprednisolone, neurologic evaluation and physical therapy rehabilitation, facial paralysis improved in the ensuing weeks until House-Brackmann I was achieved at week 12.@*Conclusion@#Delayed-onset Facial Palsy (DFP) following tympanomastoid surgery may be approached conservatively, including steroids, acyclovir, and, if with a history of herpes or varicella infection, immunization can be given. Prognosis for DFP is good especially when the facial nerve is identified intraoperatively during otologic surgeries

Complicaciones respiratorias en el posoperatorio inmediato en pacientes sometidos a cirugías de hemiabdomen superior

Las complicaciones respiratorias durante el posoperatorio inmediato justifica el interés del anestesiólogo por el conocimiento actualizado con el fin de disminuir la morbimortalidad. Con el objetivo de caracterizar las complicaciones respiratorias más frecuentes que se presentan en el posoperatorio inmediato de cirugía de hemiabdomen superior se realizó estudioobservacional, descriptivo de serie de casos, en 146 pacientes sometidos a cirugía de hemiabdomen superior atendidos en la unidad de cuidados posanestésicos del Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora", de Santiago de Cuba, duranteenero a diciembre de 2020; los datos se obtuvieron a partir de la historia clínica hospitalaria y examen clínico general realizado, los que fueron plasmados en una planilla confeccionada para el efecto. Fueron utilizados el test del Xi-cuadrado (X2), y la prueba de diferencias de proporciones, con un valor de p = 0,05durante el procesamiento estadístico. Los pacientes con edades mayores de 60 años, del sexo masculino y que presentaban como hábitos tóxicos el tabaquismo, la hipertensión arterial seguida de las neuropatías son las más frecuentes; mientras que los diagnósticos operatorios fueron la colecistitis aguda convencional y el trauma hepático. La intervención quirúrgica urgente, los pacientes ASA II, y los procedimientos que duraron más de 2 horas fueron los más frecuentes. Las complicaciones respiratorias más frecuentes encontradas fue la hipoxia; seguida de la ventilación mecánica prolongada y la atelectasia. Las complicaciones respiratorias encontradas en el posoperatorio inmediato de cirugía de hemiabdomen superior se asociaron desde el punto de vista estadístico con la clasificación ASA.

Respiratory complications during the immediate postoperative period justify the anesthesiologist's interest in updated knowledge in order to reduce morbidity and mortality. In order to characterize the most frequent respiratory complications that occur in the immediate postoperative period of upper hemiabdomen surgery, an observational, descriptive case series study was conducted in 146 patients undergoing upper hemiabdomen surgery attended at the post-anesthetic care unit of the "Saturnino Lora" Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba. during January to December 2020; The data were obtained from the hospital clinical history and general clinical examination performed, which were reflected in a form prepared for this purpose. The Xi-square test (X2) and the proportions differences test were used, with a p value = 0.05 during statistical processing. Patients over 60 years of age, male and who presented smoking as toxic habits, hypertension followed by neuropathies are the most frequent; while the operative diagnoses were conventional acute cholecystitis and liver trauma. Urgent surgery, ASA II patients, and procedures lasting more than 2 hours were the most frequent. The most frequent respiratory complications found were hypoxia; followed by prolonged mechanical ventilation and atelectasis. The respiratory complications found in the immediate postoperative period of upper hemiabdomen surgery were statistically associated with the ASA classification.

As complicações respiratórias no pós-operatório imediato justificam o interesse do anestesiologista em atualizar o conhecimento para reduzir a morbimortalidade. Com o objetivo de caracterizar as complicações respiratórias mais frequentes que ocorrem no pós-operatório imediato de cirurgia de hemiabdome alto, foi realizado um estudo observacional descritivo de série de casos em 146 pacientes submetidos à cirurgia de hemiabdome superior atendidos na unidade de recuperação pós-anestésica do Hospital Provincial Clínico Cirúrgico Universitário "Saturnino Lora" em Santiago de Cuba de janeiro a dezembro de 2020; Os dados foram obtidos da história clínica hospitalar e do exame clínico geral realizados, os quais foram refletidos em um formulário elaborado para esse fim.Utilizou-se o teste do xi-quadrado (X2) e o teste de diferenças de proporções, com valor de p = 0,05 durante o processamento estatístico. Pacientes acima de 60 anos, do sexo masculino e que apresentavam o tabagismo como hábitos tóxicos, sendo a hipertensão arterial seguida de neuropatias os mais frequentes; enquanto os diagnósticos operatórios foram colecistite aguda convencional e trauma hepático. Cirurgias de urgência, pacientes ASA II e procedimentos com duração superior a 2 horas foram os mais frequentes. As complicações respiratórias mais frequentes encontradas foram hipóxia; seguido de ventilação mecânica prolongada e atelectasia. As complicações respiratórias encontradas no pós-operatório imediato de cirurgia de hemiabdome alto foram estatisticamente associadas à classificação ASA.

Previsões do número de cirurgias suspensas utilizando o software Power BI® em um hospital universitário / Predictions of the number of suspended surgeries using software Power BI® in a university hospital / Predicciones del número de cirugías suspendidas utilizando software Power BI® en un hospital universitario

Objetivo: analisar as cirurgias suspensas, realizando previsões futuras de três meses, a partir de outubro de 2022, através de um gráfico de linhas utilizando o software Power BI®. Método: se utilizou a técnica de médias moveis ponderada, alisamento exponencial simples, utilizando a ferramenta gráfico de linhas do Power BI®, com intervalo de confiança de 95% e previsões de três meses. Resultados: os resultados demostraram que existem diferentes etapas para construir previsões e alguns pré-requisitos devem ser preenchidos, foram encontradas as seguintes previsões com seus respectivos intervalos de confiança novembro 134(97,172), dezembro 141(102,180), janeiro 147(106.188). Conclusão: a utilização de previsões pode ser uma ferramenta útil para a tomada de decisão, prever problemas e sempre necessário na gestão de um hospital, podendo até suprimir gastos se antecipando a uma variedade de problemas.

Objective: to analyze the suspended surgeries, making future predictions of three months, starting in October 2022, through a line graph using the Power BI software. Method: we used the technique of weighted moving averages, simple exponential smoothing, using the Power BI® line graph tool, with a confidence interval of 95% and predictions of three months. Results: the results showed that there are different steps to construct predictions and some prerequisites must be fulfilled, the following predictions were found with their respective confidence intervals: November 134 (97,172), December 141 (102,180), January 147 (106,188). Conclusion: the use of forecasts can be a useful tool for decision making, predicting problems and always necessary in the management of a hospital, and can even suppress expenses in anticipation of a variety of problems.

Objetivos:analizar las cirugías suspendidas, haciendo predicciones futuras de tres meses, a partir de octubre de 2022, a través de un gráfico lineal utilizando el software Power BI®. Método: se utilizó la técnica de medias móviles ponderadas, suavizado exponencial simple, utilizando la herramienta de gráfico de líneas de Power BI®, con un intervalo de confianza del 95% y predicciones de tres meses. Resultados: los resultados mostraron que existen diferentes pasos para construir predicciones y se deben cumplir algunos requisitos previos, se encontraron las siguientes predicciones con sus respectivos intervalos de confianza: noviembre 134 (97,172), diciembre 141 (102,180), enero 147 (106,188). Conclusión: el uso de pronósticos puede ser una herramienta útil para la toma de decisiones, predicción de problemas y siempre necesaria en la gestión de un hospital, e incluso puede suprimir gastos en previsión de una variedad de problemas.

Regurgitation on pressure over the lacrimal sac versus lacrimal irrigation in determining lacrimal obstruction prior to intraocular surgeries

Purpose: To determine the diagnostic accuracy of manual regurgitation on pressure over the lacrimal sac (ROPLAS) versus lacrimal irrigation for screening nasolacrimal duct obstruction (NLDO) in adults prior to intraocular surgeries. Methods: This cross-sectional study took place in a tertiary eye care hospital in South Tamil Nadu, India. From January to December 2017 and included consecutive patients who presented for routine cataract surgery. Prospective data collection occurred in 8369 eyes of patients who underwent cataract surgery. All patients underwent ROPLAS testing by an ophthalmologist followed by lacrimal irrigation by trained ophthalmic assistants, rechecked or confirmed in equivocal cases by ophthalmologists who were masked to the ROPLAS status. The primary outcome, the sensitivity, specificity, positive, and negative predictive values to detect lacrimal occlusion by ROPLAS compared with lacrimal irrigation with 95% confidence intervals was estimated. Results: A total of 8369 eyes underwent cataract surgery during the time periods of the study. ROPLAS and lacrimal irrigation were performed in all eyes. The sensitivity of ROPLAS to diagnose NLDO correctly was 54.5% (95% CI, 44.8%�.9%) and its specificity was 100% (95% CI, 100%�0%). The positive and negative predictive values were 75.3% (95% CI, 65.6%-83.0%) and 99.4% (95% CI, 99.2%�.5%), respectively. Conclusion: We found that ROPLAS when used alone had very low sensitivity and low positive predictive value in detecting NLDO prior to cataract surgery as compared with lacrimal irrigation. Hence, we recommend performing ROPLAS and lacrimal irrigation in every patient as part of the routine preoperative workup prior to cataract surgery

A prospective comparative randomized controlled study of erector spinae plane block using local anesthetics versus general anesthesia for the perioperative control of pain in patients undergoing thoracoscopic procedures

Background: Patients posted for video-assisted thoracoscopic surgeries (VATS) are nowadays managed intraoperatively by general anesthesia (GA) with the use of oral and parenteral analgesics in the post-operative period. Ongoing research points out that the erector spinae plane block (ESP Block) with local anesthetics is a safe technique for the perioperative management of pain in thoracoscopic procedures. Aims and Objectives: Our study aimed at comparing ultrasound guided ESP block using local anesthetics versus GA for perioperative pain management in patients who underwent thoracoscopic procedures. The objectives of this research were to assess the hemodynamic changes in patients undergoing the procedure, to calculate the total amount of analgesics required by patients in the next 24 h, to assess the overall patient satisfaction and complications in the post-operative period. Materials and Methods: In this prospective comparative randomized controlled trial, 40 patients aged 18–65 years planned to undergo VATS were enrolled and randomized to either group G or group E in equal numbers depending on the anesthetic technique employed. Group G patients received GA and Group E patients received ultrasound guided ESP block. Both the groups were compared for hemodynamic stability, pain in postoperative period using visual analog scale (VAS), time to first rescue analgesia requested since induction, total amount of rescue analgesia requested, overall patient satisfaction, and post-operative complications. Results: Better control of hemodynamic parameters, less post-operative pain, prolonged duration of analgesia (P < 0.05), and requirement of lesser amount of rescue analgesics were observed in patients of Group E in comparison with patients of Group G. Side effects such as post-operative nausea and vomiting were more in patients of Group G in the first 24 h (P < 0.05). Conclusion: ESP block with local anesthetics can be used as an effective sole anesthetic technique for VATS <60 min providing a longer pain free post-operative period, lesser rescue analgesic requirement, better patient satisfaction, and lesser post-operative complications.

Management of Patients with the Intravascular Ventricular Assist System (iVAS) for Non?Cardiac Surgery

Intravascular ventricular assist system (iVAS) is an investigative device in clinical trials for the management of advanced heart failure. It works on the principle of counterpulsation, similar to the classic intra?aortic balloon counterpulsation (IABP).We present a case of a 66?year?old man with iVAS in situ who required emergency laparotomy for a strangulated umbilical hernia. Patients with mechanical circulatory devices (MCD) are presenting more frequently for emergency and even elective noncardiac operations. Managing such patients poses significant challenges to the perioperative team due to its novelty and paucity of management recommendations.

Antiemetic Efficacy of Prophylactic Ondansetron Versus Ondansetron with Dexamethasone Combination Therapies in Women Undergoing Breast Surgeries: A Randomized Controlled Trial

Objective: To compare the prophylactic antiemetic efficacy of ondansetron monotherapy with that of the combination of ondansetron and dexamethasone in the prevention on postoperative nausea and vomiting (PONV) in breast surgeries by observing the incidence of PONV, assess the percentage of participants requiring rescue antiemetics, know the side effects of drugs, and analyze the effect of the surgical duration of breast surgeries. Methods: The group ondansetron (O) received 0.1 mg/kg IV ondansetron and the other group (ondansetron and dexamethasone combination, OD) received 0.1 mg/kg IV ondansetron and 0.1 mg/kg of dexamethasone. The incidence of PONV in the first 24 h, percentage of population receiving rescue antiemetics, surgical duration, and hemodynamic parameters were noted. Results: In the 0 h to 6 h postoperative period, 38.9% of participants of group O had PONV, whereas only 13.9% in group OD had PONV, which was statistically significant (P < .016). About 30.6% of study population in group O and 8.3% in group OD required rescue antiemetics which was statistically significant (P = .017). Surgical duration of more than 120 min had a statistically significant higher incidence of PONV in the O group with a P-value of .048. Conclusion: The combination of prophylactic ondansetron with dexamethasone is more efficacious than ondansetron alone for the prevention of PONV in women undergoing breast surgeries.

Suspensiones quirúrgicas: un desafío para la gestión clínica post Covid 19

Objetivo: Determinar la frecuencia, las causas y los factores asociados de suspensión de cirugías programadas en un hospital de alta complejidad en un periodo de 5 años. Materiales y Método: Se realizó un estudio descriptivo transversal, en un hospital terciario del sur de Chile durante los años 2014 a 2018. Se describe la frecuencia de suspensión quirúrgica del establecimiento y por especialidad, especificando sus principales causas. Además, se identificaron aquellas suspensiones evitables y sus factores asociados mediante regresión logística. Resultados: La tasa de suspensión en los 5 años de estudio fue de 11,2%. Neurocirugía y Traumatología tuvieron la mayor tasa de suspensión (18,8% y 13,9%, respectivamente), mientras que Ginecología y Obstetricia la menor (4,1%). Las causas más frecuentes fueron la inasistencia del paciente (16,9%), la prolongación de la cirugía anterior (16,4%) y la paralización de actividades por motivos gremiales (7,9%). Un 80,1% de las causas fueron evitables. La especialidad quirúrgica y la edad del paciente fueron los factores asociados más relevantes. Discusión: Se evidenció una alta tasa de suspensiones quirúrgicas y la mayoría por causas evitables. Su disminución puede ser la intervención más costo efectiva para contribuir a reducir las extensas listas de espera quirúrgica posterior a la crisis sanitaria por COVID 19, ya que sólo requiere optimizar los recursos existentes. Conclusiones: La suspensión quirúrgica es un problema frecuente en el proceso quirúrgico. Nuestros resultados permiten identificar a los grupos de mayor riesgo de suspensión, asignar responsabilidades a los equipos quirúrgicos y desarrollar estrategias efectivas para su prevención.

Aim: To determine the frequency, the causes and the associated factors of the surgical cancellation of scheduled surgeries at the Hospital Base Valdivia between the years 2014 and 2018. Materials and Method: A descriptive cross-sectional study was carried out. Were described the frequency of suspension of scheduled surgeries of the establishment, by specialty and their main causes, identifying those that can be avoided. In addition, the factors associated with suspension were identified by logistic regression. Results: The suspension rate in the 5 years of study was 11.2%. Neurosurgery and Traumatology had the highest frequency of surgical cancellation (18.8% y 13.9%, respectively), Obstetrics, and Gynecology the lowest (4.1%). The most frequent causes of suspension were the absence of the patient (16.9%), the prolongation of the previous surgery (16.4%) and the suspension of activities due to Union reasons (7.9%). 80.1% of the causes were avoidable. The age and surgical specialty were the most relevant associated factorsm Discussion: A high rate of surgical suspensions and most for avoidable reasons were evident. Reducing surgical cancellations can be the most cost effective intervention to help reduce the extensive post-health crisis surgical waiting lists by COVID 19, as it only requires optimizing existing resources. Conclusions: Surgical suspension is a common problem in the surgical process. Our results allow to identify the groups most at risk of suspension, assign responsibilities to surgical teams and develop effective strategies for their prevention.

A comparative study on thyroid surgeries without drain versus with drain in tertiary care centre

Background: Thyroid surgery is one of the most commonly performed surgery for benign and malignant conditions of the thyroid gland worldwide. The thyroid gland is closely related to many vital structures and hence poses a unique challenge to the surgeon. Kocher and Billroth developed the approach to the thyroid gland, both revolutionized the understanding of treatment of thyroid disease. Drainage in thyroid Surgeries has been a routine but empirical practice with no scientific evidence to support its benefit. Materials and methods: The patients admitted in Govt. Stanley Medical College Hospital, Chennai at Department of General Surgery who were having thyroid swelling were included. Results: The mean duration of hospital stay in Group A patient was 2.30+1.20 days whereas it was 5.34+2.37 days in Group B patients, it has a statistical significance in the Cost effectiveness for the Group A patients and also regarding the patient satisfaction in early discharge with significant P value of < 0.001.The wound healing time in the Group A patient was 7+ 0.81 days which was considerably less compared to the Group B patients which was 10.08+0.97 which had a statistical significance with the P value of <0.001. Conclusion: In short the drains are not required in most cases of thyroidectomy. Drains cause discomfort, increase septic complications and prolong hospital stay. These may be useful in patients with Thyroid Swellings.

Compassionate and standard operating procedure-based counseling and practice are essential in high-risk infantile anesthesia and managing death in eye surgery

Physicians have to play the role of a team leader and counselor and take written informed consent for high?risk surgeries in many cases. This is the first step toward initiating a mutually trustworthy relationship with the patient and family. The situation is more sensitive when vulnerable patients like small premature babies or the elderly are under consideration. In the event of a death, leadership and processes in place become extremely critical. We share our experience and practice pattern during this process, especially suited to India, but the broad principles would apply to most human situations. Hopefully, some of these can be incorporated into the existing training curriculum for team building and the art of effective physician?patient communication that should be intricately woven into the curriculum for the Science of Ophthalmic care.

Evolución hacia la era digital de la cirugía ortognática: experiencia en un centro universitario / Evolution towards the digital era of orthognatic surgery: experience in a university center

Resumen Introducción: La incorporación de tecnologías en la práctica quirúrgica, ha cambiado la forma de enfrentar el proceso quirúrgico. Objetivo: Describir la experiencia de los últimos 9 años, en cirugía ortognática, con la incorporación de la cefalometría 3D. Materiales y Método: Se realizó una revisión retrospectiva de pacientes operados de cirugía ortognática durante el período enero de 2011 a agosto de 2018. Se registraron datos demográficos, quirúrgicos, tipo de planificación quirúrgica, complicaciones y resultados a largo plazo. Resultados: 21 pacientes requirieron cirugías ortognáticas. Se realizaron 16 cirugías bimaxilares (76%), 3 cirugías de avance maxilar superior (14%) y 2 cirugías de osteotomía sagital de rama (10%). Las principales etiologías fueron: 67% maloclusión clase III (n = 14), 28% maloclusión clase II (n = 6) y 5% desviación mandibular (n = 1). La planificación prequirúrgica virtual fue utilizada en 11 pacientes (52%). La tasa de complicaciones Clavien-Dindo > III fue 4,8% (n = 1). Conclusiones: En nuestra experiencia, las técnicas de cirugía ortognática son seguras. Las complicaciones de la serie fueron escasas y bien toleradas por los pacientes. Durante los últimos años y, de acuerdo a los avances tecnológicos, la incorporación de la planificación quirúrgica virtual 3D favoreció el desarrollo de la cirugía ortognática en nuestro centro.

Introduction: Technological advances have been incorporated into cranio-maxillo-facial surgery changing the clinical practice of surgeons. Aim: The aim of this article is to describe our experience in orthognatic surgery in the last 9-years, with the incorporation of 3D cephalometry. Materials and Method: A retrospective chart review was performed from January 2011 to August 2018 on patients undergoing Orthognatic Surgery. Demographic and surgical data, type of surgical planning, complications and long-term results were recorded. Results: A total of 21 patients underwent orthognatic surgery. Average age was 28 years (DE 8.1), 11 men (52.3%) and 10 women (47.61%). The principal surgeries performed were: 16 (76%) bimaxillary, 3 maxillary advancement surgery 3 (14%) and bilateral sagital split osteotomy 2 (10%). Ethiologies were: 14 patients (this 67%) with malocclusion class III, 6 patients (28%) with malocussion class II, and 1 patient (5%) with mandibular deviation. Virtual 3D presurgical planning was used in 11 patients (52%). The total of complications Clavien-Dindo > III was 4.8% (n = 1). None patient required reoperation. Satisfaction rate with the procedure was high. Conclusions: Based on our experience, orthognatic surgery techniques are safe. The complication rate was lower and well tolerated by patients. The introduction of virtual planning provided a better scenario to develop maxillo-facial surgery.

Rational blood transfusion in elective gynecologic surgeries in a tertiary hospital in the Philippines / Philippine Journal of Obstetrics and Gynecology

Background@#Blood transfusion plays a vital role in modern health care; however, local studies on the utilization of blood products intra-operatively, especially in elective gynecologic surgeries, are lacking. @*Objective@#To determine the blood transfusion use during elective gynecologic surgical cases performed at a tertiary hospital in the Philippines. Methods: This retrospective descriptive study included data from patients admitted for elective gynecologic surgeries between January 2019 – December 2019. Pertinent data was gathered from the admission charts, preoperative laboratory results (hemoglobin levels, prothrombin time, partial thromboplastin time), blood bank records of deposited/donated blood and crossmatched units, anesthesia as well as intra-operative records, and medical charts. All abstracted variable were analyzed and transfusion indices were calculated. @*Results@#Majority of the patients who underwent elective surgeries were from the general gynecologic service (60.4%), with abdominal hysterectomies comprising majority of the transfused patients. The calculated crossmatched-to-transfused ratio (C/T ratio) for pRBCs, FFPs, and PCs are 5.1, 7.6, and 19.7; the transfusion indices are 0.57, 0.44, and 0.17, while transfusion probabilities are 28.1%, 10.4%, and 4.2%, respectively. We found a significant association between transfusion status and primary service (p = 0.01), previous pregnancy (p = 0.02), preoperative hemoglobin count (p < 0.01), preoperative hematocrit (p < 0.01), postoperative hemoglobin count (p < 0.01), postoperative hematocrit (p < 0.01), and intra-operative blood loss (p < 0.01).@*Conclusion@#There is consistent over-ordering of blood products. Primary gynecologic service, previous pregnancy, preoperative hemoglobin and hematocrit, as well as introperative blood loss are factors associated with transfusion status.

Comparison of Outcome between the Implementation of Enhanced Recovery after Surgery Programme (ERAS) vs. Traditional Care, in Elective Abdominal Surgeries

ERAS has been responsible for reducing surgical stress, maintaining postoperative physiological function, and for enhancing mobilization after surgery. It has been ultimately shown to reduce the rates of morbidity, hastening recovery, and reducing the length of hospital stay. The objective of this study was to compare the outcome between the implementation of enhanced recovery after surgery program vs. traditional care in elective abdominal surgeries. METHODSThis retrospective study was carried out in the General Surgery Department of Government Medical College, Kottayam, Kerala. This is a tertiary care centre that caters to the needs of nearly five districts in the state. The hospital has excellent critical care and surgical facilities. Patients were grouped as ERAS and Non-ERAS. 78 patients were included in each group. A standard questionnaire was formulated. The clinical outcomes, functional recovery, and patient experience in ERAS and conventional methods of recovery after surgery were analyzed and compared. RESULTSDuration of hospital stay, complications, and costs incurred were found to be almost 60 % less as compared to the non-ERAS group and patient satisfaction was high in the ERAS group. By using ERAS, we have been able to reduce the duration of hospital stay by more than 30 % and the post-operative complications by up to 50 %. CONCLUSIONSThe ERAS programme has definite advantage over traditional methods in terms of hospital stay, treatment cost, complications, readmission rates and overall patient satisfaction. We have to analyse the avoidable factors leading to substandard care or any missed opportunities. Patient education must also be given utmost importance.

Seroprevalence of IgG Antibodies for Dengue among Blood Donors

Dengue fever is endemic India and the prevalence of dengue is on the rise owing to various social and economic factors. Prevalence of asymptomatic dengue infection varies widely from less than 1 % to 80 % in India. Transfusion transmissible dengue has been reported in different parts of the word. Prevalence of subclinical dengue among blood donor poses a threat to the blood supply leading to transfusion transmissible dengue. We wanted to estimate the prevalence of IgG antibodies for Dengue in the blood donor population. METHODSSix hundred and eight whole blood donors were included in the study during the period January 2017 to October 2018. Donor registration and education was done as per the national guidelines. Donors who gave a history of previous dengue or symptoms consistent with dengue were excluded from the study. Serum samples from whole blood donors were tested for IgG antibodies using ELISA technology. RESULTSOf the total of 608 donors, 602 were male donors and 55 % of the donors were in the age group 21 - 30 years. Majority (69 %) of the donors were from urban locations. Anti IgG antibodies for dengue were present in 4.14 % of donors of which 38 % of donors were in the age group 31 - 40 years. Three hundred and eighty-four donors revealed history of fever, myalgia and headache in the past one year. No statistical significance was found between fever, myalgia and the presence of IgG anti-dengue antibodies. CONCLUSIONSThe subclinical or asymptomatic prevalence of dengue infection is low when compared to other studies in other parts of the country. Enquiring into donor history for history of dengue or symptoms of dengue and deferring such donors for a recommended period will prevent transfusion transmissible dengue.

Robert’s uterus: a rare mullerian anomaly mystery unfolded

Anomalies of female genital tract may not be detected until after menarche when they present a cyclical pain due to outlet obstruction. Mullerian anomalies represent a vast array of structural abnormalities resulting from improper development and fusion of embryological mullerian ducts. 19-year-old girl attained menarche at the age of 14, had progressive dysmenorrhoea and diagnosed as right haemotosalphinx and ovarian endometrioma which were removed in 2008. As pain progressed, she underwent laparoscopic adhesiolysis in 2013. Since, pain persisted, diagnosed as right haematometra, and drainage done by laparotomy. Left adnexa were normal. She was given depot provera till she completed schooling. She developed recurrent dysmenorrhoea after stopping depot provera. USG and MRI revealed recurrent haematometra on right side with normal left horn. The possibility of atypical septum was thought about and hystero laparoscopy was done. It showed right side haemetometra with absent right adnexa. Left adnexa normal. Hysteroscopy showed normal left horn with septum with a bulge towards the left side. Hence, proceeded with hysteroscopic septostomy and haemetometra was drained to the left horn. Later patient was free from dysmenorrhea and repeat hysteroscopy was found to be normal. This case highlighting mullerian anomalies have to be considered when young girls present with severe progressive dysmenorrhoea and diagnosis remains a challenge most of the clinicians. This rare entity has to be kept in mind while evaluating such patients. Prompt diagnosis and early surgical correction are essential to avoid future morbidity in the form of repeated unnecessary surgeries.