Cura por vacío (VAC), a propósito de un caso en Atención Primaria / Vacuum assisted closure (VAC), about a case in primary care

El síndrome compartimental agudo requiere de la descompresión quirúrgica, mediante fasciotomía, esta técnica debe ser urgente y será clave para evitar la instauración de graves secuelas. El posterior abordaje de estas heridas de difícil y lenta cicatrización suponen un reto para los profesionales de la salud y un problema para la salud pública debido a los altos costes y elevada morbilidad. La terapia de presión negativa (TPN) o cura por vacío (VAC, "vacuum assisted closure") es un tratamiento no invasivo que consigue la curación de las heridas favoreciendo la vascularización, la aparición del tejido de granulación y eliminación del exceso de exudado[AU]

Acute compartment syndrome requires surgical decompression by fasciotomy, this technique must be urgent and will be key to avoid the establishment of serious sequels. The subsequent approach to these wounds, which are difficult and slow to heal, is a challenge for health professionals and a problem for public health due to high costs and high morbidity. Negative pressure therapy (NPWT) or vacuum assisted closure (VAC) is a non-invasive treatment that achieves wound healing by promoting vascularization, the appearance of granulation tissue and elimination of excess exudate[AU]

A síndrome compartimental aguda requer descompressão cirúrgica, por fasciotomia, esta técnica deve ser urgente e será fundamental para evitar o estabelecimento de sequelas graves. O tratamento subsequente destas feridas difíceis e de cicatrização lenta é um desafio para os profissionais de saúde e um problema desaúde pública devido aos elevados custos e à elevada morbilidade. A terapia por pressão negativa (NPWT) ou o encerramento assistido por vácuo (VAC) é um tratamento não invasivo que permite a cicatrização de feridas através da promoção da vascularização, do aparecimento de tecido de granulação e da remoção do excesso de exsudado[AU]

Experiencia de parto instrumental con vacuum en Hospital Público de Santiago de Chile

Introducción: El vacuum es el instrumento de elección para asistir el parto instrumental en países desarrollados. Objetivo: El objetivo del estudio es exponer los resultados maternos y fetales del uso del vacuum en población chilena y promover su disponibilidad y uso en nuestro país y Latinoamérica. Método: El estudio se realizó entre octubre de 2017 y diciembre de 2021, incluyendo a pacientes que tuvieron parto instrumental con vacuum en el Hospital San Juan de Dios de Chile. Se compararon los partos exitosos con vacuum y los partos en los que se requirió el uso de otro instrumento o una cesárea posterior al uso del instrumento. Resultados: Se realizaron 153 vacuum, correspondientes al 28,59% del total de partos instrumentales. El 79,74% tuvo éxito. El 5,88% no recibió anestesia o se aplicó anestesia local. Solo el 3,27% presentó desgarro perineal con compromiso del esfínter anal. El 91,5% de los recién nacidos no tuvieron complicaciones fetales. Un 20,3% requirió reanimación neonatal. Conclusiones: El estudio muestra que el vacuum es una opción segura y efectiva de parto instrumental en nuestra población. La correcta capacitación y protocolos adecuados son necesarios para garantizar resultados exitosos.

Introduction: Vacuum extraction is the instrument of choice for assisting instrumental delivery in developed countries. Objective: The aim of the study is to present the maternal and fetal outcomes of vacuum use in the Chilean population and promote its availability and usage in our country and Latin America. Method: The study was performed between October 2017 and December 2021, including patients who underwent instrumental delivery with a vacuum extraction at the Hospital San Juan de Dios in Chile. Successful vacuum deliveries were compared with deliveries where another instrument was required, or a cesarean section was performed after instrument use. Results: A total of 153 vacuum deliveries were carried out, accounting for 28.59% of all instrumental deliveries. 79.74% were successful. 5.88% did not receive anesthesia or received local anesthesia. Only 3.27% experienced perineal tear with involvement of the anal sphincter. 91.5% of newborns had no fetal complications. 20.3% required neonatal resuscitation. Conclusions: The study demonstrates that the vacuum is a safe and effective option for instrumental delivery in our population. Proper training and appropriate protocols are necessary to ensure successful outcomes.

Comparison between Vacuum-Assisted Closure Technique and Conventional Approach in Patients with Mediastinitis After Isolated Coronary Artery Bypass Graft Surgery

ABSTRACT Introduction: Median sternotomy is the most preferred approach in heart surgery. Post-sternotomy mediastinitis is a catastrophic and potentially life-threatening complication with an incidence rate of 0.15% to 5%, and its overall mortality rate reaches 47%. In this study, we aimed to compare the results of vacuum-assisted closure technique and the conventional methods on the management of mediastinitis following isolated coronary artery bypass graft surgery. Methods: Between February 2001 and July 2013, 32,106 patients who underwent cardiac operations were evaluated retrospectively. One hundred and fourteen patients who developed post-sternotomy mediastinitis were included in this study. The patients were divided into two groups and compared - vacuum-assisted closure group (n=52, 45.6%) and conventional treatment group (n=62, 54.4%). Results: There were no differences between the two groups according to the patients' characteristics, surgical data, and mediastinal cultures. However, we found that total treatment duration for post-sternotomy mediastinitis, time interval from diagnosis to negative culture, hospitalization time, and in-hospital mortality were statistically significantly lower in the vacuum-assisted closure group than in the conventional treatment group (P<0.001, P<0.001, P<0.001, and P=0.03, respectively). Conclusion: This study demonstrates that the vacuum-assisted closure technique improves the medical outcome of patients with post-sternotomy mediastinitis compared with the conventional treatment. The vacuum-assisted closure is a safe and more effective treatment modality for patients with post-sternotomy mediastinitis after cardiac surgery with reasonable morbidity and mortality.

Optimization of the preparation process of Soft-shelled turtle blood lyophilized powder using Box-Behnken response surface methodology / 中国药房

OBJECTIVE To optimize the preparation process of Soft-shelled turtle blood lyophilized powder （STBLP）， and to provide a reference for improving the availability and quality stability of soft-shelled turtle blood （STB）. METHODS STBLP was prepared with vacuum freeze-drying. Taking the solubility as the index， the preparation process parameters of STBLP were optimized by single factor experiment and Box-Behnken response surface method. RESULTS The optimal freeze-drying process for STBLP was obtained： pre-freezing time of 4 h， total drying time of 13 h （before at 0 ℃）， and resolution drying temperature of 25 ℃. The average solubility of 3 batches of STBLP prepared according to the optimal process was 95.72% （RSD＝0.68%， n＝3）， the relative error of which was －0.97% to the theoretical solubility （96.66%）. CONCLUSIONS Optimized lyophilization process in this study are stable and feasible， the solubility of the prepared sample is high.

Efficacy of flexible vacuum aspiration ureteral access sheath for renal and upper ureteral calculi / 现代泌尿外科杂志

【Objective】 To investigate the safety and efficacy of flexible vacuum aspiration ureteral access sheath in ureteroscopic lithotripsy in the treatment of renal and upper ureteral calculi. 【Methods】 Clinical data of 41 cases treated in our hospital were retrospectively analyzed, including 20 cases treated with flexible vacuum aspiration ureteral access sheath (experimental group), and 21 cases treated with traditional ureteral access sheath (control group). The stone-clearance rate, operation time, postoperative fever (T>37.5 ℃), length of hospital stay and hospitalization costs were compared between the two groups. 【Results】 All operations were successful. The experimental group had significantly shorter operation time than the control group [(54.0±19.8) min vs. (76.6±20.1) min, P0.05). 【Conclusion】 Flexible vacuum aspiration ureteral access sheath in flexible ureteroscopic lithotripsy can shorten the operation time, improve stone-clearance rate and reduce incidence of postoperative fever, which is worth promoting.

Clinical efficacy of double-sheath vacuum suction microchannel percutaneous nephrolithotomy in the treatment of complex renal stones / 现代泌尿外科杂志

【Objective】 To investigate the efficacy and safety of double-sheath vacuum suction microchannel percutaneous nephrolithotomy (MPCNL) in the treatment of complex renal stones. 【Methods】 The clinical data of 139 patients with complicated renal stones who received MPCNL during Aug. 2019 and Jul.2020 were retrospectively analyzed. According to the operation modes, the patients were divided into the double-sheath vacuum suction group (dsVS group, n=72) and conventional nephrostomy sheath group (cNS group, n=67). The perioperative indexes and the first-stage stone clearance rate of the two groups were compared. 【Results】 In the dsVS group and cNS group, the mean operation time was (46.72±9.55) min and (57.22±11.31) min, respectively (P<0.05). The first-stage stone clearance rate was 83.33% and 70.15%, respectively (P<0.05). The BUN value was (5.07±1.65) mmol/L and (5.75±1.83) mmol/L, respectively (P<0.05). The WBC value was (9.45±2.46)×109/L and (10.71±3.14)×109/L, respectively (P<0.05). The incidence of postoperative fever was 1.39% and 11.94%, respectively (P<0.05). There was no significant difference in other clinical data between the two groups (P>0.05). 【Conclusion】 The double-sheath vacuum suction MPCNL is safe and effective to manage complex renal stones, which can shorten the operation time, reduce postoperative complications, and improve the stone clearance rate.

Operative vaginal delivery: practice patterns and outcomes at a tertiary general hospital

INTRODUCTION@#There has been a global decrease in operative vaginal deliveries, with a marked shift towards the vacuum extractor. However, little is known about the trends in operative vaginal delivery in Singapore.@*METHODS@#A retrospective study was conducted on all operative vaginal deliveries performed from 2012 to 2017 at Singapore General Hospital (SGH). Maternal outcomes in terms of postpartum haemorrhage and obstetric anal sphincter injuries were compared between forceps- and vacuum-assisted deliveries. Neonatal outcomes in terms of neonatal intensive care unit (NICU) admission and clinically significant neonatal events were compared. The instrument preference of obstetricians was analysed.@*RESULTS@#A total of 906 consecutive operative vaginal deliveries were included in the study, comprising 461 forceps- and 445 vacuum-assisted deliveries. The rate of operative vaginal delivery was maintained at approximately 10% from 2012 to 2017. Neonatal cephalohematomas were more common after vacuum-assisted deliveries. Other maternal and neonatal outcomes did not differ significantly between the two groups. Clinically significant neonatal events were mostly due to shoulder dystocia, whereas all cases of NICU admissions were not directly related to the mode of delivery. Obstetricians' choice of instrument appeared to reflect personal preference and was not affected by the year of graduation.@*CONCLUSION@#The rates of neonatal and maternal morbidity were low at SGH. Overall instrument use of forceps and vacuum was balanced, and proficiency in both was demonstrated by all operators. Operative vaginal delivery remains an essential skill in facilitating safe vaginal delivery, which should be maintained to keep Caesarean section rates in check.

Uso concomitante de sutura elástica associada ao curativo a vácuo no fechamento de grandes perdas de partes moles / Concomitant use of elastic suture associated with vacuum dressing in the closure of large soft tissue losses

O tratamento das feridas complexas com grande perda de partes moles é um desafio para a cirurgia plástica, principalmente quando a ferida encontra-se infectada. Várias opções são consideradas para o tratamento, como sutura, enxertos, retalhos, expansores. Devido à complexidade dos casos, frequente associação de morbidades, necessidade de intervenções multidisciplinar e longos internamentos, os custos do tratamento são frequentemente elevados. Este trabalho vem demonstrar a técnica de sutura elástica empregada em um caso clínico, utilizando tração contínua da pele em associação ao curativo a vácuo, que possibilitou reabilitação do paciente sem a necessidade de intervenções mais agressivas para o fechamento da ferida traumática extensa.

Treating complex wounds with great loss of soft tissues is a challenge for plastic surgery, especially when the wound is infected. Several options are considered for treatment, such as sutures, grafts, flaps, and expanders. Due to the complexity of the cases, the frequent association of morbidities, the need for multidisciplinary interventions, and long hospital stays, treatment costs are often high. This work demonstrates the elastic suture technique used in a clinical case, using continuous skin traction in association with a vacuum dressing, which enabled patient rehabilitation without the need for more aggressive interventions to close the extensive traumatic wound.

SURGICAL WOUND MANAGEMENT WITH VACUUM ASSISTED DRESSING

Background and Objectives: To evaluate the role and efficiency of vacuum dressing in thehealing of wounds and to assess the benefits and limitations of using vacuum dressing indifferent types/categories of wound.Methods: The study of 25 cases was conducted in the Department of Surgery of atertiary care teaching hospital over a period of 2 years.Results: Vacuum dressing had a significant effect on the final outcome of wounds.Wounds which seemingly needed a flap surgery in the first impression, withsuccessive application of vacuum dressing cycles, could be covered with a simplesplit thickness skin graft. Many patients were salvaged of a revision amputation asshowed by the decrease in overall amputation rates.Interpretation and Conclusion: Based on the data from the present study and otherstudies available, vacuum dressing results in better healing, with minimalcomplications, and thus looks to be a promising alternative for the management ofvarious wounds. Vacuum dressing leads to faster healing of the wounds, thereforedecreasing the overall hospital stay. Hence, it is cost effective also. It reduces theinconvenience and discomfort caused to the patient by frequent change in dressings.It helps in reducing size of the wounds, has profound effect on wound depth andgranulation as seen in our study. It promotes granulation tissue completely coveringthe tendon, thus enabling simple techniques (e.g., skin graft) rather than formal flapclosure in few cases. Wounds with exposed underlying bone and chronic nonhealing ulcers can be managed well with vacuum dressing. It reduces the number ofamputations and re-debridement required. More number of wounds can be managedsuccessfully with secondary closure or skin grafting after multiple cycles of vacuumdressing. This reduces patient morbidity and minimizes the overall effect on hisquality of life. Good outcome of vacuum dressing also depends on its properapplication.

Vacuum-assisted cortex removal - A novel change to the tradition

In developing countries, manual small-incision cataract surgery (MSICS) has surfaced as the cost-effective alternative to phacoemulsification. The Simcoe irrigation-aspiration cannula was developed nearly 40 years ago and is still the most frequently employed tool for cortex aspiration. Although it stands unsurpassed, here we attempt to introduce an addition to the existing Simcoe cannula to achieve a dynamic and controlled vacuum with the added advantage of less physical strain and an effective volume of aspiration. The vacuum-assisted cortex removal device is based on a simple spring action mechanism, where the relaxation of the spring pushes the plunger up and thereby generates a controlled vacuum

Vacuum rhexis � A novel capsulorhexis technique for white cataracts

Capsulorhexis in white intumescent cataract is often associated with extension leading to radial tears or biradial extension 揂rgentinian flag sign� and associated complications. We describe a novel technique of managing this situation. Vacuum rhexis is performed with a 24 G bent cannula attached to a 10-ml syringe. The flap is lifted and then caught using 24 G cannula. The suction is manually controlled by the surgeon, and the rhexis is completed using circumferential movement. The chamber stability is well maintained as there is no leakage, and the bent tip gives excellent fulcrum for movement. The advantage of this technique is that a single port is used for maintaining the chamber stability and it needs no special surgical instruments. Vacuum rhexis is a novel surgical technique used for performing successful continuous curvilinear capsulorhexis (CCC) of adequate size in white and intumescent cataracts, with a consistent and predictable outcome.

Zero Phaco: A new technique for dealing with soft cataracts

Phacoemulsification in soft cataracts can be challenging due to the lack of rigid cleavage planes and the inability to crack. We describe a new phacoemulsification technique for dealing with soft cataracts using high vacuum and zero energy. Following capsulorhexis and hydrodissection, we introduced the phacoemulsification probe, keeping the torsional and longitudinal power at zero. A central groove was created in sculpting mode. We held the nucleus with adequate vacuum in chop mode and divided the nucleus. Then, we rotated and chopped the nucleus similarly into small pieces without using any power. For emulsification, we increased the vacuum to 600 mmHg and then shredded and stuffed the pieces into the phaco probe by the chopper. A newer generation phaco machine with active fluidic system and monitored pressurized infusion helps the surgeon control the intraocular pressure (IOP) and hold the nucleus with vacuum alone, allowing chopping and emulsifying of the pieces without any energy.

NEGATIVE PRESSURE WOUND THERAPY (NPWT): OUR EXPERIENCE USING HOSPITAL WALL SUCTION

Study Design: Prospective case series Delayed wound healing is a significant concern, particularly in Introduction: complex wounds and the elderly with co-morbidities. It leads to pain, morbidity, prolonged treatment, and requires major reconstructive surgery, which imposes an enormous social and financial burden. Negative Pressure Wound Therapy (NPWT) was used to cover large wounds, decubitus ulcers, and open fractures that cannot be closed either primarily or secondarily and often require a complex reconstructive procedure to protect the injury. NPWT is an alternative method of wound management, which uses the negative pressure to prepare the wound for spontaneous healing or by lesser reconstructive options. We applied NPWT on pa Materials and Methodology: tients with open fractures, decubitus ulcers, neglected wounds, fasciotomies, and large wounds. Compared to the patented VAC system, ours include pre-sterilized PVA foam, cling drape (Surgiwear TM), nasogastric tube or an infant feeding tube, and a hospital wall suction. There Results: were three cases of soft tissue injury of the foot with wound defect, one case of fasciotomy for compartment syndrome, one case of the decubitus ulcer, one case of open fractures, and three cases of degloving injuries of the foot. In our study, the NPWT was changed every five days, the average number of NPWT changes was 3-4, length of time NPWT applied before the closure was 14-21 days. The most frequent coverage mode is Split Thickness Skin Graft obviating the need for more complex flaps and microvascular reconstructive procedures. Negative Conclusion: pressure therapy stabilizes the wound environment, reduces wound edema/bacterial load, improves tissue perfusion, and stimulates granulation tissue and angiogenesis. NPWT appears to be simple and more effective than conventional dressings for managing complex wounds, reducing wound volume, depth, treatment duration, and cost.

Proficiency of topical platelet-rich plasma with vacuum-assisted closure over platelet-rich plasma alone in diabetic foot ulcers - A clinical prospective comparative study

Background: Type 2 Diabetes Mellitus is usually associated with peripheral neuropathy, peripheral vascular disease with consequential limb ischemia, and eventually diabetic foot ulcers (DFU). The healing process is slow due to microangiopathy and wound is easily infected with microbials leading to superficial infection, progressing to deep infection and eventually landing in amputation most of the times. Plate rich plasma (PRP) is very cost-effective, readily available blood derivative and has the capability to stimulate cell proliferation and differentiation. It improves tissue healing and regeneration and exhibits potent activities against a number of pathogens. Vacuum assisted closure (VAC), on the other hand, is a new novel way to treat DFU by having negative pressure wound healing. The present study focused on the advantage of (PRP+VAC) dressing over (topical PRP application with its peripheral injection) alone for aiding and enhancing the process of wound healing in DFU. Aims and Objectives: To appraise the advantage of (PRP+VAC) dressing over (topical PRP application with its peripheral injection) alone for aiding and enhancing the process of wound healing in DFU. Materials and Methods: This was a prospective comparative study of 100 cases to compare the outcomes of wound healing by (topical PRP application with its peripheral injection. Results: Mean time taken for appearance of granulation tissue, 100% granulation tissue, average reduction in wound surface area, showed significant (P => 0.005) differences between the (PRP+VAC) and the (topical PRP application with its peripheral injection) dressing groups. Conclusion: (PRP+VAC) dressings are more effective than conventional (topical PRP application with its peripheral injection) dressings in wound healing of DFU.

A clinical study of management of wounds using vacuum assisted dressings

Background: The application of controlled levels of negative pressure has been shown to accelerate debridement and promote healing in many different types of wounds. Vacuum assisted closure (VAC) has proved its efficacy for wound dressing leading to faster wound healing and shorter hospital stay. The aim of the study was to determinethe advantage of vacuum assisted closure over conventional dressing in SCBMCH hospital.Methods:The study was conducted at general surgery wards of SCB Medical College hospital. After debridement of the wound vacuum assisted dressing was applied. Control group was given conventional dressing.Results:In the study sample 10% patients were less than 40 years,76% belonged to 41-60 age group and 7% were more than 61 years of age, 60% male and 40% female. Wounds were located in the foot 27 (54%), leg 19 (38%), sole 2 (4%) and forearm 2 (4%). Patients with sterile pre (VAC), culture and sensitivity was not turning non sterile after VAC, but 90% non-sterile turns sterile after vacuum assisted dressing. In 5 days 25% of granulation tissue formed in VAC dressing whereas only 10% in case control. Similarly, in 10 days it was 40% for VAC and 25% in case of control. Finally, in 15 days it was 70% in case of VAC and 40% in case of control.Conclusions:VAC results in better healing, with few serious complications, and a promising alternative for the management of various wounds.

Analysis Of Completeness Of Blood Vacuume Tube Filling At A Clinical Laboratory Attached To Tertiary Care Center, A Cross Sectional Study

Background:Overfilled and under filled tube are most important cause of pre-analytical error and failure to complete requested examination in sample. The study was performed to analyse relationship betweentime of receiving of sample, location of sample, type of vacuum tube, method of collection, total volume required in a patient and volume incompleteness.Material And Methods:The study involved collection and patient samples data, i.e. receiving time of sample, place of collection, type of vacuum tube, blood collection method, total volume required in a patient, measurement of volume before processing. Average incompleteness of vacuum tube was calculated and average relationship between incompleteness and these parameters done.Result:Average incompleteness in OPD samples is better than Non-OPD samples. Averageincompleteness is better during 9 am to 12 am than early morning hour s. Incompleteness with relation to vacuum tube type is in general Plain > (EDTA/Fluoride) > Citrate. Average incompleteness better in sample collected with vacuum tube needle with holder than use of syringe. Average incompleteness increases as total volume required in a patient increases.Conclusion:Dedicated phlebotomist and use of vacuum tube needle with holder is required to bring overall improvement in completeness of blood collection.

Role of vacuum assisted closure in wound healing among patients attending a tertiary care hospital

Background: Vacuum assisted closure is procedure to aid in improved wound healing. This negative pressure wound therapy can be used in cases of both acute and chronic wounds. Objectives: To find out pattern of wound healing while using vacuum assisted closure for healing chronic non healing ulcers. Materials and methods: It was a prospective study conducted among patients admitted to the Department of General Surgery. Participant included had chronic non healing ulcer due to various etiologies. The study period was from October 2021 to December 2021. 50 participants were enrolled into the study. The data was compiled and analyzed using SPSS version 26. Results: The wound healing was better after day 3. There was significant positive change in wound healing with P value of less than 0.05 over the follow up period. No other factor was found to influence wound healing. Conclusion: Vacuum assisted closure would enhance wound healing among those suffering from chronic non-healing ulcer.

Best Practice Guidelines for Breast Imaging, Breast Imaging Society, India: Part—2

Breast imaging is a prerequisite for providing high quality breast health care. Choosing the appropriate investigation is central to diagnosing breast disease in patients who present to health professionals for treatment. These patients present to doctors of different subspecialties as well as to general practitioners in our country. It is important, therefore, to provide uniform guidance to doctors in different healthcare setups of our country, urban and rural, government and private, for optimal management of breast diseases. These guidelines framed by the task group set up by the Breast Imaging Society, India, have been formulated focusing primarily on the Indian patients and health care infrastructures. They aim to provide a framework for the referring doctors and practicing radiologists to enable them to choose the appropriate investigation for patients with breast symptoms and signs. The aim has been to keep this framework simple and practical so that it can guide not only subspecialists in breast care but also help doctors who do not routinely deal with breast diseases, so that breast cancer is not missed. Overall, the aim of this document is to provide a holistic approach to standardize breast care imaging services in India. Part 2 of these guidelines focuses on the best practice principles for breast interventions and provides algorithms for the investigation of specific common breast symptoms and signs. Ultrasound is the preferred imaging modality for image-guided breast interventions due to real-time needle visualization, easy availability, patient comfort and absence of radiation. Stereotactic mammography guided procedures are performed if the lesion is visualized on mammography but not visualized on ultrasound. 14-gauge automated core biopsy device is preferred for breast biopsies although vacuum assisted biopsy devices are useful for biopsy of certain abnormalities as well as for imaging guided excision of some pathologies. MRI guided biopsy is reserved for suspicious lesions seen only on MRI. Algorithms for investigation of patients presenting with mastalgia, breast lumps, suspicious nipple discharge, infections and inflammation of the breast have been provided. For early breast cancers routine use of investigations to detect occult distant metastasis is not advised. Metastatic work up for advanced breast cancer is required for selection of appropriate treatment options.

Efecto sedativo de Dexmedetomidina intranasal versus sublingual más Remifentanil-Propofol mediante bombas de infusión

Objetivos: evaluar el efecto de dexmedetomidina sublingual frente a dexmedetomidina vía nasal más remifentanilo -propofol con bomba de infusión en procedimientos ginecológicos. Métodos: ensayo clínico no controlado, doble ciego, prospectivo. 68 pacientes con criterios de inclusión dividas en 3 grupos, grupo A [dexmedetomidina sublingual a 0.75 ug/kg], grupo B [dexmedetomidina vía nasal a 0,9 gg/kg] y grupo C [control] más adición de remifentanil y propofol por bombas de infusión. Análisis estadístico de variables cualitativas con chi cuadrado, variables cuantitativas de distribución libre se usó Kruskal-Wallis y distribución normal Anova. Nivel de confianza del 95 % y margen de error del 9 %. Resultados: edad con un rango de 30 a 32 años, la dosis de inicio y sostén tanto del remifentanilo y propofol se disminuyó hasta la mitad comparada con el grupo control, a predominio en el grupo A. Con poca variabilidad en los parámetros hemodinámicos sin repercusión clínica. Efectos adversos más frecuentes como depresión respiratoria en el grupo control, no se observó analgesia con el uso de dexmedetomidina. Y con menor tiempo de estancia en salas de recuperación en pacientes que se administró dexmedetomidina vía nasal. Conclusiones: la administración sublingual es superior con la nasal debido al menor requerimiento de propofol, menos cambios en la presión sanguínea media, sin efectos adversos que se puedan manejar, con mayor facilidad en su administración. Aunque la administración nasal produce un despertar más rápido y mejor control de la frecuencia cardiaca.

Objectives: to evaluate the effect of sublingual dexmedetomidine versus nasal dexmedetomidine plus remifentanil-propofol infusion pump in gynecological procedures. Methods: Uncontrolled, double-blind, prospective clinical trial. 68 patients with inclusion criteria were divided into 3 groups, group A [sublingual dexmedetomidine at 0.75 ug/kg], group B [nasal dexmedetomidine at 0.9 ug/kg] and group C [control] plus the addition of remifentanil and propofol by infusion pumps. Statistical analysis of qualitative variables with chi- square, quantitative variables with free distribution used Kruskal-Wallis and normal distribution Anova. Confidence level of 95% and margin of error of 9%. Results: age with a range of 30 to 32 years, the starting and maintenance dose of both remifentanil and propofol was halved compared to the control group, mainly in group A. With little variability in hemodynamic parameters without clinical repercussion. The most frequent adverse effects were respiratory depression in the control group, no analgesia was observed with the use of dexmedetomidine. And with a shorter stay in recovery rooms in patients who received nasal dexmedetomidine. Conclusions: sublingual administration is superior to nasal due to the lower requirement of propofol, less changes in mean blood pressure, with no adverse effects that can be managed, and with greater ease of administration. Although nasal administration produces a faster awakening and better control of heart rate.

Comparison of Topical Oxygen with Vacuum Assisted Closure in Wound Healing in a Low Resource Setting

The aim of this pilot study is to obtain preliminary results comparing topical oxygen therapy (TOT) and vacuum assisted closure (VAC) in terms of its ability to accelerate wound healing. METHODS: This non-randomised prospective study included patients with age 16-50 years, wound size ≥ 16cm2 and present below knee joint within seven days of occurrence. Bates-Jensen wound assessment tool (BWAT) was used for evaluation at 8-day interval along with percent area reduction at final follow up. RESULTS: Mean number of cycles required in VAC and TOT group were 1.97 (range 1-3) and 2.1 (range 1-3) (each cycle of 5 days) per patient respectively. Percent area reduction was significantly higher in the VAC group (34±9.7%) than TOT (11.3±3.8%) group at final follow up (p<0.05). TOT patients had better improvement in epithelialization compared to VAC at last follow up. More extensive debridement was needed in patients of TOT than VAC. There was no significant difference between final score in both groups. CONCLUSION: TOT appears to be comparable to well-established VAC in treatment of fresh traumatic wounds below the knee joint. Further large scale, multicentric and randomised studies comparing both these modalities of treatment should be the way forward