role of pre-operative inflammatory markers in predicting postoperative infection in patients undergoing total knee arthroplasty

Background: C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR] are frequently used to aid the diagnosis of postoperative peri-prosthetic infections [PPIs] following total knee arthroplasty [TKA]. The role of using these inflammatory markers preoperatively to predict the risk of postoperative PPIs in patients undergoing TKAs has not been well documented to date

Objective: To evaluate the role and cost-effectiveness of preoperative markers; ESR and CRP in predicting postoperative PPIs in patients undergoing elective primary TKA

Design: A Prospective Study

Setting: Department of Orthopedic Surgery, Salmaniya Medical Complex, Kingdom of Bahrain

Method: All patients who underwent primary or simultaneous bilateral TKA from 1 September 2014 to 31 December 2016 were included in the study. Patients who had uncontrolled diabetes, previous surgery or septic arthritis on the same knee, or lost for follow-up were excluded. Inflammatory markers were documented 1-2 days preoperatively. Patients were followed up over a period of 12 months postoperatively. All necessary data were collected prospectively and documented. The data were analyzed using SPSS 20

Result: One hundred thirty-nine patients were included in this study. One hundred and forty-two primary TKAs were performed during the study period, three patients underwent simultaneous bilateral TKA. Eighty-seven [62.59%] patients were females and 52 [37.41%] were males. The mean age was 64 years. Ninety-five [68.34%] patients had one or more preoperative comorbidities. High preoperative levels of CRP and/or ESR were found in thirty-seven [26.62%] patients. Two [1.44%] patients developed postoperative infection and were treated successfully. No other complications were recorded

Conclusion: In our study, we found no significant link between elevated preoperative inflammatory markers and the presence of PPI. Therefore, we do not support the routine use of preoperative inflammatory markers

Arteriovenous fistula aneurysm

Background: Arterio-venous fistula [AVF] provides the best functional patency for patients on regular hemodialysis [HD]. Nevertheless, complications such as AVF aneurysms, steal syndrome, venous hypertension and infections are not uncommon

Objective: To evaluate the trends in AVF aneurysm formations, prophylaxis and treatment options

Design: A Retrospective, Descriptive Study

Setting: Hemodialysis Centers, Ministry of Health, Kingdom of Bahrain

Method: Two hundred and eleven patients on hemodialysis via arterio-venous fistula and arteriovenous graft were included in the study

Result: Two hundred and eleven patients were on hemodialysis via arterio-venous fistula and arterio-venous graft. Thirty [14.22%] patients developed arterio-venous fistula aneurysm. Sixteen [53.33%] were males, and the mean age was 57 years. Eleven [36.66%] patients had excision of the aneurysms with interposition graft. Six [20%] patients had excision of the aneurysms with new fistula formation. Six [20%] patients required a change of the cannula insertion site while the remaining 7 [23.33%] patients were waiting for their scheduled date of surgery

Conclusion: Aneurysm formation is the most common complication in post AVF patients on regular HD. AVF aneurysms are at high risk of rupture and fatal hemorrhage. Surgical treatments could safely be performed for high risk aneurysms. The most common cause of aneurysm formation is repeated punctures at the same site

Peritoneal dialysis: trends, outcomes and complications

hospital visits, has greater patient autonomy and could be adjusted to daily personal activities. However, complications such as peritonitis, line blockage, leakage and hernia, may occur. To evaluate the trends of Peritoneal Dialysis, its outcome and associated complications. A Retrospective, Descriptive Study. Peritoneal Dialysis Centers, Ministry of Health, Bahrain. One hundred eight patients who underwent peritoneal dialysis line insertion from January 2007 to January 2015 were included in this study. One hundred eight patients had peritoneal dialysis line insertion from January 2007 to January 2015. Forty-eight [44.44%] patients are currently on regular peritoneal dialysis. Sixty [55.55%] stopped peritoneal dialysis due to several reasons: 23 [38.3%] blockage, 11 [18.3%] death, 5 [8.3%] inadequate dialysis, 4 [6.6%] transplant, 4 [6.6%] social and 8 [13.3%] unknown. Complications occurred in 52 [48.1%] patients: peritonitis in 29 [26.8%], and blockage in 23 [21.3%] patients. No other complications were reported. Peritoneal Dialysis remains an effective method of renal replacement therapy and it offers several advantages in comparison to hemodialysis. Our results are consistent with most reported regional and international findings. However, we look forward to improve our practice, particularly reducing the infection and blockage rates