Perioperative Blood Transfusions and Cancer Progression: A Narrative Review.

PURPOSE OF REVIEW: To examine the most recent evidence about known controversies on the effect of perioperative transfusion on cancer progression. RECENT FINDINGS: Laboratory evidence suggests that transfusion-related immunomodulation can be modified by blood management and storage practices, but it is likely of less intensity than the effect of the surgical stress response. Clinical evidence has questioned the independent effect of blood transfusion on cancer progression for some cancers but supported it for others. Despite major changes in surgery and anesthesia, cancer surgery remains a major player in perioperative blood product utilization. Prospective data is still required to strengthen or refute existing associations. Transfusion-related immunomodulation in cancer surgery is well-documented, but the extent to which it affects cancer progression is unclear. Associations between transfusion and cancer progression are disease-specific. Increasing evidence shows autologous blood transfusion may be safe in cancer surgery.

Predictors of postoperative pain, opioid consumption, and functionality after arthroscopic shoulder surgery: A prospective observational study.

PURPOSE: This study aims to identify predictors of postoperative pain and opioid consumption after shoulder surgery to help optimize postoperative pain protocols. STUDY DESIGN: Observational cohort study. METHODS: One thirty-four patients undergoing arthroscopic shoulder repair were included. Variables related to the patient, surgery and anesthesia were collected and correlated with postoperative pain intensity, analgesic consumption, and functionality up to 1-month post-surgery. We used mixed-effect linear models to estimate the association of gender, interscalene block (ISB), preoperative shoulder pain, non-steroidal anti-inflammatory drugs (NSAIDs) consumption before surgery, and type of surgery with each of the following outcomes: postoperative pain scores, opioid consumption, and functionality. We further analyzed the data for pain scores and opioid consumption per body weight using the multiple linear regression analysis to demonstrate the aforementioned associations specifically at 1 h, 6 h, 12 h, 24 h, 72 h, 1 week and 1 month after surgery. RESULTS: Omitting the ISB was associated with higher postoperative pain and cumulative opioid consumption over the first 24 h after surgery. Rotator cuff repair and stabilization surgeries were found to be predictive of higher postoperative pain at 24 h, 72 h, and 1 week and lower functionality at 1 week after surgery. Preoperative shoulder pain and NSAIDs consumption were also predictive of postoperative pain and cumulative opioid consumption. CONCLUSION: Omitting a single shot ISB is a strong predictor of postoperative pain and opioid consumption in the early postoperative phase, beyond which the type of surgery, particularly rotator cuff repair and stabilization surgery, emerges as the most important predictor of postoperative pain and functionality.

Colistin monotherapy v/s colistin combination therapy for treatment of Acinetobacter infections, a systematic review.

INTRODUCTION: Acinetobacter baumanii is currently responsible of many nosocomial life threatening infections, and growing multiple types of resistance mechanisms causing a great therapeutic challenge. Colistin has been used for the treatment of Acinetobacter infections after the emergence of resistant strains as an alternative and salvage therapy. Our study's aim is to compare the efficacy of colistin monotherapy versus colistin in combination therapy, its safety in terms of nephrotoxicity and potential resistance emergence. METHODOLOGY: Online electronic databases were searched for studies evaluating colistin in monotherapy compared to colistin in combination therapy. Seven studies met the inclusion criteria after eliminating duplicates according to a Prism flow chart. Endnote and Review Manager 5.3 softwares were used. RESULTS: we found that there is no significant difference in the mortality between the group treated with colistin alone compared to colistin in combination with other antibiotics (OR: 0. 87 95% CI= 0.62, 1.24 P=0.45), we also found no difference in terms of clinical cure or nephrotoxicity, however, microbiological eradication was found to be superior in the combination therapy group (OR: 1.88 95% CI = 1.13, 3.12 p = 0.01). CONCLUSION: Colistin is a safe and effective option in monotherapy as in combination therapy for the treatment of Acinetobacter baumanii infections. Larger RCTs are needed.