Risk Factors for Wound Infections after Vascular Surgery: Kuwait Experience.

INTRODUCTION: Wound infections represent a serious complication after vascular surgery particularly after vascular reconstructive procedures. We aimed to identify risk factors predisposing patients to these complications. METHODS: This was a retrospective review of open vascular surgical procedures performed between April 2014 and March 2019 in Kuwait. Patient demographics, procedures performed and their indications, and post-operative outcomes were collected and analyzed. Patients with pre-operative active infections were excluded from the analysis. Statistical analysis was performed, and odds ratios (ORs) and relative risks were calculated for the outcomes of interest. Fisher's exact test and two-tailed t test were used where appropriate. RESULTS: 391 patients were identified. The majority (54%) presented with chronic limb threatening ischemia. The mean age was 58 (±10) years, with a male predominance (76%). Wound infection occurred in 53 (14%) patients. The most commonly isolated organism was Staphylococcus aureus (47%). Diabetes (OR 8.03, 95% CI: 1.9142-33.7439, p = 0.0044), hypertension (OR 2.38, 95% CI: 1.2960-4.3684, p = 0.0052), ischemic heart disease (OR 2.30, 95% CI: 1.4349-4.6987, p = 0.0016), hyperlipidemia (OR 2.12, 95% CI: 1.0305-4.3620, p = 0.0412), and chronic renal failure (OR 2.55, 95% CI: 1.0181-6.4115, p = 0.0457) were all found to be significantly associated with the development of post-operative wound infections in vascular surgery patients. CONCLUSION: Diabetes, hypertension, ischemic heart disease, hyperlipidemia, and chronic renal failure were associated with post-operative wound infections. Anticipation of wound complications in patients with these risk factors may aid early diagnosis and treatment.

Are the cytokines TNF alpha and IL 1Beta early predictors of embryo implantation? Cross sectional study.

The cross-talk between endometrium and embryo is not accessible to the researcher for obvious ethical reasons that let understand why implantation remains the black box of reproduction. We aimed to detect of the concentrations of IL-1ß and TNF-α in endometrial secretion at the time of oocyte retrieval for early prediction of implantation. One hundred twenty women participated in the study during ICSI cycles. All women participating in the study included the following criteria; age; 22-36 years, BMI; less than 35 kg/m2, a husband with oligo- or oligoasthenospermia. All women received controlled ovarian hyperstimulation and immediately after ovum pickup, an intrauterine flushing was done. Embryo transfer was done at the blastocyst stage five days after ovum pick up. Serum pregnancy tests were done for all women. The clinical pregnancy was defined as the appearance of the gestational sac and positive embryo cardiac activity was confirmed by TVS. The ongoing pregnancy was detected by abdominal ultrasound at 12 weeks. The participants were divided into two groups: the pregnant group and the non-pregnant group. Thirty-two and half percent of women got pregnant. There were non-significant differences between the two groups regarding the demographic, clinical and laboratory data except for the duration of infertility and concentrations of TNF-α and IL-1ß. The concentrations of TNF-α and IL-1ß were significantly higher in the pregnant group than the non-pregnant group.Therefore,The use of TNF-α and IL-1ß to predict implantation in IVF is promising especially before embryo transfer. Clinical trial.gov registration NCT02854514.