Preventable morbidities of a successful intervention, Textiloma/Gossypiboma: A case series.

Preventable morbidities are serious conditions that have the potential to cause serious harm or death of the patient. One of the preventable morbidities is Gossypiboma or involuntary leaving of surgical sponge inside the body. The implication for the patient and the surgeon is grave. Gossypiboma is preventable if guidance and safety recommendations are followed. The purpose of presenting this case series is to rekindle awareness of the phenomena of Gossypiboma, highlight the implications, and stress prevention. Data of patients presented in the Lahore General Hospital was collected, which includes their demographic, clinical features, and management outcome. Their age, gender, surgery conducted, onset of symptoms, and salvage procedure were noted. Five cases are included in this case series from which it was concluded that Gossypiboma is encountered most commonly after intra-abdominal operation. Women are at increased risk during obstetric and gynaecological operations, though both genders are affected.

The Emergence of Multiple Antibiotic Resistance in Culture Sensitivities of Post-surgical Patients in Lahore General Hospital, Lahore.

Objective The purpose of this study is to isolate the organisms which are developing resistance and to recognize the drugs against which resistance has emerged so that antibiotic policy can be formulated for the proper and effective use of antibiotics. Setting and design An observational study was conducted for a period of six months from July 1, 2021 and December 31, 2021 in LGH. Methods Statistics regarding the culture and sensitivity of the organisms isolated from different sources were collected from the surgery department. 195 cultural and sensitivity reports were analyzed for identification of genus/species of bacteria and sensitivity of the organism.  Results Out of 195 culture reports, 124 showed significant growth of organisms exhibiting resistance to either single or multiple drugs. Escherichia and acinobactor was the most common organism isolated with a total of 30 each (24%, 24%), followed by pseudomonas 21 (17%), Klebsiella was 13 (10%), Proteus was 10 (8%), Methicillin-resistance Staph-aureus was seven (5%), Methicillin-sensitive Staph-aureus was five (4%), Staphylococcus epidermidis was four (3%), Providencia, Streptococci, Enterobacter species and Citrobacter species were one (1%). Maximum resistance was detected with frequently used first-line antimicrobials such as Ceftriaxone, ampicillin and Clavulanic acid. Least resistant were Azithromycin, Cefoxitin, Cefaclor among the gram-negative and gram-positive bacteria. Conclusion Antimicrobial resistance (AMR) was more against frequently used antibiotics that are accessible for an extended duration. Variation of resistance and sensitivity pattern with time is identified. Periodic AMR monitoring and rotation of antibiotics are suggested to restrict further emergence of resistance.

Multiscale Anisotropic Tissue Biofabrication via Bulk Acoustic Patterning of Cells and Functional Additives in Hybrid Bioinks.

Recapitulation of the microstructural organization of cellular and extracellular components found in natural tissues is an important but challenging feat for tissue engineering, which demands innovation across both process and material fronts. In this work, a highly versatile ultrasound-assisted biofabrication (UAB) approach is demonstrated that utilizes radiation forces generated by superimposing ultrasonic bulk acoustic waves to rapidly organize arrays of cells and other biomaterial additives within single and multilayered hydrogel constructs. UAB is used in conjunction with a novel hybrid bioink system, comprising of cartilage-forming cells (human adipose-derived stem cells or chondrocytes) and additives to promote cell adhesion (collagen microaggregates or polycaprolactone microfibers) encapsulated within gelatin methacryloyl (GelMA) hydrogels, to fabricate cartilaginous tissue constructs featuring bulk anisotropy. The hybrid matrices fabricated under the appropriate synergistic thermo-reversible and photocrosslinking conditions demonstrate enhanced mechanical stiffness, stretchability, strength, construct shape fidelity and aligned encapsulated cell morphology and collagen II secretion in long-term culture. Hybridization of UAB is also shown with extrusion and stereolithography printing to fabricate constructs featuring 3D perfusable channels for vasculature combined with a crisscross or circumferential organization of cells and adhesive bioadditives, which is relevant for further translation of UAB toward complex physiological-scale biomimetic tissue fabrication.

Characterizing the Effects of Synergistic Thermal and Photo-Cross-Linking during Biofabrication on the Structural and Functional Properties of Gelatin Methacryloyl (GelMA) Hydrogels.

Gelatin methacryloyl (GelMA) hydrogels have emerged as promising and versatile biomaterial matrices with applications spanning drug delivery, disease modeling, and tissue engineering and regenerative medicine. GelMA exhibits reversible thermal cross-linking at temperatures below 37 °C due to the entanglement of constitutive polymeric chains, and subsequent ultraviolet (UV) photo-cross-linking can covalently bind neighboring chains to create irreversibly cross-linked hydrogels. However, how these cross-linking modalities interact and can be modulated during biofabrication to control the structural and functional characteristics of this versatile biomaterial is not well explored yet. Accordingly, this work characterizes the effects of synergistic thermal and photo-cross-linking as a function of GelMA solution temperature and UV photo-cross-linking duration during biofabrication on the hydrogels' stiffness, microstructure, proteolytic degradation, and responses of NIH 3T3 and human adipose-derived stem cells (hASC). Smaller pore size, lower degradation rate, and increased stiffness are reported in hydrogels processed at lower temperature or prolonged UV exposure. In hydrogels with low stiffness, the cells were found to shear the matrix and cluster into microspheroids, while poor cell attachment was noted in high stiffness hydrogels. In hydrogels with moderate stiffness, ones processed at lower temperature demonstrated better shape fidelity and cell proliferation over time. Analysis of gene expression of hASC encapsulated within the hydrogels showed that, while the GelMA matrix assisted in maintenance of stem cell phenotype (CD44), a higher matrix stiffness resulted in higher pro-inflammatory marker (ICAM1) and markers for cell-matrix interaction (ITGA1 and ITGA10). Analysis of constructs with ultrasonically patterned hASC showed that hydrogels processed at higher temperature possessed lower structural fidelity but resulted in more cell elongation and greater anisotropy over time. These findings demonstrate the significant impact of GelMA material formulation and processing conditions on the structural and functional properties of the hydrogels. The understanding of these material-process-structure-function interactions is critical toward optimizing the functional properties of GelMA hydrogels for different targeted applications.