Early clinical outcomes of two regimens of prophylactic antibiotics in cardiac surgical patients with delayed sternal closure.

BACKGROUND: Delayed sternal closure (DSC) can be a lifesaving approach for certain patients who have undergone cardiac surgery. The value of the type of prophylactic antibiotics in DSC is still debatable. AIM: To investigate clinical outcomes of different prophylactic antibiotic regimens in patients who had DSC after cardiac surgery. METHODS: This was a retrospective observational single-center study. Fifty-three consecutive patients who underwent cardiac surgery and had an indication for DSC were included. Patients were subjected to two regimens of antibiotics: Narrow-spectrum and broad-spectrum regimens. RESULTS: The main outcome measures were length of hospital and intensive care unit (ICU) stay, duration of mechanical ventilation, and mortality. Of the 53 patients, 12 (22.6%) received narrow-spectrum antibiotics, and 41 (77.4%) received broad-spectrum antibiotics. The mean age was 59.0 ± 12.1 years, without significant differences between the groups. The mean duration of antibiotic use was significantly longer in the broad-spectrum than the narrow-spectrum group (11.9 ± 8.7 vs 3.4 ± 2.0 d , P < 0.001). The median duration of open chest was 3.0 (2.0-5.0) d for all patients, with no difference between groups (P = 0.146). The median duration of mechanical ventilation was significantly longer in the broad-spectrum group [60.0 (Δ interquartile range (IQR) 170.0) h vs 50.0 (ΔIQR 113.0) h, P = 0.047]. Similarly, the median length of stay for both ICU and hospital were significantly longer in the broad-spectrum group [7.5 (ΔIQR 10.0) d vs 5.0 (ΔIQR 5.0) d, P = 0.008] and [27.0 (ΔIQR 30.0) d vs 19.0 (ΔIQR 21.0) d, P = 0.031]. Five (9.8%) patients were readmitted to the ICU and 18 (34.6%) patients died without a difference between groups. CONCLUSION: Prophylactic broad-spectrum antibiotics did not improve clinical outcomes in patients with DSC post-cardiac surgery but was associated with longer ventilation duration, length of ICU and hospital stays vs narrow-spectrum antibiotics.

Can Incidental Gastric GISTs During Bariatric Surgeries Change the Primary Plan of Surgery? A Single Team Experience and a Systematic Review of Literature.

As bariatric surgeries (BS) increase, more incidental findings are liable to be discovered. Incidental gastric gastrointestinal stromal tumors (GISTs) during BS can be found in around 0.7% of the cases. In this article, we have performed a systematic review of the literature and added our data to those of the review to review a conceptual treatment strategy to both improve patient outcomes and decrease the risk of overall cancer. With the rise of new bariatric techniques, we have proposed a new classification to BS to enhance our description of the treatment strategy.

Covid-19 and its relation to the human eye: transmission, infection, and ocular manifestations.

BACKGROUND: The world is suffering from a new strain of the coronavirus family-Covid-19. This virus strain affected different organs in the human body with a wide range of mild symptoms and moderate signs to severe and deadly ones. Multiple organs can be infected, and one of these organs is the eye. The eye is a vital organ that consists of vascular tissues and is connected to the respiratory tract through the tears and the nasolacrimal duct. METHODS: Recent papers and research from PubMed, Researchgate, and Google Scholar were cited and thoroughly discussed. These papers were chosen based on their relevancy, reliability, publication year, published journal, and ease of accessibility to the paper itself. RESULTS: The theory concluded that the ocular surface might consider a pathway for the virus attack and infection causation through the tears and the angiotensin-converting enzyme 2 located in the eye. This article thoroughly reviewed the history, the existing aspects of Covid-19, the ocular system features, and the claims about the possible involvement of the eye in the virus transmission along with the eye infection. There was no consensus on the eye's involvement theory. CONCLUSION: The authors highlighted the extra work and research needed to be conducted to prove or deny these claims to provide a better understanding of the immune response of the eye to Covid-19 infection.

Coronavirus Disease 2019-induced Acute Exudative Polymorphous Vitelliform Maculopathy.

Acute exudative polymorphous vitelliform maculopathy (AEPVM) is a rare entity characterized by acute multifocal macular detachment with polymorphous subretinal vitelliform deposits. The disease is a presumed retinal pigment epithelial dysfunction and is reported to occur with malignancies. We report a case of a 32-year-old otherwise healthy woman who presented with an acute bilateral visual disturbance a few days after testing positive for coronavirus disease 2019 (COVID-19). Her initial visual acuity was 6/6 in both eyes. Fundus examination revealed bilateral multifocal round yellowish subretinal deposits. Spectral-domain optical coherence tomography showed bilateral foveal serous retinal detachment with subretinal hyperreflective materials consistent with vitelliform deposits. Systemic workup to exclude malignancies and genetic diseases was unremarkable. The patient was observed without treatment, and the vitelliform materials gradually resolved over 18 months of follow-up. In our era of the global pandemic, AEPVM may be associated with COVID-19 infection.