Is non-woven fabric a useful method of packaging instruments for operation theatres in resource constrained settings?

INTRODUCTION: Studies have highlighted the advantages and disadvantages of woven and non-woven fabrics. The present study assessed the change in resterilisation proportion after introduction of non-woven fabric for packaging of instruments and to evaluate the cost-effectiveness of non-woven fabrics compared with woven fabrics. MATERIALS AND METHODS: The present study is a secondary data analysis of resterilisation data collected from November 2009 to August 2013. We calculated the proportions (and their 95% confidence intervals) of resterilisation done every month. The proportion over time was compared using a Chi-square test for trend. We used linear regression analysis to adjust for the number of surgeries performed every month. We also compared the cost of woven and non-woven fabrics. RESULTS: Of the total 117,335 surgical packets prepared during the study period, 1900 were resterilised; thus, the overall proportion was 1.62% (95% CI: 1.55% to 1.69%). The resterilisation proportion was 8.95% (95% CI: 7.73% to 10.17%) in November 2009 and was 0.38% (95% CI: 0.16% to 0.62%) in August 2013 (P < 0.001). After adjusting for the total number of surgeries conducted every month, we found that the number of packets resterilised reduced every month (per month reduction: -1.97, 95% CI: -2.76 to -1.18). The total cost (initial preparation and resterilisation) for 100 units of woven fabric is INR 6359.41 per month (confidence limit estimates: 6228.20 to 6430.62) and for non-woven fabric was INR 6208.50 (confidence limit estimate: INR 6194.90 to 6223.35) (P < 0.01). CONCLUSIONS: The introduction of non-woven spunbond-meltblown-spunbond fabrics did reduce the proportion of resterilisation of packaged instruments. The decline was sharp and sustained over time, even after accounting for the change in the number of procedures. Furthermore, though the switch from woven to non-woven fabric was cost-effective in our situation, it may not be directly translated to other scenarios.

Immunoglobulin levels and CD4 / CD8 counts in ß- thalassemia major.

OBJECTIVE: This cross-sectional study determined the CD4, CD8 counts and serum immunoglobulins in transfusion dependent b - thalassemic patients, and correlated them with anti-HIV, anti-HCV and HBsAg status, number of transfusions, iron overload and splenectomy. METHODS: Patients with acute or chronic diseases (except HIV, Hepatitis B and C), on immunosuppressive drugs or vaccinated within one month prior to study were excluded. CD4, CD8 counts and serum Immunoglobulins were documented. RESULTS: Increasing transfusions led to higher IgA and IgM as well as a decline in CD4 and CD8 levels. Higher ferritin correlated with high IgM. CD4, CD8 and IgA were significantly higher in splenectomized subjects. HCV correlated significantly with lower IgA values. CONCLUSION: Higher transfusion requirement, iron overload, splenectomy and HCV infection correlated with alterations in different immunological parameters.

Alterations in the systemic acid-base status and blood gas dynamics during progressive hypocalcaemia in cow calves.

Hypocalcaemia, induced in cow calves by slow infusion of Na2EDTA for 6 hr, led to biphasic changes in acid-base status. Decrease in ionized plasma Ca2+ concentration upto 0.82 +/- 0.06 mmole 1(-1) was associated with metabolic alkalosis. Further decrease in ionized plasma Ca2+ concentration (0.61 +/- 0.09 mmole 1(-1)) led to metabolic acidosis, superimposed by a respiratory component. There was significant decrease in oxygen tension and saturation of arterial blood as well as impaired uptake of oxygen by peripheral tissues and pulmonary blood.

Serum zinc levels in hepatic encephalopathy.

BACKGROUND: Zinc is essential for various metabolic processes of the body. Since serum zinc levels are lowered in liver diseases, it has been postulated to be a precipitating factor for hepatic encephalopathy. METHODS: We prospectively studied serum zinc levels in consecutive patients with fulminant hepatic failure, subacute hepatic failure and chronic liver disease with encephalopathy. Serum zinc levels were correlated with various clinical and biochemical parameters and final outcome of patients. Serum zinc levels were estimated by atomic absorption spectrometry at admission and also 24 hours after recovery in survivors. RESULTS: Of the 55 patients (age 17-65 years, 35 men) studied, 30 had acute, 5 subacute and 20 chronic liver disease. Patients with hepatic encephalopathy had significantly lower serum zinc levels as compared to 20 age and sex matched controls. High serum bilirubin levels and prothrombin time showed inverse relationship with serum zinc levels. There was no relationship of serum zinc levels with age, sex, grade and duration of encephalopathy, liver size, ascites or splenomegaly. CONCLUSIONS: Hepatic encephalopathy is associated with low serum zinc levels. Recovery occurred in 17 patients despite persisting low serum zinc levels. Serum bilirubin > 23 mg/dL and prothrombin time prolongation > 12 seconds above control have inverse correlation with serum zinc level.

Alterations in acid-base status and blood gas dynamics during progressive hyperkalaemia in neonatal calves.

Alterations in acid-base status and blood-gas dynamics were studied during induced progressive hyperkalaemia in neonatal calves. The hyperkalaemia was associated initially with respiratory alkalosis in arterial blood when plasma K+ was increased to 6.08 +/- 1.02 mmol litre-1. The rise of plasma K+ above 6.08 +/- 1.02 mmol litre-1 led to the development of metabolic acidosis in arterial and venous blood. There was partial respiratory compensation. Plasma K+ concentrations at or above 11.03 +/- 0.34 mmol litre-1 were associated with a decrease in arterial oxygen tension and arterial oxygen saturation. The oxygen extraction ratio was increased during hyperkalaemia.