Effect of 24 mg dexamethasone preoperatively on surgical stress, pain and recovery in robotic-assisted laparoscopic hysterectomy.

Background: Robotic-assisted hysterectomy is an alternative to laparoscopic surgery as part of a minimal invasive regimen. Several treatment strategies are followed to improve the overall outcome and minimize surgical stress. Glucocorticoids provide significant analgesic and antiemetic effects but their role in reducing inflammatory stress in a fast-track, multi-modal setting in patients undergoing minimally invasive surgery remains to be investigated in details. Methods: This study will evaluate in a randomized trial the effect of a single dose of 24 mg dexamethasone on 100 women undergoing robotic-assisted hysterectomy with regard to surgical stress, measured by c-reactive protein as primary outcome and, further, other stress markers like white blood cell subtypes. The postoperative recovery will be registered in validated charts and questionnaires for pain and analgesic use, quality of recovery, incontinence, sexual and work life. Furthermore, in a sub-analysis, transcriptional profiling will be performed to explore the mechanism of systemic innate and adaptive immune system perturbation induced by surgical stress. Conclusion: The study will provide solid evidence on markers of immunomodulation biomarkers and in addition the subjective effects and underlying mechanisms of perioperative glucocorticoid in women undergoing robotic hysterectomy. These include important aspects of life quality like pain, fatigue, freedom of medications, resuming work and sexual activities.

Pseudomonas otitidis bacteraemia in a patient with COPD and recurrent pneumonia: case report and literature review.

BACKGROUND: Pseudomonas otitidis is a novel species of Pseudomonas bacteria that has been isolated from patients with otic infections. CASE PRESENTATION: In this report, we describe a case of a 59-year-old known with moderate chronic obstructive pulmonary disease with bronchiectasis and recurrent pneumonia where blood cultures revealed the growth of P. otitidis. CONCLUSIONS: This case describes the first report of bacteraemia to P. otitidis and raises questions regarding the misdiagnosis and underestimation of the incidence of infections caused by this novel pathogen.