Preventive Antibiotic Therapy in the Placement of Immediate Implants: A Systematic Review

Immediate implants present a high risk of early failure. To avoid this, preventive antibiotics (PAs) are prescribed; however, their inappropriate administration leads to antimicrobial resistance. The present study aims to clarify whether the prescription of PAs reduces the rate of early failure of immediate implants and to establish guidelines to avoid the overprescription of these drugs. An electronic search of the MEDLINE database (via PubMed), Web of Science, Scopus, LILACS and OpenGrey was carried out. The criteria described in the PRISMA® statement were used. The search was temporarily restricted from 2010 to 2021. The risk of bias was analysed using the SIGN Methodological Assessment Checklist for Systematic Reviews and Meta-Analyses and the JBI Prevalence Critical Appraisal Tool. After searching, eight studies were included that met the established criteria. With the limitations of this study, it can be stated that antibiotic prescription in immediate implants reduces the early failure rate. Preoperative administration of 2–3 g amoxicillin one hour before surgery followed by 500 mg/8 h for five to seven days is recommended. It is considered prudent to avoid the use of clindamycin in favour of azithromycin, clarithromycin or metronidazole in penicillin allergy patients until further studies are conducted.

Maternal and Fetal Response to Pre Anesthetic ‎Magnesium Sulphate in Cesarean Section

Background: Magnesium, the fourth most common cation in the body, has an ‎antagonistic effect at the N-methyl-D-aspartate (NMDA) receptor, as ‎well as calcium-channel blocker properties. Antagonism at the ‎NMDA receptor is thought to alter the mechanism of central ‎hypersensitivity and to subsequently decrease analgesic requirements ‎including opioid consumption.‎‎ This study aimed to assess the effects of preoperative administration of intravenous magnesium sulphate on the intubation stress response as a primary outcome and uterine, fetal middle cerebral and umbilical arterial blood flow, Apgar score and postoperative analgesia as secondary outcomes in participants undergoing elective caesarian section under general anesthesia. Methods: This prospective randomized controlled double blinded study ‎was carried out on 65 pregnant females between 21-35 years old undergoing elective caesarian section under general anesthesia. who were randomly classified randomly into two groups: Magnesium sulphate (Mg) group: received 25 mg/kg magnesium sulphate in 100 ml isotonic saline over 10 minutes before induction of anesthesia. Control group (C): received the same volume of isotonic saline over the same period. Results: Heart rate and mean arterial blood pressure were decreased significantly at post induction to the end of surgery in mg sulphate compared to control group and was insignificantly different between the studied groups at T0 and T1. VAS was significantly lower in mg sulphate group compared to control group at 1, 2, 4, 8, 12 and 24 hours and was insignificantly different among the two groups at PACU admission and 30 min. preoperative administration of magnesium sulphate (25 mg/kg) was associated with lower postoperative pain scores, less post-operative analgesic consumption, better hemodynamic stability without significant difference in umbilical, middle cerebral and uterine arteries blood flow or Apgar score compared to control group in patients undergoing cesarean section under general anesthesia. There was no statistically significant difference in the incidence of sedation and hypotension. No cases showed respiratory depression in the two groups. Conclusion: Preoperative administration of ‎magnesium sulphate (25mg/kg) was associated with better ‎hemodynamic stability, lower postoperative pain scores, less post-‎operative analgesic consumption without significant difference in ‎umbilical, middle cerebral and uterine arteries blood flow or Apgar ‎score with nil complications except for PONV compared to control ‎group in patients undergoing cesarean section under general ‎anesthesia.‎‎

THE EFFECT OF HIGH DOSE AND LOW DOSE PREGABALIN AS PREMEDICATION ON PREOPERATIVE ANXIETY AND SEDATION LEVELS

Objective: To assess the role of pregabalin as premedication for preoperative sedation & anxiolysis with two different doses in laparoscopic cholecystectomy patients. Study Design: Prospective, randomized control study Place and Duration of Study: Department of Pharmacology and Therapeutics, Army Medical College, Rawalpindi in collaboration with Department of Anesthesiology, CMH, Rawalpindi from February 2019 to July 2019. Patients & Methods: 96 patients of either gender, aged between 18 to 60 years with ASA grade I-II, undergoing elective laparoscopic cholecystectomy were enrolled in this study. They were randomly divided into three groups having 32 patients each. Group 1 received oral placebo drug, Group 2 received oral pregabalin 150 mg, whereas Group 3 received oral pregabalin 300mg with sip of water 90 mins before the induction of general anesthesia. The effects of drugs on the patient’s level of sedation and anxiety were evaluated at baseline and before the induction of anesthesia using Ramsay Sedation Score and Beck Anxiety Inventory respectively. Results: Premedication with pregabalin 150mg and 300mg significantly produced sedation as compared to placebo. Though, pregabalin 300mg exhibited more sedation than pregabalin 150mg but the difference between them was statistically insignificant (p >0.05). Preoperative administration of pregabalin was related with anxiolysis, with the most prominent results shown by pregabalin 300mg (p <0.05) whereas pregabalin 150mg couldn’t alleviate anxiety and the results were statistically insignificant (p >0.05). Conclusions: Premedication with pregabalin 300mg, 90 mins before the induction of general anesthesia is an effective regimen to alleviate preoperative anxiety and sedation.

Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease: A Multicentre Study of Geteccu

Background: The impact of biologics on the risk of postoperative complications (PC) in inflammatory bowel disease (IBD) is still an ongoing debate. This lack of evidence is more relevant for ustekinumab and vedolizumab. Aims: To evaluate the impact of biologics on the risk of PC. Methods: A retrospective study was performed in 37 centres. Patients treated with biologics within 12 weeks before surgery were considered “exposed”. The impact of the exposure on the risk of 30-day PC and the risk of infections was assessed by logistic regression and propensity score-matched analysis. Results: A total of 1535 surgeries were performed on 1370 patients. Of them, 711 surgeries were conducted in the exposed cohort (584 anti-TNF, 58 vedolizumab and 69 ustekinumab). In the multivariate analysis, male gender (OR: 1.5; 95% CI: 1.2–2.0), urgent surgery (OR: 1.6; 95% CI: 1.2–2.2), laparotomy approach (OR: 1.5; 95% CI: 1.1–1.9) and severe anaemia (OR: 1.8; 95% CI: 1.3–2.6) had higher risk of PC, while academic hospitals had significantly lower risk. Exposure to biologics (either anti-TNF, vedolizumab or ustekinumab) did not increase the risk of PC (OR: 1.2; 95% CI: 0.97–1.58), although it could be a risk factor for postoperative infections (OR 1.5; 95% CI: 1.03–2.27). Conclusion: Preoperative administration of biologics does not seem to be a risk factor for overall PC, although it may be so for postoperative infections.

Current Concepts in the Treatment of Giant Cell Tumors of Bone

The 2020 World Health Organization classification defined giant cell tumors of bone (GCTBs) as intermediate malignant tumors. Since the mutated H3F3A was found to be a specific marker for GCTB, it has become very useful in diagnosing GCTB. Curettage is the most common treatment for GCTBs. Preoperative administration of denosumab makes curettage difficult and increases the risk of local recurrence. Curettage is recommended to achieve good functional outcomes, even for local recurrence. For pathological fractures, joints should be preserved as much as possible and curettage should be attempted. Preoperative administration of denosumab for pelvic and spinal GCTBs reduces extraosseous lesions, hardens the tumor, and facilitates en bloc resection. Nerve-sparing surgery after embolization is a possible treatment for sacral GCTBS. Denosumab therapy with or without embolization is indicated for inoperable pelvic, spinal, and sacral GCTBs. It is recommended to first observe lung metastases, then administer denosumab for growing lesions. Radiotherapy is associated with a risk of malignant transformation and should be limited to cases where surgery is impossible and denosumab, zoledronic acid, or embolization is not available. Local recurrence after 2 years or more should be indicative of malignant transformation. This review summarizes the treatment approaches for non-malignant and malignant GCTBs.

Safety profile of preoperative administration of low-molecular-weight heparin on minimally invasive lung cancer surgery: a randomized controlled trial

Background Venous thromboembolism remains a common but preventable complication for cancerous lung surgical patients. Current guidelines recommend thromboprophylaxis for lung patients at high risk of thrombosis, while a consensus about specific administration time is not reached. This study was designed to investigate the safety profile of preoperative administration of low-molecular-weight-heparin (LMWH) for lung cancer patients. Methods From July 2017 to June 2018, patients prepared to undergo lung cancer surgery were randomly divided into the preoperative LMWH-administration group (PRL) for 4000 IU per day and the postoperative LMWH-administration group (POL) with same dosage, all the patients received thromboprophylaxis until discharge. Baseline characteristics including demographics and preoperative coagulation parameters were analyzed, while the endpoints included postoperative coagulation parameters, postoperative drainage data, hematologic data, intraoperative bleeding volume and reoperation rate. Results A total of 246 patients were collected in this RCT, 34 patients were excluded according to exclusion criterion, 101 patients were assigned to PRL group and 111 patients belonged to POL group for analysis finally. The baseline characteristic and preoperative coagulation parameters were all comparable except the PRL group cost more operation time (p = 0.008) and preoperative administration duration was significantly longer (p < 0.001). The endpoints including postoperative day 1 coagulation parameters, mean and total drainage volume, drainage duration, intraoperative bleeding volume and reoperation rate were all similar between the two groups. Moreover, coagulation parameters for postoperative day 3 between the two groups demonstrated no difference. Conclusion Preoperative administration of low-molecular-weight-heparin demonstrated safety and feasibility for lung cancer patients intended to receive minimally invasive surgery. Trial registration: ChiCTR2000040547 (www.chictr.org.cn), 2020/12/1, retrospectively registered.