Incidence and risk factors for surgical site infection post-gynecological operations in a tertiary hospital in Egypt: a retrospective study

Background: Surgical site infection (SSI) is the most common complication of surgical procedures in gynecology and it poses a significant burden for both patients and healthcare systems. Our objective was determining the incidence and risk factors for SSI post-gynecological operations during the period of five years.Methods: A matched case-control study at Minia maternity university, Egypt where A total of 18772 cases had undergone different gynecological procedures. The 876 cases were complicated with SSI (SSI cases group) and 2 matched controls per case were chosen from the rest of the cases and served as the control group (n=1752 cases).Results: The overall incidence of SSI post-gynecological operations was 4.67% and post-hysterectomy was 7.57%. SSI group had a significantly higher number of cases with diabetes, obesity, high parity (>4), increased blood loss and those had prolonged duration of surgery compared to the control group (all p<0.01).Conclusions: The identified risk factors are crucial for risk stratification of SSI and prioritizing interventions to improve the outcome. These results could give a picture for SSI post-gynecological operations in our country and identifying these risk factors is crucial for risk stratification of SSI and prioritizing interventions to improve the outcome.

Hypoxemia associated with lumbar puncture in neonates

Objectives: The objectives of the study were to study the effect of different stages of lumber puncture (LP) procedure on oxygen saturation (SpO2) in newborn baby. Materials and Methods: It was a 1-year, prospective observational study conducted in a tertiary care hospital. Forty neonates were included who fulfilled the inclusion criteria. SpO2 was measured during the different stages of LP in the recruited newborns and comparison was done between SpO2 changes in LP duration of <5 min and more than 5 min groups and the effect on SpO2 in preterm and term babies during LP. Results: Mean SpO2 during baseline, flexion, needle insertion, immediate repositioning, and 5 min after procedure were 94.5, 91.82, 88.92, 94.7, and 95.38, respectively. When compare to baseline, drop in SpO2 was found during flexion and needle insertion with p = 0.0025 and <0.0001, respectively. While comparing Mean SpO2 during different phases between duration of LP >5 min versus <5 min group, the saturation was less during flexion positioning with maximum fall at the time of needle insertion in LP duration >5 min. The regain of saturation during repositioning was more in LP <5 min versus duration >5 min group. Comparing between LP duration >5 min versus <5 min group, fall in SpO2 from baseline (5 min before LP procedure) was more in LP duration >5 min group during flexion and needle insertion phase. Hypoxemia is more in preterm than term neonates during flexion and during needle insertion, supine repositioning. Furthermore, hypoxia recovered after 5 min of supine repositioning more in term infants. Conclusions: Significant hypoxia was associated in newborn in flexion and needle insertion phase of lumbar puncture, especially in preterm newborns and those with prolonged duration of procedure.

A REVIEW ON ANALYSIS OF THERAPEUTIC PROCEDURE OF SHIRODHARA AND ITS PROBABLE MODE OF ACTION

Shirodhara is one of the four types of Murdha Taila, which involves a continuous impact of medicated oil due to gravity flow from a dhara pot at the height of 4 angulas through a wick on the forehead of the subject at a controlled temperature for a prolonged duration (approx. 30-45 min.). In today’s era, unhealthy lifestyle, stress, and anxiety lead to many problems like insomnia, headache, facial paralysis, scalp psoriasis, hair fall etc. There is a need for time to find out the safe and effective treatment modalities to combat these challenges from the treasures of Ayurveda. In Ayurveda, many Samhitas have mentioned procedural outcomes, but their mode of action is not mentioned anywhere. So a review study was conducted, and various Samhitas, Nighantus, research papers, scientific journals, and modern books were considered.

Influence of Fasting Plasma Glucose Level on Admission of COVID-19 Patients: A Retrospective Study

Background. The coronavirus disease 2019 (COVID-19) is a serious global health threat and has spread dramatically worldwide. Prolonged viral shedding is associated with a more severe disease course and inflammatory reaction. Blood glucose levels were significantly associated with an increased hazard ratio (HR) for poor outcomes in COVID-19 patients. Objective. Previous studies focused primarily on the relationship between blood glucose and mortality or severe outcomes, but there were few research studies on the relationship between fasting plasma glucose (FPG) and duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA positive status. To explore the relationship between FPG levels and prolonged duration of SARS-CoV-2 viral positivity, the clinical data of COVID-19 patients were analyzed. Method. In this retrospective study, 99 cases of COVID-19 patients in Beijing Ditan Hospital were recruited, and their clinical and laboratory findings at admission were collected and analyzed. Furthermore, the risk factors for prolonged duration of SARS-CoV-2 RNA shedding were identified, and the relationship between FPG levels and the prolonged presence of SARS-CoV-2 RNA was evaluated. Result. We found that elevated FPG levels were correlated with longer duration of SARS-CoV-2 RNA positivity, classification of COVID-19, imaging changes of chest CT, inflammation-related biomarkers, and CD8+ T cell number in COVID-19 patients. In a logistic regression model, after adjusting for gender and age, COVID-19 patients with elevated FPG were more likely to had longer duration of SARS-CoV-2 RNA positivity than those with normal FPG levels (OR 3.053 [95% CI 1.343, 6.936]). Conclusion. Higher FPG levels (≥6.1 mmol/l) at admission was an independent predictor for prolonged SARS-CoV-2 shedding, regardless of a known history of diabetes. It suggests that intensive monitoring and control of blood glucose are important for all COVID-19 patients.

A multi-center, cross-sectional study on the prevalence of facial dermatoses induced by mask use in the general public during the COVID-19 pandemic

Background: The use of face masks and coverings has been recommended in public settings to minimize the risk of the transmission of coronavirus. The rampant surge in the use of masks for a prolonged duration has resulted in various facial dermatoses. Materials and Methods: The present study was an outpatient, multicentric, observational survey conducted over the period of one year. A total of 350 patients were enrolled. A structured questionnaire was employed to collect data identifying adverse skin reactions that had occurred in the area covered by a face mask. Results: Most of the facial dermatoses were observed in the urban population (78.85%). Maskne was the most common facial dermatosis, detected in 62% of the participants, followed by hypopigmentation (11.42%), hyperpigmentation (8.28%), contact dermatitis (5.42%), non-specific erythema (4.28%), desquamation (3.71%), urticaria (2.57%), and cheilitis (2.28%). The mean duration of mask use was 5.76 hours. A majority of the participants reported maskne in the U zone (both on the cheeks and the chin area) of the face (34%), followed by isolated involvement of the chin (26%), cheeks (20%), mandible region (14%), and bridge of the nose (6%). Conclusion: The use of face masks for extended hours without adequate precautions causes various cutaneous adverse effects. Thus, it is important to identify the risk factors precipitating mask-related facial dermatoses.

Clinical use of Anti-Müllerian Hormone to Monitor Resumption of Ovarian Activity following Removal of a 4.7 mg Deslorelin Implant in Queens.

Objective: The use of deslorelin implantsto control reproduction in cats is increasing but because of its prolonged duration, cat breeders oftenrequest implant removal before the end of the treatment. Assaying Anti Mullerian Hormone (AMH) concentrations might be useful to predict time of resumption of ovarian activity in deslorelin-treated queens following implant removal. In queens a minimum of 3 weeks during increasing photoperiod after implant removal has been described for resumption of ovarian activity but no information about AMH concentrations were observed for determining ovarian activity.Animals: Sixteen queens in whichdeslorelinimplants were surgically removed after3, 6 or 9 months (n= 6, 4 and 6 queens, respectively) were used in this study. Procedures: A general and reproductive health check with a GnRH stimulation test were performed before the treatment.After implant removal queens were checked every 1-2 weeks withreproductive ultrasonography, a vaginal smear and blood collection to assay AMHconcentrations. Results: AMH concentrations decreased significantly during treatment to < 2.5+0.6 ng/ml (p<0.05) and reached a nadir at 1.9+0.9 (p<0.05) one-week post-removal.Following implant removal AMH concentrations started to rise reaching a value of 4.3+1.2 ng/ml on the third week and were not different from pre-treatment levels on week 6 post-removal (5.8 ng/ml +0.9, p>0.05).AMH values did not differ depending on duration of deslorelin treatment but were lower in adult queens (p<0.05).Clinical relevance: AMH assay can be a useful tool to follow resumption of feline ovarian function following a deslorelin treatment.

Bacterial Load Associated With Tunneled Dialysis Catheters in Symptom-Free Hemodialysis Patients

Objective This study aimed to evaluate the rate of asymptomatic bacterial infection of tunneled dialysis catheters (TDCs) removed due to maturation of native arteriovenous fistula (nAVF) or catheter dysfunction in hemodialysis patients with no clinically apparent infection. Materials and Methods A total of 229 patients (43.2% [n = 99] female and 56.8% [n = 130] male), who underwent hemodialysis through a TDC, were included in this study. Tip cultures of TDCs removed in an operating room and under sterile conditions were collected. All patients were asymptomatic for catheter infection and had not received antibiotic therapy for the last month. Results The median duration of catheterization was 80 days (min: 5, max: 2880). Bacterial growth was observed in a total of 62 (27.1%) patients. The most common microorganisms were Staphylococcus epidermidis and Staphylococcus aureus. The asymptomatic infection rate was highest in catheters placed through the right and left subclavian veins; however, this was not statistically significant due to the small number of patients. Placement and usage time of TDCs were found to be the most significant factors for bacterial growth in the catheter tip culture ( P < .001). Conclusion Prolonged duration and use of the catheter is significant in terms of bacterial load. The use of TDC as vascular access in renal replacement therapy should be avoided as much as possible.

Reader fatigue – Electroencephalography findings: A case study in students

BACKGROUND: Mental fatigue is usually accompanied by a sense of weariness, reduced alertness, and reduced mental performance, which can lead to accidents, decrease of productivity in workplace and several other health hazards. OBJECTIVE: The aim of this study was to assess mental fatigue of students while reading for a prolonged duration of time by application of electroencephalography (EEG). METHODS: Ten healthy students (27.57±3.4 years; 5 females and 5 males), participated in the study. The experimental design consisted of 5 blocks of 15-min length, in total 75 min for each participant. The experiment was done without any reading activities at the first block. In the following, participants studied the texts and corrected the mistakes. In each block EEG (beta, alpha, and theta power), and the Karolinska Sleepiness Scale (KSS) were recorded. RESULTS: The mean of the self-assessment of sleepiness by KSS from the first to final 15 minutes were 2.3, 3.4, 4.3, 5.2, and 6.1, respectively. The average power in the theta band decreased from 1.23μV2/Hz at the first 15-min period to 1.02μV2/Hz at the last 15-min period. Also, mean power in the alpha band decreased from 0.85μV2/Hz at the first 15-min period to 0.59μV2/Hz at the last 15-min period. Conclusion: The study showed that the KSS and EEG activity indicate sleepiness which were highly correlated, with both changing along with performance.

A Novel Approach to First in the World Retrieval of Open Water Vertical Xmas Tree

Wells plug & abandonment was carried out in a deepwater field (Field C) offshore West Africa. There were 15 deepwater subsea wells in this field. Thirteen of the wells were completed with Open Water Vertical Xmas Tree (OXT) while remaining two were completed with Enhanced Vertical Xmas Tree (EVXT). In the wells with Open Water Vertical Xmas Tree (OXT), the upper completion tubing and hanger were ran together with the Xmas Tree in a single run. This posed challenges to Operator in retrieving the Xmas Tree. This paper will discuss the novel approach used by Operator in the OXT retrieval. Due to the design of OXT which was different from most of the vertical Xmas Trees (XT) in the world, there were a few challenges in the process of XTs retrieval. If the XTs and upper completion tubing were retrieved in reversal of the way it was completed, it will exposed the well to prolonged duration of single barrier until a BOP can be latched on for subsequent activities. On top of that, the Original Equipment Manufacturer's Completion Workover Riser (CWOR) system and Support Landing Structure (SLS) was not available in full package to be utilized in this project. Furthermore, there were constraints on the rig moonpool space, handling of OXT on surface and clashes between the rig's BOP and existing subsea structures. In managing the risk of well exposure to single proven and monitored barrier during the process of OXT retrieval, Operator has evaluated a few options and came out with a novel approach in the OXT retrieval which managed to minimize exposure time and reduce risk in operations. In contrary to the original principle of well completion here, after a barrier was established in the well, the OXTs was retrieved separately from the upper completion tubing to allow rig BOP to be latched onto wellhead in shortest possible time. To achieve this objective, operations was planned to be carried out on a dual activity derrick rig. Meanwhile, a non-OEM rental CWOR system was used together with Tree Running Tool from the OEM CWOR system to access the wells for intervention work and subsequently retrieve the OXTs. By doing this, the combined CWOR stack exceeded the height limitation at the rig's moonpool. Some modifications were carried out to allow the operations to happen. A novel approach was also used to handle the OXT on surface without the OEM Support Landing Structure - which simplified the operations and reduced HSE risks. Solution was also put into place to enable latching of the rig BOP onto wellheads on Drill Centre although there were risk of clashing initially.