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Objectives: Topical silver treatments and silver dressings are increasingly being utilized for the local treatment of wounds; nevertheless, the evidence for their usefulness is unclear. The aim of this study was to investigate the impact of conventional dressings and silver colloid dressing on diabetic foot ulcers (DFU) with and without compression therapy. Material and Methods: This prospective, double-blind experiment included 50 patients with non-ischemic DFUs, split into two groups of 25 patients each. The study was conducted for a period of six months. The primary endpoint was to evaluate the entire epithelialization (total healing) of all ulcers on the study leg. Results: The ulcer area significantly decreased in the colloidal silver group (67.77 ± 17.82%) compared to the conventional saline group (21.70 ± 23.52%). When compared to the conventional group, the colloidal silver group required considerably fewer days to reach the endpoint (23.15 ± 8.15 days vs. 48.35 ± 18.07 days), and by day 14, ulcer area reduction (from 100%) was greater (48% in the silver group vs. 89.69% in the conventional group). Conclusion: In managing DFUs, unstructured hydrogel wound dressings using silver colloids based on ionic silver are more effective than regular saline dressings since they heal wounds more quickly in fewer days while also drastically reducing ulcer areas over time.
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BACKGROUND AND OBJECTIVES: Laparoscopic cholecystectomy (LC) is a keyhole surgical procedure considered a gold standard treatment for benign gallbladder (GB) diseases. GB retrieval is done per the surgeon's choice through an umbilical or epigastric port. However, postoperative port site infection (PSI) and pain were major complications of this technique. The study aimed to compare the postoperative PSI between epigastric and umbilical ports among patients undergoing LC. METHODS: A prospective randomized controlled trial was conducted among 50 patients who underwent LC for benign GB disease at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, for 6 months. Participants were randomized into epigastric port (n=25) and umbilical port (n=25). Postoperatively, PSI on a postoperative day (POD) of 10 and 30, retrieval difficulty score, Postoperative pain (POP) using a visual analog scale (VAS), and port site scar appearance after 6 months were assessed. RESULTS: This study divided 50 LC patients into epigastric and umbilical ports (n=25). Among them, 31 were females (62%), 19 males (38%), and mean ages of 43.5 ± 10.7 and 40.7 ± 12.6 years were observed for the epigastric and umbilical ports; group age was similar (p=0.37). The gender distribution was similar between groups (p=0.9 for males, p=0.7 for females). The epigastric port displayed a mean body mass index (BMI) of 22.3 ± 1.01, while the umbilical port had a significantly higher mean BMI of 23.7 ± 1.10 (p=0.04). Patients with symptomatic cholelithiasis as the primary reason for surgery were common in both groups (p=0.2 for GB stones, p=0.4 for GB polyps). The mean hospital stays and surgical duration were similar (p=0.7 and 0.99). Epigastric ports had 8% postoperative PSI on POD 10 (vs. 12%, p=0.07) and 0% on POD 30 (vs. 4%, p=1.0), compared to umbilical ports. Umbilical port patients were more satisfied with scar appearance (92% vs. 76%, p=0.11) and less dissatisfied (8% vs. 24%, p=0.02) 6 months post-surgery. Compared to the umbilical port, patients with epigastric ports had significantly higher VAS pain scores at multiple postoperative time points (p-values <0.001 to 0.03). It was also harder to retrieve epigastric port GB (p=0.01). CONCLUSION: The current study highlights the importance of port site selection among patients who underwent LC, as it can notably impact postoperative outcomes. While the umbilical port may be associated with lower PSI rates and better cosmetic outcomes, GB retrieval through the epigastric port may result in lower postoperative port site pain. Surgeons should carefully consider these factors when choosing the port site for LC procedures. Further research, including larger multicenter trials, is needed to validate and expand upon these results, ultimately enhancing patient care in GB surgery.
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Objective: To better understand the impact of the otolaryngology-specific workforce on the burden of related diseases. Study Design: Retrospective analysis of existing workforce density data as compared with the incidence, mortality, and morbidity data for 4 otolaryngologic diseases. Setting: An overall 138 countries with known otolaryngology-head and neck surgery workforce and epidemiologic data. Methods: We obtained raw data on workforce estimates of ear, nose, and throat surgical specialists from the World Health Organization. Disease burdens for 4 conditions were estimated via 2 ratios, the mortality:incidence ratio (MIR) and YLD:incidence ratio (years lost to disability), as specified in the Global Burden of Disease database. These were correlated to country-specific otolaryngologist density data in univariate and multivariate analyses. Results: Increased density of the ear, nose, and throat workforce correlated with better outcomes for otolaryngologic-treated surgical diseases. A 10% increase in otolaryngology workforce density was associated with a 0.27% reduction in YLD:incidence ratio for chronic otitis media, a 0.94% reduction in MIR for lip and oral cavity cancer, a 1.46% reduction in MIR for laryngeal cancer, and a 1.34% reduction in MIR for pharyngeal cancer (all P < .001)-an effect that remained after adjustment for health systems factors for all conditions but chronic otitis media. Conclusion: The density of the surgical workforce is assumed to affect disease outcomes, but ours is the first analysis to show that increased workforce density for a specific surgical specialty correlates with improved disease outcomes. While there is a consensus to increase access to health care providers, quantifying the effect on disease outcomes is an important metric for those performing health economics modeling, particularly where resources are limited.
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BACKGROUND: Six billion people worldwide lack access to safe, timely, and affordable cardiac surgical and interventional care when needed. Cardiovascular diseases are the leading cause of mortality and morbidity around the world, and include a significant surgical backlog of rheumatic and congenital heart diseases. Here, we review the political commitment by the WHO, the UN, and the World Bank to build and strengthen healthcare services for cardiovascular diseases, with a particular focus on cardiac surgical and interventional cardiology services around the world. METHODS: A literature search was performed in the WHO, UN, and World Bank Governing Body databases to identify policy documents mentioning curative cardiovascular disease care. The Governing Body documentation, the Institutional Repository for Information Sharing database of the WHO, and the Official Document System of the UN were used. Documents only discussing prevention of cardiovascular diseases were excluded. RESULTS: Fifty-nine unique documents were identified, including 56 from the WHO, 3 from the World Bank, and none from the UN; 12 (20.4%) documents mentioned cardiac surgery, and 6 (10.2%) contained some actionable language to incorporate cardiac surgical services, but none was explicitly dedicated to cardiac surgical services. CONCLUSION: Although growing, high-level political commitment for curative cardiovascular health services remains minimal. Increased awareness is needed to develop comprehensive cardiovascular care that is necessary to mitigate the increasing burden of premature morbidity and mortality from cardiac disease, and to work towards the Sustainable Development Goals and Universal Health Coverage.