Vascular Surgery Practice Guidelines during COVID-19 Pandemic in a Setting of High Work Volume Against Limited Resources: Perspective of a Developing Country.

BACKGROUND: The situation of coronavirus disease 2019 (COVID-19) pandemic in the Indian subcontinent is worsening. In Bangladesh, rate of new infection has been on the rise despite limited testing facility. Constraint of resources in the health care sector makes the fight against COVID-19 more challenging for a developing country like Bangladesh. Vascular surgeons find themselves in a precarious situation while delivering professional services during this crisis. With the limited number of dedicated vascular surgeons in Bangladesh, it is important to safeguard these professionals without compromising emergency vascular care services in the long term. To this end, we at the National Institute of Cardiovascular Diseases and Hospital, Dhaka, have developed a working guideline for our vascular surgeons to follow during the COVID-19 pandemic. The guideline takes into account high vascular work volume against limited resources in the country. METHODS: A total of 307 emergency vascular patients were dealt with in the first 4 COVID-19 months (March through June 2020) according to the working guideline, and the results were compared with the 4 pre-COVID-19 months. Vascular trauma, dialysis access complications, and chronic limb-threatening ischemia formed the main bulk of the patient population. Vascular health care workers were regularly screened for COVID-19 infection. RESULTS: There was a 38% decrease in the number of patients in the COVID-19 period. Treatment outcome in COVID-19 months were comparable with that in the pre-COVID-19 months except that limb loss in the chronic limb-threatening ischemia patients was higher. COVID-19 infection among the vascular health care professionals was low. CONCLUSIONS: Vascular surgery practice guidelines customized for the high work volume and limited resources of the National Institute of Cardiovascular Diseases and Hospital, Dhaka were effective in delivering emergency care during COVID-19 pandemic, ensuring safety of the caregivers. Despite the fact that similar guidelines exist in different parts of the world, we believe that the present one is still relevant on the premises of a deepening COVID-19 crisis in a developing country like Bangladesh.

Racial differences in myocardial deformation in obese children: Significance of inflammatory state.

BACKGROUND AND AIMS: The association between racial differences in myocardial deformation and cardiometabolic risk factors is unknown in obese children. Our objective was to: 1) investigate for racial differences in myocardial deformation between white and black obese children and 2) identify biomarkers associated with these observed racial differences. We hypothesized that decreased myocardial deformation observed in black obese children could be accounted for by the differences in the markers of metabolic syndrome between the groups. METHODS AND RESULTS: Obese children were recruited prospectively. All clinical and laboratory tests for the metabolic syndrome were conducted during a single assessment using a standardized protocol. Speckle-tracking echocardiography was performed to obtain longitudinal and circumferential measures of deformation. 310 patients were included in the analysis; 158 (51%) white and 152 (49%) black. The median age was 11.3 years (IQR 5.9). Blacks demonstrated worse longitudinal strain (-14.7 ± 2.7% vs. -15.4 ± 2.9%, p = 0.04). There was no difference in circumferential strain between the groups. Multivariable linear regression showed a significant relationship between longitudinal strain and hsCRP (ß = 0.16, p = 0.03) and HOMA-IR (ß = 0.15, p = 0.04); there was no independent association between longitudinal strain and race. CONCLUSION: Black subjects demonstrated worse longitudinal strain than whites. Only hsCRP and HOMA-IR levels, not race, had an independent association with longitudinal strain, suggesting that the observed racial differences in longitudinal strain may be secondary to differences in inflammation and insulin resistance between the groups.

Innovation in public health surveillance for social distancing during the COVID-19 pandemic: A deep learning and object detection based novel approach.

The Corona Virus Disease (COVID-19) has a huge impact on all of humanity, and people's disregard for COVID-19 regulations has sped up the disease's spread. Our study uses a state-of-the-art object detection model like YOLOv4 (You Only Look Once, version 4), a very effective tool, on real-time 25fps, 1920 X 1080 video data streamed live by a camera-mounted Unmanned Aerial Vehicle (UAV) quad-copter to observe proper maintenance of social distance in an area of 35m range in this study. The model has demonstrated remarkable efficacy in identifying and quantifying instances of social distancing, with an accuracy of 82% and little latency. It has been able to work efficiently with real-time streaming at 25-30 ms. Our model is based on CSPDarkNet-53, which was trained on the MS COCO dataset for image classification. It includes additional layers to capture feature maps from different phases. Additionally, the model's neck is made up of PANet, which is used to aggregate the parameters from various CSPDarkNet-53 layers. The CSPDarkNet-53's 53 convolutional layers are followed by 53 more layers in the model head, for a total of 106 completely convolutional layers in the design. This architecture is further integrated with YOLOv3, resulting in the YOLOv4 model, which will be used by our detection model. Furthermore, to differentiate humans The aforementioned method was used to evaluate drone footage and count social distance violations in real time. Our findings show that our model was reliable and successful at detecting social distance violations in real-time with an average accuracy of 82%.

Stability and performance analysis of storage root yield in a dataset of sweet potato varieties (Ipomoea batatas L.).

The dataset focuses on evaluating the performance of 17 sweet potato varieties (G) released by the Bangladesh Agricultural Research Institute (BARI) in terms of storage root yield and stability across five locations (E) in Bangladesh-Gazipur, Bogura, Jamalpur, Jashore, and Chattogram. The result revealed that BARI Mistialu-12 exhibited the highest average storage root yield at 45.35 t/ha, closely followed by BARI Mistialu-16 at 44.64 t/ha. Conversely, BARI Mistialu-1 had the lowest mean yield of 25.99 t/ha. Among the locations, Bogura recorded the highest mean root yield at 37.05 t/ha, while Chattogram exhibited the lowest at 31.27 t/ha. A combined analysis of variance revealed the presence of variability in storage root yield attributed to the genotype-location (environment) interaction (GEI). To delve deeper into this interaction, additive and multiplicative interaction effect models (AMMI) along with a linear mixed model (LMM) were employed for further investigations to confirm the significant contribution of GEI variance to root yield. The LMM results showed genetic variance (%), heritability (%), selection accuracy (%), and GEI correlation coefficients of 52.27, 54, 94, and 30, respectively. The AMMI analysis indicated that the first two principal components accounted for 74.60 % of GEI, with 20.16 % attributed to it. Assessing significant Interaction Principal Component Analyses (IPCAs) through the Weighted Average of Absolute Scores (WAAS) indicated that BARI Mistialu-12 is the most stable genotype, followed by BARI Mistialu-16 and BARI Mistialu-8, all displaying above-average root yield. The mega-environment analysis associated the highest root production of BARI Mistialu-11 and BARI Mistialu-2 with the Jamalpur location, while Gazipur, Bogura, and Jashore were linked with the superior performance of BARI Mistialu-12 and BARI Mistialu-16 genotypes. These findings are crucial for future breeding programs and the rapidly growing sweet potato industry, given the stable high-yield potential across diverse agro-ecological conditions. However, it is imperative to repeat the study to ensure reliable outcomes.

Economic burden of dengue in urban Bangladesh: A societal perspective.

BACKGROUND: Dengue, a vector-borne disease, is a major public health problem in many tropical and subtropical countries including Bangladesh. The objective of this study is to estimate the societal cost of illness of dengue infections among the urban population in Dhaka, Bangladesh. METHODS: A cost-of-illness study was conducted using a prevalence-based approach from a societal perspective. Costs attributable to dengue were estimated from a bottom-up strategy using the guideline proposed by the World Health Organization for estimating the economic burden of infectious diseases. RESULTS: A total of 302 hospitalized confirmed dengue patients were enrolled in this study. The average cost to society for a person with a dengue episode was US$ 479.02. This amount was ranged between US$ 341.67 and US$ 567.12 for those patients who were treated at public and private hospitals, respectively. The households out-of-pocket cost contributed to a larger portion of the total costs of illness (66%) while the cost burden was significantly higher for the poorest households than the richest quintile. CONCLUSIONS: Dengue disease imposes a substantial financial burden on households and society. Therefore, decision-makers should consider the treatment cost of dengue infections, particularly among the poor in the population while balancing the benefits of introducing potentially effective dengue preventive programs in Bangladesh.

Clinico-epidemiological Characteristics of Asymptomatic and Symptomatic COVID-19-Positive Patients in Bangladesh.

As of August 15, 2020, Bangladesh lost 3591 lives since the first Coronavirus disease 2019 (COVID-19) case announced on March 8. The objective of the study was to report the clinical manifestation of both symptomatic and asymptomatic COVID-19-positive patients. An online-based cross-sectional survey was conducted for initial recruitment of participants with subsequent telephone interview by the three trained physicians in 237 adults with confirmed COVID-19 infection in Bangladesh. The study period was 27 April to 26th May 2020. Consent was ensured before commencing the interview. Collected data were entered in a pre-designed case record form and subsequently analyzed by SPSS 20.0. The mean±SD age at presentation was 41.59±13.73 years and most of the cases were male (73.0%). A total of 90.29% of patients reside in urban areas. Among the positive cases, 13.1% (n=31) were asymptomatic. Asymptomatic cases were significantly more common in households with 2 to 4 members (p=0.008). Both symptomatic and asymptomatic patients shared similar ages of presentation (p=0.23), gender differences (p=0.30) and co-morbidities (p=0.11). Only 5.3% of patients received ICU care during their treatment. The most frequent presentation was fever (88.3%), followed by cough (69.9%), chest pain (34.5%), body ache (31.1%), and sore throat (30.1%). Thirty-nine percent (n=92) of the patients had co-morbidities, with diabetes and hypertension being the most frequently observed. There has been an upsurge in COVID-19 cases in Bangladesh. Patients were mostly middle-aged and male. Typical presentations were fever and cough. Maintenance of social distancing and increased testing are required to meet the current public health challenge.

Out-of-pocket payment for healthcare among urban citizens in Dhaka, Bangladesh.

OBJECTIVES: Out-of-pocket (OOP) payment is the major payment strategy for healthcare in Bangladesh, and the share of OOP expenditure has increased alarmingly. Dhaka is recognised as one of the fastest-growing megacities in the world. The objective of this study is to capture the self-reported illnesses among urban citizens and to identify whether and to what extent socioeconomic, demographic and behavioural factors of the population influence OOP healthcare expenditures. SUBJECT AND METHODS: This study utilises cross-sectional survey data collected from May to August 2019 in urban Dhaka, Bangladesh. A total of 3,100 households were randomly selected. Simple descriptive statistics including frequencies, percentage, mean (95% CI), median and inter-quartile range were presented. Bivariate analysis and multivariate regression models were employed. RESULTS: We observed that acute illnesses (e.g., fever, flu/cough) were dominant among participants. Among the chronic illnesses, approximately 9.6% of people had diabetes, while 5.3% had high/low blood pressure. The richest quintile only spent 5.2% of their household income on healthcare, while the poorest households spent approximately six times more than the richest households. We noted that various factors such as marital status, religion, source of care, access to safe water, income quintile and even the location of households had a significant relationship with OOP expenditure. CONCLUSIONS: Our findings can serve as important source of data in terms of disease- specific symptoms and out-of-pocket cost among urban citizens in Dhaka. The people belonging to wealthier households tended to choose better healthcare facilities and spend more. A pro-poor policy initiative and even an urban health protection scheme may be necessary to ensure that healthcare services are accessible and affordable, in line with the Bangladesh National Urban Health Strategy.

Modeling the SARS-CoV-2 parallel transmission dynamics: Asymptomatic and symptomatic pathways.

Asymptomatic transmission of the coronavirus disease and the infected individual prediction has become very important in the COVID-19 outbreak study. The asymptomatic and symptomatic transmission studies are still ongoing to assess their impacts on disease monitoring and burden. However, there has been limited research on how asymptomatic and symptomatic transmissions together can affect the coronavirus disease outbreak. A mathematical model is therefore needed to be developed in order to assess the effect of these transmissions on the coronavirus disease dynamics. This paper develops a mathematical model concerning asymptomatic and symptomatic disease transmission processes in the COVID-19 outbreak. The model sensitivity has been analysed in terms of the variance of each parameter, and the local stability at two equilibrium points have been discussed in terms of the basic reproduction number (R0). It is found that the disease-free equilibrium gets stable for R0 < 1 whereas the endemic equilibrium becomes stable for R0 > 1 and unstable otherwise. The proportion of the effect of asymptomatic and symptomatic transmission rates on R0 is calculated to be approximately between 1 and 3. The results demonstrate that asymptomatic transmission has a significant impact compared to symptomatic transmission in the disease outbreak. Outcomes of this study will contribute to setting an effective control strategy for the COVID-19 outbreak.

Differentiation of Solitary Mass Lesion of Brain using MR Spectroscopy with Histopathological Correlation.

Different types of solitary brain lesions and also tumefactive demyelinating lesions exhibit many features on CT and MRI that are characteristics of malignancy and surgical biopsy is often performed in suspected tumour. Proton MR Spectroscopy has been used to differentiate different type of these solitary brain lesions. Our purpose is to determine whether MR spectroscopy is able to improve preoperative diagnostic accuracy in case of intracranial solitary tumors. This cross sectional study was carried out among 44 patients who were referred to Radiology and Imaging Department by Neurosurgery and Neuro-medicine department of BSMMU, Dhaka, Bangladesh as MRI suspected glioma for MRS scan during the period of 24 months. MRS was performed in 44 patients with suspected glioma. Metabolic ratio of choline: Cr, NAA: Cr, Lactate: Cr was calculated in short and intermediated echo times (TES). Tumors were subdivided into neoplasm and inflammatory mass. Neoplasm was again subdivided into glioblastoma multiforme and solitary metastasis. The patients were followed up and surgical resection biopsy reports were collected. MRS findings and histopathological findings were then correlated. In this study 68.18% of patients were diagnosed as Glioblastoma multiform by MRS and also in histopathology 18.18%. Patient was diagnosed as solitary metastasis in MRS and 20.45%. Patient was diagnosed as solitary metastasis by histopathology and 13.64%. Patient was diagnosed as abscess in MRS while in histopathology 11.37% patients were diagnosed as abscess.

Non-fatal burn is a major cause of illness: findings from the largest community-based national survey in Bangladesh.

OBJECTIVE: To examine the incidence and characteristics of non-fatal burn injury in Bangladesh. METHODS: A population-based cross-sectional survey was conducted between January and December 2003 in Bangladesh. Nationally representative data were collected from 171 366 rural and urban households, with a total sample size of 819,429. RESULTS: The incidence of non-fatal burns was 166.3 per 100,000 per year. The rate was higher in females than in males (RR 1.15; 95% CI 1.03 to 1.27). Children less than 5 years of age were at much higher risk of burn injury than those older than 5 years (RR 7.05; 95% CI 6.35 to 7.8). Rural people were at more than three times higher risk of burn. The average number of days absent from school due to burn injury was 21.64 (SD 19.64); the average number of workdays lost was 22.96 (SD 35.94). The average duration of assistance required in daily living activities was 17.26 (SD 20.34) days. The hospitalisation rate was 12.6 per 100,000 population per year. The mean duration of hospital stay was 15.88 (SD 20.47) days. The rate of permanent disability was 2.6 per 100,000 population-years. CONCLUSION: Burn is a major cause of morbidity, disability, school absence, and workday loss. Young children, females, and rural dwellers are at highest risk. Home is the most risky place for children and females in terms of burn injury risk. To halt this devastating health issue, a national strategy and programme for burn prevention must be developed.

Analysis of the childhood fatal drowning situation in Bangladesh: exploring prevention measures for low-income countries.

OBJECTIVE: To determine the epidemiology of child drowning in order to propose possible interventions for Bangladesh and other similar low-income countries. DESIGN: Population-based cross-sectional study. SETTING: Rural and urban communities in Bangladesh. SUBJECTS: About 352,000 children 0-17 years were selected from over 171,000 households, using multistage cluster sampling. MAIN OUTCOME MEASURES: Incidence of fatal drowning. RESULTS: Drowning was the leading cause of death (28.6 per 100,000 child-years) in children aged 1-17 years. The highest incidence (86.3 per 100,000 child-years) was in children aged 1-4 years. More than two-thirds of drownings occurred in ponds and ditches. Most drownings (85%) happened in daylight. In more than one-third of cases of drowning, the child was alone. In the two-thirds of cases in which the child was accompanied, almost half were with children who were 10 years or below. Only 7% of drowned children over 4 years of age knew how to swim. CONCLUSIONS: Drowning is a major cause of childhood mortality in Bangladesh. Creating drowning-safe homes, improving supervision of children, modifying the environment, and developing water safety skills for children and the community may be effective interventions for drowning prevention.

Perceptions of rural people about childhood burns and their prevention: a basis for developing a childhood burn prevention programme in Bangladesh.

OBJECTIVES: This study was conducted to gain an in-depth understanding of people's perceptions of childhood burns and their prevention in rural areas of Bangladesh. STUDY DESIGN: Qualitative study. METHODS: Five focus group discussions were conducted in this study. Eight to twelve members were present in each group. Groups were composed of mothers of children under 5 years of age, adolescent male and female students in Grades IX and X, fathers and local leaders such as school teachers and religious leaders. The study was conducted in a rural community of Bangladesh in 2003. RESULTS: Focus group participants were aware of the devastating consequences of childhood burn injuries. They reported that younger boys and older girls are at higher risk of burn injuries. They identified home as the most common place for childhood burn injuries, and stated that occurrence was more common in winter. They held the household members or caregivers responsible because of their lack of supervision and carelessness. The focus group participants suggested that people should supervise their children more carefully, and should take initiatives to modify their homes and premises as necessary so that children would not have access to fires and heat sources. Regarding first aid, the focus group participants reported prevailing harmful practices which are likely to make injuries worse. CONCLUSIONS: A safety education programme could be an effective intervention to improve knowledge and practices of rural people in Bangladesh with regard to prevention of burns injuries in children.

Epidemiology of childhood burn: yield of largest community based injury survey in Bangladesh.

In terms of mortality, morbidity and disability, burns are emerging as a major child health problem in Bangladesh. This trend is similar to many other developing countries. To develop effective burn prevention programmes, information on its magnitude and determinants is necessary. The purpose of this study was to document the magnitude and determinant of childhood burns in Bangladesh, based on a population-based survey which was conducted between January and December 2003. Nationally representative data was collected from 171,366 rural and urban households, comprising of a total population of 819,429. To facilitate data collection, face-to-face interviews were conducted. The rate of non-fatal burn among children under 18 years of age was calculated as 288.1 per 100,000 children-year. The highest incidence (782.1/100,000 children-year) was found among the 1-4 years age group. About 46% of non-fatal burn injuries occurred between 9 a.m. and 3 p.m. The incidence of childhood burn was found to be more than four times higher in rural children than urban children. Ninety percent (90%) of the childhood burns occurred at homes and the kitchen was the most common place. The rate of disability due to burn was 5.7 per 100,000 children per year. The rate of fatal burn was 0.6 per 100,000 per year among all children. The study findings confirmed that childhood burn was a major childhood illness in Bangladesh. An urgent and appropriate prevention programme is required to prevent these unwanted morbidities, disabilities and deaths due to burn.

Condylar Joint Fusion and Stabilization (by Screws and Plates) in Nontraumatic Atlanto-Occipital Dislocation: Technical Report of 2 Cases.

BACKGROUND: Nontraumatic spontaneous atlanto-occipital dislocation (AOD) is rare. In this report, we discuss the technical steps of condylar joint fusion and stabilization (by screws and plates) in nontraumatic AOD. To the best of our knowledge, it is the first report of such techniques. MATERIAL AND METHODS: A young girl and a young man with progressive quadriparesis due to nontraumatic spontaneous atlanto-occipital dislocation were managed by microsurgical reduction, fusion, and stabilization of the joint by occipital condylar and C1 lateral mass screw and plate fixation after mobilization of vertebral artery. RESULT: In both cases, condylar joints fixation and fusion were done successfully. CONCLUSION: Condylar joint stabilization and fusion may be a good or alternative option for AOD.

Changes in mangrove species assemblages and future prediction of the Bangladesh Sundarbans using Markov chain model and cellular automata.

The composition and assemblage of mangroves in the Bangladesh Sundarbans are changing systematically in response to several environmental factors. In order to understand the impact of the changing environmental conditions on the mangrove forest, species composition maps for the years 1985, 1995 and 2005 were studied. In the present study, 1985 and 1995 species zonation maps were considered as base data and the cellular automata-Markov chain model was run to predict the species zonation for the year 2005. The model output was validated against the actual dataset for 2005 and calibrated. Finally, using the model, mangrove species zonation maps for the years 2025, 2055 and 2105 have been prepared. The model was run with the assumption that the continuation of the current tempo and mode of drivers of environmental factors (temperature, rainfall, salinity change) of the last two decades will remain the same in the next few decades. Present findings show that the area distribution of the following species assemblages like Goran (Ceriops), Sundari (Heritiera), Passur (Xylocarpus), and Baen (Avicennia) would decrease in the descending order, whereas the area distribution of Gewa (Excoecaria), Keora (Sonneratia) and Kankra (Bruguiera) dominated assemblages would increase. The spatial distribution of projected mangrove species assemblages shows that more salt tolerant species will dominate in the future; which may be used as a proxy to predict the increase of salinity and its spatial variation in Sundarbans. Considering the present rate of loss of forest land, 17% of the total mangrove cover is predicted to be lost by the year 2105 with a significant loss of fresh water loving mangroves and related ecosystem services. This paper describes a unique approach to assess future changes in species composition and future forest zonation in mangroves under the 'business as usual' scenario of climate change.

Pitfalls of formalin fixation for determination of antineutrophil cytoplasmic antibodies.

Sera can produce nuclear or perinuclear immunofluorescence staining in neutrophils which may be caused by antibodies with differing antigenic specificities. These include perinuclear antineutrophil cytoplasmic antibodies (P-ANCA), granulocyte specific antinuclear antibody (GS-ANA), and antinuclear antibody (ANA). There is controversy over the value of formalin fixation of neutrophils in differentiating antibodies giving selective or preferential reaction with the nuclear or perinuclear area of neutrophils. In a comparative study of 77 sera, formalin fixation caused inconsistency, nonspecific effects, and false positivity owing to enhanced fluorescence. If formalin fixed neutrophils are used in the routine diagnostic laboratory, this will add confusion to the interpretation of the ANCA assay.

Prevention of postoperative adhesions in the rat by in situ photopolymerization of bioresorbable hydrogel barriers.

OBJECTIVE: To assess the efficacy of a novel resorbable hydrogel barrier for preventing postoperative adhesions in animals. METHODS: A hydrogel barrier was formed in situ by photopolymerizing a solution of a macromolecular prepolymer in buffered saline using long-wavelength ultraviolet light. Two models in the rat were evaluated. In a primary adhesion model, devascularization and serosal injury were performed on the uterine horns using bipolar electrocautery. The prepolymer solution was applied to the horns and illuminated to form the barrier. On the seventh postoperative day, the fraction of the length of the horns involved in adhesions was scored, as was the quality of the adhesions. In a readhesion model, adhesions were formed as described and were surgically lysed on the seventh day, then were treated subsequently with the barrier and scored after 7 additional days. Each group in both models consisted of seven animals per treatment condition. Four prepolymer concentrations were examined in the primary adhesion model, and the optimal one was examined in the readhesion model. RESULTS: A conformal hydrogel barrier coating was formed upon in situ photopolymerization and adhered to the treated tissues. No residual hydrogel barrier was observed 7 days after application of the optimal gel concentrations. In the primary adhesion model, the mean fraction of the horns involved in adhesions was reduced significantly, from 76% in controls to 10% (P < .0001), and treatment with a 10% solution of prepolymer was determined to be optimal (P = .025). In the readhesion model, surgical lysis of adhesions alone did not reduce adhesions significantly (from 86% to 79%; P = .3), whereas lysis with barrier treatment did (79% to 28%; P = .002). CONCLUSIONS: In situ photopolymerization allowed the formation of adherent, conformal barriers, which demonstrated high efficacy in the prevention of adhesion formation and reformation in animals. This efficacy and ease of use warrant clinical evaluation.

Efficacy of a resorbable hydrogel barrier, oxidized regenerated cellulose, and hyaluronic acid in the prevention of ovarian adhesions in a rabbit model.

OBJECTIVE: To compare the efficacy of a resorbable hydrogel material with oxidized regenerated cellulose and hyaluronic acid in an ovarian adhesion model. DESIGN: Controlled, blinded, and randomized study involving female rabbits. SETTING: Academic research environment. INTERVENTIONS: A water-soluble hydrogen precursor was applied to the ovary as a liquid and converted to a hydrogel by exposure to long wavelength ultraviolet light, a 0.4% solution of hyaluronic acid was applied to the ovary, or an oxidized regenerated cellulose patch was applied to the ovary after wedge resectioning. MAIN OUTCOME MEASURES: Extent and severity of adhesion formation. RESULTS: Application of the hydrogel reduced adhesion formation by 88%. Neither oxidized regenerated cellulose nor hyaluronic acid reduced adhesion formation. CONCLUSION: The photopolymerized, resorbable hydrogel material is highly effective for the reduction of periovarian adhesions in this model.

Efficacy of adhesion barriers. Resorbable hydrogel, oxidized regenerated cellulose and hyaluronic acid.

OBJECTIVE: To compare a novel resorbable hydrogel barrier with two previously studied barriers, oxidized regenerated cellulose and hyaluronic acid, for the prevention of postoperative adhesions. STUDY DESIGN: Two models were employed in the rat uterine horn, one of adhesion formation after devascularization and serosal injury and one of adhesion reformation after adhesiolysis RESULTS: In the devascularization model, hydrogel treatment reduced the mean extent of adhesion formation from 73% in the control group to 13% (P < .005). Hyaluronic acid pretreatment reduced the extent of adhesion formation to 44% (P < .05), while oxidized regenerated cellulose failed to reduce formation (P > .25). In the adhesiolysis model, treatment with the hydrogel reduced the mean extent of adhesion formation from 87% in the control group to 20% (P < .005). Neither the oxidized regenerated cellulose nor the hyaluronic acid treatments lowered the extent of adhesion formation from the control group (P > .25). The hydrogel barrier was observed to be resorbed over a five-day period and remained adherent to the tissue during resorption. CONCLUSION: Resorbable hydrogel barriers are highly effective in the reduction of adhesion formation and reformation in the rat. This probably due to the good biocompatibility and retention of these materials upon the site of application.