Predicting Superficial Surgical Site Infections: A Study of the Risk Factors and an Assessment Scale From Western India.

Introduction Superficial surgical site infections (SSSIs) are very common nosocomial infections that can complicate a range of surgeries, resulting in increased morbidity and mortality, and an overall decreased benefit of surgical interventions, along with exorbitant expenditure of healthcare resources. An assessment scale could help in the segregation of the high-risk patient population, and appropriate resources could be directed toward them. Methods A prospective observational study was carried out in a tertiary care hospital in Western India with 200 participants. Certain probable preoperative, intraoperative, and postoperative risk factors for SSSIs were assessed for significance of association, and each patient was given a score according to the assessment scale. The predictive power of the scale was calculated. Results Body mass index (BMI), preoperative laboratory investigations, and preoperative hospital stay showed a significant association with the complication. Clean-contaminated wounds had a higher incidence of postoperative SSSIs as compared to clean wounds. Postoperatively, fever and the presence of open drains predisposed the patient to complications. The assessment scale was found to have a positive predictive value of 40.94% and a negative predictive value (NPV) of 86.30%. Conclusion The factors that could significantly prevent the development of SSSIs are normal preoperative laboratory investigations, less than three days of preoperative hospital stay, and avoiding the use of open drains. The high NPV of the assessment scale means that it can be used as a screening tool to segregate high-risk patients.

Overreliance on Radiological Findings Leading to Misdiagnosed Giant Retroperitoneal Ganglioneuroma: A Case Report and Literature Review.

Ganglioneuroma is a rare, benign, well-differentiated neurogenic tumor most commonly located in the posterior mediastinum or retroperitoneum. Giant ganglioneuromas are even less common; this is only the 19th reported case in literature to date. We present a case of a giant retroperitoneal ganglioneuroma in a five-year-old child, which on imaging mimicked a mesenteric cyst and posed various challenges in its management. Histopathology later confirmed our misdiagnosis and revealed the tumor to be a ganglioneuroma. This unique case serves as a lesson for clinicians to not operate before receiving histopathological confirmation of their diagnosis.

Comparative study of onlay versus sublay mesh repair in the management of ventral hernias.

Ventral hernias with large defects (≥ 2 cm) are managed with tension free mesh repair. The growing consensus that sublay (retrorectus) mesh repair is superior to onlay mesh repair due to fewer complications is based on literature dominated by retrospective studies from high and upper-middle income countries. There is thus a need of more prospective studies from various countries to resolve the controversy. The objective of this study was to compare the outcomes of onlay versus sublay mesh repair in the management of ventral hernias. Our single centre, prospective comparative study set in a low-middle income country comprised of 60 patients with a ventral hernia undergoing open surgical repair using either onlay technique (n = 30) or sublay technique (n = 30). Surgical site infections, seroma formation, recurrence were found in 3.33%, 6.67%, 0% patients in sublay repair group and in 16.67%, 20%, 6.67% patients in onlay repair group respectively. Mean duration of surgery, mean Visual Analogue Scale (VAS) score for chronic pain, mean duration of hospital stay were 46 min, 4.5, 8 days in onlay repair group and 61 min, 4.2, 6 days in sublay repair group respectively. Onlay repair group was associated with shorter duration of surgery. However, sublay repair was associated with lesser rates of surgical site infections, chronic pain and recurrence than onlay repair. Sublay mesh repair had better outcomes than onlay mesh repair for the management of ventral hernias, however superiority of any one technique could not be established.

Comparison of Fracture Resistance of Endodontically Treated Teeth With Traditional Endodontic Access Cavity, Conservative Endodontic Access Cavity, Truss Endodontic Access Cavity, and Ninja Endodontic Access Cavity Designs: An In Vitro Study.

INTRODUCTION:  Endodontic access cavity preparation plays a vital role as preservation of enamel structure is of utmost importance for a tooth's strength to be maintained. As teeth become fragile after a root canal therapy, this study was designed to compare in vitro the fracture resistance of root-filled and restored teeth with traditional endodontic access cavity, conservative endodontic access cavity (CEC), ninja endodontic access cavity (NEC), and truss endodontic access cavity (TEC). MATERIALS AND METHODS:  Control (intact teeth) and traditional endodontic access cavity as well as CEC, NEC, and TEC groups were each given a new human mandibular molar that was freshly removed. Cone beam computed tomography (CBCT) scans of the cone beam showed the values of CEC, NEC, and TEC. After that the teeth were endodontically treated and repaired. To test the specimens, universal testing equipment was used. In order to avoid tooth breakage, the maximum load was determined. Statistical analysis was used in the form of Kolmogorov-Smirnov and Levene tests, which were used to examine data for typical dispersion and consistency in change. RESULTS:  Intact teeth showed the highest resistance to fracture compared with other groups. TEC showed significantly higher resistance to fracture compared to the CEC design. CONCLUSIONS:  It is possible, within the restrictions of this research, to infer that the TEC design enhanced tooth fracture strength in comparison with the CEC design.

Cyanobacteria and microalgae growing on monuments of UNESCO World Heritage site Champaner Pavagadh, India: biofilms and their exopolysaccharide composition.

The present study investigated the biofilm organisms growing on selected monuments of the Champaner Pavagadh complex (Gujarat, India), which is a UNESCO World Heritage Site. The cyanobacteria and microalgae were isolated from biofilms collected through non-destructive methods. The identification of these biological organisms was done using micro-morphological characters and confirmed by 16S rRNA gene sequencing. The exopolysaccharide of each of the isolated strains was extracted, hydrolysed and analysed by the HPTLC. Six isolated strains representing five cyanobacteria and one microalga belong to the genera Desmonostoc, Nostoc, Leptolyngbya, Chroococcidiopsis and Asterarcys. The relationships between substrates' specificity of these isolated biofilm organisms and those identified globally were evaluated using maximum parsimony analysis to generate a consensus phylogenetic tree. The five strains of cyanobacteria isolated were closely clustered with cyanobacteria belonging to a tropical region. At the generic level, no relationship between the species and substratum specificity was recorded. The exopolysaccharide analysis of the isolated strains revealed the presence of seven monosaccharides. While glucose was present in all the analysed species, the concentration of either fucose or arabinose was high. The current study presents a novel HPTLC-based method for determination of monosaccharides composition from the extracellular polymeric substances.

Upper gastrointestinal bleeding: audit of a single center experience in Western India.

Upper gastrointestinal (GI) bleeding is defined as bleeding proximal to the ligament of Treitz. The most important aspect of management of GI bleeding is to locate the site and cause of bleeding. The aim of the study is to find out the common etiology, presentation and management, including the role of upper GI endoscopy. Recent advances have meant that endoscopic hemostatic methods are now associated with a reduced rate of re-bleeding, cost, blood transfusion, length of hospital stay and mortality. A prospective study of 50 cases was carried out between August 2001 and July 2003. Patients with signs and symptoms suggestive of upper GI bleeding (UGIB) such as hematemesis, melena, aspirated blood from nasogastric tubes, profuse hematochezia, etc., were included in the study. The patients were selected randomly. The most common cause of UGIB in the present study was acute erosive gastritis (34%) followed by portal hypertension (24%) and peptic ulcer (22%). All 50 patients underwent upper GI endoscopy, of whom 39 patients were treated conservatively and 11 patients underwent endotherapy to control bleeding. Out of 39 patients treated non-endoscopically, 6 cases required laparotomy to control UGIB. 8 of 50 cases had past history of UGIB, 5 of whom had a previous history of endotherapy. One case was treated with de-vascularization as routine hemostatic methods failed. So, initial method of choice to control the bleeding was endotherapy and surgery was undertaken if an endoscopic method failed. The most common cause of hematemesis in our setting was acute erosive gastritis followed by portal hypertension. Endoscopy is a valuable minimal invasive method to diagnose and treat upper GI bleeding.

Massive penoscrotal haematoma following inguinal hernia repair: a case report.

INTRODUCTION: Inguinal hernia is one of the commonest surgical conditions that one comes across in a surgical career. Operative repair is the only successful treatment for hernias. As with other surgical procedures, this is also associated with possible complications. Scrotal haematoma is one of the well-known complications following hernia repair, but massive penoscrotal haematoma requiring surgical intervention is very rare. CASE PRESENTATION: A 53-year-old black man had undergone elective hernia repair. He underwent standard open hernia repair with a prolene mesh and developed massive scrotal haematoma which required drainage. Eventually he recovered well, although slowly. CONCLUSION: To achieve adequate bleeding control during and at the end of operation is the key preventive measure to avoid scrotal haematoma. Here, we report a case of massive penoscrotal haematoma following repair of a moderate sized inguinal hernia. We strongly emphasize the importance of adequate control of bleeding, even in small to moderate sized inguinal hernias in order to avoid such disastrous complications with long-term cosmetic disfigurement.

Spontaneous intra-peritoneal bleeding secondary to warfarin, presenting as an acute appendicitis: a case report and review of literature.

BACKGROUND: Warfarin is a coumarin anti-coagulant, used widely for the therapeutic and prophylactic anticoagulation. Although, it is considered as a life saving medicine, it is associated with the significant adverse effects including intra-abdominal bleeding, which have been very well documented in literature. However, the presentation of warfarin induced intra-peritoneal bleeding as an acute appendicitis has not been reported in English literature. We report this rare, spontaneous intra-peritoneal bleeding secondary to warfarin therapy, mimicking the signs and symptoms of an acute appendicitis for the first time in English literature. CASE PRESENTATION: A 41 year-old female patient who was on warfarin for prophylaxis following the previous episode of pulmonary embolism, presented to the Casualty with the typical symptoms of an acute appendicitis. During operative intervention, we found it to be the spontaneous intra-peritoneal bleeding secondary to warfarin. The patient recovered well following the operation. CONCLUSION: We recommend the use of the radiological investigations in all the cases of acute abdomen who are on warfarin even if the INR is within the therapeutic range.

Penile skin necrosis - complication following selfcircumcision.

Circumcision is one of the commonest operations performed throughout the world for ritual, traditional or medical reasons. Self-circumcision may lead to disastrous complications. There have been reports of the complications following use of the constricting devices for improved sexual performance and for auto-erotic intentions, but cases of self-circumcision leading to complications such as necrosis of the penile skin and strangulation of the penis are very rarely reported. This case represents penile skin necrosis in a 55-year-old white English man following an attempt at self-circumcision with a medically unapproved plastic device available in the market. He recovered after surgical debridement and treatment with antibiotics.