The Royal College of Ophthalmologists' National ophthalmology database study of cataract surgery: Report 14, cohort analysis - the impact of CapsuleGuard® utilisation on cataract surgery posterior capsule rupture rates.

BACKGROUND/OBJECTIVES: The aim of this study was to investigate whether the use of the silicone tipped irrigation/aspiration (I/A) handpiece CapsuleGuard® (Bausch + Lomb, Laval, Canada) reduced rates of posterior capsule rupture (PCR) during cataract surgery. METHODS: Royal College of Ophthalmologists' National Ophthalmology Database (NOD) Cataract Audit data from 01/04/2010 and 31/03/2021 and Bausch + Lomb sales figures were combined to identify centres participating in national cataract audit who have routinely adopted the silicone tipped I/A handpiece, CapsuleGuard®. Data were included only from centres with eligible cataract operations recorded on the NOD both before and after adopting CapsuleGuard®. Review of the literature was undertaken to estimate the proportion of PCR that occurs during I/A, to evaluate the impact of adoption of CapsuleGuard® on PCR occurring in this phase of surgery. RESULTS: Within the study period, 267 371 eligible cataract operations were performed in 14 centres with >50 eligible operations both before and after adopting CapsuleGuard®. Within centres adopting CapsuleGuard®, the rate of PCR occurrence reduction was 16.4%. Before and after the adoption of CapsuleGuard® the median change of PCR was 21.7% reduction (IQR: 4.8% to 37.7% reduction). CONCLUSIONS: A reduction in the rate of PCR was seen after regular adoption of CapsuleGuard® during cataract operations. Review of published studies attributing PCR to various components of the cataract operation suggest around 25% of PCR may occur during I/A; adoption of CapsuleGuard may, therefore, be associated with avoidance of a substantial proportion of the PCR during that phase of surgery.

Streptokinase irrigation through a percutaneous catheter helps decrease the need for necrosectomy and reduces mortality in necrotizing pancreatitis as part of a step-up approach.

BACKGROUND: Percutaneous catheter drainage in pancreatic necrosis with a predominant solid component has a reduced success rate. To improve the efficacy of percutaneous catheter drainage, we used streptokinase in the irrigation fluid in the present study. METHODS: In this retrospective analysis of 4 prospective randomized studies performed at our center from 2014 to 2019, 108 patients were evaluated. We assessed the safety, feasibility, and efficacy of streptokinase irrigation compared to saline irrigation. Data were also analyzed between 50,000 IU and 150,000 IU streptokinase. RESULTS: There were 53 patients in the streptokinase irrigation group and 55 in the saline irrigation group, and both groups were comparable in terms of age, sex, etiology, APACHE II score, and percutaneous catheter drainage characteristics. The modified computerised tomography severity index and modified Marshall score at the onset of pain were significantly higher in the streptokinase group. Sepsis reversal was significantly higher in the streptokinase group (75% vs 36%), and the need for necrosectomy (34% vs 54%) was also lower in the streptokinase group. Mortality was lower in the streptokinase group than in the saline group (32% vs 40%). The incidence of bleeding in the streptokinase group was lower than that in the saline group (7% vs 18%). A higher dose of streptokinase (150,000 IU) resulted in lower rates of necrosectomy, bleeding, and mortality compared to those with 50,000 IU streptokinase. CONCLUSION: Significant reductions in the need for surgery and sepsis reversal were noted in the streptokinase group. The results using 150,000 IU streptokinase were superior to those using 50,000 IU streptokinase.

Use of Pulsed Lavage Reduces the Rate of Surgical Site Infection After Laparotomy.

INTRODUCTION: Surgical site infections (SSI) are a preventable and common post-operative complication within general surgery. Intra-operative irrigation of surgical incisions is an inexpensive method to reduce post-operative SSI rates, however its use is predominantly limited to orthopaedic surgery. We aimed to assess the effects of pulsed lavage (PL) irrigation on SSI rates following elective and emergency laparotomies. METHODS: Elective and emergency patients who underwent a laparotomy between 2018 and 2019 were included. Relevant demographic and peri-operative risk factors collected retrospectively, following strengthening the reporting of observational studies in epidemiology (STROBE) criteria. The primary outcome was rate of superficial SSI within 30 days of the operation. Independent risk factors were assessed via multivariate logistic regression analysis. RESULTS: 176 patients were identified, with an average age of 60.7 ± 19.1 y. 82.4% (145/176) were emergencies and the mean ASA grade was 2.8. Fifty-two patients (29.5%) had PL used during their operation. Thirty-seven patients (29.8%, 37/124) in the control group developed a SSI, compared to seven patients (13.5%, 7/52) in the PL group (P = 0.022). At multi-variate analysis, the use PL conferring an Odds Ratio 0.36 (CI 0.12-0.94, P= 0.047) for developing a SSI. CONCLUSION: PL appears to significantly reduced the rate of SSI following laparotomy. There remains scope to reduce the incidence of this common and expensive post-operative complication, and PL could provide a potential cost-effective means to deliver improved outcomes. Future prospective randomised trials are essential to fully assess its benefits and wider use within general surgery.

Can bipolar transurethral enucleation of the prostate be a better alternative to the bipolar transurethral resection of the prostate?: A prospective comparative study.

ABSTRACT: To analyze the efficacy and safety between bipolar transurethral enucleation of the prostate (BipoLEP) and bipolar transurethral resection of the prostate (B-TURP).One hundred twenty eight patients with benign prostatic hyperplasia were recruited and divided into group 1 (BipoLEP group, n = 72) and group 2 (B-TURP group, n = 56). The study period was from October 2016 to February 2019. All data parameters were prospectively collected and analyzed.In these 2 groups, there were no significant differences of the mean ages (71.88 ±â€Š6.54 years vs 73.05 ±â€Š7.05 years, P = .407), prostate volumes (99.14 ±â€Š9.5 mL vs 95.08 ±â€Š10.93 mL, P = .302) and the mean operation times (93.7 ±â€Š27.5 minutes vs 89.8 ±â€Š22.4 minutes, P = .065). In BipoLEP group, it had more prostate tissue resected (64.2 ±â€Š22.1 g vs 52.7 ±â€Š28.6 g, P = .018), less duration of continuous bladder irrigation (20.7 ±â€Š6.5 hours vs 29.6 ±â€Š8.3 hours, P = .044), shorter catheterization time (4.3 ±â€Š1.5 days vs 5.6 ±â€Š2.1 days, P = .032), shorter hospitalization stay (5.2 ±â€Š1.4 days vs 6.5 ±â€Š1.9 days, P = .031) and less complications (3 cases vs 9 cases, P = .021). There were significant improvements in 3-month postoperative parameters, including: post void residual urine, maximum flow rate, International Prostatic Symptoms Scale, and quality of life in each group (p < 0.01). However, there were no significant differences of preoperative and 3-month postoperative parameters, including: post void residual urine, maximum flow rate, International Prostatic Symptoms Scale, and quality of life between these 2 groups (P > .05).BipoLEP can produce a more radical prostatic resection with better safety profile and faster postoperative recovery. It may become a more favorable surgical alternative to the B-TURP, especially for the prostate larger than 80 g.

Open Tibial Shaft Fractures: Treatment Patterns in Latin America.

BACKGROUND: Open tibial shaft fractures are an important source of disability in Latin America. High-income countries (HICs) worldwide have established standardized treatment protocols for open tibial fractures, but less is known about their treatment in middle-income countries (MICs) in Latin America. This survey of Latin American orthopaedic surgeons characterizes open tibial fracture treatment patterns. METHODS: Orthopaedic surgeons from 20 national orthopaedic societies throughout Latin America completed an online survey assessing their treatment of open tibial fractures. Demographic information was collected. Treatment patterns were queried according to 2 groupings of Gustilo-Anderson (GA) fracture types: treatment of type-I and type-II fractures (GA-I/II) and treatment of type-III fractures (GA-III). Treatment patterns were evaluated across 4 domains: antibiotic prophylaxis, irrigation and debridement, fracture stabilization, and wound management. Summary statistics were reported; analysis was performed using the Fisher exact test (p < 0.05). RESULTS: There were 616 survey participants from 20 Latin American countries (4 HICs and 16 MICs). Initial external fixation followed by staged internal fixation was preferred for GA-I/II (51.0%) and GA-III fractures (86.0%). Nearly one-third (31.5%) of GA-IIIB fractures did not receive a soft-tissue coverage procedure. Stratifying by country socioeconomic status, surgeons in MICs more commonly utilized delayed internal fixation for GA-I/II (53.3% versus 22.0%, p < 0.001) and GA-III fractures (94.0% versus 80.4%, p = 0.002). Surgeons in MICs more commonly used primary closure for GA-I/II (88.9% versus 62.8%, p < 0.001) and GA-III fractures (32.6% versus 9.8%, p < 0.001). CONCLUSIONS: This survey reports Latin American orthopaedic surgeons' treatment patterns for open tibial shaft fractures. Surgeons in MICs reported higher delayed internal fixation use for all fracture types, while surgeons in HICs more routinely avoid primary closure. Soft-tissue coverage procedures are not performed in nearly one-third of GA-IIIB fractures because of a lack of operative personnel and training.

Comparing between second-generation cryoballoon vs open-irrigated radiofrequency ablation in elderly patients: Acute and long-term outcomes.

BACKGROUND: Limited comparative data are available regarding catheter ablation (CA) of atrial fibrillation (AF) using second-generation cryoballoon (CB-2) vs radiofrequency (RF) ablation in elderly patients (>75-year-old). HYPOTHESIS: CB-2 ablation may demonstrate different outcomes compared with that using RF ablation for elderly patients with AF. METHOD: Elderly patients with symptomatic drug-refractory AF were included in the study. Pulmonary vein isolation was performed in all patients. RESULTS: A total of 324 elderly patients were included (RF: 176, CB-2:148) from September 2016 to April 2019. The CB-2 was associated with shorter procedure time and left atrial dwell time (112.9 ± 11.1 vs 135.1 ± 9.9 minutes, P < .001; 53.7 ± 8.9 vs 65.1.9 ± 9.0 minutes, P < .001), but marked fluoroscopy utilization (22.1 ± 3.3 vs 18.5 ± 3.6 minutes, P < .001). Complications occurred in 3.3% (CB-2) and 6.2% (RF) of patients with no significant different (P = .307). The length of stay after ablation was shorter, but the costs were higher in the CB-2 group (1.94 vs 2.53 days, P < .001 and 91 132.6 ± 3723.5 vs 81 149.4 ± 6824.1 CNY, P < .001) compared to the RF group. Additionally, the rate of early recurrence of atrial arrhythmia was lower in the CB-2 group (14.2 vs 23.3%, P = .047), but the long-term success rate was similar between two groups. CONCLUSIONS: CB-2 is associated with shorter procedure time, left atrial dwell time, and length of stay after ablation, but its costs and fluoroscopy time are greater than the RF group. Moreover, the rate of complications and long-term success are similar between the two groups.

Rectal douching among men who have sex with men in six cities in China: a cross-sectional study.

Background Rectal douching, which is a common practice among men who have sex men (MSM) as a preparation for anal sex, may potentially increase the risk of HIV infection. However, little is known about the practice of rectal douching among Chinese MSM. This study investigated the characteristics of rectal douching and factors associated with rectal douching. METHODS: Between January and March 2019, MSM aged ≥18 years in six cities in China were recruited to the study. Participants were asked to complete a self-administered online questionnaire. Chi-squared tests and multivariable logistic regression were used to examine factors associated with rectal douching by calculating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Of 485 MSM in this study, 278 (57.3%) practiced rectal douching in the preceding 6 months. The most common reasons for douching before and after anal sex were hygiene/cleanliness (78.6% and 66.1% respectively) and HIV/STI prevention (8.5% and 17.4% respectively). The most used enemas and equipment before and after anal sex were tap water (73.5% and 70.2% respectively) and showerhead hoses (76.1% and 75.2% respectively). Men who engaged in both insertive and receptive anal sex (OR 8.84; 95% CI 4.52-17.30), exclusively receptive anal sex (OR 6.56; 95% CI 3.55-12.13), condom-less anal intercourse (OR 1.64; 95% CI 1.03-2.63) and anal sex after alcohol use (OR 1.54; 95% CI 1.00-2.35) were more likely to perform douching. CONCLUSION: Rectal douching is common in MSM, some of whom may not realise the potential risks associated with douching. The co-occurrence of douching and other high-risk behaviours would make MSM more vulnerable to HIV. Health education aimed at informing MSM of the potential risks and addressing the high prevalence of douching are urgently needed.

Adherence with bladder irrigation following augmentation.

BACKGROUND: Patients with bladder augmentation (BA) are routinely counseled to irrigate their bladders daily. However, reports of adherence with this regimen are lacking. OBJECTIVE: To evaluate adherence to a bladder irrigation protocol and identify risk factors associated with adherence among adults with spina bifida (SB) and BA. STUDY DESIGN: Adults with SB after BA followed in a multidisciplinary clinic were identified (2017-2019). All patients or caregivers were taught the importance of and the technique for the bladder irrigation protocol prior to and after BA. Patient demographics (age, gender, ambulatory status, and presence of a caregiver in clinics) and surgical details (type of BA, age at surgery, length of follow-up, presence of a catheterizable channel, position of stoma, bladder neck surgery, presence of Malone antegrade colonic enema or ventriculo-peritoneal shunt, and number of stone surgeries) were obtained from the medical record. Patients reported other variables in a standardized clinic questionnaire. Answers were confirmed by health care providers. The variables included who performs clean intermittent catheterization (CIC), size of catheter, frequency of CIC, use of overnight catheterization, difficulties with CIC, number of UTIs, and continence per urethra and per catheterizable channel. Adherence to bladder irrigation was also assessed in the questionnaire. ?Strict adherence' was defined as bladder irrigation performed ≥6 times/week with ≥120 mL of saline. For statistical analysis, a more lenient definition of ?higher adherence' was used: bladder irrigation ≥2 times/week with at least 60 mL. ?Lower adherence' was defined as ≤1 time/week or with less than 60 mL. Factors associated with ?higher adherence' were assessed with non-parametric tests (Bonferroni-corrected p-value: 0.002). RESULTS: Adherence was assessed in 87 eligible patients (60.9% females; mean age of 28.8 ± 8.2 years). No patient (0.0%) reported ?strict adherence', and 62 and 25 patients (71.3% and 28.7%) reported ?higher' and ?lower' adherence' to bladder irrigation, respectively. Nine patients (10.3%) in the ?lower adherence' group did not irrigate at all. No variables were statistically significant on univariate analysis, including previous bladder stone surgery or having a channel (p ≥ 0.01). On exploratory analysis, higher adherence was only associated with self-catheterizations versus those performed by caregivers (76.7% vs 33.3%, p = 0.01). CONCLUSIONS: Adherence to a bladder irrigation protocol in adults with SB and BA is poor. A history of bladder stones requiring surgery and the presence of a catheterizable channel do not appear to affect adherence. It remains unclear why some patients are more likely than others to irrigate their bladders. Future work will focus on methods to improve adherence.

Treatment of Isolated Serosanguinous Incision Drainage after Thoracolumbar Surgery: Is Surgical Management Always Necessary?

Background: There is no consensus regarding how to care for a patient presenting with early isolated incision drainage after thoracolumbar spine surgery. Although drainage is the most common presenting symptom of surgical site infection (SSI), it has low specificity for SSI in the absence of other symptoms. Given that invasive treatment for SSI is costly and high risk, it would be beneficial to determine whether antibiotic treatment alone is sufficient for isolated drainage and what factors predispose to failure of this conservative strategy. Methods: The authors retrospectively reviewed a clinical database of patients who underwent thoracolumbar spine surgery at a single center between 2012-2017. Patients were included if serosanguinous drainage was present within six weeks of surgery without other signs and symptoms of infection such as fever, chills, purulent discharge, fluctuance, wound dehiscence, or erythema. Results: Fifty-eight patients met the study inclusion criteria. After initial conservative management with antibiotics, drainage resolved in 51 patients. The seven patients with drainage that did not resolve were treated with operative surgical washout. Although the groups were similar in most respects, there was a significant difference in the American Society of Anesthesiologists (ASA) score, which is a marker of overall health (surgical group score 2.89 ± 0.33 versus 2.06 ± 0.61; p < 0.0001). In addition, patients with greater estimated blood loss, length of hospital stay, operative time, and spinal levels treated were more likely to require surgical washout, although these differences were not statistically significant. Groups were similar with respect to age, Body Mass Index, smoking status, diabetes mellitus status, revision versus primary surgery, and drainage latency. Conclusion: Most patients who present with isolated serosanguinous incision drainage within six weeks of surgery may be managed successfully using antibiotics only. Patients who fail to respond to conservative therapy have significantly worse general health, as indicated by the ASA score.

Peri-Procedural Aggressive Hydration for Post Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis Prophylaxsis: Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Periprocedural intravenous hydration is suggested to decrease the risk of post-ERCP pancreatitis (PEP). However, quality of evidence supporting this suggestion remains poor. Here we hypothesized that aggressive hydration(AH) could be an effective preventive measure. METHODS: Pubmed, EMBASE, CINAHL, Google Scholar, Clinical Trials. gov, Clinical Key, International Standard Randomized Trial Number registry as well as secondary sources were searched through January 2019 to identify randomized controlled studies comparing AH to standard hydration (SH) for prevention of PEP. Pooled odds ratio (OR) and 95% confidence intervals (CIs) were calculated using the random-effects model. RevMan 5.3 was used for analysis. RESULTS: A total of 9 RCTs, with 2094 patients, were included in the meta-analysis. AH reduced incidence of PEP by 56% compared to SH (OR = 0.44, CI:0.28-0.69; p = 0.0004). The incidence of post-ERCP hyperamylasemia also decreased with AH compared to SH (OR = 0.51; p = 0.001). Length of stay decreased by 1 day with AH (Mean Difference (MD): -0.89 d; p = 0.00002). There was no significant difference in adverse events related to fluid overload between two groups (OR:1.29; p = 0.81) and post-ERCP abdominal pain (OR:0.35; p = 0.17). Numbers of patient to be treated with AH to prevent one episode of PEP was 17. Final results of the meta-analysis were not affected by alternative effect measures or statistical models of heterogeneity. CONCLUSION: Aggressive hydration is associated with a significantly lower incidence of PEP and it appears to be an effective and safe strategy for the prevention of Post ERCP pancreatitis.

Randomized clinical trial of prophylactic transanal irrigation versus supportive therapy to prevent symptoms of low anterior resection syndrome after rectal resection.

Background: Low anterior resection syndrome (LARS) is a frequent problem after rectal resection. Transanal irrigation (TAI) has been suggested as an effective treatment in patients who have developed LARS. This prospective RCT was undertaken to evaluate the effect of TAI as a prophylactic treatment to prevent symptoms of LARS. Methods: Patients who had undergone ultralow rectal resection were randomized to start TAI on a daily basis, or to serve as a control with supportive therapy only after ileostomy closure. All patients were seen after 1 week, 1 month and 3 months, and the maximum number of defaecation episodes per day and night documented during follow-up. Wexner score, LARS score and Short Form 36 questionnaire responses were evaluated in both groups. Results: Thirty-seven patients could be evaluated according to protocol (TAI 18, control 19). The maximum number of stool episodes per day and per night was significantly lower among patients who underwent TAI at 1 month (median 3 versus 7 episodes/day in TAI versus control group, P = 0·003; 0 versus 3 episodes/night, P = 0·001) and 3 months (3 versus 5 episodes per day, P = 0·006; 0 versus 1 episodes/night, P = 0·002). LARS scores were significantly better in the TAI group after 1 month (median 16 versus 32 in control group; P = 0·044) and 3 months (9 versus 31; P = 0·001). A significantly better result in terms of Wexner score was seen in the TAI group after 3 months (median 2 versus 6 in controls; P = 0·046). Conclusion: Prophylactic TAI led to a significantly better functional outcome compared with supportive therapy for up to 3 months. Registration number: DRKS00011752 ( http://apps.who.int/trialsearch/).

Outcomes of Superficial and Deep Irrigation and Debridement in Total Hip and Knee Arthroplasty.

BACKGROUND: Following total knee arthroplasty and total hip arthroplasty, wound-related problems and deep periprosthetic joint infection may present in a similar fashion. Irrigation and debridement (I&D) has a great role in management of patients with early infection. The question that often arises is how to tell the difference between superficial and deep infection. This study evaluated the role and outcomes of both superficial and deep I&D in patients with wound-related issues and/or suspected periprosthetic joint infection. METHODS: A retrospective study was conducted evaluating patients who underwent I&D within 28 days of total joint arthroplasty. A total of 176 cases with a minimum of 1-year follow-up were identified, and clinical records were reviewed in detail. Reoperations included superficial (fascia not opened) or deep (fascia opened) I&D. Failure was defined as the need for further surgical intervention within 1 year of initial I&D. RESULTS: The overall success for superficial I&D was 84.28% vs 68.86% for deep I&D. The success of both deep and superficial I&D was higher if the I&D was performed closer to the index surgery. Superficial I&D in patients with a positive joint aspiration or evidence of intraoperative purulence or those in whom had no subcutaneous fluid had higher failure rates. CONCLUSION: Superficial I&D is a viable option in patients with wound-related issues as long as joint aspiration is performed to rule out infection involving the prosthesis. If there are findings of no fluid or purulence, fascia may need to be opened and the deeper tissues explored.

Outcome of Direct Anterior Total Hip Arthroplasty Complicated by Superficial Wound Dehiscence Requiring Irrigation and Debridement.

BACKGROUND: Superficial wound dehiscence after total hip arthroplasty (THA) performed through the direct anterior approach (DAA) can be treated with superficial irrigation and debridement (I&D). The incidence and treatment of this complication has been described, but there are little data on the outcomes after a superficial I&D have not been described. The purpose of this paper was to examine the clinical outcomes of DAA THAs requiring postoperative superficial I&D. METHODS: A retrospective review of 1573 THAs performed using the DAA were identified utilizing a prospectively collected, single-institution joint registry. Of these 1573 cases, 18 THAs in 18 patients (1.1%) underwent a superficial I&D for superficial wound dehiscence. Outcomes studied included prosthetic joint infection (PJI) after superficial I&D, revisions, re-reoperations, complications, and clinical outcome scores. RESULTS: Survivorship from superficial I&D at 1, 2, and 5 years postoperatively was 98.6% at all time points. In the 18 patients who underwent superficial I&D, this was performed an average of 37 (range 12-83) days after their THA. Female gender (hazard ratio 5.5, 95% confidence interval 1.20-32.34, P = .0271) was associated with a higher risk of undergoing superficial I&D as was body mass index >30 kg/m2 (P = .0028), >35 kg/m2 (P < .0001), and >40 kg/m2 (P = .0037). At average follow-up of 2.2 (range 0.2-5.5) years, 0 patients developed PJI. Complications included femoral revision for a painful fibrously ingrown femoral component (1), pulmonary embolus (1), and death from respiratory failure (1). Postoperative Harris Hip Scores averaged score was 86.8 (range 57-99). CONCLUSIONS: Superficial wound dehiscence requiring superficial I&D after DAA THA occurs in about 1%-2% of patients with low risk of subsequent PJI.

Clinical practice in prevention of fracture-related infection: An international survey among 1197 orthopaedic trauma surgeons.

INTRODUCTION: Open fractures are still a challenge in orthopaedic trauma surgery, and compared to closed fractures, the rate of complications including fracture-related infection (FRI) remains significantly higher. Although different guidelines on prevention of FRI have been published in past decades, the current recommendations vary significantly. The objectives of this international questionnaire were to evaluate clinical practice procedures for the prevention of FRI in open fractures and to evaluate adherence to available guidelines. METHODS: A 17-item questionnaire regarding prophylaxis against infection in fracture care was administered by SurveyMonkey® and was sent via blast e-mail to all users of AOTrauma (Davos, Switzerland). RESULTS: Overall, 1197 orthopaedic trauma surgeons answered the survey. Although cephalosporins were the most commonly prescribed agents for perioperative antibiotic prophylaxis (PAP) in open fractures, a total of 13 different antibiotics were mentioned in the survey. Furthermore, the duration of PAP was extremely variable with a tendency towards longer treatment periods with increasing open fracture severity. The majority of surgeons (71%) agreed that the optimal duration of PAP was not well defined in the literature. The use of local anti-infective agents varied significantly, although all options received additional votes with increasing injury severity. Some of the other surgical aspects addressed in this review were associated with debridement and irrigation. A delay of six hours from injury to the first debridement was acceptable to 47% of surgeons, but delays were tolerable. Normal saline was the solution used most often for wound irrigation in open fractures (89%), with low-pressure irrigation being applied most commonly (55%). CONCLUSIONS: This international survey provided an overview of clinical practice in FRI prevention, particularly in open fracture cases. The treatment of these serious injuries remains heterogeneous. A major issue is the lack of consensus concerning type and duration of PAP. Furthermore, there seems to be no agreement on the indication for the use of local anti-infective agents. Overall, it is unknown what the repercussions are of this lack of internationally accepted guidelines on daily clinical practice, but it is clear that standardised treatment protocols are preferable in the current medical landscape.

Douching practices among women in the Bolgatanga municipality of the upper east region of Ghana.

BACKGROUND: Vaginal douching is a common practice among women all over the world. Women douche for various reasons, despite evidence indicating the harmful health effects of the practice. There is lack of data on the practice in Ghana but health behaviors like vaginal douching may be influenced by differences in culture and geography. Therefore, this study sought to assess prevalence and predictors of vaginal douching practices among women of the Bolgatanga Municipality of Ghana. METHODS: This cross-sectional study was conducted among 200 women from January to March 2016. RESULTS: Sixty-seven percent of the women practiced vaginal douching, from which a similar proportion did it daily. Over two-thirds (67.7%) of the women used water for douching. The reasons for douching were cleansing the vagina (67.7%), therapeutic effects (12.8%) and tightening of the vaginal muscles (19.5%). The majority (87.2%) of women who douched were unaware of the harmful health effects associated with the practice. The educational level of the women (p = 0.025) and having knowledge of the dangers associated with douching (p <  0.001) were then significantly associated with douching practices. CONCLUSION: Vaginal douching is commonly practiced by women in the Bolgatanga Municipality. Most of these women douche because they did not know that there are health problems associated with the practice. Health education on the issues of women health is very vital for the improvement of women's health.

Rectal Douching Practices Associated with Anal Intercourse: Implications for the Development of a Behaviorally Congruent HIV-Prevention Rectal Microbicide Douche.

Tenofovir administration via rectal douching results in higher rectal-mucosa drug concentration than oral administration. Many who engage in receptive anal intercourse (RAI) use cleansing rectal douches. To inform development of a behaviorally-congruent tenofovir douche, 4751 individuals ≥ 18 years-old, born male, from all US states/territories, who engaged in anal intercourse responded to an online survey. Of those who reported RAI in the prior 3 months, 80% douched beforehand, 82% within 1 h, mean 2.9 consecutive applications; 27% douched afterwards, 83% within 1 h, mean 1.7 consecutive applications. Among multidose users, 78% applied doses within 2 min, and 76% retained liquid < 1 min. Most used tap water (89%) in an enema bottle (50%) or rubber bulb (43%), and douched for cleanliness (97%), to avoid smelling bad (65%), and to enhance pleasure (24%). 98% reported high likelihood of using an HIV-prevention douche. An ideal product will protect within a user's typical number of applications, within 1 h, and be dissolvable in tap water.

Risk factors for morbidity in walled-off pancreatic necrosis and performance of continuous postoperative lavage: A single-center experience.

BACKGROUND: The aim of this study was to evaluate the risk factors for morbidity in cases of walled-off pancreatic necrosis (WOPN) and the performance of continuous postoperative lavage (CPL) for patients who demonstrated resistance to a minimally invasive approach. METHODS: The study enrolled 19 of 28 consecutive patients with WOPN who underwent surgical treatment or an endoscopic necrosectomy at Sakarya University Education and Research Hospital. The patients were divided into 2 groups according to the length of time from the first diagnosis of acute pancreatitis (AP) (Group 1, n=19) to preoperation or endoscopic necrosectomy (Group 2) (n=19). All of the cases were retrospectively evaluated and compared in terms of demographic features, operative features, and complications. RESULTS: No statistically significant difference was found between the number of complications or the duration of hospital stay in terms of age, body mass index, size of the walled-off pancreatic necrosis, American Society of Anesthesiologists score, Ranson's criteria, operation time, and duration from AP to endoscopic necrosectomy or operation (p>0.05). Performance of an endoscopic necrosectomy was determined to be correlated with a decrease in the number of complications (B=-0.626, 95% confidence interval [CI]: -0.956 to -0.296; p<0.001), and when a high neutrophil-to-lymphocyte ratio (NLR) was detected at first admission, the number of complications was greater (B=0.032, 95% CI: 0.009-0.055; p=0.01). Reproduction in a culture and male gender were found to be risk factors for a prolonged hospital stay (B=0.669, 95% CI: 0.365-0.973; p<0.001), (B=0.484, 95% CI: 0.190-0.778; p=0.003), respectively. CONCLUSION: CPL is a safe and effective surgical treatment approach for WOPN. Reproduction in a culture, male gender, and a high NLR on first admission and a negative or not-available endoscopic necrosectomy were determined to be risk factors for a poor prognosis.

Femoroacetabular Impingement Randomised controlled Trial (FIRST) - a multi-centre randomized controlled trial comparing arthroscopic lavage and arthroscopic osteochondroplasty on patient important outcomes and quality of life in the treatment of young adult (18-50 years) femoroacetabular impingement: a statistical analysis plan.

BACKGROUND: The research objectives of the Femoroacetabular Impingement Randomised controlled Trial (FIRST) are to assess whether surgical correction of the hip impingement morphology (arthroscopic osteochondroplasty) with or without labral repair, in adults aged 18-50 years diagnosed with non-arthritic femoroacetabular impingement (FAI), provides decreased pain and improved health-related quality of life at 12 months compared to arthroscopic lavage of the hip joint. This article describes the statistical analysis plan for the FIRST trial. METHODS/DESIGN: FIRST is an ongoing multi-centre, blinded randomised controlled trial of 220 patients who have been diagnosed with FAI and are optimized for surgical intervention. This article describes the overall analysis principles, including how participants will be included in each analysis, the presentation of the results, adjustments for covariates, the primary and secondary outcomes and their respective analyses. In addition, we will present the planned sensitivity and subgroup analyses. DISCUSSION: Our rationale for FIRST is based upon (1) an epidemic of FAI surgery with resultant increased healthcare costs over that last decade, (2) worldwide disparity in perceptions about its utility, and (3) consensus that definitive evidence for or against surgical approaches is lacking. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01623843 . Registered on 20 June 2012.

[Low-concentration hydrogen peroxide solution for continuous bladder irrigation after transurethral resection of the prostate].

OBJECTIVE: To evaluate the effectiveness and safety of low-concentration hydrogen peroxide solution (HPS) for continuous bladder irrigation after transurethral resection of the prostate (TURP). METHODS: We retrospectively analyzed the clinical data about 148 cases of benign prostatic hyperplasia (BPH) treated by TURP from January 2013 to January 2016. Seventy-six of the patients received postoperative continuous bladder irrigation with 0.15% HPS (group A) and the other 72 with normal saline (group B). We compared the two groups of patients in their postoperative hemoglobin (Hb) levels, duration of bladder irrigation, frequency of catheter blockage, time of catheterization, and length of hospital stay. RESULTS: There were no statistically significant differences between the two groups of patients preoperatively in the prostate volume, International Prostate Symptoms Score, maximum urinary flow rate, postvoid residual urine, or levels of serum PSA and Hb (P > 0.05). At 48 hours after operation, a significantly less reduction was observed in the Hb level in group A than in group B (ï¼»3.38 ± 2.56ï¼½ vs ï¼»7.29 ± 6.58ï¼½ g/L, P < 0.01). The patients of group A, in comparison with those of group B, also showed remarkably shorter duration of postoperative bladder irrigation (ï¼»32.57 ± 5.99ï¼½ vs ï¼»46.10 ± 8.79ï¼½ h, P < 0.01), lower rate of catheter blockage (3.3% vs 11.8%, P < 0.01), shorter time of catheterization (ï¼»3.74 ± 0.79ï¼½ vs ï¼»4.79 ± 0.93ï¼½ d, P < 0.01), and fewer days of postoperative hospital stay (ï¼»4.22 ± 0.81ï¼½ vs ï¼»4.67 ± 0.88ï¼½ d, P < 0.01). CONCLUSIONS: Low-concentration HPS for continuous bladder irrigation after TURP can reduce blood loss, catheter blockage, bladder irrigation duration, catheterization time, and hospital stay, and therefore deserves a wide clinical application.