The Impact of Nursing Education on Emergency Bedside External Ventricular Drain Insertion for Patients With Acute Hydrocephalus.

Objectives Acute hydrocephalus is a neurosurgical emergency that requires immediate intervention. With emergency external ventricular drain (EVD) insertion and management, such rapid intervention can be a safe bedside procedure. Nurses play an integral role in patient management. Thus, this study aims to assess the knowledge, attitudes, and practices of nurses from different departments regarding bedside EVD insertion in patients with acute hydrocephalus. Methods EVD and intracranial pressure (ICP) monitoring competency checklists were developed, and a quasi-experimental, single-group, pre/post-test study was conducted at a university hospital in Jeddah, Saudi Arabia, in January 2018 during an educational program. The neurosurgery team determined program efficacy using pre/post-questionnaires. All attendees who agreed to fill in the pre- and post-survey and whose data were complete were included in the study. Results Of the 140 nurses who participated in the study, the data of 101 were analyzed. Knowledge level improved significantly between the pre- and post-test; for example, when asked about administering antibiotics before EVD insertion, the pre-test correct response rate of 65% increased to 94% in the post-test (p<0.001), and 98% considered the session informative. However, the attitude toward bedside EVD insertion did not change after the teaching sessions. Conclusion This study emphasizes the importance of ongoing nursing education, hands-on training, and strict adherence to an EVD insertion checklist to achieve successful bedside management of patients with acute hydrocephalus.

Clinical trial combining botulinum toxin A injection and fissurectomy for chronic anal fissure: a dose-dependent study

ABSTRACT Background Anal fissure is a common surgical disease that is usually treated conservatively. The golden surgical treatment for anal fissure is lateral internal sphincterotomy, but it may result in multiple complications. Therefore, other treatment methods have recently been introduced, and one of them is the injection of botulinum toxin A (BTA) and fissurectomy. In the present study, we aim to evaluate the effectiveness of the combination of fissurectomy and BTA injection in the treatment of chronic anal fissure by single surgeon. Materials and Methods The present is a non-randomized prospective cohort study conducted by a single surgeon in Saudi Arabia. Our sample was composed of 116 female patients, with mean age of 36.57 ± 11.52 years, who presented to our Surgical Outpatient Clinic with chronic anal fissure between October 2015 and July 2020, and were treated with BTA injection combined with fissurectomy. They were followed up for 1, 2, 3, 4, and 8 weeks, and after one year to evaluate the efficacy and safety of the treatment. The main outcomes analyzed were symptomatic relief, complications, recurrence, and the need for further surgical intervention. Results The treatment with BTA injection combined with fissurectomy was effective and safe in 115 patients (99.1%) at 1 year of follow-up. A total of 5 patients experienced recurrence at 8 weeks, which resolved completely with pharmacological sphincterotomy, and 12 patients experienced minor incontinence, which disappeared later. Conclusion In total, 70 units of BTA injection combined with fissurectomy is a suitable second-line treatment of choice for chronic anal fissure, with a high degree of success and a low rate of major morbidity. (AU)

Clinical Trial of Combining Botulinum Toxin Injection and Fissurectomy for Chronic Anal Fissure: A Dose-Dependent Study.

PURPOSE: Our aim was to evaluate the effectiveness of combining a fissurectomy with a botulinum toxin A injection in treating chronic anal fissure. METHODS: A single surgeon in Saudi Arabia conducted a nonrandomized prospective cohort study between October 2015 and July 2020. The cohort included 116 female patients with chronic anal fissures with a mean age of 36.57±11.52 years who have presented to the surgical outpatient clinic and received a botulinum toxin injection A combined with fissurectomy. They were followed up with for at least 1, 2, 3, 4, and 8 weeks to evaluate the effects of the treatment, then again at 1 year. Primary outcome measures were symptomatic relief, complications, recurrence, and the need for further surgical intervention. RESULTS: Treatment with botulinum toxin A combined with fissurectomy was effective in 99.1% of patients with chronic anal fissure at 1 year. Five patients experienced recurrences at 8 weeks which resolved completely with a pharmacological sphincterotomy. Twelve patients experienced minor incontinence which later disappeared. Pain completely disappeared in more than half of the patients (55.2%) within 7 to 14 days. Pain started to improve in less than 8 days among patients treated with a dose of 50±10 IU (P=0.002). CONCLUSION: Seventy units of botulinum toxin A injection combined with a fissurectomy is a suitable second-line treatment of choice for chronic anal fissure, with a high degree of success and low rate of major morbidity.

Vacuum-Assisted Closure in a Patient With Entero-Atmospheric Fistula: A Case Report.

The entero-atmospheric fistula (EAF) is a recognized complication of open abdomen surgeries, which causes significant morbidity and mortality. This usually causes long hospitalizations and may require many surgical operations. While different methods of treatment for EAF are used, all different methods share the same goal, which is a proper closure of the fistula and the open abdomen to avoid recurrence and complications. We report a case of a 48-year-old female with a bowel perforation following an attempted open bilateral ovarian cyst drainage with cyst wall biopsy complicated by entero-atmospheric fistula treated by wound closure with vacuum-assisted pressure. In conclusion, the use of vacuum-assisted closure (VAC) to induce spontaneous healing of EAFs can provide a safe acceptable alternative to surgical treatment.

Factors Influencing Saudi Medical Student's Decision Towards Cardiothoracic Surgery as a Future Career, a Cross Sectional Study.

INTRODUCTION: There has been a progressive decline in students' interest to consider cardiothoracic surgery as future career in the distant regions in the world. There are many factors could explain declining interest in cardiothoracic surgery including diminished caseloads due to the expansive growth of interventional cardiology; length of training programs that influences medical student's perception. King Abdulaziz University student's interest to join the speciality explored in our study. We determined some factors that influence their decision making toward their cardiothoracic career. AIM: We aimed to estimate the current interests of medical students at King Abdulaziz University to pursue a career in Cardiothoracic surgery and to determine the factors that positively or negatively affect their decision. MATERIAL AND METHODS: A self-administered online survey designed on Google form was distributed through email to fourth, fifth, and sixth-year medical students. Five domains; demographics, current career intentions, previous exposure to surgery, experiences and perceptions of cardiothoracic surgery were covered in the questionnaire to identify factors affecting student decision to choose cardiothoracic surgery as a future career. RESULTS: Among 486 students at our institution, 179 (36, 83%) medical students completed the questionnaire more than half of them 91 (50.8%) were males. The percentage of students who considered cardiothoracic surgery as a future career was (4.5%); when asked if they were serious in pursuing a career in cardiothoracic surgery, (14.5%) of the student were affirmative. Of those participated in the survey, Twenty-four students believed they had adequate introduction to the cardiothoracic surgery during their undergraduate program. CONCLUSION: cardiothoracic surgery is falling away behind other specialties as career of choice for many future physicians. It is believed mainly related to inadequate introduction to the field. Increasing exposure and close mentorship is needed to attract more students to pursue a career in cardiothoracic surgery.

Cost minimization analysis of line probe assay for detection of multidrug-resistant tuberculosis in Arkhangelsk region of Russian Federation.

BACKGROUND: The development of new diagnostic tools allows for faster detection of both tuberculosis (TB) and multidrug-resistant (MDR) TB and should lead to reduced transmission by earlier initiation of anti TB therapy. The research conducted in the Arkhangelsk region of the Russian Federation in 2012-14 included economic evaluation of Line Probe Assay (LPA) implementation in MDR-TB diagnostics compared to existing culture-based diagnostics of Löwenstein Jensen (LJ) and BacTAlert. Clinical superiority of LPA was demonstrated and results were reported elsewhere. STUDY AIM: The PROVE-IT Russia study aimed to report the outcomes of the cost minimization analysis. METHODS: Costs of LPA-based diagnostic algorithm (smear positive (SSm+) and for smear negative (SSm-) culture confirmed TB patients by Bactec MGIT or LJ were compared with conventional culture-based algorithm (LJ-for SSm- and SSm+ patients and BacTAlert-for SSm+ patients). Cost minimization analysis was conducted from the healthcare system, patient and societal perspectives and included the direct and indirect costs to the healthcare system (microscopy and drug susceptibility test (DST), hospitalization, medications obtained from electronic medical records) and non-hospital direct costs (patient's travel cost, additional expenses associated with hospitalization, supplementary medicine and food) collected at the baseline and two subsequent interviews using the WHO-approved questionnaire. RESULTS: Over the period of treatment the LPA-based diagnostic corresponded to lesser direct and indirect costs comparing to the alternative algorithms. For SSm+ LPA-based diagnostics resulted in the costs 4.5 times less (808.21 US$) than LJ (3593.81 US$) and 2.5 times less than BacTAlert liquid culture (2009.61 US$). For SSm- LPA in combination with Bactec MGIT (1480.75 US$) vs LJ (1785.83 US$) showed the highest cost minimization compared to LJ (2566.09 US$). One-way sensitivity analyses of the key parameters and threshold analyses were conducted and demonstrated that the results were robust to variations in the cost of hospitalization, medications and length of stay. CONCLUSION: From the perspective of Russian Federation healthcare system, TB diagnostic algorithms incorporating LPA method proved to be both more clinically effective and less expensive due to reduction in the number of hospital days to the correct MDR-TB diagnosis and treatment initiation. LPA diagnostics comparing conventional culture diagnostic algorithm MDR-TB was a cost minimizing strategy for both patients and healthcare system.

Measurement of exhaled volatile organic compounds from patients with chronic obstructive pulmonary disease (COPD) using closed gas loop GC-IMS and GC-APCI-MS.

Due to its high sensitivity, compact size and low cost ion mobility spectrometry (IMS) has the potential to become a point-of-care breath analyzer. Therefore, we developed a prototype of a compact, closed gas loop IMS with gas chromatographic (GC) pre-separation and high resolving power of R = 90. In this study, we evaluated the performance of this GC-IMS under clinical conditions in a COPD study to find correlations between VOCs (10 ppbv to 1 ppmv) and COPD. Furthermore, in order to investigate possible correlations between ultra-low concentrated breath VOCs (0.1 pptv to 1 ppbv) and COPD, a modified mass spectrometer (MS) with atmospheric pressure chemical ionization (APCI) and GC pre-separation (GC-APCI-MS) was used. The GC-IMS has been used in 58 subjects (21 smokers with moderate COPD, 12 ex-smokers with COPD, 16 healthy smokers and 9 non-smokers). GC-APCI-MS data were available for 94 subjects (21 smokers with moderate COPD, 25 ex-smokers with COPD, 25 healthy smokers and 23 non-smokers). For 44 subjects, a comparison between GC-IMS and GC-APCI-MS data could be performed. Due to service intervals, subject availability and corrupt data, patient numbers were different for GC-APCI-MS and GC-IMS measurements. Using GC-IMS, three VOCs have been found showing a significant difference between healthy controls and patients with COPD. In the GC-APCI-MS data, we only observed one distinctive VOC, which has been identified as 2-pentanone. This proof-of-principle study shows the potential of our high-resolution GC-IMS in the clinical environment. Due to different linear dynamic response ranges, the data of GC-IMS and GC-APCI-MS were only comparable to a limited extent.

A dual center study to compare breath volatile organic compounds from smokers and non-smokers with and without COPD.

There is increasing evidence that breath volatile organic compounds (VOC) have the potential to support the diagnosis and management of inflammatory diseases such as COPD. In this study we used a novel breath sampling device to search for COPD related VOCs. We included a large number of healthy controls and patients with mild to moderate COPD, recruited subjects at two different sites and carefully controlled for smoking. 222 subjects were recruited in Hannover and Marburg, and inhaled cleaned room air before exhaling into a stainless steel reservoir under exhalation flow control. Breath samples (2.5 l) were continuously drawn onto two Tenax(®) TA adsorption tubes and analyzed in Hannover using thermal desorption-gas chromatography-mass spectrometry (TD-GC-MS). Data of 134 identified VOCs from 190 subjects (52 healthy non-smokers, 52 COPD ex-smokers, 49 healthy smokers, 37 smokers with COPD) were included into the analysis. Active smokers could be clearly discriminated by higher values for combustion products and smoking related VOCs correlated with exhaled carbon monoxide (CO), indicating the validity of our data. Subjects from the study sites could be discriminated even after exclusion of cleaning related VOCs. Linear discriminant analysis correctly classified 89.4% of COPD patients in the non/ex-smoking group (cross validation (CV): 85.6%), and 82.6% of COPD patients in the actively smoking group (CV: 77.9%). We extensively characterized 134 breath VOCs and provide evidence for 14 COPD related VOCs of which 10 have not been reported before. Our results show that, for the utilization of breath VOCs for diagnosis and disease management of COPD, not only the known effects of smoking but also site specific differences need to be considered. We detected novel COPD related breath VOCs that now need to be tested in longitudinal studies for reproducibility, response to treatment and changes in disease severity.

[Stress tests of reconstruction plates for bridging mandibular angle defects]. / Beanspruchungsuntersuchungen an Rekonstruktionsplatten zur Uberbrückung von Kieferwinkeldefekten.

AIM: The aim of the present study was to evaluate the mechanical stress in reconstruction plates used for bridging mandibular angle defects and in the screw-plate-bone interface with the finite element method. Additionally, the influence of reconstruction plate geometry, screw configuration, and screw diameter upon the mechanical stress distribution was determined. Suggestions for design improvements of the plate were derived from the results. MATERIAL AND METHODS: Based on the geometrical data of a human mandible, an angle defect bridged by a titanium reconstruction plate was generated and exposed to chewing force. The reconstruction plate was securely fixed by M 2.7 titanium screws. A variation of plate design, screw configuration, and screw diameter was carried out. The mechanical stress was calculated following the von Mises stress hypothesis. RESULTS: Using the standard plate the mechanical stress in all components exceeded by far the ultimate tensile strength. Possible clinical consequences could be a fatigue fracture of the plate, loosening of the screw, and irreversible damage of the bone leading to infection. Increasing the screw diameter by 50% would lead to a decrease of the mechanical stress by far more than 50%. An increase of the interface area between bone and plate and a triangular screw configuration diminishes the mechanical stress further, which may consequently allow a reduction of plate thickness with better adaptation to the actual jaw geometry. CONCLUSION: As a preliminary result the reconstruction plate could be thinned out in areas subject to less mechanical load.

[Purification of proteinases on bacitracin-modified silochromes with differing concentration of ligands and fragment lengths]. / Ochistka proteinaz na batsitratsin-silokhromakh s raznoi kontsentratsiei liganda i dlinoi fragmenta.

The binding of subtilisin, bovine pancreatic trypsin, and human blood thrombin to bacitracin-modified silochromes differing in the ligand concentrations and arm lengths were studied. The optimal conditions for trypsin isolation and purification were found. Methods for isolation and purification of subtilisin and thrombin were developed that provided the extents of enzyme purification of 20-80. The specific activities of thrombin trypsin, and subtilisin were 1200-2625 NIH units per mg protein and 7-18 and 19-34 units per mg protein, respectively. The possibility of isolation and purification of trypsin, thrombin, and subtilisin on bacitracin-modified silochromes was demonstrated. The sorbents studied were suggested for industrial application.

[Enzymatic synthesis of acyl peptides containing p-nitroanilides of basic amino acids]. / Fermentativnyi sintez atsilpeptidov, soderzhashchikh n-nitroanilidy osnovnykh aminokislot.

A method is suggested for synthesis of acylpeptides, containing arginine or lysine p-nitroanilides at the C-terminus, via the acyl transfer reaction catalyzed by the Bacillus subtilis serine proteinase. Acyl-di- and acyltripeptide ethers with L- and D-amino acids were used as the carboxyl component taken in a twofold excess. When the concentration of dimethylformamide increases, the hydrolysis of the initial ether and the reaction product diminishes. Because of the enzyme inactivation by dimethylformamide the latter's optimal concentration is 70-80%.

[Control of anticoagulant therapy by using soluble thromboplastin]. / Kontro'l antikoaguliantnoi terapii pri pomoshchi preparata "tromboplastin rastvorimyi".

The characteristics of soluble thromboplastin, a new coagulant agent, were under study. This drug is a high-molecular lipoprotein complex of human cadaver brain, purified by gel chromatography. The new preparation has been standardized and compared to thromboplastin preparations manufactured in this country and abroad. Soluble thromboplastin has been found fairly sensitive to reductions of the prothrombin factors levels, it may be used for monitoring the efficacy of indirect anticoagulant therapy, and conforms to WHO regulations for thromboplastin reference agents; this latter fact recommends this new drug as a thromboplastin reference agent in this country.

[Partial purification of tissue thromboplastin by the gel filtration method and its use for reproducing the generalized decompensated thrombinogenesis syndrome]. / Chastichnaia ochistka tkanevogo tromboplastina metodom gel'-pronikaiushchei khromatografii i vosproizvedenie s ego pomoshch'iu sindroma generalizovannogo dekompensirovannogo trombinogeneza.

Tissue thromboplastin was purified using various chromatographic resins: Sephadex G-200, Ultragel AcA 34, Acrylex P-300 and Toyopearl HW-55F. The purity of the preparations obtained was evaluated by means of the ratio of the thromboplastin solutions absorbency at 540 nm and a protein concentration in the solution expressed as mg/ml. The most purified preparations of tissue thromboplastin were obtained after gel filtration on Toyopearl HW-55F. The thromboplastin preparation produced was used for experimental reproduction of the syndrome of generalized decompensated thrombinogenesis.

[Isolation of human thrombin using affinity chromatography on gramicidin C-silochrome C 80]. / Poluchenie trombina cheloveka s pomoshch'iu affinnoi khromatografii na gramitsidin C-silokhrome C 80.

Thrombin purification is conducted by biospecific chromatography on gramicidin C-silochrome C 80. Preparations possessing the fibrinogen-coagulating activity of 2500-3200 NIH units per 1 mg of protein and containing 98% of active sites are obtained. Data obtained from electrophoresis in PAAG with the presence of DS-Na show the alpha-thrombin content to be 96%; the admixture of beta-thrombin possessing no coagulating activity does not exceed 4%. The kinetic constants are presented for thrombin hydrolysis of tosyl-L-arginine methyl ester (TAME), benzoyl-L-arginine ethyl ester (BAEE) and chromogenic substrate S-2238. The addition of isopropanol increases sharply the stability of thrombin when storing it in the aqueous-salt solutions.

[Bacitracin and gramicidin S as biospecific ligands for affinity chromatography of human thrombin]. / Batsitratsin i gramitsidin S kak biospetsificheskie ligandy pri affinnoi khromatografii trombina cheloveka.

It was shown that the cyclic polypeptide antibiotic bacitracin is a competitive inhibitor of fibrinogen clotting by thrombin. Biospecific adsorbents for isolation of thrombin by gramicidin S and bacitracin attachment to silochrome S-80 modified by gamma-glycido-oxypropyl groups were synthesized. The thrombin yield at pH 7.2 and 8.0 was 76.5-96%, purification--6.2-11.6-fold, specific coagulating activity--940-1750 NIH u./mg protein. At pH 6.1 the enzyme does not practically bind to the adsorbents. In all probability, the differences in thrombin binding are due to conformational changes in the enzyme molecule, when pH changes from 6.1 to 7.2. Possible application of the synthesized adsorbents for obtaining laboratory and commercial preparations of thrombin and their perspective use for purification of other blood plasma serine proteinases possessing a narrow specificity are discussed.

[Multiple forms of horse pepsin]. / Mnozhestvennye formy pepsina loshadi.

Using ion-exchange and affinity chromatography and isoelectrofocusing, eight forms of pepsin with pI 1.6, 1.8, 2.1, 2.3, 2.6, 2.8, 3.2 and 3.6, were isolated from horse gastric juice. The molecular weights, amino acid composition, N-terminal sequence and functional activity of these multiple forms were determined. Partial primary structure of tryptic peptides of pepsin with pI 2.3 was investigated. The analyzed partial sequences of the forms with pI 1.8, 2.1, 2.3, and 2.6 have identical structures which differ from the amino acid sequence of pepsin with pI 3.2 by four substituents. In terms of their functional activity, horse pepsins differ only insignificantly. Presumably, the pepsins under study (at least the forms with pI 1.8, 2.1, 2.3, 2.6 and 3.2) arose comparatively recently as a result of duplication of the common precursor gene and exist at an early stage of structural and functional divergence. As far as their primary structure and functional properties are concerned, these pepsins are more related to pepsin A than to other isoenzymes of gastric aspartyl proteinases of mammalia, e. g., gastricsin or chymosin.