Irrigation suction therapy reduces post-hysterectomy surgical site infection in middle-aged and older diabetic women: A randomized prospective study.

OBJECTIVE: To determine whether or not closed wound irrigation and suction therapy can reduce post-hysterectomy surgical site infections in middle-aged diabetic women without increasing pain, causing complications or lowering patient satisfaction. Methods: The prospective randomised controlled study was conducted from April 2017 to March 2022 at Lady Willingdon Hospital, Lahore, Pakistan, and comprised women aged >40 years with body mass index >25kg/m2 who were scheduled for hysterectomy. The subjects were randomised into intervention group A and control group B. In the irrigation and suction group A, subcutaneous drains were inserted for daily closed wound saline irrigation followed by full-day suction for 3 days. In control group B, wound closure was done without drains and irrigation and suction. Wounds were assessed daily during hospitalisation and at 4, 8 and 12 weeks postoperatively. Primary outcome was surgical site infection rate, fever, white blood cell count, pain score and length of hospital stay. Secondary outcomes were readmission rate, wound pain during follow- up other complications and patient satisfaction. Data was analysed using SPSS 20. RESULTS: Of the 334 patients, 300(89.8%) were included; 150(50%) in group A with mean age 56.66±9.264 years, and 150(50%) in group B with mean age 55.77±9.394 years. However, the study was completed by 274(91.3%) subjects; 138(50.4%) in group A and 136(49.6%) in group B. Group A had significantly fewer surgical site infections (p<0.0001), lower white blood cell count (p<0.0001), fever (p<0.001) and pain scores (p<.0001), shorter hospital stay (p<.0001) and higher patient satisfaction (p<.0001) compared to group B. Follow-up pain scores and other complications did not differ significantly between the groups (p>0.05). Conclusion: Irrigation and suction strategy reduced surgical site infection rates without increasing pain, causing complication or compromising patient satisfaction.

Covid19 in pregnancy - a literature review.

Coronavirus disease-2019, or Covid-19, was first reported in Wuhan, China, at the end of December 2019 as viral pneumonia. The causative agent, the Novel Coronavirus also known as severe acute respiratory syndrome Corona virus (SARS CoV-2), spread rapidly across the world to cause a considerable death toll. On March 11, 2020, the World Health Organisation declared Covid-19 a pandemic. For a little over a year, the coronavirus has been around. Pregnancy is an immunodeficient state predisposing women to an increased risk of respiratory viral infections. The risk is even higher in pregnant women who already have underlying health problems due to growing age, such as diabetes, hypertension, cardiac or respiratory diseases. The exact treatment of Covid-19 is still unknown. This narrative review was planned to summarises the current information on pathophysiology, diagnosis and effects of Covid-19 in pregnancy for better treatment plans.

A randomized controlled trial of cystoinflation to prevent bladder injury in the adhesive disease of multiple caesarean sections.

Caesarean sections carry the risk of urinary bladder injury due to formation of adhesions obscuring pelvic planes. Visualizing bladder during retro-fill (cystoinflation) makes it recognizable as it rises into the abdomen taking a tense rounded contour. We conducted a prospective randomized controlled trial to find out whether improved identification of bladder margins by cystoinflation could decrease bladder injury rate and blood loss without causing urological complications. This study included 214 healthy women with previous operative deliveries undergoing elective caesarean section and found to have dense pelvic adhesions. The subjects were randomly allocated into cystoinflation and control groups. Adhesiolysis was performed using bladder retro-fill with 300 cc saline in cystoinflation group, and without retro-fill in control. The bladder injury rate was significantly lower in cystoinflation group compared to control (2.8% vs 20.6%, P < .0001) with lesser blood loss in cystoinflation group (585.33 cc vs 797.10 cc, P < .0001). Mean operative time was similar in both groups. Urinary tract infection and micturition problems occurred more frequently in control group than cystoinflation group (16.8% vs 1.9%, P = .001 and .47 ± 1.63% vs 077 ± .633%, P = .021 respectively) with fistula in one subject compared to none in cystoinflation group. In this study, cystoinflation was effective to significantly reduce bladder injury rate and blood loss. This technique may also prove useful in the fields of surgery, urology and urogynecology.

Labor management in a patient with von Willebrand disease.

von Willebrand disease (VWD) is an inherited bleeding disorder involving a deficiency or abnormal function of a blood clotting protein called von Willebrand factor (VWF). Deficiency of VWF, therefore, shows primarily in organs with small blood vessels such as the skin, the gastrointestinal tract and the uterus. This case report describes management of a patient presenting with type II von Willebrand disease in labor. She had history of life-threatening hemorrhage from an operation for deviated nasal septum and had a risk of severe postpartum hemorrhage (PPH) within 48 hors of delivery, which was avoided by appropriate planning and timely management.