Surgical Site Infections in Elective and Emergency Abdominal Surgeries: A Prospective Observational Study About Incidence, Risk Factors, Pathogens, and Antibiotic Sensitivity at a Government Tertiary Care Teaching Hospital in India.

Background Surgical site infections (SSIs), the third most common nosocomial infection, endanger hospitals and patients. SSIs must be monitored continuously. This present study examined SSI incidence, risk factors, pathogens, and antibiotic sensitivity in emergency and elective or planned abdominal surgeries. Methods The Dr. S.N. Medical College General Surgery Department in Jodhpur, India, operated on 100 patients. The sample was divided into two 50-person groups. Group A includes emergency surgery patients, while Group B includes elective surgery patients. The samples were aseptically collected and processed according to microbiological methods. Data were processed with IBM SPSS Statistics for Windows, version 20 (released 2011; IBM Corp., Armonk, New York, United States). Results Out of a sample size of 100 patients, 17 individuals experienced SSIs. SSI incidence was 16.66% in male patients and 18.18% in female patients. In addition, the rate of SSIs was 26% in the emergency group and 8% in the planned group. The association was stronger among elderly individuals, diabetics (33.33% in Group A and 12.5% in Group B), and anemics with a history of smoking. The association was higher in those who underwent surgery for more than 60 minutes (34.37% in Group A and 18.8% in Group B). The incidence of SSIs was higher in emergency cases compared to elective surgeries, with rates of 26% and 8%, respectively, but was statistically insignificant. The infection rate in clean cases during planned surgery was 3.70%, while clean contaminated cases during planned surgery had a wound infection rate of approximately 13.04%. In emergency surgery, no clean case was operated on, but the SSI rate in the emergency group was 9.09%, 22.22%, and 47.36% in the clean-contaminated, contaminated, and dirty cases, respectively. In Group A, Escherichia coli was the predominant organism found in SSI wounds, while in Group B, Staphylococcus aureus was the predominant organism, accounting for 46.15% and 50% of infections, respectively. Amikacin and metronidazole exhibited the highest efficacy against E. coli, with amikacin demonstrating the highest sensitivity. Conclusion SSIs are more common in emergencies than planned procedures. Age, gender, diabetes, hypertension, smoking, and prolonged surgery are risk factors for SSIs. Effective antibiotic policy and infection control can greatly prevent SSIs.

Raynaud's Phenomenon and Limb Hypertrophy Presenting Phacomatosis Pigmentovascularis: A Rare Association.

Phacomatosis pigmentovascularis is a rare dermal disorder attributed to the presence of various nevi. These lesions exist since birth, so the patient remains well aware of them. Various systemic involvements may be associated with the nevus, but the association of Raynaud's phenomenon is seldom reported. Our patient came with similar features and, on workup, no neurovascular compression was present, such as cervical rib or thoracic outlet syndrome. Therefore, he was managed conservatively and experienced improvement following the treatment. The objective of reporting this case is to highlight the association of Raynaud's phenomenon with such nervous lesions.

A Comparative Study of Analgesic Efficacy of Epidural Ropivacaine With Dexmedetomidine Versus Ropivacaine With Ketamine in Adult Patients Undergoing Elective Lower Limb Surgery.

INTRODUCTION: Adjuvating of the epidural block with local anaesthetics during lower limb surgeries improves Intraoperative as well as postoperative analgesia. A comparison of epidural ropivacaine plus dexmedetomidine (RD) versus ropivacaine plus ketamine (RK) was done in terms of quality of the motor and sensory blockade, changes in hemodynamic parameters, and efficacy of analgesia. METHODS:  A prospective randomized parallel double-blind study was conducted on 68 patients of the American Society of Anaesthesiologists (ASA) grade 1 and 2, ages 18 to 75 years, which were divided into two groups (RD and RK; 34 patients in each group). After receiving a loading dose through an epidural catheter consisting of 20ml of 0.5% ropivacaine, the epidural infusion was started after an hour of surgery at 5ml/hrs of 0.2% ropivacaine with 1µg/ml dexmedetomidine in Group RD and at 5ml/hrs of 0.2% ropivacaine with 0.5mg/ml ketamine in Group RK for 48 hours. Both groups were compared regarding the onset of sensory and motor block, resolution of sensory and motor block, hemodynamic parameters, analgesic efficacy, and total rescue analgesic requirement in 48 hours. RESULTS: A significant difference was observed in the time of resolution of sensory blockade which was 9.77±2.38 hrs in the RD group as compared to 7.79±1.82 hrs in the RK group (p-value 0.0003) and the time of resolution of motor block was 6.53±2.44 hrs in the RD group compared to 4.58±0.83 hrs in the RK group (p-value 0.001). CONCLUSIONS: Epidural dexmedetomidine significantly increases the duration of analgesia and duration of the motor blockade in comparison to ketamine.

Prediction of Mortality in Acute Thermal Burn Patients Using the Abbreviated Burn Severity Index Score: A Single-Center Experience.

Background Burn injuries are highly variable and dynamic. The outcome of patients is influenced by various factors and requires prompt therapeutic interventions, including fluid resuscitation, for a favorable result. Although having varying shortcomings, many scoring indexes are developed and validated in Western countries to predict mortality in a burn patient. The Abbreviated Burn Severity Index (ABSI) estimates survival expectancy in a burn patient via various negative prognostic factors. This study describes the pattern of burn injuries to validate the ABSI as an outcome predictor in burnt patients. Methodology From January to December 2018, 100 patients participated in this observational research conducted in the Department of Surgery at Mahatma Gandhi Hospital's Burn Ward, a part of Dr. Sampurnanand Medical College, Jodhpur. Risk factors for death from a burn were patients' age and gender, the depth of the burn, the inhalation burn, and the total burned body surface area (TBSA). The area under the receiver operating curve (AUROC) was used to determine how well it could predict burn deaths. Results This study included 100 patients (69 men and 31 women, with a ratio of 2.22:1). In total, 73 patients survived, and 27 died (a mortality rate of 27%). The fatality rate increased with increased burn surface area, reaching 100% in patients with >80% burns (p < 0.0001). Additionally, those with an ABSI of >11 expressed 100% mortality rate (p < 0.0001). Conclusions In this study, older age, high burned surface area, concomitant inhalational burns, full-thickness burns, and a higher ABSI were found to be significant predictors of mortality.