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   Table of Contents - Current issue
January-June 2022
Volume 1 | Issue 1
Page Nos. 1-45

Online since Friday, June 17, 2022

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Combating surgical infections p. 1
Jianan Ren
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Bacteriological profile of bile in cholecystectomy patients in tertiary care center p. 3
Sunil Kaval, Swati Tewari
Aims and Objectives: This study was done to evaluate the microbiological profile of bile from the gall bladder in patients undergoing cholecystectomy and to determine the appropriate antibiotic for preoperative prophylaxis in cholecystectomy patients based on the microbiological profile of bile. Materials and Methods: A retrospective study done with 126 patients with a diagnosis of cholecystolithiasis postoperated of laparoscopic cholecystectomy had surgery department their bile sent to the Department of Microbiology, Lala Lajpat Rai Memorial Medical College, Meerut (UP) from October 2017 to November 2018. Results: A total of 126 patients were included in this study, of which the male-to-female ratio was 1:2.71, while females were 92 (83%) and males were 34 (17%). The age of the patients ranged from 01 to >61 years of age, in which the maximum number of patients was in the 41–60 age group 78 (62%). In the microbiological analysis, only 68 (54%) samples were culture positive, in which the most common organism isolated was Escherichia coli 43 (63.2%) and the second-most common was Klebsiella spp. 17 (25%). Conclusions: Therefore, it is important to know about common bacteria causing gallbladder infection and their antibiotic resistance pattern. This study may be helpful in designing antibiotic prophylaxis among these patients.
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Implementing surgical site infection surveillance in the context of WHO's implementation cycle – The perspective of one London teaching hospital p. 7
Claire Kilpatrick, Lilian Chiwera
The role of implementation and improvement science in preventing surgical site infections (SSI) has been recognized as important and the global situation with SSI prevention warrants on-going attention. Monitoring and understanding SSI data, including ensuring the on-going availability of local infection rates is one intervention recommended by the World Health Organization (WHO) and plays a critical part in addressing SSI and overall health care-associated infection prevention and antimicrobial resistance. SSI monitoring, specifically surveillance, can be supported by the use of a WHO-recommended implementation cycle which is aimed at health care facility infection prevention and control (IPC) and patient safety efforts. In order to understand how the five steps in the WHO-recommended implementation cycle are being applied in the context of SSI prevention, as part of an IPC programme, a desk exercise was undertaken to collate one hospital's SSI surveillance experiences and to map these to the steps in the cycle. It was possible to map this one hospital's efforts to the WHO five steps for implementation, despite the program of work not being planned around these from the outset. Throughout all of the steps, it was evident that teamwork and communications are frequently at the core of all actions, as well as engagement, leadership, champions, and standardization to support reliability, credibility, and trust in relation to surveillance data. Sharing the experiences of hospitals in applying a recommended implementation cycle may help to highlight the importance of committing to a systematic approach to SSI prevention in the context of global IPC recommendations.
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Minimally invasive approach in appendectomy and cholecystectomy reduces risk for early but not late-onset Clostridioides difficile infection p. 15
Hugo Bonatti, Tjasa Hranjec, Robert G Sawyer, Karim W Sadik
Introduction: Clostridioides difficile-associated colitis (CDAC) may develop even after minor abdominal surgeries such as appendectomy and cholecystectomy. Minimally invasive techniques may reduce rates of postoperative CDAC due to less surgical trauma, shorter hospitalizations, and a lower incidence of certain complications. Patients and Methods: This retrospective cohort study includes a total of 10,601 patients undergoing appendectomy (2529 laparoscopic and 2049 open) and cholecystectomy (3541 laparoscopic and 2482 open) at a single center between 1992 and 2011, who were diagnosed with CDAC and were followed for a minimum of 2 years. Results: Cumulative CDAC rates were 2.3% after appendectomy and 4% after cholecystectomy (P < 0.0001) with 2.1% for all laparoscopic and 4.8% for all open procedures (P < 0.0001). The median time to CDAC onset was 76d after appendectomy and 122d after cholecystectomy (P < 0.05). Factors associated with the development of CDAC were older age (median 52 vs. 38 years, P < 0.0001), length of stay (median 8 vs. 2 days, P < 0.0001), development of non-C. difficile infections (23% vs. 7%, P < 0.0001), and having an open procedure (4.8% vs. 2.1%, P < 0.0001). Almost 40% of all patients developed their CDAC after 1 year and age, length of stay, and development of non-C. difficile infections or open surgical approach were not found to be risk factors. Conclusion: Patients undergoing open appendectomy and cholecystectomy have a higher risk for early-onset CDAC when compared to their laparoscopic counterparts. Late-onset CDAC after these procedures is common and seems unrelated to perioperative factors.
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A cross-sectional survey of perioperative lung protection in gastrointestinal surgery in Mainland China p. 21
Yuqiang Yang, Xuri Sun, Zhizhao Jiang, Tinglong Huang, Jianbao Wang, Donglin Zhuang, Yuqi Liu
Objective: To understand the implementation status of perioperative lung protection (PLP) in gastrointestinal surgery patients and the awareness of PLP and respiratory care (RC) among gastrointestinal surgeons in Mainland China. Methods: Taking the hospital of the investigator as the initiating unit, the questionnaire was distributed to gastrointestinal surgeons, intensive care unit doctors, and respiratory therapists (RTs) of hospitals in Chinese Mainland in the form of WeChat questionnaires. The investigation was divided into two rounds: preliminary screening and return visit. Results: A total of 157 valid questionnaires were collected, including 89 hospitals in 24 provinces, autonomous regions, and municipalities in Mainland China. Thirty-two hospitals did not have RTs. In the 57 (64%) of 89 hospitals with RTs, there were 26 (57%) hospitals with RTs number of 2 or less, only 6 hospitals had full-time RTs, 33 (59%) of 56 hospitals had no more than 2 RTs with over 3 years working experience, and perioperative patients of gastrointestinal surgery in only 9 (16%) of 57 hospitals often received help from RTs. A total of 60 gastrointestinal surgeons were surveyed, among which 23 (38%) answered that they knew nothing about RC, 44 (73%) considered gastrointestinal surgery patients should receive RC, and 57 (95%) considered their hospitals should set up RC department. Three main resistance sources of RC development of gastrointestinal surgery from high to low were insufficient attention of leaders (67%), human resources' shortage (57%), and charging too cheaply or even without related services' charges (48%). Conclusions: In Chinese Mainland, patients with gastrointestinal surgery were seriously lack of PLP support, and gastrointestinal surgeons lack awareness of RC. We appeal to pay more attention to PLP in gastrointestinal surgery patients and promote perioperative safety.
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Intestinal rehabilitation in critical illness p. 30
Sicheng Li, Peizhao Liu, Ye Liu, Jinjian Huang, Xiuwen Wu, Jianan Ren
Intestinal rehabilitation is a treatment strategy to promote the resumption of enteral nutrition and transoral diet in the residual small intestine of patients with short bowel syndrome from the early stage, which mainly includes four phases: total parenteral nutrition, parenteral combined enteral nutrition, total enteral nutrition, and transoral diet. New meanings and indications have been continuously given in clinical practice over the years. It is currently being applied to treat gastrointestinal (GI) injuries in critical illnesses. This review discusses the current conditions of diagnosis of GI injury and intestinal rehabilitation treatment at home and abroad in critical illnesses.
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Progress on the diagnosis and management of surgical infection: Dialogue with the world p. 38
Xiuwen Wu, Xing Chen, Jianan Ren
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Side effects of Covishield vaccine on COVID-positive history family in India p. 40
Parikshit Gautam Jamdade, Shrinivas Gautamrao Jamdade
In India, COVID-19 vaccination was carried out in a phased manner from January 16, 2021, with Covishield. This study was carried out in Pune, Maharashtra, India, where COVID-positive history family who had taken the first dose of the Covishield vaccine were followed up to check for any side effects post vaccination. The data were collected with a participant-administered questionnaire. The predominant side effects reported were malaise, headache, fatigue, sneezing, nausea, and chills in participants, followed by pyrexia (fever) with a sore throat, while the most uncommon side effect seen is insomnia. The side effects were started at 6–8 h post vaccination, while it takes an average duration of 24–100 h to last. The absence of serious side effects makes the Covidshield vaccine safe for use in COVID-positive history population.
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Perforated acute cholecystitis complicated by a fistula to the appendix p. 43
Hugo Bonatti
Fistulas between the gallbladder (GB) and intestinal tract are rare but require surgical repair. The most commonly involved alimentary tract segments are the duodenum and the hepatic colon flexure. An 80-year-old obese male with multiple comorbid conditions presented with acute right upper quadrant pain, weakness, and signs of sepsis; computed tomography (CT) scan showed a perihepatic phlegmon and pneumobilia suspicious for contained GB perforation. He was not a surgical candidate at this time; antibiotics were started and a percutaneous cholecystostomy tube was placed. Magnetic resonance cholangiopancreatography (MRCP) showed choledocholithiasis and he underwent endoscopic retrograde cholangiopancreatography revealing GB perforation and tracking of contrast toward the right lower quadrant; stone extraction was done and a biliary stent was placed. After 2 months of rehabilitation and clinical improvement, he underwent laparoscopic interval cholecystectomy. The appendix was fused with the GB creating a cholecystoappendiceal fistula. The appendix was stapled at the cecal base. Thereafter, the cholecystectomy was done. The GB fundus was fused to the hepatic duct, and during dissection, an anterior wall injury to the hepatic duct occurred, which was successfully managed by laparoscopic T-tube insertion. The patient recovered well and removed the T-tube himself after 4 weeks. An MRCP showed no evidence of a leak or stenosis. To the best of our knowledge, this is the first reported case of a cholecystoappendiceal fistula, which explains the pneumobilia on the initial CT scan. In a retrospective study, the cholangiogram showed the pathology but was not recognized. Combined laparoscopic appendectomy and cholecystectomy was done.
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