A meta‐analysis showing the effect of surgical site wound infections and associated risk factors in neonatal surgeries

A meta‐analysis was performed to assess the effect of surgical site wound infections and risk factors in neonates undergoing surgery. A systematic literature search up to January 2022 incorporated 17 trials involving 645 neonates who underwent surgery at the beginning of the trial; 198 of them had surgical site wound infections, and 447 were control for neonates. The statistical tools like the dichotomous or continuous method used within a random or fixed‐influence model to establish the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to evaluate the risk factors and influence of surgical site wound infections in neonates undergoing surgery. Surgical site wound infections had significantly higher mortality with OR value 2.03 at 95% CI 1.40–2.95 with P‐value <0.001, the longer length of hospital stay (MD, 31.88; 95% CI, 18.17–45.59, P < 0.001), and lower birthweight of neonates (MD, −0.30; 95% CI, −0.53 to −0.07, P = 0.01) compared with neonates with no surgical site wound infections undergoing surgery. However, no remarkable change was observed with surgical site wound infections in the gestational age at birth of neonates (MD, −0.70; 95% CI, −1.46 to 0.05, P = 0.07), and the preoperative antibiotic prophylaxis (OR, 1.28; 95% CI, 0.57–2.87, P = 0.55) compared with no surgical site wound infections for neonates undergoing surgery. Surgical site wound infections had significantly higher mortality, a longer length of hospital stay, and lower birthweight of neonates. However, they had no statistically significant difference in the gestational age at birth of neonates and the preoperative antibiotic prophylaxis compared with no surgical site wound infections for neonates undergoing surgery. Furthermore, evidence is needed to confirm the outcomes.     

Minimally Invasive Retroperitoneal Approach for Pancreatic Necrosectomy via a Percutaneous Drainage Tract

Aim-Background

Infected pancreatic necrosis (IPN) develops in approximately one third of patients with necrotizing pancreatitis (NP). In the past, open necrosectomy (ON) was the standard treatment for this condition, but it carried significant morbidity and mortality. Currently, minimally invasive procedures (MIPs) have been established for the management of IPN, decreasing the risk of complications compared with ON.

Methods

A prospective study was made of patients with IPN treated by a MIP for necrosectomy via a percutaneous drainage catheter, followed by video-assisted retroperitoneal debridement (VARD).

Results

Between 2013 and 2016, 3 consecutive patients, with a mean age of 58 years, underwent a MIP for the management of IPN. All 3 patients had left lateral retroperitoneal pockets of necrosis, and the first-line procedure consisted of placement of a pigtail catheter. The drain tract was subsequently used to carry out VARD. None of the patients presented major postoperative complications or required re-intervention.

Conclusion

The management of IPN has shifted away from ON, which was associated with high morbidity, towards less invasive techniques. MIPs should be used initially as the surgical treatment of choice in most cases. When this is not feasible, or when the MIP is not successful, ON should be implemented.

     

Offering routine trichomonas vaginalis testing to patients presenting for abortion at an urban hospital-based clinic

IntroductionThe Centers for Disease Control and Prevention recommend considering screening asymptomatic women for trichomonas in high-prevalence settings. Whether urban abortion clinics constitute such a setting is unknown.Material and MethodsWe offered trichomonas screening to patients presenting for abortion from October 2018 to February 2019 as a practice improvement and conducted a chart review.ResultsNinety-two percent (593/644) of patients underwent testing. Trichomonas prevalence was 10.0% (95% CI 7.7?12.6). Ninety five percent of patients diagnosed were treated. Testing only symptomatic patients would have missed 98% of infections.ConclusionsTrichomonas was highly prevalent, and universal testing and treatment was feasible in an urban abortion clinic.     

Production of pheromones by artificially fed males of the tick Amblyomma maculatum (Acari: Ixodidae)

Aggregation-attachment pheromones are produced only by male ticks of the genus Amblyomma that have imbibed blood for at least 8 d from their mammalian hosts. This report demonstrates that production and release of aggregation-attachment pheromones by Amblyomma maculatum (Koch) males can be induced in vitro by using nonblood media, artificially introduced through capillary tubes, into the male ticks. The presence of these pheromones is demonstrated by using both biological observations on bovine hosts and in vitro experimentation with petri dishes. The attraction of unfed female ticks to the artificially fed males (using the petri dish method) was significantly higher (P < 0.001) than the attraction of unfed females to unfed males. Similarly, attraction and attachment were recorded on bovine hosts. Only 62.8 +/- 17.5% of the females released attached to the bovine host. Of these, 61.9 +/- 19.37% attached around artificially fed males that were placed on the bovine 24 h earlier. This percentage did not differ significantly from the 81.4 +/- 7.1% of the total that attached around males that fed naturally for 8 d. In comparison, only 33.3 +/- 21.9% of the total number of females placed on the host did so after being fed 1 d (control group). The possibility of using capillary feeding as a new tool for investigating the physiology and reproductive behavior of blood-sucking arthropods is discussed.     

Natural cycle in-vitro fertilization in couples with unexplained infertility: impact of various factors on outcome

This study evaluated outcome in 117 couples with unexplained infertility who underwent 162 attempts at natural cycle in-vitro fertilization (NIVF) between 1991 and 1993. An egg was obtained in 138 cycles and a single embryo was transferred in 89 cycles. There were 16 implantations (four biochemical pregnancies, three clinical abortions and nine live births). The implantation rate per embryo was 16/89 (18.0%), which translated into a live birth rate per egg collection of 9/138 (6.5%). The impact factors that were assessed included oocyte quality, sperm quality, embryo quality and woman's age. The outcome measures used were fertilization/inseminated egg and implantation/replaced embryo. All embryo transfers were of single embryos. We conclude that, in couples with unexplained infertility, outcome following NIVF is affected by both egg and sperm quality and by the age of the woman. Embryo quality was independent of the above factors but was also critical for successful implantation.      

Role of mutational analysis in diagnosis of tuberous sclerosis complex

We describe three cases in whom identification of a disease-causing mutation in the TSC1 or TSC2 gene preceded the appearance or detection of symptoms sufficient for a clinical diagnosis of tuberous sclerosis complex (TSC). We suggest that genetic testing be given a more prominent role in the evaluation of individuals with a family history of TSC or symptoms suggestive of TSC and propose that diagnostic criteria be revised to include genetic testing.