Correlation of Intra Vascular Cannula Insertion Technique and Ward Practices with Local Site Infection

Background

Peripheral intravascular cannulas are indispensable in modern day medical care. These cannulas, if not inserted properly, predispose a patient to various morbidities. The present study was carried out to assess the incidence of intravascular cannula associated infections and correlate it with cannula insertion techniques and ward practices.

Methods

The study was carried out in the wards of a tertiary care hospital. The study was divided into two phases, each phase comprising of 50 patients. In phase 1, cannula insertion was carried out after normal ward cleaning practices. In phase 2, cleaning of the site was done by standard surgical cleaning procedure. The cannula samples after removal were cultured and local signs of thrombophlebitis looked for at the site of insertion. Thrombophlebitis was considered a surrogate marker of local infection in the vessel wall.

Result

The relative risk of acquiring thrombophlebitis increased by 2.18 times (applying univariate analysis) by existing methods as compared to the standard method.

Conclusion

Use of standard cleaning protocol had a significant effect on decreasing the incidence of cannula associated infections and cannula related morbidity.Key Words: Intravascular cannula, Peripheral vein thrombophlebitis, Cannula associated infections     

Follicular-fluid anti-Müllerian hormone concentration is similar in patients with endometriosis compared with non-endometriotic patients

This cross-sectional prospective study assessed follicular-fluid anti-Müllerian hormone (AMH) concentrations in infertile patients with mild/minimal endometriosis during natural IVF. Thirty-two women participated in the study. Patients were divided into two groups: tubal obstruction without endometriosis (control group) and minimal/mild endometriosis (study group). All patients underwent laparoscopy for assessment of infertility; at the same time, any foci of endometriosis found were cauterized. AMH concentration was measured in the follicular fluid of a single follicle when it achieved pre-ovulatory maturation by ultrasensitive enzyme-linked immunosorbent assay. Likewise, AMH, FSH and inhibin B content in serum was also measured. Age (30 ± 1.3 and 32 ± 0.8 years) and body mass index (22 ± 0.6 and 22 ± 0.5 kg/m²), day-3 antral follicle count (11.3 ± 1.7 and 10.7 ± 1.5), serum FSH concentrations (5.4 ± 0.6 and 5.0 ± 0.3 IU/ml) and follicular-fluid AMH concentrations (1.8 ± 0.3 and 1.5 ± 0.1 ng/ml, study and control group, respectively; mean difference 0.33, 95% CI ?0.21 to 0.88) were similar in both groups. This study shows that infertile patients with minimal/mild endometriosis have a similar concentration of AMH in the follicular fluid after natural IVF as compared with control subjects.The purpose of this prospective study was to assess the follicular-fluid environment measuring anti-Müllerian hormone in infertile patients with mild/minimal endometriosis, which is a disease in which endometrial uterine tissue invades sites outside the uterus, during natural IVF. Measurement of anti-Müllerian hormone was chosen as it controls the formation of primary follicles and, therefore, has a role in folliculogenesis. Thirty-two women submitting to natural IVF cycles participated from the study. Patients were divided into two groups: tubal obstruction without endometriosis (control group), and minimal/mild endometriosis (study group). All patients underwent laparoscopy for assessment of infertility; at the same time, any foci of endometriosis found were cauterized. Anti-Müllerian hormone concentration was measured in the follicular fluid of a single follicle when it achieved pre-ovulatory maturation. Likewise, anti-Müllerian hormone content in serum was also measured, as well as FSH and inhibin B. Average age, approximately 30 years, was not statistically different between groups. In addition, day-3 antral follicular count (resting follicles at the beginning of each menstrual cycle), and serum FSH concentrations were also not statistically different between groups. Moreover, follicular-fluid AMH concentrations were also similar in both groups. This study shows that infertile patients with minimal/mild endometriosis have a similar concentration of AMH in the follicular fluid as compared with control subjects.     

Early and mid-term angiographic and clinical results after intracoronary duet stent placement.

The Duet stent (Guidant/Advanced Cardiovascular Systems) is a new stent with a corrugated ring design and very limited data on its short- and mid-term performance. Accordingly, in this study we sought to determine the early and mid-term clinical and angiographic outcomes in a moderate-sized series of 86 consecutive patients who underwent placement of 108 premounted Duet stents in 98 coronary lesions. Procedural success, accomplished in all patients, was accompanied by a significant reduction in lesion severity from 89% +/- 11% before to 5% +/- 3% diameter stenosis after the procedure (P = 0.0001) and a 0.9% incidence of subacute stent thrombosis. Angiographic restudy at 5.7 months in 89% of eligible patients revealed a binary in-stent restenosis rate of 26%. Coronary stenting with the new Duet stent confers a low risk of stent thrombosis and a favorable mid-term clinical and angiographic outcome despite the presence of a large proportion of patients at high risk of in-stent restenosis.     

Renal Transplantation: Experience at a Single Centre

Background

Renal transplantation program in the Armed Forces commenced in Feb 1991 and till date 245 patients have undergone renal transplantation at INHS Asvini. We describe our protocols for donor and recipient evaluation and immunosuppression. Methods: 245 patients received renal transplants during this period, 243 (99.2%) being from live donors. Most of them were started on triple immunosuppression comprising of cyclosporine, azathioprine and prednisolone. Newer drugs like mycophenolate, tacrolimus and sirolimus were administered in a select population.

Result

69 (28.1%) of them had at least one episode of acute rejection, most of which were steroid responsive and 13 (18.8%) of them required either anti CD3 monoclonal or anti-thymocyte globulin (ATG). Complete recovery with normal renal function occurred in 54 (78.2%) cases and 15 (21.7%) recovered with residual dysfunction with maximum serum creatinine being 2.1mg/dl. There were three (1.2%) cases of accelerated rejection during the first week of transplantation and one had graft rupture. All three lost their grafts. There were eight (3.2%) cases of acute tubular necrosis, who recovered completely within 8–14 days. Immediate infections included wound sepsis, lower respiratory tract infection, disseminated candidiasis and disseminated aspergillosis. Late infections included pulmonary tuberculosis, disseminated tuberculosis, cytomegalovirus infection and recurrent urinary tract infection. 28 (11.4%) patients developed post transplant diabetes mellitus. At the end of one year and five years, graft and patient survival were 97.2%, 93%, 80.9% and 85.7% respectively.

Conclusion

Our outcomes show that the transplantation is a viable mode of renal replacement therapy in patients of end stage kidney disease with a near normal rehabilitation.Key Words: Kidney, Transplantation, Immunosuppression, Complications     

Measuring domestic violence in human immunodeficiency virus-positive women

Background

Violence affects the lives of millions of women worldwide, in all socioeconomic classes. Violence and the fear of violence are emerging as important risk factor contributing to the vulnerability to human immunodeficiency virus (HIV) infection for women. The objective of the present cross sectional study is to compare the experiences of domestic violence between HIV-positive and HIV-negative married women seeking treatment in a tertiary care hospital.

Methods

The study is conducted in a tertiary care hospital in Pune on a randomly selected 150 married women (75 HIV-positive and 75 HIV-negative). Informed consent was obtained from all the women and also a trained counsellor was present during the process of data collection. The data was collected by interview method by taking precautions as laid down in the World Health Organization's ethical and safety recommendations for research on domestic violence and using modified conflict tactics scale (CTS). The definition of violence followed is as per the Declaration on the Elimination of Violence against Women, adopted by the United Nations General Assembly in 1993.

Results

The percentage of women reporting domestic violence is 44.7% (95% confidence interval [CI] = 36.84–52.68). The proportion of physical, emotional and sexual violence reported is 38% (95% CI = 30.49–45.96), 24% (95% CI = 17.67–31.31), and 14.7% (95% CI = 9.66–21.02), respectively. The odds of reporting violence of all forms is significantly higher among HIV-positive women than among HIV-negative women (P<0.05). Univariate and multivariate logistic regression is carried out to examine the possible predictors of domestic violence.

Conclusion

The findings suggest high proportion of HIV-positive women report violence then HIV-negative women which must be addressed through multilevel prevention approaches.