Evaluation of immune response to Hepatitis B vaccine in health care workers at a tertiary care hospital in Pakistan: an observational prospective study

Background  

Seroconversion rates reported after Hepatitis B virus (HBV) vaccination globally ranges from 85–90%. Health care workers (HCWs) are at high risk of acquiring HBV and non responders' rates after HBV vaccination were not reported previously in Pakistani HCWs. Therefore we evaluated immune response to HBV vaccine in HCWs at a tertiary care hospital in Karachi, Pakistan.     

The effect of the arterial catheter insertion technique on the success of radial artery cannulation: A prospective and randomized study

Purpose

The main objective of the current investigation was to compare a single wall puncture to vessel transfixing on the success of radial artery cannulation by resident physicians.

Material and Methods

The study was a prospective and randomized investigation. Twelve anesthesiology residents performed radial arterial insertions in 126 patients using both the single wall and vessel transfixing technique in random order. The primary outcome was successful cannulation of the radial artery in 4 or less attempts. Other data collected included the total number of attempts and total time to catheter cannulation.

Results

Successful radial artery cannulation was achieved in 88% and 86% of patients using the transfixing technique and single wall group, respectively (difference 2%; 95% CI, 14-9, P = 0.8, Fisher exact test). Cannulation was successfully on the first attempt in 38% of the transfixing compared to 54% using the single wall technique (difference − 16%; 95% CI, 32-2, P = 0.1, Fisher Exact test). The median (interquartile range) time to successful cannulation was longer in the transfixing group, 105 (69-176) seconds compared to 65 (25-114) seconds in the single puncture group (P = .009, log-rank test).

Conclusions

Our findings suggest that there does not appear to be an advantage of the transfixing technique over the single wall puncture method for cannulating the radial artery by resident physicians. Cannulation was achieved in shorter time using the single wall puncture technique even after accounting for differences between residents and prior levels of experience.     

Perforated peptic ulcer at the J.G. Strijdom Hospital. A retrospective study of 99 patients

This is a retrospective analysis of 99 patients with perforated peptic ulcer treated in the Department of Surgery at the J. G. Strijdom Hospital over a 6-year period. The incidence of this condition is increasing in our population. The mortality rate for perforated peptic ulcer remains high (12.1%). Forty-three per cent of our patients were suffering from a major medical illness at the time of perforation, with a mortality rate of 25.6%. The mortality rate for relatively fit patients was 1.8%. While more conservative surgery is indicated for high-risk patients, a definitive ulcer operation can be performed safely in patients who are not suffering from a major medical illness. Our selective operative policy is discussed.     

Efficacy of a Prophylactic Epidural Blood Patch in Preventing Post Dural Puncture Headache in Parturients after Inadvertent Dural Puncture

Background: Postdural puncture headache (PDPH) occurs in up to 80% of parturients who experience inadvertent dural puncture during epidural catheter placement. The authors performed a randomized double blind study to assess the effect of prophylactic epidural blood patch on the incidence of PDPH and the need for therapeutic epidural blood patch.

Methods: Sixty-four parturients who incurred inadvertent dural puncture were randomized to receive a prophylactic epidural blood patch with 20 ml autologous blood (prophylactic epidural blood patch group) or a sham patch (sham group). Subjects were evaluated daily for development of PDPH for a minimum of 5 days after dural puncture. Those who developed a PDPH were followed daily for a minimum of 3 days after resolution of the headache. Subjects with moderate headaches who reported difficulties performing childcare activities and all those with severe headaches were advised to receive a therapeutic epidural blood patch.

Results: Eighteen of 32 subjects in each group (56%) developed PDPH. Therapeutic blood patch was recommended in similar numbers of patients in each group. The groups had similar onset time of PDPH, median peak pain scores, and number of days spent unable to perform childcare activities as a result of postural headache. The median duration of PDPH, however, was shorter in the prophylactic epidural blood patch group.     

Endometrial actinomycosis. Two case reports]

Actinomyces is an aerobic, Gram positive bacteria saprophyte of the genital tract. The endometrial involvement is extremely rare. The authors report two cases of pelvic actinomycosis in a 58 and 55 year old women, the second using intrauterine device for 11 years.     

Intraoperative peritoneal lavage

The successful management of the contaminated or septic abdomen rests on at least three tenets: The use of systemic perioperative antibiotics, the control of the source of infection and the aspiration of the gross contaminants. The additional use of any modality of IOPL is well entrenched in modern surgical practice. It does, however, owe more to force of habit or prejudice than to sound scientific evidence. Most, if not all, experimental or clinical studies suggesting the benefits of IOPL suffer from many deficiencies, some of which we made a point of emphasizing. In broad terms, one could recognize three major pitfalls invalidating these studies. First, the design of some of the experimental studies bears no resemblance to clinical situations. For example, laparotomy was omitted in either both arms of the trial or in the control arm. Second, far too frequently, the data were drawn from retrospective or uncontrolled trials. Although the value of such studies cannot be denied, the literature is replete with examples of perpetuation of erroneuos concepts through lack of properly designed prospective, randomized controlled studies. Third, many of the trials were performed before the revolutionary introduction of perioperative antibiotics in clinical practice. Of greater concern is the existence of studies which, for unexplained reasons, have ignored this principle. From this review, it seems that neither the benefit nor the safety of IOPL with crystalloid or antiseptic solution has been established beyond any reasonable doubt. The theory for the addition of judicious antibiotics to the IOPL may be stronger, although no absolute proof exists to suggest that this practice will decrease mortality rates from intra-abdominal infections. Obviously, there is a need for well constructed, controlled, prospective clinical trials to examine the role of IOPL in modern surgical groups of patients assembled under the label intra-abdominal infection. Until some stratification of peritonitis in various clinical studies is undertaken, either by how ill the patient is or the source of contamination and its duration, it will be difficult to compare studies from different centers.