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Revista Brasileira de Ginecologia E... 2024
Topics: Humans; COVID-19; Ascitic Fluid; SARS-CoV-2
PubMed: 38765511
DOI: 10.61622/rbgo/2024rbgo24 -
Trials May 2024The recent guidelines from the European and American Hernia Societies recommend a continuous small-bite suturing technique with slowly absorbable sutures for fascial...
Superiority trial for the development of an ideal method for the closure of midline abdominal wall incisions to reduce the incidence of wound complications after elective gastroenterological surgery: study protocol for a randomized controlled trial.
BACKGROUND
The recent guidelines from the European and American Hernia Societies recommend a continuous small-bite suturing technique with slowly absorbable sutures for fascial closure of midline abdominal wall incisions to reduce the incidence of wound complications, especially for incisional hernia. However, this is based on low-certainty evidence. We could not find any recommendations for skin closure. The wound closure technique is an important determinant of the risk of wound complications, and a comprehensive approach to prevent wound complications should be developed.
METHODS
We propose a single-institute, prospective, randomized, blinded-endpoint trial to assess the superiority of the combination of continuous suturing of the fascia without peritoneal closure and continuous suturing of the subcuticular tissue (study group) over that of interrupted suturing of the fascia together with the peritoneum and interrupted suturing of the subcuticular tissue (control group) for reducing the incidence of midline abdominal wall incision wound complications after elective gastroenterological surgery with a clean-contaminated wound. Permuted-block randomization with an allocation ratio of 1:1 and blocking will be used. We hypothesize that the study group will show a 50% reduction in the incidence of wound complications. The target number of cases is set at 284. The primary outcome is the incidence of wound complications, including incisional surgical site infection, hemorrhage, seroma, wound dehiscence within 30 days after surgery, and incisional hernia at approximately 1 year after surgery.
DISCUSSION
This trial will provide initial evidence on the ideal combination of fascial and skin closure for midline abdominal wall incision to reduce the incidence of overall postoperative wound complications after gastroenterological surgery with a clean-contaminated wound. This trial is expected to generate high-quality evidence that supports the current guidelines for the closure of abdominal wall incisions from the European and American Hernia Societies and to contribute to their next updates.
TRIAL REGISTRATION
UMIN-CTR UMIN000048442. Registered on 1 August 2022. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055205.
Topics: Humans; Prospective Studies; Abdominal Wound Closure Techniques; Abdominal Wall; Suture Techniques; Surgical Wound Infection; Digestive System Surgical Procedures; Incisional Hernia; Elective Surgical Procedures; Treatment Outcome; Incidence; Wound Healing; Equivalence Trials as Topic; Randomized Controlled Trials as Topic; Time Factors
PubMed: 38760769
DOI: 10.1186/s13063-024-08167-w -
BMC Nephrology May 2024Recent studies have suggested that the N-terminal fragment of B-type natriuretic peptide (NT-proBNP) level serve as a significant risk factor for mortality in patients...
BACKGROUND
Recent studies have suggested that the N-terminal fragment of B-type natriuretic peptide (NT-proBNP) level serve as a significant risk factor for mortality in patients with end-stage renal disease. However, the relationship between NT-proBNP levels and technique failure in peritoneal dialysis-associated peritonitis (PDAP) remains unclear. This study investigated the relationship between NT-proBNP levels at the onset of PDAP and the risk of technique failure in patients with PDAP.
METHODS
A retrospective analysis was conducted on patients with PDAP from December 1, 2009, to December 31, 2021, at our peritoneal dialysis center. We recorded all demographic and baseline clinical data at the time of admission for each PDAP episode. Logistic and Cox regression analyses were performed to assess the association between NT-proBNP levels and technique failure.
RESULTS
Of 485 PDAP episodes included in this study, 130 episodes of technique failure were observed. Multivariate logistic analysis revealed that hospital stay, Na and NT-proBNP levels, and peritoneal dialysate white blood cell counts on days 3 and 5 were independently associated with technique failure. The receiver operating characteristic curve demonstrated that the NT-proBNP level was a better indicator than the other four variables in indicating technique failure. In the multivariate Cox regression analysis, after adjusting for confounding factors, higher NT-proBNP levels (HR of 3.020, 95% CI 1.771, 5.150, P < 0.001) were associated with PDAP technique failure.
CONCLUSIONS
This retrospective study identified the serum NT-proBNP level at the onset of PDAP as an independent risk factor for technique failure in these patients.
Topics: Humans; Natriuretic Peptide, Brain; Male; Female; Peritoneal Dialysis; Peptide Fragments; Middle Aged; Peritonitis; Retrospective Studies; Risk Factors; Kidney Failure, Chronic; Treatment Failure; Aged; Adult; Biomarkers
PubMed: 38760707
DOI: 10.1186/s12882-024-03603-0 -
Nature Communications May 2024Sepsis results from systemic, dysregulated inflammatory responses to infection, culminating in multiple organ failure. Here, we demonstrate the utility of CD5L for...
Sepsis results from systemic, dysregulated inflammatory responses to infection, culminating in multiple organ failure. Here, we demonstrate the utility of CD5L for treating experimental sepsis caused by cecal ligation and puncture (CLP). We show that CD5L's important features include its ability to enhance neutrophil recruitment and activation by increasing circulating levels of CXCL1, and to promote neutrophil phagocytosis. CD5L-deficient mice exhibit impaired neutrophil recruitment and compromised bacterial control, rendering them susceptible to attenuated CLP. CD5L peritoneal cells from mice subjected to medium-grade CLP exhibit a heightened pro-inflammatory transcriptional profile, reflecting a loss of control of the immune response to the infection. Intravenous administration of recombinant CD5L (rCD5L) in immunocompetent C57BL/6 wild-type (WT) mice significantly ameliorates measures of disease in the setting of high-grade CLP-induced sepsis. Furthermore, rCD5L lowers endotoxin and damage-associated molecular pattern (DAMP) levels, and protects WT mice from LPS-induced endotoxic shock. These findings warrant the investigation of rCD5L as a possible treatment for sepsis in humans.
Topics: Animals; Sepsis; Mice, Inbred C57BL; Mice; Neutrophils; Mice, Knockout; Phagocytosis; Chemokine CXCL1; Disease Models, Animal; Male; Neutrophil Infiltration; Cecum; Recombinant Proteins; Humans; Pore Forming Cytotoxic Proteins; Ligation; Lipopolysaccharides; Shock, Septic
PubMed: 38750020
DOI: 10.1038/s41467-024-48360-8 -
International Journal of Nursing... Dec 2023Inadequate training on how to care for haemodialysis and peritoneal dialysis catheters can lead to mechanical issues with the catheters and infectious complications... (Review)
Review
BACKGROUND
Inadequate training on how to care for haemodialysis and peritoneal dialysis catheters can lead to mechanical issues with the catheters and infectious complications (such as peritonitis) that could endanger patient safety, reduce the effectiveness of the dialysis treatment, and have a negative impact on patient morbidity and mortality. Such incidents can be prevented as they are mostly dependant on controllable factors - proper dialysis catheter care, which can be addressed through effective patient education. Effective patient education is crucial in ensuring that patients are equipped with the knowledge and skills necessary for both peritoneal and haemodialysis catheter care.
AIMS
To synthesise evidence on the: (1) patient educational interventions on haemodialysis and peritoneal dialysis catheter care; and (2) reported learning and clinical outcomes of the educational interventions provided for patients with haemodialysis and peritoneal dialysis catheter.
DESIGN
Integrative review.
METHODS
This review followed the framework by Whittemore and Knafl. The literature search was performed using four electronic databases: PubMed, CINAHL, Cochrane Library and ProQuest Nursing and Allied Health. The Joanna Briggs Institute Critical Appraisal Tool was used to appraise the articles that fit the inclusion and exclusion criteria. Studies published in the English language were retrieved.
RESULTS
A total of 14 studies were included. All the studies focused on educating patients who were on either tunnelled (permanent) haemodialysis catheters or peritoneal dialysis catheters. The findings identified: (1) teaching strategies used for educating patients on haemodialysis catheter care (2) teaching strategies for educating peritoneal dialysis patients on peritoneal dialysis catheter care and (3) outcomes of patient education on both haemodialysis and peritoneal dialysis catheters. Written materials and educational videos were used to instruct patients on haemodialysis catheters care. Different educational strategies for educating patients on peritoneal dialysis catheter care were also reported. They varied in terms of the composition and experience of the implementation care team members, educational approach, training duration, training location, timing relative to catheter placement, assessment method and follow-up support. The various teaching strategies were assessed and compared based on the patients' knowledge levels, catheter-related mechanical issues, and catheter-related infectious consequences (such as peritonitis).
CONCLUSION
This review highlighted various education materials and compared different educational practices on tunnelled (permanent) haemodialysis catheter and peritoneal dialysis catheter care that healthcare providers used to increase knowledge and reduce catheter-related blood stream infections and peritonitis rates.
PubMed: 38746579
DOI: 10.1016/j.ijnsa.2023.100156 -
Surgical Neurology International 2024Ventriculoperitoneal (VP) shunt placement is one of the most performed procedures in neurosurgery to treat various types of hydrocephalus (HC). Immediate or late...
BACKGROUND
Ventriculoperitoneal (VP) shunt placement is one of the most performed procedures in neurosurgery to treat various types of hydrocephalus (HC). Immediate or late postoperative complications may quite commonly occur, especially in immunosuppressed patients, who are predisposed to develop rare and difficult-to-treat conditions.
CASE DESCRIPTION
Herein, we report the case of a 41-year-old female patient with a prior history of acute myeloid leukemia, followed by a tetra-ventricular acute HC due to a spontaneous non-aneurysmal subarachnoid hemorrhage. After an urgent external ventricular drainage placement, she underwent careful testing of "shunt dependency," which ended with a VP shunt placement. After 2 months, she presented at the emergency department with worsening abdominal pain and fever. She underwent a computed tomography scan with contrast administration, which has shown abscesses in the abdominal cavity. An urgent surgical revision of the VP shunt and antibiotics administration followed this. After inflammatory markers normalization, due to the high risk of post-infective peritoneal adherence and consequent impairment of cerebrospinal fluid absorption, a ventriculoatrial shunt was considered the most appropriate solution.
CONCLUSION
Abdominal abscesses are a rare but subtle complication after VP shunt placement. Their management depends on etiology, patient clinical characteristics, and manifestations. Prompt interventions have been shown to improve clinical outcomes and optimize quality of life in such delicate patients.
PubMed: 38742012
DOI: 10.25259/SNI_151_2024 -
RSC Advances May 2024The urgent need to develop biocompatible, non-resistant antibacterial agents to effectively combat Gram-negative bacterial infections, particularly for the treatment of...
The urgent need to develop biocompatible, non-resistant antibacterial agents to effectively combat Gram-negative bacterial infections, particularly for the treatment of peritonitis, presents a significant challenge. In this study, we introduce our water-soluble Cu nanoclusters (NCs) as a potent and versatile antibacterial agent tailored for addressing peritonitis. The as-synthesized atomically precise Cu NCs demonstrate exceptional broad-spectrum antibacterial performance, and especially outstanding bactericidal activity of 100% against Gram-negative (). Our experimental findings indicate that the Cu NCs exhibit remarkable therapeutic efficacy against primary peritonitis caused by infection. Specifically, the treatment leads to a profound reduction of drug-resistant bacteria in the peritoneal cavity of mice with peritonitis by more than 5 orders of magnitude, along with the resolution of pathological features in the peritoneum and spleen. Additionally, comprehensive biosafety assessment underscores the remarkable biocompatibility, low biotoxicity, as well as efficient hepatic and renal clearance of Cu NCs, emphasizing their potential for application. This investigation is poised to advance the development of novel Cu NC-based antibacterial agents for antibacterial treatment and the elimination of abdominal inflammation.
PubMed: 38741962
DOI: 10.1039/d4ra01785d -
Infection and Drug Resistance 2024is an opportunistic pathogen that rarely causes clinical infections. Here, we first report a case of spontaneous bacterial peritonitis in patients with hepatitis C...
BACKGROUND
is an opportunistic pathogen that rarely causes clinical infections. Here, we first report a case of spontaneous bacterial peritonitis in patients with hepatitis C cirrhosis caused by .
CASE PRESENTATION
A 71-year-old male patient was diagnosed with spontaneous bacteria peritonitis secondary to hepatitis C cirrhosis. The result of bacterial culture in ascites was positive, and the pathogenic bacteria was preliminarily identified as the genus by matrix-assisted laser desorption ionization-time of flight mass spectrometry. After 16S rRNA sequencing analysis, it was determined to be the . Symptoms relieved after treatment with ceftazidime.
CONCLUSION
This case indicates that the clinical infections caused by should be brought to the forefront. Accurate and rapid bacterial identification results are highly beneficial to the diagnosis and therapeutic regime.
PubMed: 38741944
DOI: 10.2147/IDR.S459821 -
Laboratory Animal Research May 2024Community-acquired respiratory infection is the commonest cause of sepsis presenting to emergency departments. Yet current experimental animal models simulate peritoneal...
Community-acquired respiratory infection is the commonest cause of sepsis presenting to emergency departments. Yet current experimental animal models simulate peritoneal sepsis with intraperitoneal (I.P.) injection of lipopolysaccharide (LPS) as the predominant route. We aimed to compare the progression of organ injury between I.P. LPS and intranasal (I.N.) LPS in order to establish a better endotoxemia murine model of respiratory sepsis. Eight weeks old male BALB/c mice received LPS-Escherichia coli doses at 0.15, 1, 10, 20, 40 and 100 mg per kg body weight (e.g. LPS-10 is a dose of 10 mg/kg body weight). Disease severity was monitored by a modified Mouse Clinical Assessment Score for Sepsis (M-CASS; range 0-21). A M-CASS score ≥ 10 or a weight reduction of ≥ 20%, was used as a criterion for euthanasia. The primary outcome was the survival rate (either no death or no need for euthanasia). The progression of disease was specified as M-CASS, body weight, blood glucose, histopathological changes to lung, liver, spleen, kidney, brain and heart tissues. Survival rate in I.P. LPS-20 mice was 0% (2/3 died; 1/3 euthanized with M-CASS > 10) at 24 h. Survival rate in all doses of I.N. LPS was 100% (20/20; 3-4 per group) at 96 h. 24 h mean M-CASS post-I.P. LPS-10 was 6.4/21 significantly higher than I.N. LPS-10 of 1.7/21 (Unpaired t test, P < 0.05). Organ injury was present at 96 h in the I.P. LPS-10 group: lung (3/3; 100%), spleen (3/3; 100%) and liver (1/3; 33%). At 24 h in the I.P. LPS-20 group, kidney injury was observed in the euthanized mouse. At 96 h in the post-I.N. LPS-20 group, only lung injury was observed in 2/3 (67%) mice (Kruskal-Wallis test with Dunn's, P < 0.01). At 24 h in the post-I.N. LPS-100 group all (4/4) mice had evidence of lung injury. Variable doses of I.N. LPS in mice produced lung injury but did not produce sepsis. Higher doses of I.P. LPS induced multi-organ injury but not respiratory sepsis. Lethal models of respiratory virus, e.g., influenza A, might provide alternative avenues that can be explored in future research.
PubMed: 38741131
DOI: 10.1186/s42826-024-00205-7 -
Cureus Apr 2024We present the case of a 62-year-old immunocompromised man with ulcerative colitis, primary sclerosing cholangitis, and cirrhosis treated with azathioprine and...
We present the case of a 62-year-old immunocompromised man with ulcerative colitis, primary sclerosing cholangitis, and cirrhosis treated with azathioprine and ustekinumab who quickly developed invasive infection after incidental identification on routine paracentesis. The infection rapidly progressed from bacterial peritonitis to bacteremia and meningitis within three days. Treatment with ampicillin and trimethoprim/sulfamethoxazole was successful. We highlight the increased risk of invasive listeriosis in immunocompromised individuals, including those on biologic therapies, and the importance of considering as a pathogen from sterile sites even in asymptomatic patients.
PubMed: 38738136
DOI: 10.7759/cureus.58116