Patient Safety and Infection Control

Audit on hand hygiene and use of personal protective equipment: Prevention of nosocomial transmission of COVID-19 Indranath Roy Journal of Patient Safety and Infection Control 2020 8(2):37-38

Attitude and beliefs about surgical safety checklist in a North Indian tertiary care hospital, a decade later of World Health Organisation checklist Lovenish Bains, Anurag Mishra, Daljit Kaur, Pawan Lal, Lalit Gupta, Vikas Malhotra Journal of Patient Safety and Infection Control 2020 8(2):39-47 Background: Avoidable surgical complications account for a large proportion of preventable medical injuries and deaths globally. Surgical safety checklist (SSCL) is evidence‑based, internationally accepted valid instrument, which has been found to reduce postoperative morbidity and mortality; the benefits of which are most striking in low and middle‑income countries (LMICs) Despite implementation in many hospitals throughout the country, there is still lack of awareness and concern in many LMICS health care facilities towards SSCL and its use, even after a decade of World Health Organisation (WHO) checklist. Methods: This was a single centre e-survey to assess the knowledge, attitudes and beliefs about the WHO‑surgical checklist, in which 65.4% (138) surgeons, 25.1% (53) anaesthetists and 9.5% (20) nurses participated. Results: Majority believed that the use of SSCL improves the safety of procedures, improves communication amongst theatre staff and will result in a reduction in errors in theatre, yet there was no commitment for the use of SSCL. Although all theatre personnel support implementation and use of SSCL; however, hierarchical issues, lack of administrative support, lack of training, logistics and timing, high patient volume and overburdened residents, lack of co‑ordinator or leadership role and shortage of workforce can be impediment to effective use. Discussion: Nurses and junior doctors play a crucial role. Commitment rather than compliance and teamwork will be the key, ably supported by education and training which should be mandatory for all operation theatre stakeholders. Therefore, any measure that can potentially improve patient safety should be embraced and benefits of SSCL be told to motivate them and enhance participation for patient safety. Committed leadership, knowledge sharing and periodic trainings, interdisciplinary communication, feedback and regular audits can define and determine effective implementation process.

Seroprevalence of hepatitis C infection in patients undergoing haemodialysis in a tertiary care centre Anjali Nair Vinayakumar, Reena John Journal of Patient Safety and Infection Control 2020 8(2):48-53 Introduction: Hepatitis C virus (HCV) infection is a major health problem among these patients in developing countries like India. This could be either due to a non-adherence to strict infection control measures or the unavailability of vaccine to prevent HCV infection. Objectives of the Study: This study aims to estimate the prevalence of HCV infection in patients undergoing haemodialysis and assess the major risk factors, the efficacy of infection control measures in the dialysis unit by studying the seroconversion rates from HCV negative to HCV positive and also formulate ways to prevent the nosocomial spread of HCV infection in the dialysis unit. Materials and Methods: This was a cross-sectional study carried out among 250 patients undergoing haemodialysis in the dialysis unit of a tertiary care centre. They were tested for the presence of anti-HCV antibody by enzyme linked immunosorbent assay. Results: The seroprevalence of HCV infection among the patients undergoing haemodialysis as per this study is 4.8%. The risk factors identified were age >50, prolonged duration of dialysis and multiple blood transfusions. One significant observation was of the probability of lateral spread of HCV infection within the dialysis unit. Conclusions: Although there is no consensus regarding machine dedication between HCV non-infected and HCV-infected patients, we found that using dedicated HD machines had an important role in reducing HCV transmission in our dialysis unit. However, risk prevails if any seronegative patient acts as HCV carrier.

Practice gaps and challenges to effective patient safety culture in a tertiary hospital in Nigeria Amaka Y Ezeuko, Chinomnso C Nnebue, Raymond C Okechukwu, Chigozie O Ifeadike Journal of Patient Safety and Infection Control 2020 8(2):54-59 Background: Knowledge and experiences of inefficiencies, odds and difficulties in patient safety culture (PSC) maintenance in health-care systems can facilitate the development and implementation of better strategies. Objective: The aim is to determine the practice gaps and challenges to effective PSC in Nnamdi Azikiwe University Teaching Hospital, (NAUTH) Nnewi, Nigeria. Materials and Methods: This was a cross-sectional survey conducted from June to November 2016 in NAUTH Nnewi, Nigeria. Data were collected through mixed methods:-self-administered structured questionnaire survey (QS), focus group discussions (FGD) and key informant interviews (KII). Stratified sampling technique was used for the QS, while the convenience sampling technique. was employed in the FGD and KII. Data were analysed using the Statistical Package for the Social Sciences version 22. Results: Challenges to the effective promotion of PSC each relate to gaps in either poor staff strength or punitive response to the error report. The challenges reported from the FGD are lack of training and re-training programmes (61%), poor team spirit and low staff capacity (56%). From the KII >80% reported non-availability of PSC unit, patient safety committee, patient safety guideline/policy, nor standard operation procedure while (61%) reported that management effort to provide enabling patient safety environment was adequate. Conclusions: This study found challenges to effective PSCsuch as poor training, staff strength, team spirit cum communication, excessive work hours and fear of punitive response to the error report. This buttresses the need for urgent attention to these areas of weakness through awareness and educational programmes on PSC, adequate staffing and prompt information dissemination.

Applying patient safety principles in public safety in the COVID-19 scenario Thanjavur S Ravikumar, Aravindakshan Rajeev, Shikha Yadav Journal of Patient Safety and Infection Control 2020 8(2):60-63 COVID-19 has overwhelmed the health systems all over the world. Using a methodology for finding excess deaths due to illnesses, we estimated the statistics for the countries which had their first case of coronavirus infection in January 2020. For illustration, the avoidable harm in the USA was 160,988 and that of the UK was 38,857 until the 2nd week of August 2020. Geographic distribution of excess deaths was plotted on GeoDa® shaded map. Spatial error model showed that early and vigorous testing reduced the mortality load. Strategy has to be worked out to contain the pandemic using the appropriate public health tools.

Nasal carriage of methicillin-resistant Staphylococcus aureus amongst healthcare workers of intensive care unit of a tertiary care centre in South India: An observational cross-sectional study Abhishek Thanuja Jayadhar, Ashish Jitendranath, Amalu Ann Thomas, GS Sarika Journal of Patient Safety and Infection Control 2020 8(2):64-67 Staphylococcus aureus is one of the dangerous pathogens causing infections in both community level and hospital setting. This study aims to find the carrier rate of S. aureus and a resistant strain of the bacterium–methicillin-resistant S. aureus (MRSA). Sterile cotton swabs (saline moistened) were used to collect the nasal samples from the healthcare workers (HCWs) of different intensive care units. The isolation S. aureus was done by standard bacteriological procedures. Antibiotic susceptibility testing of all isolates was performed by modified Kirby–Bauer disc diffusion method. Methicillin resistance of S. aureus was identified using cefoxitin disc diffusion test. One hundred and forty-one nasal swabs were processed (104 nurses, 27 doctors and 10 non-medical staff). Amongst the 141 nasal swabs processed, 18.4% of HCWs were carriers of S. aureus, out of which 9.9% tested positive for MRSA. To prevent the colonisation of HCWs by S. aureus and avoid cross infection amongst patients, proper hand hygiene practices are vital. Creating an awareness and periodic screening is yet another task needed to tackle this crisis.

Impact of COVID-19 in non-COVID hospitals: Do we need a pandemic to augment healthcare worker and patient safety? Areena Hoda Siddiqui, HN Tripathi, R Harsvardhan Journal of Patient Safety and Infection Control 2020 8(2):68-69

A virtual birth companion! – Yet another application of virtual reality during the COVID-19 pandemic Vijayan Sharmila, Thirunavukkarasu Arun Babu Journal of Patient Safety and Infection Control 2020 8(2):70-71

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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Interdisciplinary Dentistry

Webinars-boon or bane Mahalaxmi Sekar, Monisha P Khatri Journal of Interdisciplinary Dentistry 2020 10(3):95-96

Detection and comparison of spirochetes in periodontal health and disease by microscopy and polymerase chain reaction techniques: A microbiological study Reshma Naik, SP Pushpa, Kishore Bhat, Sanjeevini Hattarki Journal of Interdisciplinary Dentistry 2020 10(3):97-104 Background: Periodontitis is caused by specific microorganisms or group of specific microorganisms. Spirochetes have been implicated to play a role in the pathogenesis of the periodontal disease. Objectives: The aim is to detect the prevalence of total spirochetes in patients with healthy periodontium, gingivitis, and periodontitis using microscopy and polymerase chain reaction (PCR) techniques. And to compare microscopy (silver nitrate staining) technique and PCR technique in the detection of spirochetes. Subjects and Methods: A total of 150 patients were selected and divided into healthy, gingivitis, and periodontitis groups with 50 patients in each group. Subgingival plaque samples were collected using sterile Gracey curettes. The plaque samples were analyzed for the presence of spirochetes using microscopy and PCR techniques. Statistical analysis for the prevalence of spirochetes was performed using the Chi-square test. The sensitivity and specificity of the microscopy and PCR techniques were compared. Results: The prevalence of spirochetes increased from healthy to gingivitis to periodontitis patients. The prevalence of spirochetes was statistically significantly higher in the periodontitis group as compared to the healthy and gingivitis group. PCR was more sensitive in detecting spirochetes than microscopy, but that microscopy showed slightly greater specificity than PCR. Conclusion: There is a strong association between the presence of spirochetes with periodontal disease as well as its severity. The microscopic method by silver nitrate staining can be a very useful, simple, and rapid screening method for the evaluation of oral spirochetes, but PCR technique may serve as more sensitive indicator of subjects at risk for periodontal disease, thus allowing preventive measures.

Comparison of tensile and tear strength of three silicone materials for maxillofacial prosthesis in Indian climatic condition Vibha Shetty, Anoop Sharma, Sweekriti Mishra Journal of Interdisciplinary Dentistry 2020 10(3):105-110 Aims: The aim of the study was to evaluate and compare physical properties such as tensile strength and tear strength of three commonly used silicone maxillofacial materials in Indian climatic condition. Settings and Design: An in vitro study was conducted to compare the tensile and tear strength using a universal testing machine with 100 N load at a speed of 20 mm/min. Specimens were prepared from three commercially available silicones, i.e., medical grade silicone (control group), prosthetic grade silicone (test Group 1), and a locally available medical grade silicone (test Group 2). One-way analysis of variance was carried out to test any significant difference between the mean values of tensile and tear strength between the tested materials. Post hoc test of Tukey was used to find which of the two groups' means shows a significant difference. Results: Prosthetic grade silicone showed the highest tensile strength with a P< 0.001* among the two tested materials. Tear strength and mean elongation was highest in control showing statistically significant results (<0.001*). Locally available medical grade silicone showed the least favorable properties among all the tested materials, though tensile strength was within acceptable range. Conclusions: Tensile strength of prosthetic silicone was highest followed by medical grade, whereas tear strength and elongation were maximum in medical grade silicone. Locally available medical grade silicone showed the least favorable properties.

Effect of probiotics on Candida in diabetic and nondiabetic complete denture wearers – An In vivo study Bonda Rajasekhar, Anil Kumar Gujjari, Ranjitha Shankaregowda, Karteek Durbakula Journal of Interdisciplinary Dentistry 2020 10(3):111-116 Aim: To evaluate the effectiveness of probiotics on Candida albicans in diabetic and nondiabetic complete denture wearers. Study Design: Twenty complete denture wearers with dentures aging more than 6 months were selected randomly and divided into two groups (controlled diabetic and nondiabetic) based on their blood glucose levels and medical history. Materials and Methods: Probiotics were prescribed for all the subjects for the duration of 30 days. Microbial swab was collected from their dentures at 0, 15th, and 30th days and incubated in Sabouraud's dextrose agar broth. C. albicans colony-forming units (CFU/ml) were counted. Statistical Analysis: The candidial CFUs were compared using statistical analyses such as descriptive statistics, paired samples t-test, independent samples t-test, and repeated-measures ANOVA test and P < 0.05 was considered as statistically significant. Results: C. albicans count reduced in both the groups during the usage of probiotics, but the reduction was more in controlled diabetic subjects which showed statistically significant results. Conclusion: Probiotics can be used as an alternative therapy for the management of oral candidiasis in denture wearers particularly in controlled diabetic patients.

Management of a velopharyngeal defect with hollow speech bulb prosthesis Snehal Jaiswal, Mohit Kheur, Tabrez Lakha Journal of Interdisciplinary Dentistry 2020 10(3):117-121 Velopharyngeal (VP) insufficiency is an anatomic defect of the soft palate which renders the palatopharyngeal sphincter incomplete. In cases where a surgically repaired soft palate is too short to contact the pharyngeal walls during function, speech aid prosthesis or speech bulbs are optimum choices of treatment. This case report elaborates the correction of hypernasality of speech associated with VP insufficiency, by means of speech bulb prosthesis. This speech bulb is a combination of cast partial denture with extension into the defect area to hold heat cure acrylic material. This retentive component was embedded in heat cure acrylic resin material to aid in retention. This improved the hypernasality, speech, comfort, retention, and overall patient acceptance.

Rehabilitation of dentition affected by stage IV periodontitis through an interdisciplinary approach Abin Sam Abraham, Jimmy George, Deepak Thomas, Babu Cherian Journal of Interdisciplinary Dentistry 2020 10(3):122-125 Rehabilitation of periodontally compromised dentitions is always challenging in order to restore the masticatory function as well as to prevent future disease progression. This case report discusses an interdisciplinary approach for managing a case of Stage IV periodontitis in a female patient who presented with multiple mobile furcations involved posterior teeth. By a combined endo-perio-prosthetic effort, the retention and rehabilitation of majority of her teeth was achieved.

Rehabilitating a maxillectomy patient by interdisciplinary alveolar bone preservation technique using submergence of teeth roots C Femil Jilta, RS Sreeraj, R Ravichandran, K Harsha Kumar Journal of Interdisciplinary Dentistry 2020 10(3):126-131 Retention for edentulous maxillary obturator is always challenging. Although implants offer good retention in edentulous patients, lack of tissue beds, less predictable integration, economic constraints may preclude implantation. Therefore, the preservation of residual alveolar ridge is mandatory to enhance the retention, support, and stability of the removable obturator prosthesis. Retaining roots through “Root submergence technique” maintains the attachment apparatus and aids in decreasing the resorptive pattern, thereby preserving the residual ridge to some extent. Here, we report a case in which nonvital root submergence is carried out in a partial maxillectomy patient to prevent alveolar ridge resorption adhering to DeVan's dictum “Perpetual preservation” of what remains is more important than the meticulous replacement of what is missing.

Managing esthetics by immediately placed immediately loaded implants: A case report Amitabh Srivastava, Shivam Yadav, Anshdha Shah, Sajid Husain Journal of Interdisciplinary Dentistry 2020 10(3):132-136 \Immediate implants offer a suitable treatment modality as treatment time is reduced, and postextraction bone loss can be avoided. Temporization of implants in the anterior region is becoming much needed for esthetics as well as helps to avoid the second-stage surgical procedure. A 23-year-old female presented with mobility in lower anterior teeth and radiographic bone loss extending to the apical third. The patient was treated with postextraction immediate implants, and immediate nonfunctional prosthesis was given after evaluation of implant stability quotient by radiofrequency analysis using the Ostell® device. A 7-month follow-up presented successful temporization and osseointegration.

Management of a nonvital discolored tooth associated with radicular cyst: A multidisciplinary approach Richa Gupta, Nilav Bhagabati, Gaurav Jain, Jyoti Ahlawat Journal of Interdisciplinary Dentistry 2020 10(3):137-140 The radicular cyst arises from proliferated epithelial cell rests of malassez when they get stimulated by an inflammatory process originating from pulpal necrosis of a nonvital tooth. The associated tooth is usually asymptomatic and may result in swelling of the soft tissues and mobility of the teeth involved. The typical radiographic description of the lesion is a round or oval, well-circumscribed radiolucency involving the apex of the tooth. Radicular cysts can be managed either surgically or nonsurgically. The nonvital, discolored anterior tooth associated with the lesion is a common esthetic concern for patients. It can effect their self-confidence and employability. Discolored nonvital teeth are frequently compromised due to root canal treatment, previous trauma, or caries. Invasive treatment options like crowns or veneers further weaken the tooth structure. This case report presents the successful surgical management of a radicular cyst associated with a nonvital discolored anterior tooth. This will also include the technicalities involved in the inside/outside nonvital bleaching technique.

Salvaging a tooth with radisection: A case report with 3-year long-term follow-up Monisha P Khatri, Anupama Biradar, Shruti Paradkar, Sachin Shivanaikar Journal of Interdisciplinary Dentistry 2020 10(3):141-144 The successful management of endodontically involved teeth depends on adequate biomechanical preparation and obturation in adherence to a satisfactory coronal seal. However, challenges such as extensive carious involvement, periodontal attachment loss, and iatrogenic mishaps which include ledges, blocked canals, and instrument separation compromise the salvation of the teeth. Treatment options for such mishaps in multirooted teeth can range from endodontic treatment alone, combined endodontic-periodontic treatment, or extraction in cases with poor prognosis. One such treatment in case of file fracture or extensive periodontal involvement in maxillary molars could be root resection, also known as radisection. This procedure offers an economically viable treatment option for the patient to preserve the natural tooth. This article highlights a case report of root resection in maxillary molar with endodontic, periodontic, and prosthetic management with resultant successful oral rehabilitation along with a follow-up of 3 years.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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Neurosurgical Anesthesiology

Correlation Between Invasive and Noninvasive Technique of Intracranial Pressure Measurement in Children With Traumatic Brain Injury: An Observational Study Background: Direct measurement of intracranial pressure (ICP) is an invasive technique with potential complications, which has prompted the development of alternative, noninvasive, methods of ICP assessment. The aim of this study was to determine the relationship between noninvasive ultrasound-based measurement of optic nerve sheath diameter (ONSD), transcranial Doppler-derived pulsatility index (PI), and invasive ICP measurements in children with traumatic brain injury (TBI). Methods: Children aged 1 to 18 years undergoing invasive ICP monitoring following TBI were included in the study. Noninvasive ONSD and PI measurements were compared with simultaneous invasive ICP. Results: In all, 406 measurements of ONSD and PI were obtained in 18 patients. ONSD and PI correlated with ICP (r=0.76 and 0.79, respectively), combining ONSD and PI resulted in an even stronger correlation with ICP (r=0.99). Formulas were derived from mixed-effect models that best fitted the data for noninvasive ICP estimation. A combination of ONSD and PI had the highest ability to detect ICP >20 mm Hg (area under the receiver operating characteristic curve=0.99, 95% confidence interval: 0.99-1.00). Optimal cutoff values for the prediction of intracranial hypertension were 5.95 mm for ONSD (sensitivity, 92%; specificity, 76%) and 1.065 for PI (sensitivity, 92%; specificity, 87%). Conclusions: In children with TBI, a combination of ONSD and PI strongly correlates with invasive ICP and has potential to screen for intracranial hypertension noninvasively. ONSD and PI may be useful tools for assessing ICP where invasive monitoring is unavailable or contraindicated. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Gyaninder P. Singh, DM. E-mail: drsingh_gp@yahoo.co.in. Received August 2, 2020 Accepted November 20, 2020 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

Kratschmer Reflex During Transnasal Endoscopic Pituitary Surgery No abstract available

Genome-wide Association Study of Postoperative Cognitive Dysfunction in Older Surgical Patients Background: Postoperative cognitive dysfunction (POCD) is a common neurocognitive disorder after surgery and anesthesia, particularly in elderly patients. Various studies have suggested genetic risk factors for POCD. The study aimed to detect genome-wide associations of POCD in older patients. Methods: In this prospective observational cohort study, participants aged 65 years and above completed a set of neuropsychological tests before, at 1 week, and 3 months after major noncardiac surgery. Test variables were converted into standard scores (z-scores) based on demographic characteristics. POCD was diagnosed if the decline was >1 SD in ≥2 of the 15 variables in the assessment battery. A genome-wide association study (GWAS) was performed to determine potential alleles that are linked to the POCD phenotype. In addition, candidate genes for POCD were identified in a literature search for further analysis. Results: Sixty-three patients with blood samples were included in the study. POCD was diagnosed in 47.6% of patients at 1 week and in 34.2% of patients at 3 months after surgery. Insufficient sample quality led to exclusion of 26 patients. In the remaining 37 patients, a GWAS was performed, but no association (P<5×10−8) with POCD was found. The subsequent gene set enrichment analysis of 34 candidate genes did not reveal any significant associations. Conclusion: In this patient cohort, a GWAS did not reveal an association between specific genetic alleles and POCD at 1 week and 3 months after surgery. Future genetic analysis should focus on specific candidate genes for POCD. Preliminary data in this manuscript were presented at the Euroanaesthesia Congress, Vienna, Austria, June 1–3, 2019, as well as at the European Society of Human Genetics Conference, June 6–9, 2020. This research was supported by departmental sources and a grant no. 32003B-121956 from the Swiss National Science Foundation. L.A.S. has received speaker honoraria from Medtronic Schweiz (Münchenbuchsee, Switzerland), Covidien (Neuhausen am Rheinfall, Switzerland) MSD, (Luzern, Switzerland), Hamilton Medical (Bonaduz, Switzerland), Lilly (Vernier, Switzerland), and Orion Pharma (Zug, Switzerland). N.G. has received consultancy fees from PIPRA AG (Zug, Switzerland). None of these fees were related to this study. The remaining authors have no conflicts of interest to disclose. Address correspondence to: Nicolai Goettel, MD. E-mail: nicolai.goettel@usb.ch. Received September 21, 2020 Accepted October 27, 2020 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

Management of Endovascular Treatment for Acute Ischemic Stroke During the COVID-19 Pandemic at a Single Institution in Beijing, China: A Brief Report Background: The coronavirus disease (COVID-19) pandemic is currently a major challenge for health care systems around the world. For a time-sensitive emergency such as acute ischemic stroke (AIS), streamlined workflow times are essential to ensure good clinical outcomes. Methods: The aim of this single-center, retrospective, observational study was to describe changes in stroke workflow patterns and clinical care during the COVID-19 pandemic. Data from AIS patients undergoing emergent endovascular treatment (EVT) between 23 January and 8 April 2020 were retrospectively collected and compared with data from patients admitted during a similar period in 2019. The primary outcome was difference in time from symptom onset to recanalization. Secondary outcomes included workflow times, clinical management, discharge outcomes, and health-economic data. Results: In all, 21 AIS patients were admitted for emergent EVT during the 77-day study period, compared with 42 cases in 2019. Median time from symptom onset to recanalization was 132 minutes longer during the pandemic compared with the previous year (672 vs. 540 min, P=0.049). Patients admitted during the pandemic had a higher likelihood of endotracheal intubation (84.6% vs. 42.4%, P<0.05) and a higher incidence of delayed extubation after EVT (69.2% vs. 45.5%, P<0.05). National Institutes of Health Stroke Scale at hospital discharge was similar in the 2 cohorts, whereas neurointensive care unit stay was longer in patients admitted during the pandemic (10 vs. 7 days, P=0.013) and hospitalization costs were higher (123.9 vs. 95.2 thousand Chinese Yuan, P=0.052). Conclusion: Disruptions to medical services during the COVID-19 pandemic has particularly impacted AIS patients undergoing emergent EVT, resulting in increased workflow times. A structured and multidisciplinary protocol should be implemented to minimize treatment delays and maximize patient outcomes. This study was supported by the Beijing Municipal Science and Technology Commission (Z191100006619068) and Beijing Municipal Administration of Hospitals (DFL20180502). The study investigators did not receive compensation for participating in the study. No funding agencies had any role in the design or conduction of the study, study management, data collection, analysis, interpretation, decision to publish, or preparation of the manuscript. S.L. and M.Z. contributed equally to the manuscript as co-first authors. Y.P. and R.H. contributed equally to the manuscript. R.H. is a member of the Editorial Board of Journal of Neurosurgical Anesthesiology. The remaining authors have no conflicts of interest to disclose. Address correspondence to: Yuming Peng, MD, PhD, E-mail: florapym766@163.com. Received June 20, 2020 Accepted October 25, 2020 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

Early Lymphopenia and Infections in Nontraumatic Subarachnoid Hemorrhage Patients Introduction: Subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality. A certain degree of immunodepression has been reported during critical illness, and lymphopenia identified as an independent predictor of poor outcome; no data are available for critically ill SAH patients. We aimed to evaluate the prevalence of lymphopenia among SAH patients and its association with hospital-acquired infection. Methods: Retrospective cohort study of adult patients admitted to an intensive care unit with nontraumatic SAH between January 2011 and May 2016. Lymphocyte count was obtained daily for the first 5 days; lymphopenia was defined as lymphocyte count <1000/mm3. The occurrence of infection during the first 21 days after hospital admission, hospital mortality, and unfavorable neurological outcome (Glasgow Outcome Scale score 1 to 3 at 3 mo) were recorded. Results: Data from 270 patients were analyzed (median age 54 y; male 45%); 121 (45%) patients had lymphopenia and 62 (23%) patients developed infections. Median (25th to 75th percentiles) lymphocyte count at hospital admission was 1280 (890 to 1977)/mm3. Lymphopenia patients had more episodes of infection (38/121, 31% vs. 24/139, 17%; P=0.003) than nonlymphopenia patients, while mortality and unfavorable outcome were similar. Lymphopenia was not independently associated with the development of infection, unfavorable neurological outcome or with mortality. Conclusions: Early lymphopenia is common after SAH, but is not significantly associated with the development of infections or with poor outcome. This study was present as an e-poster at LIVES congress—ESICM, September 28th to October 2nd, Berlin, Germany. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Elisa Gouvêa Bogossian, MD, MSc. E-mail: elisagobog@gmail.com. Received August 5, 2020 Accepted October 6, 2020 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

Utility and Predictive Value of CHIIDA Score in Pediatric Traumatic Brain Injury: A Prospective Observational Study Background: The Children's Intracranial Injury Decision Aid (CHIIDA) is a tool designed to stratify children with mild traumatic brain injury (mTBI). The aim of this study was to assess the utility and predictive value of CHIIDA in the assessment of the need for intensive care unit (ICU) admission in pediatric patients with mTBI. Methods: This prospective observational study included 425 children below 18 years of age admitted to the ICU of a tertiary care hospital with mTBI (Glasgow Coma Scale 13 to 15). The primary outcome was the composite of neurosurgical intervention, intubation for more than 24 hours for TBI, or death from TBI. Sensitivity, specificity, predictive values and likelihood ratios were calculated at CHIIDA scores 0 and 2. Results: Among 425 children with mTBI, 210 (49%) had a CHIIDA score 0, 16 (4%) scored 2 points, and 199 (47%) scored more than 2 points. Thirty-six (8.47%) patients experienced the primary outcome, and there were 3 deaths. A cutoff CHIIDA >0 to admit to ICU had a sensitivity of 97.22% (95% confidence interval [CI], 97.05%-97.39%) and a negative predictive value of 99.54% (95% CI, 99.50%-99.56%). A cutoff of score >2 had a sensitivity of 97.22% (95% CI, 97.05%-97.39%), and negative predictive value of 99.56% (95% CI, 99.54%-99.59%). The post-test probability at cutoff score of 0 and 2 was 16.65% and 16.27%, respectively. Conclusions: CHIIDA score does not serve as reliable triage tool for identifying children with TBI who do not require ICU admission. The pilot data of this study has been presented at the 19th annual conference of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) 2018 and published as an abstract in the conference proceedings in the Journal of Neuroanaesthesiology and Critical Care 2018. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Ruchi A. Jain, MD, DNB, PDFC. E-mail: ruchiajain@gmail.com. Received July 5, 2020 Accepted September 29, 2020 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

Hemoglobin Concentration May Influence the Incidence of Postoperative Transient Neurological Events in Patients With Moyamoya After Extracranial-intracranial Arterial Bypass: A Retrospective Single Center Experience Background: Moyamoya is a rare condition characterized by cerebral angiographic findings of intracranial carotid artery stenosis with abnormal net-like vessels in the brain, and often presents as transient ischemic attacks or intracranial hemorrhage. Revascularization in the form of extracranial-intracranial (EC-IC) artery bypass has demonstrated efficacy in preventing ischemic attacks and intracranial hemorrhage, although it is associated with a relatively high rate of perioperative ischemic and hemorrhagic stroke. This retrospective analysis aims to evaluate the possible association between postoperative hemoglobin (Hgb) concentration and early postoperative transient neurological events (TNEs) experienced at our center. Methods: Consecutive patients undergoing EC-IC bypass between January 1, 2017 and August 31, 2019 were identified, resulting in a study population of 24 patients with 34 individual cases for different cerebral hemispheres. Postoperative Hgb level was evaluated upon arrival to the intensive care unit (ICU) and the primary outcome was the occurrence of TNEs within 24-hours after surgery. Results: The incidence of TNEs within 24 hours postoperatively was 12% (n=4). Statistically significant differences were demonstrated between patients who did and did not experience TNEs in the postoperative period: total Hgb value (mean 9.4 vs. 11.3 g/dL, respectively; P=0.012) and percentage of patients with Hgb <10 g/dL (75% vs. 20%, respectively; P=0.048). Patients with a postoperative Hgb value <10 g/dL upon arrival to the ICU were significantly more likely to experience TNEs (odds ratio, 12; 95% confidence interval, 1.053-136.794; P=0.045). Conclusions: This study reports a possible association between postoperative Hgb level and the occurrence of TNEs within the first 24 hours after surgery in patients undergoing EC-IC for moyamoya. Present address: Nicholas V. Mendez, MD, Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA. Catherine Chen, MD, Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH. Angela M. Richardson, MD, PhD, Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI. Previous presentations: (1) Online abstract for the Annual Meeting of the Florida Society of Anesthesiologists; 2020 June; Palm Beach, FL. (2) Online abstract for the Annual Meeting of the International Anesthesia Research Society; 2020 May; San Francisco, CA. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Nicholas V. Mendez, MD. E-mail: nckmendez@gmail.com. Received June 22, 2020 Accepted September 28, 2020 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

Transcranial Ultrasound as a Useful Tool in Early Detection and Follow-up of Hydrocephalus in Acute Subarachnoid Hemorrhage No abstract available

Stellate Ganglion Block Effects on Cerebral Vascular Tone: A Missing Piece of the Puzzle No abstract available

Facemask as Eye Cover: Think Beyond Mask Ventilation No abstract available

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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Fwd: Panafrican Medical Journal - Recently Published

Panafrican Medical Journal 

Authors are invited to submit original articles for consideration  The special issue will run for a period of one year and articles will be published continuously. The PAMJ will expedite the publication and PubMed Central indexation of accepted articles. Article Processing Charges will be waived for accepted submissions. Submit Now!                               Recently Published in PAMJ, 14-21 December 2020 RESEARCH Prevalence and associated factors of alcohol use patterns among university students in Uganda Louis Henry Kamulegeya et al. The harmful use of alcohol is a serious global health burden causing both acute and chronic health problems and adverse social consequences are common when they are associated with alcohol consumption. Every year, the harmful use of alcohol kills 2.5 million people, including 320,000 young people between 15 and 29 years of age. It is the third leading risk factor for poor health globally and harmful use of alcohol was responsible for almost 4% of all deaths in the world, according to the estimates for 2018. READ MORE   Compared efficacy and tolerance of the neuromuscular blockade induced by brand-name (Nimbex®) and generic (Cisatrex®) of cisatracurium in mechanically ventilated critically ill patients: a crossover double-blind randomized study Nesrine Fraj et al. Generic drugs are made to be chemically and therapeutically equivalent to the brand name ones. These equivalencies are obtained at lower costs making generic drugs use certainly appealing. Therefore, many payers/providers have encouraged substitution of brand name drugs with inexpensive bioequivalent generic versions. In the last 30 years, several controversies concerning generic drugs legislation have arisen. Recent literature reviews demonstrated that physicians, pharmacists and general population hold negative perceptions and knowledge of generic medicines. Neuromuscular Blocking Agents (NMBAs) are usually used in patients with altered respiratory mechanics properties such as Acute Respiratory Distress Syndrome (ARDS), status asthmaticus or severe acute exacerbation of COPD (AECOPD).  READ MORE  CASE REPORTS Concomitant in-situ and in transit right heart thrombi: a case report Najlaa Belharty et al. In absence of atrial fibrillation, right heart thrombi (RHT) mostly represent an embolus in transit originating from a deep venous thrombosis which has the propensity of distal embolization. They are uncommon but are associated with higher mortality (80-100%). Right atrial clots may also form in-situ and are mostly small and immobile. There is little if any consensus for the optimal management of RHT, thus being challenging, most importantly, when treating a combination of in transit and in-situ RHT. READ MORE 1p36 deletion syndrome: first case report in Morocco detected by fluorescence in situ hybridization (FISH): a case report Kenza Dafir et al.  1p36 deletion syndrome (OMIM: 607872) is a chromosomal abnormality characterized by intrauterine growth retardation, a characteristic facial dysmorphism made up of straight eyebrows, sunken eyes, wide and flat nasal bridge, upper floor middle of the hypoplastic face, a long philtrum, a pointed chin and a frequent delay in closing the anterior fontanel (>3cm at birth), microbrachycephaly, upturned ears of low implantation and malformed, brachydactyly, camptodactyly, short feet, hypotonia, developmental delay, intellectual deficit, seizures, heart defects and hearing and vision impairment. It is considered to be the most common terminal deletion in humans. It is estimated that the syndrome occurs in one in every 5,000 to 10,000 births without differentiation of sex or ethnicity READ MORE Do you want to submit fot the special issue on COVID-19?  Submit your manuscript through the PAMJ Manuscript Hut (https://www.manuscript-hut.panafrican-med-journal.com) Select Supplement - PAMJ COVID 19 Series as manuscript type and follow the instructions to upload your submission The submissions should comply to the PAMJ Instructions for Authors (http://www.panafrican-med-journal.com/instruction.php) We look forward to receiving your submission. Submit Manuscript Copyright © -2018- PAMJ-CEPHRI/ThePAMJ.org. Kenya: 3rd Floor, Park Suite Building, Parkland Road, Nairobi. PoBox 38583-00100, tel: +254 (0)20-520-4356 | Cameroon: Immeuble TechnoPark Essos, Yaounde, PoBox: 10020 Yaounde, tel: +237 (0)24-309-5880     Address queries to  editor@panafrican-med-journal.com. Add pamj.alert@panafrican-med-journal.com to your safe senders list in your e-mail address book. Doing so ensures that our e-mails reach your Inbox. Thank you. Terms and conditions | Privacy statement | Contact technical board

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Anesthesiology

Roadmap: one anesthesiology department's strategic approach to COVID-19 Purpose of review The COVID-19 pandemic has driven transformation in every aspect of the healthcare delivery system. The unpredictable onset and magnitude of COVID-19 infections resulted in wide gaps in preparedness for healthcare systems. The development of protocols to address both scarcity of resources and staff protection continues to be essential for risk mitigation. Recent findings The northeast region of the United States had a rapid early surge of COVID-19 infections leading to the exhaustion of critical care capacity. In addition, northeastern hospitals experienced decrease in elective surgical interventions, including organ transplantation. Limited availability of COVID-19 testing and personal protective equipment further fueled the pandemic. This commentary highlights a comprehensive innovative approach to addressing the operating room and hospital demands, as well as the shortages in resources and staffing during the pandemic. Summary The VCU Department of Anesthesiology operated at 40% of its regular operating room volume throughout the COVID-19 pandemic because of the increased demand from emergency cases. The delay in the peak surge allowed Virginia Commonwealth University, Department of Anesthesiology to develop a comprehensive infrastructure resulting in resulting is maximal workforce risk mitigation. Correspondence to Alice A. Tolbert Coombs, MD, MPA, FCCP, Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA. Tel: +1 804 512 6538; e-mail: Alice.coombs@vcuhealth.org Copyright © 2020 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

Telephone consultation 11855 int 1193,

Surgical site infections after distal radius fracture surgery:

xlomafota.13 shared this article with you from Inoreader Surgical site infections after distal radius fracture surgery: a nation-wide cohort study of 31,807 adult patients Via Latest Results for BMC Musculoskeletal Disorders Abstract Background Surgical site infections (SSI) after distal radius fracture (DRF) surgery have not previously been studied as the primary outcome in a large population with comparative data for different surgical methods. The aims of this study were 1) to compare SSI rates between plate fixation, percutaneous pinning and external fixation, and 2) to study factors associated with SSI. Methods We performed a nation-wide cohort study linking data from the Swedish national patient register (NPR) with the Swedish prescribed drug register (SPDR). We included all patients ≥18 years with a registration of a surgically treated DRF in the NPR between 2006 and 2013. The primary outcome was a registration in the SPDR of a dispensed prescription of peroral Flucloxacillin and/or Clindamycin within the first 8 weeks following surgery, which was used as a proxy for an SSI. The SSI rates for the three main surgical methods were calculated. Logistic regression was used to study the association between surgical method and the primary outcome, adjusted for potential confounders including age, sex, fracture type (closed/open), and a dispensed prescription of Flucloxacillin and/or Clindamycin 0–8 weeks prior to DRF surgery. A classification tree analysis was performed to study which factors were associated with SSI. Results A total of 31,807 patients with a surgically treated DRF were included. The proportion of patients with an SSI was 5% (n = 1110/21,348) among patients treated with plate fixation, 12% (n = 754/6198) among patients treated with percutaneous pinning, and 28% (n = 1180/4261) among patients treated with external fixation. After adjustment for potential confounders, the surgical method most strongly associated with SSI was external fixation (aOR 6.9 (95% CI 6.2–7.5, p < 0.001)), followed by percutaneous pinning (aOR 2.7 (95% CI 2.4–3.0, p < 0.001)) (reference: plate fixation). The classification tree analysis showed that surgical method, fracture type (closed/open), age and sex were factors associated with SSI. Conclusions The SSI rate was highest after external fixation and lowest after plate fixation. The results may be useful for estimation of SSI burdens after DRF surgery on a population basis. For the physician, they may be useful for  estimating the likelihood of SSI in individual patients. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The faster the better? Time to first CT scan after admission in moderate-to-severe traumatic brain injury and its association with mortality

xlomafota.13 shared this article with you from Inoreader The faster the better? Time to first CT scan after admission in moderate-to-severe traumatic brain injury and its association with mortality Via Latest Results for Neurosurgical Review Abstract Fast acquisition of a first computed tomography (CT) scan after traumatic brain injury (TBI) is recommended. This study is aimed at investigating whether the length of the period preceding initial CT scan influences mortality in patients with leading TBI. A retrospective cohort analysis of patients registered in the TraumaRegister DGU® was conducted including adult patients with TBI, defined as Abbreviated Injury ScaleHead ≥ 3 and GCS ≤ 13 who had been treated in level 1 or 2 trauma centers from 2007–2016. Patients were grouped according to time intervals either from trauma or from admission to CT. A total of 6904 patients met the inclusion criteria. Mean time period from trauma to hospital admission was 68.8 min. From admission to first CT, a mean of 19.0 min elapsed. Trauma severity was higher in groups with a longer duration from trauma to CT as represented by a mean (± standard deviation) Injury Severity Score (ISS) of 19.8 ± 9.0, 20.7 ± 9.3, and 21.4 ± 7.5 and similar distribution of mortality of 24.9%, 29.9%, and 36.3% in the ≤ 60-min, 61–120-min, and ≥ 121-min groups, respectively. An adjusted multivariable logistic regression model showed a significant influence of the level of the trauma center (p = 0.037) but not for interval from admission to CT (p = 0.528). TBI patients with a longer time span from trauma to first CT were more severely injured and demonstrated a worse prognosis, but received a CT scan faster when duration from admission is observed. The duration until the CT scan was obtained showed no significant impact on the mortality. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.