This study analyzed 252 knee replacement surgeries performed between 2008-2013 to determine surgical site infection rates. 10 patients (4%) developed superficial infections treated with antibiotics or debridement. 4 patients (1.6%) developed deep infections, with 1 acute infection treated with debridement and antibiotics. 3 patients developed delayed deep infections between 4 weeks to 2 years post-op, with 2 requiring revision surgery. Increased body mass index was the only risk factor significantly associated with higher superficial infection rates. Overall infection rates were comparable to literature reports for primary knee replacements.
Analytical Study of Clinicopathological Data of Saudi Patients with Osteoarth...Prof. Hesham N. Mustafa
SUMMARY: Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk
factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological,
and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study
population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department
of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patient’s clinical and radiological data were collected
from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done.
Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women
than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded
obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral
condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions
were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making
relevant to TKA in knee OA in Saudi Arabia and elsewhere.
KEY WORDS: Osteoarthritis; Knee; Arthroplasty.
Fungal Periprosthetic Joint Infection By Candida Glabrata – Two Stage Revisio...Queen Mary Hospital
Fungal Periprosthetic Joint Infection By Candida Glabrata – Two Stage Revision Is A Good Option.
Dr. Suryanarayan Pitchai, Dr. Kalaivanan Kanniyan , Dr. P. Ashok Kumar, Dr. Y. Subramanyam
Asian Joint Reconstruction Institute (AJRI), SIMS Hospitals, Chennai 600026, Tamil Nadu, India.
— Wound infection is the second commonest complication of wound healing. This study was carried out on 250 post-operative cases operated at a district hospital of western Rajasthan, India with the aim the aim to find out prevalence of post-operative surgical site infection and its causing organism. After taking personal information and detailed clinical, operative and post-operative history of these cases, swab from post-operative wound was taken and sent for culture and sensitivity test in Microbiology. Association was inferred with Chi-square test. Post operative surgical site infection rate was found 11.6 % which was found significantly more in intestinal surgeries than the other. Most common causative organism for infection was Staphylococci cases followed by Streptococci, E. Coli and Klebsella. Out of total 11.6% infected cases, majority (8.8%) of patients had infection with more than one organism only 2.8% were having single organism. Keywords— Post-operative surgical Site Infection (SSI), Microorganism , SSI Infection Rate.
Surgical Site Infections: Predisposing factors and Preventioniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Analytical Study of Clinicopathological Data of Saudi Patients with Osteoarth...Prof. Hesham N. Mustafa
SUMMARY: Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk
factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological,
and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study
population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department
of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patient’s clinical and radiological data were collected
from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done.
Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women
than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded
obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral
condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions
were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making
relevant to TKA in knee OA in Saudi Arabia and elsewhere.
KEY WORDS: Osteoarthritis; Knee; Arthroplasty.
Fungal Periprosthetic Joint Infection By Candida Glabrata – Two Stage Revisio...Queen Mary Hospital
Fungal Periprosthetic Joint Infection By Candida Glabrata – Two Stage Revision Is A Good Option.
Dr. Suryanarayan Pitchai, Dr. Kalaivanan Kanniyan , Dr. P. Ashok Kumar, Dr. Y. Subramanyam
Asian Joint Reconstruction Institute (AJRI), SIMS Hospitals, Chennai 600026, Tamil Nadu, India.
— Wound infection is the second commonest complication of wound healing. This study was carried out on 250 post-operative cases operated at a district hospital of western Rajasthan, India with the aim the aim to find out prevalence of post-operative surgical site infection and its causing organism. After taking personal information and detailed clinical, operative and post-operative history of these cases, swab from post-operative wound was taken and sent for culture and sensitivity test in Microbiology. Association was inferred with Chi-square test. Post operative surgical site infection rate was found 11.6 % which was found significantly more in intestinal surgeries than the other. Most common causative organism for infection was Staphylococci cases followed by Streptococci, E. Coli and Klebsella. Out of total 11.6% infected cases, majority (8.8%) of patients had infection with more than one organism only 2.8% were having single organism. Keywords— Post-operative surgical Site Infection (SSI), Microorganism , SSI Infection Rate.
Surgical Site Infections: Predisposing factors and Preventioniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
DOI:10.21276/ijlssr.2016.2.4.1
ABSTRACT- Introduction: Surgical Site Infections (SSI) still remains a significant problem following an operation
and the third most frequently reported nosocomial infections. SSI contributes significantly to increased health care costs in
terms of prolonged hospital stay and lost work days.
Objective: The current study was undertaken to identify incidence of SSI and the risk factors associated with it, and the
common organism isolated and its antibiotic sensitivity and resistance.
Material and Methods: A total number of 3211 patients admitted in general surgical wards for elective surgery in the
study period, out of which 1225 were clean and clean contaminated cases, fulfilling our study criteria. Totally 56 cases
had surgical site infections which had been taken up for this study. Wound discharges were sent for culture and sensitivity.
Results and Conclusions: The overall infection rate was 4.57%. The SSI rate was almost equal in clean surgeries and
clean contaminated ones. Superficial surgical site infections in the most commonest type and accounted for about 66.07%
of all the SSI’s and deep surgical site infection accounted for about 25% with 8.92% was organ space. The most
commonly isolated organism from surgical site infections was staphylococcus aureus followed by pseudomonas and then
E. coli. Drains, prosthesis usage and other risk factors of SSI have been identified. Most of the organisms which were
isolated were multidrug resistant. The high rate of resistance to many antibiotics underscored the need for a policy that
could promote a more rational use of antibiotics. Key-words- Surgical site infections, National Nosocomial Infections Surveillance (NNIS) risk index, Antibiotic
A 10 year old boy presented with fever, local swelling around the ankle with tenderness and antalgic gait, without any antecedent trauma or discharging sinus. He had no evidence of pulmonary tuberculosis. Laboratory tests revealed signs of inflammation with normal Mantoux test and chest X-ray. An irregular lytic lesion of the talus was seen on the x-ray of the affected part. Ziehl Nelson staining of the aspirated fluid revealed acid-fast bacilli. Material obtained after curettage and bone grafting confirmed the diagnosis of tuberculosis. He was treated conservatively with splintage and 4 drug anti-tubercular chemotherapy for 18 months, without any residual tenderness or foot deformity at the final follow-up. This case has been reported because of its rarity and atypical clinical presentation.
Effect of Surgery Difficulty According to Impaction Level on the Incidence of...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Association of Hypertension and Pulmonary Functions-Association between cardiac dysfunction and abnormal pulmonary function has remained controversial since long. The objective of this study is to find out the association of hypertension and its severity on pulmonary functions. Study was conducted on 30 hypertensive (study group) and 30 non hypertensive (control group) subjects identified from Medical OPD of SMS Hospital, Jaipur. Pulmonary functions were assessed of both hypertensive (study group) and non hypertensive (control group) subjects by Medspiror). Among pulmonary function tests, difference in means of FVC, FEV1 PEFR, FEF25-75%, MVV and FVC/ FEV1 were found less with significant difference in cases group with predominantly restrictive type of effects are observed. Female’s shows lower values than male hypertensive subjects. Furthermore, FVC, FEV1, PEFR, FEF25-75%, MVV, FVC/ FEV1 were not found to be associated with severity of illness. An inverse relation is found between hypertension and pulmonary functions predominantly restrictive type of pattern. While non significant effects are observed with severity of illness.
DOI:10.21276/ijlssr.2016.2.4.1
ABSTRACT- Introduction: Surgical Site Infections (SSI) still remains a significant problem following an operation
and the third most frequently reported nosocomial infections. SSI contributes significantly to increased health care costs in
terms of prolonged hospital stay and lost work days.
Objective: The current study was undertaken to identify incidence of SSI and the risk factors associated with it, and the
common organism isolated and its antibiotic sensitivity and resistance.
Material and Methods: A total number of 3211 patients admitted in general surgical wards for elective surgery in the
study period, out of which 1225 were clean and clean contaminated cases, fulfilling our study criteria. Totally 56 cases
had surgical site infections which had been taken up for this study. Wound discharges were sent for culture and sensitivity.
Results and Conclusions: The overall infection rate was 4.57%. The SSI rate was almost equal in clean surgeries and
clean contaminated ones. Superficial surgical site infections in the most commonest type and accounted for about 66.07%
of all the SSI’s and deep surgical site infection accounted for about 25% with 8.92% was organ space. The most
commonly isolated organism from surgical site infections was staphylococcus aureus followed by pseudomonas and then
E. coli. Drains, prosthesis usage and other risk factors of SSI have been identified. Most of the organisms which were
isolated were multidrug resistant. The high rate of resistance to many antibiotics underscored the need for a policy that
could promote a more rational use of antibiotics. Key-words- Surgical site infections, National Nosocomial Infections Surveillance (NNIS) risk index, Antibiotic
A 10 year old boy presented with fever, local swelling around the ankle with tenderness and antalgic gait, without any antecedent trauma or discharging sinus. He had no evidence of pulmonary tuberculosis. Laboratory tests revealed signs of inflammation with normal Mantoux test and chest X-ray. An irregular lytic lesion of the talus was seen on the x-ray of the affected part. Ziehl Nelson staining of the aspirated fluid revealed acid-fast bacilli. Material obtained after curettage and bone grafting confirmed the diagnosis of tuberculosis. He was treated conservatively with splintage and 4 drug anti-tubercular chemotherapy for 18 months, without any residual tenderness or foot deformity at the final follow-up. This case has been reported because of its rarity and atypical clinical presentation.
Effect of Surgery Difficulty According to Impaction Level on the Incidence of...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Association of Hypertension and Pulmonary Functions-Association between cardiac dysfunction and abnormal pulmonary function has remained controversial since long. The objective of this study is to find out the association of hypertension and its severity on pulmonary functions. Study was conducted on 30 hypertensive (study group) and 30 non hypertensive (control group) subjects identified from Medical OPD of SMS Hospital, Jaipur. Pulmonary functions were assessed of both hypertensive (study group) and non hypertensive (control group) subjects by Medspiror). Among pulmonary function tests, difference in means of FVC, FEV1 PEFR, FEF25-75%, MVV and FVC/ FEV1 were found less with significant difference in cases group with predominantly restrictive type of effects are observed. Female’s shows lower values than male hypertensive subjects. Furthermore, FVC, FEV1, PEFR, FEF25-75%, MVV, FVC/ FEV1 were not found to be associated with severity of illness. An inverse relation is found between hypertension and pulmonary functions predominantly restrictive type of pattern. While non significant effects are observed with severity of illness.
Abstract— If job satisfaction is there in employees, work done by these employees is usually of better quality in comparison where the employees are not satisfied with their jobe. So this study to assess job satisfaction and influence of demographic variables on job satisfaction, this study was carried out on 105 doctors of teaching hospitals. Questionnaire method of data collection was adopted. Job satisfaction was measured by six domains: Organizational functioning, Interpersonal relationship, Financial incentives, Non-financial incentives, Physical facilities and Working conditions. Study observed that over all, doctors were moderately satisfied with their job. Domains such as Interpersonal relationship and Working conditions, doctors were highly satisfied, whereas rest of the domains: Organizational functioning, Financial incentives, Non-financial incentives, and Physical facilities doctors were moderately satisfied. It is important to note that even though overall satisfaction is moderate, there were few components, where doctors were highly satisfied were - Communication system between patients and doctors, Involvement in decision making in the department, Rules and regulations of the institution, relationship between the department colleagues and other department colleagues, Provision for leave encashment, reward given for research work, workload of clinical aspect and workload of teaching aspect. Age and sex both shown significant association on level of satisfaction where as experience, designation and marital status of the doctors have not shown significant association.
— NUHM was launched in 1 May 2013 to improve the health status of the urban population particularly slum dwellers and other vulnerable urban section by facilitating their access to quality health care. And ASHAs are a 'bridge' or an interface between the community and health service outlets. NHM set some standard for working of ASHAs. So this study was conducted to assess the status of performance indicator for ASHA in area of Jaipur city. This cross-sectional study was conducted on 172 ASHAs working in Jaipur city. It was observed in this study that more than 80% was achieved in percentage of families counselled, ANC adequately covered, Institutional deliveries and completely immunized for age in 12-23 months age children among ASHA performance indicators. Newborn visit within 1 week of delivery, JSY claims made and newborn who were weighed by ASHAs were achieved of 70-80%. And less than 50% achievement was regarding percentage of children with diarrhoea received ORS and fever cases who received Chloroquine within first week. It can be concluded from this study that best ASHA performance indicator achieved was of percentage of institutional deliveries which is 82.53%, followed by regarding ANC adequately covered with at least 4 visits, Immunization of 12-23 months age, families counselled, newborn visit within 1 week of delivery, JSY claim made, newborn who were weighed, deliveries escorted, children with diarrhoea received ORS and fever cases who received Chloroquine within first week
Abstract— Alcohol is a psychoactive substance that their consumption can cause some damage to the body, mainly in the central nervous system, also it is possible observed changes in the social behavior of the individual when ingested in large amounts.
In addition, a placebo effect is based on the total of similar beneficial effects to health regarding physiological - psychological active substance. With regard to this issue, have been conducted to observe the behavior of volunteers where it is used a psychoactive substance such as coffe, marijuana or drugs in some volunteer groups compared to a group that ingested a placebo (inert substance).
In this study, it was observed the behavior of two groups of young volunteers aged college to which were given drinks alcoholics beverages and drinks with placebo (group A and B, respectively), where alcoholics beverages and placebo were smell similar and taste.
Previously it determined that these volunteers had no alcohol dependence. Also before giving the drinks, their levels of anxiety and depression were assessed by means of psychological testing; volunteers also underwent neurocognitive testing, neuromotor before and it then give them drinks with alcohol or placebo.
We observed in this study that the placebo effect was can be as strong as if it had ingested the psychoactive substance, In like manner, we perceived that mood at the studie moment have a significantly influence, because the psychoactive substance effect or stimulating feeling are improved even when they to believe has been drinking alcohol
Abstract— Spiritual or compassionate care involves serving the whole person i.e. physical, emotional, social, spiritual etc dimensions of health. Spirituality has now been identified globally as an important aspect for providing answers to many questions related to health and happiness. The World Health Organization is also looking beyond physical, mental and social dimensions of the health i.e. the spiritual health and its impact on the overall health and happiness of an individual. Spiritual commitment tends to enhance recovery from illness and surgery also. Spiritually is transpired both in order to comfort the dying and to broaden one's own understanding of life at its ending. Spiritual beliefs can help patients cope with disease and face death. So it should be necessarily be add-on in critical stage of disease. Nowadays in some of medical schools in developed countries has included as a curreculam of patient care. Now it is the time that all Medical Colleges should include educating their students about spiritual health care in comprehensive patient care. Medical Council of India should also take some action in this direction.
Lyshaan Hall Presents: The Quotable Jay-ZLyshaan Hall
Jay-Z, born Shawn Carter, is one of the most driving forces in modern pop culture. Jay-Z has transcended hip hop in many ways, but his skills as an MC are what made him. Lyshaan Hall shares some of his favorite lyrics from his fellow Brooklyn native.
Abstract—Theories of sociology of health and illness defy the biomedical model of disease as many of them are ‘concerned with the social origins and influence on disease’ rather than pathological reasons only. There are five sociological perspectives of health and illness: Social Constructionism, Marxism, Feminism, Foucaulian analysis, and Functionalism. These different sociological perspectives were critically analyzed through this article as for better understanding of conceptualize management of health services Social Constructionism is a sociological perspective focus on the sociology of knowledge and reality. Marxism focuses on equity between social classes and emphasizes inequality in capitalist society. According to Marxism inequality of distribution healthcare services in capitalist society arise from the marginalization of some categories of the population who do not contribute to economic system. Feminist theory is to understand and explore the multiple and various reasons for inequalities between the genders. In the healthcare sector, feminists believe that healthcare organizations are hierarchical systems, where doctors (usually men) are at the top level while nurses (usually women) have a lower level of importance. Main areas that Foucault theory emphasizes are power, knowledge and discourse. Foucault believes that there is a relationship between power and knowledge. This relationship appears clearly in the health field, as medical professionals comprise a group of people who have special knowledge (medical knowledge) and they gain the power from this knowledge. Finally, functionalism is a sociological perspective that describes society as a system made up of ‘interconnected and interrelated parts’ and it highlights the relationships between different parts of society In conclusion, the five sociological perspectives provide holistic picture about conceptualization of healthcare systems.
Association of Dental Diseases with Oral Hygiene in School Children of Rural Rajasthan, India-Oral diseases are health problem of industrialize well as developing countries because of its high prevalence. In developing countries these diseases are given less impotance because of scarcity of resources but when these dental diseases remain untreated it can cause permanent toothache and disability. It can increase school attendance and intern lead to complication and expensive treatment. A community based study was conducted in rural area of Jaipur district to find out the association of dental diseases with oral hygiene. From schools of Amer tahsil of Jaipur district 1600 students were examined for dental diseases and interrogated for oral hygiene. Association of oral hygiene with dental diseases like Dental Carries, Dental Fluorosis, Malocclusion and Periodontitis was found out with chi-square test. It was revealed that Dental diseases like Dental Carries, Dental Fluorosis, Malocclusion and peridontitis all are associated with oral hygiene. Mouth rinsing frequency and teeth cleaning frequency is inversely proportion in Dental Carries but is directly proportional in Dental Fluorosis, Malocclusion and Periodontitis
Tuberculosis affected mankind for over 5000 yrs and continue to be a major public health problem. So to generate hypothesis about tuberculosis this study was conducted to study the profile of tuberculosis cases attending at DTC Jaipur. A record based cross-sectional study of tuberculosis patients attended at District Tuberculosis Centre, Jaipur were taken. Chi-square test was used to find out association. It was found in this study that Cure Rate significantly varied with type of case, age and sex of case. It was observed highest in cat.III and below 20 yrs of age. Defaulters were max. in Relapse retreated cases and in elderly (>60 yrs.) cases whereas it was not affected significantly with age . Failure Rate was highest in category I cases and significantly varied with age and sex. About 3/4th of total deaths were observed in Failure and Relapse retreated cases. Case Fatality Rate (CFR) showed not significant variation with sex. So it can be concluded with this study that maximally affected age group with tuberculosis is either children or 40-60 years with male predominance. Category III cases are more easier to cured and Category II cases are most difficult to cured. Cure rate was lesser in 40-60 years of age group and males. Defaulters and CFR were more in category II, 40-60 year of age group and males. And Failure Rate was more in category I, 40-60 year of age group and males
Abstract—Sexual health (SH) and sexual behavior of young people have become a growing public concern. But few studies have been conducted to investigate the prevalence and psychosocial correlates of this phenomenon.
Purpose: To understand college students’ sexual knowledge (SK), sexual attitudes (SA), sexual desire (SD) and sexual behavior (SB).
Methods: A self-reported questionnaire survey on SK, SA, SD, and SB was conducted among 520 university students. Their demographic data, SK, SA, SD, and SB were assessed.
Results: A total of 500 students completed the questionnaire. The SKS total score had a mean of 23.05; 105 (21.0%) subjects had had premarital sex; 121 (24.2%) had a partner; 117 (23.4%) had a medical educational background. The results demonstrated an increased risk of premarital sex amongst males and subjects with the risk factors of smoking, drinking, having a partner, and having higher levels of SD and SK and more open SA.
Conclusions: This study provides support for the idea that university students lack SK (especially regarding contraception knowledge), even though the students had a medical educational background. Additionally, a considerable amount of them engaged in premarital SB. Our findings also suggest that university students need sex education, particularly in combining sexuality with their life, in relating to others maturely as a sexual individual, in employing contraception, and in preventing sexually transmitted diseases (STDs). Our study suggests that interventions aimed at expanding university students’ SK and other related skills are required.
Pregnancy Outcome Comparison in Elderly and Non Elderly Primigravida attending at Mahila Chikitsalay, Jaipur (Rajasthan) India-Pregnancy and child birth are normal physiological processes and outcomes of most of the pregnancies are good but sometimes because of some reasons it has bad outcomes; out of that one is supposed to be elderly primi. But nowadays it becomes essential to delay the pregnancy in changing social and economic trend. Simultaneously higher advanced technique and better supported maternal and neonatal care also exist. So to have an idea of balance between these this case-control study was done on 120 elderly and 120 non-elderly primigravida to compare the pregnancy outcomes. To find out the association Chi-Square and Unpaired‘t’ test was used. It was observed in this study that although there was no significant difference in antenatal maternal pregnancy outcomes but PPH, induction of labor, cervix dystocia were significantly more in elderly. Likewise time taken to start with breast feeding was also more in elderly. In case of newborn mean APGAR score and mean birth weight was significantly lesser in elderly than non-elderly.
A proposal for classifying peristomal skin disorders: results of a multicente...Mario Antonini
The challenges of caring for abdominal ostomy disorders have grown over the years. Because the literature shows no evidence of a tool to classify peristomal skin disorders, a study group comprised of seven enterostomal therapy nurses and four surgeons sought to provide an objective, reproducible, standardized classification instrument. A prospective, observational study was conducted
among eight ostomy centers across Italy. The 339 patient participants (272 men, 67 women, average age 63 [25 to 85] years) were divided into two groups according to onset of complications (less than or greater than 1 year); 800 digital photographs were taken to enhance observation and blood samples were drawn for additional data. From the data obtained, a classification scheme was created
and subsequently tested using four non-study group experts. The resulting instrument facilitated lesion interpretation and detection, including topography. Thus far, this is the first validated classification attempt not based on assessments of lesions attributable to entirely different etiopathogenetic factors. Further research to refine the tool and to correlate the additional data obtained from blood samples with the classification system is underway.
Post-operative Wound Infection in Cases operated in a Tertiary Level Hospital Jaipur (Rajasthan) India-Wound infection is the second commonest nosocomial infection and most troublesome disorder of wound healing. This study was carried out on 100 post-operative cases of Surgical Unit 1st of General Surgery Department of Sawai Man Singh Hospital, Jaipur (Rajasthan) India in years 2014.
After interview of these, swab from post-operative wound was taken and sent for culture and sensitivity test in Microbiology. Results were inferred by Chi-square test and unpaired‘t’ test. Among all operative cases 21% were found infected. Cases, who were operated in emergency have significantly more post-operative wound infection. Mean age and mean postoperative stay of cases with post-operative infected wound was significantly higher than in cases without post-operative infected wound. But mean pre-operative stay, mean duration of operation and type of operation was not associated with post-operative wound infection. Pre-operative antibiotics lowered the occurrence of post-operative wound infection. Maximum proportion of causative agent found in post-operative infected wound was Staphylococci (90.48%) followed with Streptococci, E. Coli, Klebsella and Pseudomonas.
Contents lists available at ScienceDirectInternational JouAlleneMcclendon878
Contents lists available at ScienceDirect
International Journal of Orthopaedic and Trauma Nursing
journal homepage: www.elsevier.com/locate/ijotn
Prevention of heel pressure ulcers among adult patients in orthopaedic
wards: an evidence-based implementation project
Siew Yi Koha, Hui Ling Yeoa, Mien Li Gohb,∗
aUniversity of Orthopaedic Cluster, National University Hospital, Singapore
b Evidence Based Nursing Unit, National University Hospital, Singapore
A B S T R A C T
Background: Immobility and prolonged bed rest often lead to heel pressure ulcers in patients. A point prevalence audit undertaken in the orthopaedic wards of a
Singapore tertiary hospital reported that 6 out of 30 patients who were audited had mild to blanching redness on their heels.
Aims: The evidence-based project sought to achieve 80% compliance from nurses to perform heel off-loading practice and a 50% reduction in the occurrence of heel
pressure ulcers.
Methods: The project, lasting two years, was undertaken in two orthopaedic wards and utilized a pre- and post-implementation audit strategy using the Joanna Briggs
Institute on-line 'Practical Application of Clinical Evidence System' and 'Getting Research into Practice' programs. Implementation occurred in four phases and
involved a sample consisting of 30 adult patients.
Results: Nurses’ compliance with performing heel off-loading techniques increased. The post-implementation audit showed 93.3% compliance of nurses undertaking
heel off-loading techniques in the subsequent four follow-up audits. Meanwhile, the compliance with documentation increased from 63.3% to 86.7%. The project
resulted in more than 50% reduction in stage one heel pressure ulcers.
Conclusion: The implementation of heel off-loading techniques significantly reduced the incidences of heel pressure ulcers in orthopaedic wards.
Background
Pressure ulcers are a common and perpetual problem in healthcare
settings worldwide (Corbett et al., 2017). Pressure ulcers (PUs), also
known as pressure injury or bed sores, are areas of necrotic soft tissue,
that usually occur over bony prominences (Ministry of Health [MOH]
Nursing Clinical Practice Guidelines, 2001; Sussman and Bates-Jensen,
2007; Smeltzer et al., 2010). They usually develop when skin is sub-
jected to shear, friction and prolonged unrelieved pressure. Many areas
in the human anatomy are susceptible to PUs, for instance occiput,
sacrum, elbow and heel (Smeltzer et al., 2010).
There are six classifications of PUs (National Pressure Ulcer
Advisory Panel, European Pressure Ulcer Advisory Panel, & Pan
Pacific Pressure Injury Alliance, 2014). Stage one PU presents as
non-blanching discoloration of intact skin, often in red, blue or
purplish hues. Stage two PUs involve partial thickness loss of
dermis with a shallow wound or intact blister. An ulcer progresses
to stage three when there is full thickness tissue loss, accompanied
by undermining or tunneling. Full thickness tissue loss with ex-
posed bone ...
Wound dehiscence in surgical procedures and its relationship to increased mor...AI Publications
This study aims to determine outcomes for Wound dehiscence in surgical procedures and its relationship to increased mortality. Twenty-five patients were collected from different hospitals in Iraq with intestinal obstruction, and they were distributed into two groups according to gender (15 males, ten females), and the average age ranged between 25-50 years. This retrospective study included those patients who were after bowel surgery at different hospitals in Iraq between January 6, 2020, and May 27, 2021, where information was obtained by reviewing clinical records.The statistical analysis program IBM SPSS SOFT 18 was also relied upon for the purpose of knowing the true value and standard regression in addition to the percentage of healthy variables to patients. Microsoft Excel 2013 was used for the purpose of describing and analysing demographic data. the results which found of this study collected 25 patients, and MEAN VALUE with slandered div of age patients was 39.4800 ± 6.8, and the type of anaesthesia used in this study was general anaesthesia. Causes of the bowel surgery according to the sex of the patients were (Mesenteric Ischaemia for one female patient and three male patients and Blunt trauma was one patient for both sexes. Bowel surgery, according to emergency basis and elective basis, was the emergency basis for 19 patients and elective for six patients. Association between Surgery * sex * presence of leaks Cross-tabulation were nine patients for an emergency basis and one patient for Elective. In this study, the mortality rate was higher for males than for females (1.4 patients), respectively and we concluded that there is a statistical relationship between the death rate and its prevalence among men
Neuroblastomas are rare extracranial tumors of the pediatric population arising from cells of the embryological sympathetic nervous system. These malignancies most commonly occur in the abdomen, but other sites include the chest, neck, and pelvis with a predisposition for lymphatic and hematogenous
spread. Metastasis to the bone is a poor prognostic indicator, requiring surgical excision and other extensive medical management.
Ochsner Sherren regimen Vs Appendectomy in Adults with Acute Appendicitis.QUESTJOURNAL
ABSTRACT: The main Objective of this study is to examine whether Ochsner Sherren regimen in adult patients with acute appendicitis is safe by correlating the interval from onset of symptoms to operation (total interval) with the degree of pathology and incidence of postoperative complications. Prompt appendectomy has long been the standard of care for acute appendicitis because of the risk of progression to advanced pathology. This time-honored practice has been recently challenged by studies in pediatric patients, which suggested that acute appendicitis can be managed in an elective manner once antibiotic therapy is initiated. No such data are available in adult patients with acute appendicitis. A retrospective review of 480 patients who underwent an appendectomy for acute appendicitis between November2012 and October 2015 was conducted. The following parameters were monitored and correlated: demographics, time from onset of symptoms to arrival at the emergency room (patient interval) and from arrival to the emergency room to the operating room (hospital interval), physical, computed tomography (CT scan) and pathologic findings, complications, length of stay, and length of antibiotic treatment. Pathologic state was graded 1 (G1) for acute appendicitis, 2 (G2) for gangrenous acute appendicitis, 3 (G3) for perforation or phlegmon, and 4 (G4) for a periappendicular abscess. The risk of advanced pathology, defined as a higher pathology grade, increased with the total interval. When this interval was <12>71 hours group compared with total interval<12 hours. Although both prolonged patient and hospital intervals were associated with advanced pathology, prehospital delays were more profoundly related to worsening pathology compared with in-hospital delays . Advanced pathology was associated with tenderness to palpation beyond the right lower quadrant , guarding , rebound , and CT scan findings of peritoneal fluid , fecalith , dilation of the appendix , and perforation . Increased length of hospital stay and antibiotic treatment as well as postoperative complications also correlated with progressive pathology. In adult patients with acute appendicitis, the risk of developing advanced pathology and postoperative complications increases with time; therefore, delayed appendectomy is unsafe. As delays in seeking medical help are difficult to control, prompt appendectomy is mandatory. Because these conclusions are derived from retrospective data, a prospective study is required to confirm their validity
— The microbiological content of Lettuce (a vegetable), commonly vended in the Benin metropolis of Edo state were evaluated. Five vending locations were chosen for the study. Whole and soft rot samples were purchased and analysed for microbiological composition. Results showed high counts in soft rot samples in lettuce. Nutrient agar plated lettuce samples had bacterial counts in the range of 2.0x 103 to 4.7x10 7. Pseudomonas species was the dominant species found in lettuce samples. Bacillus species was isolated from one location in the lettuce samples. Mac Conkey agar plated lettuce plated had bacterial counts in the range of 2.3 x 10 3 to 5.7x 10 7. Enterobacter species, E. coli, and Klebsiella species were the dominant species isolated. Though, Proteus species was isolated from lettuce samples obtained from location five only. The study observes that consuming soft rot samples could pose a risk of introducing pathogens to the consumer due to their high microbial counts and could be detrimental to the health of the consumer.
Abstract— Season seems to have its role in wound infection which is the second commonest nosocomial infection and most troublesome disorder of wound healing. This study was carried out on 100 post-operative cases of Surgical Unit 1st of General Surgery Department of Sawai Man Singh Hospital, Jaipur (Rajasthan) India in years 2014. This study aimed to find out the seasonal trend in Post-operative wound infections (PSI). After interview of these, swab from post-operative wound was taken and sent for culture and sensitivity test in Microbiology. Results were inferred by Chi-square test. In this study, post-operative wound infection rate was found 21%. In majority of cases, causative agent found in post-operative infected wound was Staphylococci (90.48%) followed with Streptococci, E. Coli, Klebsella and Pseudomonas. Maximum cases were found in April followed by March, January and none was found in other months but this variation was not found significant.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Surgical Site Infection After Total Knee Arthroplasty : A Descriptive Study
1. International Multispecialty Journal of Health (IMJH) ISSN:[2395-6291] [Vol-2, Issue-2, February- 2016]
Page | 1
Surgical Site Infection After Total Knee Arthroplasty : A
Descriptive Study
Sadik Bilgen1
, Gokay Eken2
1
Assoc. Professor, Department of Orthopedic Surgery, Uludag University School of Medicine, Bursa, Turkey
2
Chief Assistant, Department of Orthopedic Surgery, Uludag University School of Medicine, Bursa, Turkey
Abstract— Joint replacement operations which are applied to reduce the pain and increase the
movement capacity are among the surgical procedures that are used mostly nowadays. Even though a
dramatic recovery is seen in the life of the patient after total knee prosthesis, possible prosthesis
infection increases cost and causes high morbidity. This study was conducted with the aim to determine
rates of surgical site infection after performing primer total knee prothesis operation in our clinic.
Furthermore, it has been intended to understand risk factors which may cause infection and then take
precautions. This study was conducted from January 2008 to January 2013, 252 knees underwent
primary total knee arthroplasty operations. Among these patients infection rates, relationship to risk
factors and infection treatments were analysed. It was observed that iIn 252 knees, 10 (4%) superficial
infections were found, debridement and antibiotics were applied to 3 knees out of 10 and only antibiotic
treatment was applied to the rest 7 knees. Deep infection was detected in 4 knees (1,6%) out of 252.
Acute deep infection in 1 knee and recovery was provided with debridement and intravenous antibiotics
treatment. Late deep infection was not detected in any of patients. Delayed deep infection was detected
in 3 (1,1%) of these knees though. Among all risk factors only increased body mass index showed
increased superficial wound infection rate. It can be concluded that among the factors like rheumatoid
arthritis, diabetes, age, gender, body mass index, just body mass index has an impact on superficial
infection rate. Our infection rates were comparable to rates mentioned in universal literature for
primary total knee replacement operations.
Key words: Joint replacement, Surgical site Infection, Arthroplasty
I. INTRODUCTION
With the aging population, joint diseases are seen more often today. Pain and limitation of movement
ability in these diseases occur and with joint injury over time decrease life quality of the patients
considerably. Therefore, joint replacement operations which are applied to reduce the pain and increase
the movement capacity are among the surgical procedures that are used mostly now a day. Even though
a dramatic recovery is seen in the life of the patient after total knee prosthesis, possible prosthesis
infection increases cost and causes high morbidity. According to the research applied in a number of
different centers, 0,5%-5% infection rates have been reported after primer total knee arthroplasty. 1,2.3
Infection mechanism takes place through direct transmission of disease or haematogenous. Some
examples of direct transmission are unclean operating theatres, transmission from an infected patient,
usage of torn surgical gloves, negligence of the operating staff about sterility and these cases can be
taken under control. Transmission through haematogenous occurs following bacteremia. For instance,
Streptococcus viridans or peptostrepotococcus after dental intervention, staphycoccusspecies after skin
2. International Multispecialty Journal of Health (IMJH) ISSN:[2395-6291] [Vol-2, Issue-2, February- 2016]
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infections and gram negative enterococcusand anaerobic infections after gastrointestinal genitourinary
infections can be experienced. 4
Swelling, pain and decrease in functional capacity at the knee joint occur following knee arthroplasty
and as the infection progresses, periarticular bone stock decreases and implant loosenings. Patients who
are not treated sufficiently may experience sepsis and life threatening septic shock. In addition, it has
been reported that infected knee prothesis prolongs the duration of hospital stay and increases the cost
considerably. 5
In this research, it has been aimed to determine rates of surgical site infection after performing primer
total knee prosthes is operation in Uludağ University Medical Faculty Orthopedics and Traumatology
Clinic. Furthermore, it has been intended to understand risk factors which may cause infection and then
to take specific precautions.
II. METHODOLOGY
A Hospital based descriptive type of observational study was conducted on patients of primary total
knee arthroplasty operations which were performed in Uludağ University Medical Faculty Orthopaedics
and Traumatology Clinic between the years of 2008-2013 have been studied retrospectively. All
medical computer records of the patients who had the operation have been scanned. 252 total knee
arthroplasty operations were performed on 206 patients. All these 206 cases were taken into
consideration for study.
Posterior stabilised Sigma® (Depuy-Johnson ve Johnson, Warsaw, ABD) total knee prosthesis was
applied to all patients. Patients with severe collateral ligament injury were not included in the study.
Average length of follow-up was 26,8 (24-85) months. All of 252 knees were followed more than 24
months.
Descriptive statics for categorical variables were given with frequency and corresponding percentage
values. Data showing congruity with normal distribution, T test for independent samples and Mann-
Whitney U test for data showing incongruity with normal distribution were applied in comparison
among groups. Chi-square (Pearson Chi-Square), Fisher’s exact chi-square test (Fisher’s Exact Test) and
Fisher-Freeman-Halton Test were applied for qualitative variables. Statistical significance in this study
was defined as p = 0.05, statistical analyses were performed using SPSS software V.21 .
Relationships between infection, diabetes mellitus, body mass index, age, gender, length of hospital stay,
type of anaesthesia procedure, surgery side of body were analysed. Comorbidities of the patients,
besides diabetes mellitus, were also studied. The correlation between prosthesis infections and diseases
such as hypertension, asthma bronchiale, hypothyroidism, Behçet disease, coronary artery disease,
haemophilia was studied. For this Charlson Comorbidity Index that was described before calculated for
each patient and assessed the relationship between infection rates.6
At this index, certain scores were
given for each diseases according to severity. Sum of the scores were calculated for the patients that
have multiple diseases. Scoring system is described as; 0 point mild, 1-2 point moderate, 3-4 point
severe, more than 5 point very severe.
Definitions:The infection was diagnosed taking many different factors into account. Firstly, clinical
findings (fever, erythema, discharge etc) were taken into account. From imaging methods, while
radiolucency or osteolysis was observed via X-ray, intake increased around prosthesis and infection was
3. International Multispecialty Journal of Health (IMJH) ISSN:[2395-6291] [Vol-2, Issue-2, February- 2016]
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diagnosed via bone scans and indium-labeled white blood cell scans. In bacteriological research,
infection was diagnosed with culture reproduction transmitted during surgery, blood cultures and
arthrocentesis. During the operation, histological examination can support the diagnose.7
Also,
unhealthy granulation tissue, synovitis, bone destruction (osteoporosis) and loosening of the prosthesis
lead to infection again.
While infections which include skin and subcutaneous layer were referred as superficial infections,
infections which include bone and prosthesis were referred as deep infections. Time between surgery
and infection was also classified. Accordingly, acute deep infection was defined as an infection which
occurs in the first 4 weeks and could be treated with debridement and intravenous antibiotics,7
delayed
deep infection was defined as an infection which occurs after 4 weeks but within 2 years of TKR, late
deep infection was defined as an infection which occurs after 2 years and is thought to originate from
haematogenous.3
Preoperative Preparation: With the aim of septic focus scan, ear-nose- throat examination was carried
out for all patients scheduled for surgery; for female patients, clinical examinations were made by
gynaecologists, urologists and dentists. White blood cells, sedimentation, c-reactive protein levels were
tested. Urinalysis and urine culture tests were performed. During all these examinations and tests, as
soon as an infection situation was experienced, knee prosthesis surgery was cancelled and the patient
were excluded from the study.
Patients were trained by the doctors, nurses and physiotherapists. With intend to use the prosthesis
healthfully for life and to prevent late prosthesis infection, patients were informed to prevent septic
lesion from progression. All patients who complied with the training were taken into operation and
included in research. Anaesthetists evaluated the patients' suitability to the operation and informed them
about anaesthesia.
Peroperative Prophylactic Applications: All operations were performed in the operating room with
vertical laminar air flow unit. Air flow was 5253m3
per hour. Air exchange rate was 29,2m3
per hour.
Temperature was fixed to 20°C and humidity was fixed to 60% in the operating theater. Microbiological
air sampling was performed 3 times, including the last one in 2014. Bacteria count was zero in all these
samples.
Sterile waterproof clothing and double-layer orthopaedic gloves were used in all operations. All lower
limb was painted 3 times from the tourniquet and draped. After drape application, top layer gloves were
thrown. Following the induction of anaesthesia, each patient was given 1 g of cephalosporin
intravenously with the purpose of prophylaxis before the tourniquet was applied. In the following 24
hours after surgery, 3 more doses of 1 gr cephalosporin were given intravenously.
Data thus collected on a semi structured, pre designed schedule were entered in Microsoft Excel sheet to
prepare master chart, tabulated and analysed to get inferences.
III. RESULTS
All medical computer records of the patients who had the operation have been scanned. 252 total knee
arthroplasty operations were performed on 206 patients with mean aged 66.7years and range 29-
93Years. Out of these 206 cases, 167 (81%) of whom were female and 39 (19%) of whom were male.
(Figure 1)
4. International Multispecialty Journal of Health (IMJH) ISSN:[2395-6291] [Vol-2, Issue-2, February- 2016]
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Out of these 252 knee arthroplasty, 233 (92.5%) had osteoarthritis, 18 (%7.1%) had rheumatoid arthritis
and 1 (0.4%) had haemophilic arthropathy. (Figure 2)
Bilateral total knee arthroplasty operations were performed on 38 (22.7%) of female patients and
8(20.5%) of male patients at different sessions. It shows that bilateral was performed on about 1 patient
out of 4. This difference sex wise not found significant. (Figure 3)
All types of infections, microorganisms which were identified as active, operation years and treatments
were explained in Table -1.
Figure 1 Figure 2
Figure 3
In 252 knees, 10 (4%) superficial infections were found, debridement and antibiotics were applied to 3
knees out of 10 and only antibiotic treatment was applied to the rest 7 knees. It was seen that all of them
had total recovery and had no complaints in their last controls. (Table 1)
Deep infection was detected in 4 knees (1,6%) out of 252. Acute deep infection which occured two
weeks after the operation was detected in 1 knee and recovery was provided with debridement and
intravenous antibiotics treatment. No infection findings were detected in the last control. (Table 1)
5. International Multispecialty Journal of Health (IMJH) ISSN:[2395-6291] [Vol-2, Issue-2, February- 2016]
Page | 5
Late deep infection was not detected in any of the 252 knees which have been followed more than 2
years. Delayed deep infection was detected in 3 (1,1%) of these knees after 4 weeks, within 2 years. In 1
patient out of these 3, as the result of the culture which was sent from the applied arthrocentesis material
showed lack of growth, debridement and intravenous antibiotics treatment were applied and total
recovery was assured; the other two patients had swelling in the knee and complaints about pain in the
48th
and 28th
weeks after the first operation and as a result of methicillin sensitive staphylococcus growth
from the applied arthrocentesis material, two-stage knee prothesis revision surgery was applied and both
patients had a full recovery at last control. (Table 1)
Table 1
Distribution of study subjects as per type of Infection and Treatment
S. No. Infection Operation
Year
Microorganism Treatment
1 Superficial Infection
(N=10)
2010 No Growth Oral Antibiotics
2011 MRSH IV And Oral Antibiotics
2011 No Growth Oral Antibiotics
2011 No Growth Oral Antibiotics
2012 MSSA Debridement and IV Antibiotics
2012 No Growth Debridement and IV Antibiotics
2012 Morganella Debridement and Oral Antibiotics
2013 No Growth IV Antibiotics
2013 No Growth IV Antibiotics
2013 No Growth IV Antibiotics
2 Acute Deep Infection
(N=1)
2013 No Growth Debridement and IV Antibiotics
3 Delayed Deep Infection
(N=3)
2008 MSSA 2 – Stage Revision and Antibiotics
2013 MRSA 2 – Stage Revision and Antibiotics
2013 No Growth Debridement and IV Antibiotics
4 Late Deep Infection
(N=0)
None - -
(ab: antibiotic, iv: intravenous, mrsh: methicillin-resistant staphylococcus haemolyticus, mssa:
methicillin-sensitive staphylococcus aureus, mrsa: methicillin-resistant staphylococcus aureus)
While superficial infection was detected after total knee arthroplasty in 10 knees (4,9%) out of 205 of
female patients, 47 of male patients did not experience superficial infection but that difference is not
statistically significant (p=0,216). When the relationship between patient age and infection frequency
was examined, no significant correlation was found. (Table 1)
Osteoarthritis was most commonly seen arthritis type which results knee arthroplasty (92,5%).
Romatoid artrit was found in 7,1% of the knees and haemophilic arthropathy was found 0,4%,
respectively. When the correlation between arthritis etiology and infection was examined, it was seen
that before arthroplasty, osteoarthritis was present at all knees which had infection; nevertheless, no
statistically meaningful correlation between arthritis etiology and infection was found (p = 0.450). 51
patients 62 knees (24,6%) with diabetes, and 155 patients 190 kness (75,4%) wihout diabetes were
found. When the knees of the patients with diabetes were examined, 3 knees (4,8%) had superficial
infection, 2 knees (3,2%) had deep infection; as to patients wihout diabetes, 7 knees (3,6%) had
6. International Multispecialty Journal of Health (IMJH) ISSN:[2395-6291] [Vol-2, Issue-2, February- 2016]
Page | 6
superficial infection, 2 knees (1,1%) deep infection but the correlation between either infection types
and diabetes was not found statistically meaningful (p=0,976, p=0,546). (Table 1)
The mean body mass index of the patients was detected as 33.5 (obese). While the mean body mass
index of the patients who had superficial infection was 39,6. Also it was 33,2 in patients who had no
superficial infection. That difference was statistically significant (p=0,001). While the mean body mass
index of the patients who had deep infection was 37,5 and it was 33,4 in patients who had no deep
infection. That diffence was not statistically significant (p=0,191). (Figure 4 & 5)
Figure 4 Figure 5
Length of hospital stay was assessed for each patient and mean duration was found 7 (3-27) days.
Patients that had superficial infection were 8,5 (5-20) days. Also patients that had not superficial
infection were 7 (3-27) days. Patients with and without deep infection mean hospital stay were found
same and 7 days. This difference in hospital stay was not found significant (p>0.05).
There was no significant difference between these parameters like surgery time, types of anaesthesia,
and surgery side and Charlson Comorbidity Indexes for superficial and deep infections
IV. DISCUSSION
This present study observed that after total knee arthroplasty, deep infection rate was found 1,6%. When
the literature was examined, infection rates after total knee arthroplasty vary between 1-2%.8,9
While
Peersman and his friends reported infection rate as 1,45% after total knee arthroplasty, Fan and his
friends reported infection rate as 1%.10,11
Taking precautions to prevent infection after arthroplasty is
easier than infection treatment. For this purpose, preoperative routine systemic infection scans and
treatment of possible infection sources before the operation decrease rates of infection after arthroplasty.
Preoperative prophylactic antibiotic treatment is applied to prevent infections. Accumulated haematoma
during postoperative period enables us to obtain bactericidal effects. In the literature, the most common
two microorganisms which are isolated in infection after total knee arthroplasty are reported as
Staphylococcus aureus and Staphylococcus epidermidis.10,12,13
It is a known fact that first generation
cephalosporins among Staphylococcus species are quite effective. We also used intravenous cefazolin as
a routine in preoperative infection prophylaxis in our study. In our study, 14 knees had infection, 5 out
7. International Multispecialty Journal of Health (IMJH) ISSN:[2395-6291] [Vol-2, Issue-2, February- 2016]
Page | 7
of them had culture reproduction, MSSA in 2 knees, MRSH in 1 knee, MRSAin 1 knee and Morganella
strains in 1 knee were isolated.
It is reported that vertical laminar air flow among the other infection precautions decreases infection
rates after operation significantly. Postoperative infection of than other measures used were reported to
significantly reduce infection rates. In a study which was conducted by Lidwell and his friends14
it is
seen that vertical laminar airflow decreases the amount of particles of the surgery room from 164 CFU /
m3
to 2 CFU / m3
. On the other hand, in a study which was conducted by Brandt and his friends,15
it is
reported that laminar air flow does not decrease infection rates after arthroplasty. In another study which
was conducted by Bloom and his friends,16
a significant decrease is reported in infection rates along
with antibiotic prophylaxis, well patient cover, vertical laminar air flow. In our study, low infection rates
were obtained trough vertical laminar air flow, double orthopedic gloves use, proper purification and
cover techniques, microbiological air sampling at regular intervals.
When risk factors after total knee arthroplasty are studied, in the literature diabetes were shown as a
main reason frequently. Yang and his friends16
found deep infection rate as 5,5% in 109 knees with
diabetes. England and his friends17
found deep infection rate as 7% in 59 knees. In our study, 8% of the
patients with diabetes and 4, 7% of the patients without diabetes had infection. However, there is not a
significant difference. That situation contradicts with the information in the literature. When rheumatoid
arthritis, another risk factor, is examined in the literature, it was reported that it increases postoperative
infection rates.18,19
In our study, none of the patients with rheumatoid arthritis had infection and there
was no significant correlation between arthrosis etiology and infection.
V. CONCLUSION
Primary total knee arthroplasty infection rates can be kept low when necessary preoperative, intra-
operative and postoperative infection precautions are taken into account. It is found that among the
factors like rheumatoid arthritis, diabetes, age, gender, body mass index, just body mass index has an
impact on superficial infection rate. This means that when body mass index increases, superficial
infection rate also increases. Our infection rates were comparable to rates mentioned in universal
literature for primary total knee replacement operations.
CONFLICT
None declared till date.
REFERENCES
1. Widmer AF. New developments in diagnosis and treatment of infection in orthopedic implants.
Clin Infect Dis. 2001;33(Supp2):94-106.
2. Jason CH Fan. Infection in primary total knee replacement. Hong Kong Med J 2008;14:40-5.
3. Bengtson, S., and Knutson, K. The infected knee arthroplasty. A 6-year follow-up of 357 cases.
Acta Orthop. Scandinavica, 1991;62:301-311.
4. Frederick F. Buechel. The Infected Total Knee Arthroplasty. The J of Arthroplasty 2004;19:4-1.
5. Sculco TP. The economic impact of infected total joint arthroplasty. Instructional Course
Lectures.1993;42:349-51.
6. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic
comorbidity in longitudinal studies: Development and validation. Journal of Chronic
Diseases.1987;40(5):373–83.
8. International Multispecialty Journal of Health (IMJH) ISSN:[2395-6291] [Vol-2, Issue-2, February- 2016]
Page | 8
7. Lonner JH, Desai P, Dicesare PE, Steiner G, Zuckerman JD. The reliability of analysis of
intraoperative frozen sections for identifying active infection during revision hip or knee
arthroplasty. J Bone Joint Surg Am 1996;78:1553-8.
8. Bengtson S, Knutson K, Lidgren L: Treatment of infected knee arthroplasty. Clin Orthop J
1989;245:173.
9. Rorabeck CH. Salvage of the infected total knee replacement. Clin Orthop J 2002;404:113.
10. Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement: a retrospective
review of 6489 total knee replacements. Clin Orthop Relat Res 2001;392:15-23.
11. Jason CH Fan, HH Hung, KY Fung. Infection in primary total knee replacement. Hong Kong
Med J 2008;14:40-5.
12. Leone JM, Hanssen AD. Management of infection at the site of a total knee arthroplasty. J Bone
Joint Surg Am 2005;87:2335-48.
13. Ayers DC, Dennis DA, Johanson NA, Pellegrini VD. Common Complications of Total Knee
Arthroplasty. J Bone Joint Surg Am 1997;79:278-311.
14. Lidwell OM, Lowbury EJ, Whyte W, Blowers R, Stanley SJ, Lowe D. Effect of ultraclean air in
operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised
study. BMJ 1982;285:10-4.
15. Brandt C, Hott U, Sohr D, et al. Operating room ventilation with laminar airflow shows no
protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Ann
Surg 2008;248:695–700.
16. Yang K, Yeo SJ, Lee BP, Lo NN. Total knee arthroplasty in diabetic patients: a study of 109
consecutive cases. J Arthroplasty 2001;16:102-6.
17. England SP, Stern SH, Insall JN, Windsor RE. Total knee arthroplasty in diabetes mellitus. Clin
Orthop Relat Res 1990;260:130-4.
18. Poss R, Thornhill TS, Ewald FC, Thomas WH, Batte NJ, Sledge CB. Factors influencing the
incidence and outcome of infection following total joint arthroplasty. Clin Orthop Relat Res.
1984;(182):117–126.
19. Wilson MG, Kelley K, Thornhill TS. Infection as a complication of total knee-replacement
arthroplasty. Risk factors and treatment in sixty-seven cases. J Bone Joint Surg
Am.1990;72:878–883.