Antibiotic prophylaxis in colorectal surgery: are oral, intravenous or both best and is mechanical bowel preparation necessary?

BACKGROUND

The benefit of adding oral antibiotic prophylaxis (OA) to intravenous prophylaxis (IV) in elective colorectal surgery to prevent surgical site infection (SSI) and whether the benefit of OA requires a mechanical bowel cleansing (MBP) are assessed in a systematic review. Meta-analyses compare randomized trials of IV versus IV plus OA, both with MBP; OA versus IV plus OA, both again with MBP; OA plus IV in studies randomizing patients to MBP or no MBP; and IV versus IV plus OA in patients with no MBP.

METHODS

MEDLINE, EMBASE, and the Cochrane Library were searched for eligible studies from 1965 to April 1, 2020. The outcome assessed was SSI, superficial and deep, but not organ space. For each included study, risk of bias was assessed using the Cochrane Risk of Bias tool version 1. For each comparison, meta-analysis was performed from data from eligible studies to obtain a summary effect and heterogeneity using RevMan. Sensitivity analyses were performed excluding studies of poor quality. Certainty of evidence was assessed using GRADE for each comparison.

RESULTS

Sixty-one studies published in 1971-2020 from 55 publications reporting 12,297 patients were eligible for inclusion. A total of 36 studies compared IV to OA plus IV with MBP. The risk ratio (RR) and 95% confidence interval (CI) for SSI with oral and IV vs. IV alone are 0.47, 0.40-0.56. The RR in 19 studies for IV plus OA versus OA alone is 0.48, 0.38-0.62. The RR for OA plus IV with MBP versus without MBP in 5 studies is 1.17, 0.84-1.64. The RR for OA plus IV versus IV alone when no bowel prep was used in two studies is 0.36, 0.18-0.72. RRs were similar in sensitivity analyses. The GRADE is high for the first two comparisons, moderate for the 3rd, and low for the 4th due to imprecision and heterogeneity.

CONCLUSIONS

Combined OA and IV is superior to either alone in preventing SSI. The certainty of evidence is such that further research is unlikely to alter this relationship when MBP is used. In randomized trials of MBP, OA plus IV shows no benefit from MBP versus no MBP. The last comparison shows in just two studies that as in the first meta-analysis, but in the absence of MBP, combined OA plus IV is also superior to IV alone.

Characterization of immunological, biochemical and inflammatory response of clinical and subclinical endometritis in ewes in the subtropics

Pluriparus Ossimi (n = 50) ewes were used to investigate the immune profile of the affected ewes to accurately diagnose clinical and subclinical endometritis and associations with biochemical variables. Ewes were slaughtered and animals were classified into control (no fertility problems), subclinical endometritis (SCE) and clinical endometritis (CE) groups based on pre-slaughter determinations of conception failure. Serum was collected from ewes to estimate concentrations of pro-inflammatory cytokines including interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8) as well as nitric oxide (NO) concentration. The results from immunological evaluations indicated there were greater (P < 0.001) serum concentrations of IL-6, IL-8, TNF-α and NO in ewes classified with SCE and CE as compared to ewes of the control group. Furthermore, values for concentrations of TNF-α were positively correlated with IL-6 and IL-8 concentrations in ewes of the SCE and CE groups. In ewes classified with CE and SCE there were greater (P < 0.01) concentrations of blood glucose, ALT, AST, urea and creatinine than in ewes of the control group. It is concluded that serum pro-inflammatory cytokines IL-6, IL-8, and TNF-α are diagnostic markers for CE and SCE in ewes and serve as a criterion for different inflammatory complications in ewes classified as having CE or SCE.

AB0762 METABOLIC SYNDROME IN EGYPTIAN PSORIATIC ARTHRITIS PATIENTS

Background:

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis affecting 20:30% of patients with skin Psoriasis (PsO). It is strongly associated with obesity, particularly excess visceral adiposity, which leads to insulin resistance, hyperglycemia, dyslipidemia, and hypertension (HTN).

All the previous findings are grouped in Metabolic Syndrome (MetS) which increase the risk of development of Type 2 diabetes mellitus (T2DM) by five folds and cardiovascular disease (CVD) by two folds.

Objectives:

The aim of this work was to define those who fulfill MetS criteria in PsA patients thus of greater risk to develop CVD and T2DM.

Methods:

Fifty PsA patients diagnosed according to the CASPAR criteria and 50 matched healthy controls were included in this study.

All patients were subjected to thorough clinical evaluation of the musculoskeletal system. The disease activity was assessed by DAPSA and BASDAI. Skin severity was assessed by the PASI. Disability assessment was done by the HAQ-DI. Laboratory investigations included: CRP, uric acid and diabetic profile (includingHOMA-IR) and lipid profile in patients and control subjects.

Subjects were defined as having MetS according to International Diabetes Federation (IDF) criteria:

Abdominal obesity was measured by Waist circumference (WC) for Egyptian cutoffs values (WC>100.5 cm in men and >96.25 cm in women).The subjects must have central obesity to identify MetS plus any two of the following four factors:

Results:

Metabolic syndrome was significantly higher among PsA patients than control group (42% Vs 16% respectively).

Regarding frequency of MetS components, obesity was the highest component among PsA patients (62%) as illustrated in Figure 1.

CRP mean level was significantly higher in PsA patients compared to control group with p <0.001*. CRP serum level showed a positive significant correlation with DAPSA score and HOMA-IR (P= 0.031, 0.002 respectively)

Correlations between MetS components and (disease activity, skin severity and physical function) are shown in Table 1.

Conclusion:

1-There is high frequency of MetS in PsA patients compared to control group.

2- Obesity and DMT2 were the most common components of MetS.

References:

[1]Eder L, Harvey P, Chandran V, Rosen CF, Dutz J, Elder JT, et al. Gaps in diagnosis and treatment of cardiovascular risk factors in patients with psoriatic disease: an international multicenter study. The Journal of rheumatology. 2018:jrheum. 170379.

[2]Alberti KGMM, Zimmet P, Shaw J. Metabolic syndrome—a new world-wide definition. A consensus statement from the international diabetes federation. Diabetic medicine. 2006;23(5):469-80.

Psoriatic ArthritisMetabolic syndromeWCBMITGHDLFBSHOMA-IRSystolic BPDiastolic BPDAPSArs-0.2330.0810.086-0.1160.2630.3870.136-0.170P0.3080.7280.7100.6160.2500.0830.5570.462BASDAIrs0.798*0.1520.060-0.110-0.424-0.2940.168-0.027P<0.001*0.5090.7980.6360.0550.1960.4670.906PASIrs0.435*0.2260.363-0.521*-0.276-0.253-0.054-0.060P0.049*0.3240.1060.015*0.2270.2680.8180.795HAQ-DIrs0.1890.1760.168-0.286-0.240-0.184-0.343-0.276P0.4130.4450.4660.2090.2950.4240.1280.225

Disclosure of Interests:

None declared

Impact of thermal stress exposure on seminal quality, antioxidant defence system, TNF-α and TIMP-3 in Ossimi ram

Heat stress (HS) occupies huge importance nowadays as it leads to severe economic losses especially in livestock. Preserving sheep against HS is one of the governmental scopes where it represents huge percentage of global ruminant. The present research was conducted to study semen quality, some stress and inflammatory markers in Ossimi rams under both hot and mild climatic conditions. The current study was conducted on selected 46 ram samples divided into two groups during summer and winter. Semen analysis, testosterone (TES), cortisol (COR) and blood glucose (BG) levels, and lipid and protein profiles were done. Concentrations of tumour necrosis factor alpha (TNF-α), tissue inhibitor of metalloproteinase-3 (TIMP-3), nitric oxide (NO), malondialdehyde (MDA) and reduced glutathione (GSH) and specific activity of glutathione peroxidase (GPx) and superoxide dismutase (SOD) were assessed. The results in summer compared to winter revealed significant elevation of total defects and number of dead sperms; however, there was reduction in sperm total motility and concentration and external epididymal tail duct diameter. Histological study of epididymal tail lumen exhibited azoospermia. Further, TES, TIMP-3 and GSH levels were decreased and COR, TNF-α, NO and MDA were raised. Specific activities of GPx and SOD were also declined. Additionally, there was a significant increase in concentrations of BG and lipid profiles except high-density lipoprotein. Our data concluded that there were new insights into TNF-α and TIMP-3 as biomarkers can be used in diagnosis of sheep suffering from HS, but further studies are recommended to do in future work about such aspect.

Demographics and Mortality Rates of Surgical Emergencies Treated at the Casualty Operation Theater: A Six-month Retrospective Analysis

Introduction

Emergencies such as appendicitis, peritonitis, road traffic accidents and gunshots require immediate surgical intervention. Patients are first resuscitated at the emergency department and then shifted to the casualty operation theater (COT). COT is a state-of-the-art operation theater that is open 24/7 and ready to deal with any surgical crisis. Once surgery is performed, the patients are admitted to the surgical ward for post-operative care.

Jinnah Postgraduate Medical Centre (JPMC) is the largest tertiary care hospital in Karachi. There is very limited data on the cases that are dealt with on regular basis at the COT in JPMC. Here we break the mold and analyze the various aspects of surgical emergencies treated at the COT over the course of last six months.

Objectives

To evaluate the demographics and mortality rates of emergencies treated at the COT in the last six months.

Methods

This was a retrospective study, held for six months (July 1^st 2019 to December 31^st 2019). Data was obtained from the Records and Administration section, Surgical Unit IV (ward 21), Jinnah Postgraduate Medical Centre.

Results

Three hundred and fifty-five patients were inducted into the study, predominantly male. Majority (71.54%) of the referrals were made from within the city. The mean age of the patients was 48.57 ± 14.92 years. Appendicitis was the most common emergency treated at the COT. The overall mortality rate was 23.94%. Peritonitis and road traffic accidents contributed significantly to the mortality rate.

Conclusion

Surgical emergencies treated at the COT have a high mortality rate at one week. Prompt recognition, early referrals and intervention can help reduce mortality in the future.

Effect of connectivity measures on the identification of brain functional core network at rest

Magneto/Electro-encephalography (M/EEG) source connectivity is an emergent tool to identify brain networks with high time/space resolution. Here, we aim to identify the brain core network (s-core decomposition) using dense-EEG. We also evaluate the effect of the functional connectivity methods used and more precisely the effect of the correction for the so-called source leakage problem. Two connectivity measures were evaluated: the phase locking value (PLV) and phase lag index (PLI) that supposed to deal with the leakage problem by removing the zero-lag connections. Both methods were evaluated on resting state dense-EEG signals recorded from 19 healthy participants. Core networks obtained by each method was compared to those computed using fMRI from 487 healthy participants at rest (from the Human Connectome Project - HCP). The correlation between networks obtained by EEG and fMRI was used as performance criterion. Results show that PLV networks are closer to fMRI networks with significantly higher correlation values with fMRI networks, than PLI networks. Results suggest caution when selecting the functional connectivity methods and mainly methods that remove the zero-lag connections as it can severely affect the network characteristics. The choice of functional connectivity measure is indeed crucial not only in cognitive neuroscience but also in clinical neuroscience.

P902 Abnormal diastolic function in patients with transfusion dependant thalassemia major

Aim and Background

Cardiac complications secondary to iron deposition are the commonest cause of death in patients with beta thalassemia major (TM) and can cause various abnormalities. The aim of this study was to assess the diastolic function in patients with transfusion dependant TM and compare with normal controls.

Methods

This was a retrospective study involving patients with transfusion dependant TM , on chelation therapy who had a MRI T2* and a transthoracic echocardiogram during the preceeding 6 months. We compared the findings with those from normal controls. We also correlated the echo findings with the MRI T2* values.

Results

Patients with TM (n = 92, 45% male, mean age 26+ 6 years), with median MRI T2* of 32 (18-39) and normal LV function had signs of diastolic dysfunction as compared to normal controls (41% male, mean age 25 + 6 years) with E/E’ at 6.6 + 1.6 vs 5.5 +1.2 (p &lt; 0.001) and altered pulmonary vein s/d ratio (0.88 + 0.30 vs 1.04 +0.42 for controls, p = 0.02)even in the presence of normal LV systolic function (Ejection fraction 61+ 7% vs 3.4% for controls). There was no difference in the other dimensions. The E/A ratio also corelated well with the MRI T2* (spearmans correlation rho -0.226 p 0.04). There were no other significant correlations between either the MRI T2* or myocardial Iron concentration and any of the other echo parameters

Conclusion

In patients with TM signs of diastolic dysfunction appear before LV systolic dysfunction and may be used to monitor these patients in absence of MRI facilities.

Echo findings in thalassemia Controls (n= 53) Thalassemia Major (n = 92) P value Sex Male Female 22 (41%) 31(59%) 42(45%) 50(55%) 0.5 Mitral E 0.84 + 0.16 1.01 + 0.16 &lt;0.001 Mitral A 0.47 +0.11 0.55 +0.16 &lt;0.001 E/A 1.85 +0.52 1.98 + 0.71 0.24 TDseptal 13.1 + 2.6 13.2 + 3.4 0.9 TDlateral 17.1+ 3.3 17.3 +4.1 0.7 E/E’ 5.5 +1.2 6.6 + 1.6 &lt;0.001 PVs/d 1.04 + 0.41 0.88 +0.30 0.02 TD= tissue doppler; PV- pulmonary vein

A passive damping device for suppressing acoustic pressure pulsations: The infinity tube

Acoustic pressure pulsations in piping systems can cause detrimental damage and failure of industrial components. Both the acoustic resonance and the traveling wave phenomena are of concern for industrial piping systems and there is a need to study passive damping devices and their implementation into these systems. However, there is a challenge associated with manufacturing and installation of such devices as they may be cumbersome. Therefore, the infinity tube (IT) damping device has been presented here to provide a simplified device geometry which can be easily manufactured and implemented into piping systems. A theoretical equation for the transmission loss spectra of the IT device and the frequencies of resonance have been derived as a tool for designers. Additionally, the experimental investigation has shown a considerable increase in acoustic attenuation in comparison to the conventional Herschel-Quincke device due to the significantly shorter length which the IT device can be constructed from. Acoustic pressure and phase angle measurements have elucidated that the fundamental acoustic mode of an open-open pipe can be formed within the IT device. Moreover, a parametric study is presented which has clarified practical considerations required for implementation of the IT device into piping systems for suppressing pressure pulsation.

Co/Pd-Based synthetic antiferromagnetic thin films on Au/resist underlayers: towards biomedical applications

Thin film stacks consisting of multiple repeats M of synthetic antiferromagnetic (SAF) [Co/Pd]N/Ru/[Co/Pd]N units with perpendicular magnetic anisotropy were explored as potential starting materials to fabricate free-standing micro/nanodisks, which represent a promising candidate system for theranostic applications. The films were directly grown on a sacrificial resist layer spin-coated on SiOx/Si(100) substrates, required for the preparation of free-standing disks after its dissolution. Furthermore, the film stack was sandwiched between two Au layers to allow further bio-functionalization. For M ≤ 5, the samples fulfill all the key criteria mandatory for biomedical applications, i.e., zero remanence, zero field susceptibility at small fields and sharp switching to saturation, together with the ability to vary the total magnetic moment at saturation by changing the number of repetitions of the multi-stack. Moreover, the samples show strong perpendicular magnetic anisotropy, which is required for applications relying on the transduction of a mechanical force through the micro/nano-disks under a magnetic field, such as the mechanical cell disruption, which is nowadays considered a promising alternative to the more investigated magnetic hyperthermia approach for cancer treatment. In a further step, SAF microdisks were prepared from the continuous multi-stacks by combining electron beam lithography and Ar ion milling, revealing similar magnetic properties as compared to the continuous films.

Hepatocellular carcinoma response to transcatheter arterial chemoembolisation using automatically generated pre-therapeutic tumour volumes by a random forest-based segmentation protocol

AIM

To demonstrate the feasibility of correlating pre-therapeutic volumes and residual liver volume (RLV) with clinical outcomes: time to progression (TTP) and overall survival (OS) in hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolisation (TACE).

MATERIALS AND METHODS

TTP was calculated from a database of 105 patients, receiving first-line treatment with TACE. TTP cut-off for stratifying patients into responders and non-responders was 28 weeks. Pre-treatment tumour and liver volumes were correlated with the TTP and OS following treatment. Univariate cox-regression model was used to assess whether these volumes could predict TTP and/or OS. Kaplan-Meier analysis with log-rank test was used to compare the TTP between high and low volume groups for viable, necrotic, and total tumour. Kaplan-Meier analysis was performed comparing the OS of 10 patients with the longest TTP (mean=122 weeks) in the responder group and 10 patients with the shortest TTP (mean=7 weeks) in the non-responder group.

RESULTS

HCC in high tumour volume groups had a shorter TTP than lesions in low tumour volume groups (p=0.05, p=0.04, p=0.02, for enhancing, non-enhancing, total tumour groups, respectively). A negative (correlation coefficient [CC] 0.3) linear correlation between TTP and tumour volumes, and a positive linear correlation between TTP and residual liver volumes were also demonstrated (CC 0.3). Patients with the longest TTP had a higher OS than with the shortest TTP (p=0.03).

CONCLUSION

This demonstrates the feasibility of predicting treatment response of HCC to TACE using volumetric measurements of pre-treatment lesion and the feasibility of correlating RLV with TACE outcome data in HCC patients.