Basic biostatistics for post-graduate students

Efficacy of Subcutaneous Closed Suction Drain in Reduction of Postoperative Surgical Site Infection

Background  Surgical site infections (SSIs) are the infections of wound after an invasive operative approach. It remains to be a major morbidity for patients undergoing surgeries although there have been tremendous improvements in the surgical techniques.

Different interventions to suppress the selective serotonin reuptake inhibitors have been proposed. Many of them have been routinely used by surgeons like minimizing shaving, hand washing, and preoperative antibiotics and these are well accepted. Drains are used in major abdominal surgeries, hernia repairs, breast surgeries reducing collections in closed areas. 1 Hematoma, serous fluid, and dead space in surgical incision wounds raise the risk of infection as they serve as the platform for microbial growth. Studies have proved that the usage of subcutaneous drains has lowered the chances of infection.

Results  The patients in the case group had lower incidence of SSI compared with the control group. The patients in the case group had subcutaneous drain which drained any collection that developed in the subcutaneous space. When the incidence of SSI was compared between the emergency cases and elective cases, the emergency cases showed higher propensity for SSI and increased rate for patients who had co-morbidities like diabetes mellitus, hypertension, etc. The most common organism isolated from the SSI was found to be Escherichia coli . It was also noted that the mean number of days of hospital stay was comparatively higher for the patients who developed SSI compared with patients who did not develop SSI.

Conclusion  Thus the presence of SSI adds morbidity to the patient and the patients who undergo major surgeries are likely to develop SSI postoperatively. The presence of subcutaneous closed suction drain helps in reducing the SSI to a certain extent.

The Relationships Among the Organizational Factors of a Tertiary Healthcare Center for Type 2 Diabetic Patients in Palestine

BACKGROUND

Diabetes prevalence at Palestine was 10%, with a rising fund crisis, and diabetes healthcare problems. There was a limited research concerning diabetes healthcare dimensions including organizational factors and their predictors.

OBJECTIVE

This study described patient characteristics and organizational factors, and assessed relationships among organizational factors of type 2 diabetes health care in Palestine.

METHODS

This study is a retrospective cross sectional study, recruited by convenience sampling method in 330 participants from a type 2 diabetes patients list. It was carried out at Ramallah, Palestine. The Statistical Package for Social Sciences (SPSS v 19) was used to analyze data on patient characteristics and organizational factors collected from personal interview and medical records review.

RESULTS

The results showed that 51.2% were males, and 88.5% had additional chronic diseases. Preventive healthcare and patient-healthcare professionals' relationship were the most prominent organizational factors in statistically significant relationships among organizational factors.

CONCLUSION

This study reflected the need for reviewing prescription mode, and educational programs that emphasize the diabetes self-care management and the health care providers' role that would be of great benefit in health outcomes further.

Benzofurocaine: effects on experimental periodontitis, anti-diabetic activity and molecular mechanisms of action

Introduction: A promising compound for the treatment of inflammatory periodontal diseases is benzofuracaine (BFC). BFC has pronounced anti-inflammatory, analgesic, reparative, hypoglycemic and other effects. Objective: To assess the influence of benzofuracaine on experimental periodontitis and to study its antidiabetic activity and molecular mechanisms of action

Materials and methods: The work was performed on 232 white nonlinear rats of both sexes and 55 male mice. To assess the effect of BFС on experimental periodontitis, the amount of gingival fluid (AGF) was determined, an in-depth morphofunctional study of periodontal tissues was conducted, as well as the study of the biochemical composition of the gingiva and blood. Antidiabetic properties were studied using the glucose tolerance test (GTT), as well as the assessment of endothelium-dependent vasodilation and transmembrane K+-currents on an isolated aortic segment of rats with streptozotocin-induced diabetes mellitus (DM).

Results and discussion: In experimental periodontitis, BFC improves the morphological picture and decreases AGF, increases the level of blood microcirculation in the attached gingiva, has a normalizing effect on the prekallikrein-kallikrein system, reduces the synthesis of bradykinin, proinflammatory cytokines and PGE2, increases the level of VEGF, reduces the level of endothelin-1, increases the ATP content and NADH-ubiquinone-reductase activity, exhibits antioxidant properties, reduces the content of nitrosothiols and NO metabolites (NO2/NO3), increases the level of transferrin; when conducting a glucose tolerance test in mice, it reduces the level of glucose in the blood, but in this respect is inferior to glibenclamide, has a hypoglycemic effect in the early stages of diabetes (30 days), tends to restore endothelium-dependent dilatation of smooth muscle cells (SMC) of the aorta and does not affect the functioning of the K+-channels of the aortic SMC.

Conclusion: BFС is an effective drug for the treatment of periodontitis and can be recommended for further preclinical and clinical studies.

FEATURES OF CONNECTIVE TISSUE METABOLISM AND MICROELEMENTS IN BLOOD SERUM OF PREGNANT WOMEN WITH CERVICAL INSUFFICIENCY

The preterm deliveries are the leading cause of the perinatal morbidity and represent important mortality indicators. Functional cervical insufficiency, which is a phenotypic manifestation of undifferentiated connective tissue dysplasia, plays the main role in the development of pregnancy complications in primigravidas (women pregnant for the first time) and primiparas (women giving birth for the first time). Aim of the research: to study the indicators of connective tissue metabolism and basic microelements in order to determine the role of undifferentiated connective tissue dysplasia in the pathogenesis of functional cervical insufficiency during pregnancy. Methods. The 101 pregnant women (the main group) at the 22–32 week gestation period which were diagnosed with “Functional cervical insufficiency” were examined, as well as 34 pregnant women with the physiological obstructive function of the cervix (the control group). Utilizing immunoenzyme analysis we measured in blood serum the concentration of Total P1NP the amino-terminal propeptide of procollagen type I a marker of synthesis, and β-CrossLaps resorptions marker of the connective tissue. Utilizing the automatic analyzer of electrolytes and a set of reagents for their determination we estimated the content of microelements Na+, K+, Mg2+, Ca2+ and total Ca and P. Results. The functional cervical insufficiency in pregnant women was indicated by cervical shortening up to 22.88±1.02 mm, and the majority of women (76.2 %) had phenotypical manifestations of undifferentiated connective tissue dysplasia. We found a significant increase in the concentration of marker of synthesis Total P1NP, whereas the concentration of resorption marker β-CrossLaps remains normal, and strong reverse correlation (r=–0.7362) between the index of cervix length and concentration of marker of connective tissue synthesis Total P1NP. We detected a significant increase in the concentration of total and ionized calcium, total phosphorus, deficiency of ionized magnesium, potassium and sodium that lead to changes in the structure of connective tissue and reduction of cervical obstructive function.

Statistical analysis of microbiological diagnostic tests

No study in medical science is complete without application of the statistical principles. Incorrect application of statistical tests causes incorrect interpretation of the study results obtained through hard work. Yet statistics remains one of the most neglected and loathed areas, probably due to the lack of understanding of the basic principles. In microbiology, rapid progress is being made in the field of diagnostic test, and a huge number of studies being conducted are related to the evaluation of these tests. Therefore, a good knowledge of statistical principles will aid a microbiologist to plan, conduct and interpret the result. The initial part of this review discusses the study designs, types of variables, principles of sampling, calculation of sample size, types of errors and power of the study. Subsequently, description of the performance characteristics of a diagnostic test, receiver operator characteristic curve and tests of significance are explained. Lack of a perfect gold standard test against which our test is being compared can hamper the study results; thus, it becomes essential to apply the remedial measures described here. Rapid computerisation has made statistical calculations much simpler, obviating the need for the routine researcher to rote learn the derivations and apply the complex formulae. Thus, greater focus has been laid on developing an understanding of principles. Finally, it should be kept in mind that a diagnostic test may show exemplary statistical results, yet it may not be useful in the routine laboratory or in the field; thus, its operational characteristics are as important as the statistical results.

Impact of estimated glomerular filtration rate on diabetic macular edema

PURPOSE

Diabetic macular edema (DME) is a major cause of visual impairment in patients with diabetes and is influenced by various systemic factors. This study evaluates the effect of renal status on DME using estimated glomerular filtration rate (eGFR) as a study marker.

METHODS

This was a prospective observational cross-sectional study. One hundred and ninety-five patients of diabetic retinopathy (DR) were included. Group 1 had patients of DR without DME (n = 100), and group 2 had patients of DR with DME (n = 95). All patients were evaluated for DR/DME-related risk factors. eGFR was calculated in all patients. Spectral domain optical coherence tomography (SDOCT) was done to identify the various patterns and severity of DME.

RESULTS

Group 2 patients had significantly higher comorbidities than those in group 1 (p < 0.001). Hba1c, total cholesterol, triglycerides, LDL/HDL ratio, systolic and diastolic blood pressures were significantly higher in group II (p < 0.001 in each). There was no significant difference between the groups in terms of blood urea, serum creatinine or eGFR. eGFR did not show a significant association with a specific SDOCT pattern or severity of DME.

CONCLUSION

Comorbidities are more common and more severe in patients with DME. However, eGFR as a marker was not useful in predicting either the severity or pattern of DME. eGFR, in its present form, may not be useful in the evaluation and management of patients with DME.