Glove perforation in selected surgical procedures in a general hospital in La Habana, Cuba

Background

Surgical glove perforation constitutes a risk for the maintenance of aseptic technique and the risk of surgical site infection and occupational exposure to blood borne infections for healthcare workers.

Aim

To identify the frequency of glove perforation in selected surgical procedures.

Methods

A cross-sectional descriptive observational study was carried out in the surgical unit of the Joaquin Albarrán Hospital (La Habana, Cuba) during the period September–December 2019. Gloves used by surgeons in major urgent or elective surgical procedures were collected and tested for perforations.

Findings

757 gloves from 149 surgeons and 8 surgical specialties were tested and 95 (25.8%) had perforations. The highest frequencies of glove perforations were reported in vascular surgery (50.0%), proctology (37.9%), urology (28.0%) and general surgery (26.1%). The selected surgical procedures with the highest frequencies were open radical nephrectomy (87.5%), splenectomy (57.1%), open adenomectomy (55.6%), limb amputation (46.2%) and hysterectomy (41.7%). Glove perforation occurred more frequently in consultant surgeons (28.8%) than in residents (20.9%) (P = 0.021), in surgeons with more years of surgical experience (P = 0.003) and longer procedure duration (P = <0.001). Most glove perforations were identified in the left hand (64.1%), while 23.1% were in the right hand and 12.8% in both hands. 51.2% occurred in thumb and index finger. Differences in the patterns of glove perforation were observed among the different surgical procedures.

Conclusions

Our findings provide insights into the risk of glove perforation during selected surgical procedures and the need for prevention strategies to reduce adverse consequences of glove perforation in patients and healthcare workers.

Hand Hygiene Compliance in a Medical-Surgical Intensive Care Unit in La Habana

Background: Hand hygiene plays a key role in the prevention of healthcare-associated infection in critical patients. Objective: The current study aimed to evaluate compliance with hand hygiene practices. Methods: An observational and descriptive study was carried out in a 35-bed medical-surgical critical care unit in La Habana (Cuba) from January 2017 to December 2018. The observational method recommended by the World Health Organization (WHO) was used. Results: Overall compliance was 34.2% (5516/16125), with better compliance among physicians (39%) compared with nurses (31.4%) and ancillary staff (19.5%). Better compliance was observed after patient contact (65.7%) and after contact with patients’ surroundings (42.0%) in comparison with greater focus on patient safety as before patient contact (23.3%) and before an aseptic task (11.4%). Hand washing was performed more frequently than hand rubs. Conclusion: Compliance with hand hygiene practices is low and no improvement in compliance was observed during the study period. This practice is related to the high risk of transmission of healthcare-related infections in critical patients and requires quality improvement interventions.

Accumulation of as, pb, and cu associated with the recent sedimentary processes in the colorado delta, South of the United States-Mexico boundary

Sediment cores from the Colorado River (CR) remnant delta were used to assess the changing sedimentation and pollutant deposition processes in response to extensive human manipulation of the river. The cores are formed of alternating layers of clays and silts, with isolated sandy horizons. The clayey units are interpreted as periods of flood flows into this low gradient and meandering estuary after dam construction in the United States. The geochemistry of these sediments is particular because of the association of MnO with CaO rather than with the Fe(2)O(3)-rich clays. Past pollution of the CR delta by As, and probably also Pb and Cu, is recorded in some cores. Enrichment factors (EFs) >1 for these elements and their statistical association suggest anthropogenic inputs. The most likely sources for these element enrichments (especially As) are the arsenate-based pesticides used intensively in the area during the first half of the 20th century. The transport of these elements from the nearby agricultural lands into the present river reaches appears to have been driven in part by flooding events of the CR. Flushing by river and tide flows appear to be responsible of a lower pollutant deposition in the CR compared to the adjacent Hardy River (HR). Arsenic in the buried clay units of the HR has concentrations above the probable toxic effect level (PEL) for dwelling organisms, with maximum concentrations of 30 microg g(-1). Excess (210)Pb activities ((210)Pb(xs)) indicate that fluxes of this unsupported atmospheric isotope were not constant in this estuarine environment. However, the presence of (210)Pb(xs) does indicate that these sediments accumulated during the last ~100 years. Aproximate sediment ages were estimated from the correlation of historic flooding events with the interpretation of the stratigraphic record. They are in fair agreement with the reported onset of DDT metabolites at the bottom of one core.

Effect of metoprolol on myocardial function and energetics in patients with nonischemic dilated cardiomyopathy: a randomized, double-blind, placebo-controlled study

OBJECTIVES

This study examined the effects of metoprolol on left ventricular performance, efficiency, neurohormonal activation and myocardial respiratory quotient in patients with dilated cardiomyopathy.

BACKGROUND

The mechanism by which beta-adrenergic blockade improves ejection fraction in patients with dilated cardiomyopathy remains an enigma. Thus, we undertook an extensive hemodynamic evaluation of this mechanism. In addition, because animal models have shown that catecholamine exposure may increase relative fatty acid utilization, we hypothesized that antagonism of sympathetic stimulation may result in increased carbohydrate utilization.

METHODS

This was a randomized, double-blind, prospective trial in which 24 men with nonischemic dilated cardiomyopathy underwent cardiac catheterization before and after 3 months of therapy with metoprolol (n = 15) or placebo (n = 9) in addition to standard therapy. Pressure-volume relations were examined using a micromanometer catheter and digital ventriculography.

RESULTS

At baseline, the placebo-treated patients had somewhat more advanced left ventricular dysfunction. Ejection fraction and left ventricular performance improved only in the metoprolol-treated patients. Stroke and minute work increased without an increase in myocardial oxygen consumption, suggesting increased myocardial efficiency. Further increases in ejection fraction were seen between 3 and 6 months in the metoprolol group. The placebo group had a significant increase in ejection fraction only after crossover to metoprolol. A significant relation between the change in coronary sinus norepinephrine and myocardial respiratory quotient was seen, suggesting a possible effect of adrenergic deactivation on substrate utilization.

CONCLUSIONS

These data demonstrate that in patients with cardiomyopathy, metoprolol treatment improves myocardial performance and energetics, and favorably alters substrate utilization. Beta-adrenergic blocking agents, such as metoprolol, are hemodynamically and energetically beneficial in the treatment of myocardial failure.

Dobutamine stress echocardiography identifies hibernating myocardium and predicts recovery of left ventricular function after coronary revascularization

BACKGROUND

The identification of hibernating myocardium is important in selecting patients who will benefit from coronary revascularization. This study was performed to determine whether dobutamine stress echocardiography (DSE) could identify hibernating myocardium and predict improvement in regional systolic wall thickening after revascularization.

METHODS AND RESULTS

DSE was performed in 49 consecutive patients with multivessel coronary disease and depressed left ventricular function. Contractile reverse during DSE was defined by the presence of two criteria: (1) improved systolic wall thickening in at least two adjacent abnormal segments and (2) > or = 20% improvement in regional wall thickening score. Postoperative echocardiograms were evaluated for improved regional wall thickening in 25 patients at least 4 weeks after successful coronary revascularization. All studies were read in blinded fashion. Contractile reserve during DSE was present in 24 (49%) of 49 patients. The presence or absence of contractile reserve on preoperative DSE predicted recovery of ventricular function in the 25 patients who underwent successful revascularization. Thus, 9 of 11 patients with contractile reserve had improved systolic wall thickening after revascularization (hibernating myocardium), whereas 12 of 14 patients without contractile reserve did not improve (P = .003).

CONCLUSIONS

Dobutamine stress echocardiography provides a simple, cost-effective, and widely available method of identifying hibernating myocardium and predicting improvement in regional left ventricular wall thickening after coronary revascularization. This technique may be clinically valuable in the selection of patients for coronary revascularization.

Evaluation of a personal computer-based quantitative coronary analysis system for rapid assessment of coronary stenoses

Quantitative coronary analysis (QCA) is a technique that is rarely used because of the complexity and expense of existing systems. We studied a new personal computer-based QCA system that is capable of both geometric and densitometric analysis and compared it to a previously validated QCA system. Both systems performed extremely well in phantom analysis with 11 phantoms filmed in both 5-inch and 7-inch magnifications (R greater than 0.97 and SEE less than 0.33 mm for all modes). In 28 abnormal coronary angiograms analyzed at end diastole, stenosis and reference diameter correlations between the two systems were excellent (R = 0.90 and 0.96 and SEE = 0.43 and 0.33 mm for densitometric and geometric modes, respectively). Intraobserver and interobserver correlation was also excellent for both analysis modes. The new QCA system was able to perform analysis in approximately one third the time required by previously validated system and was much less expensive. We conclude that personal computer-based coronary analysis is an accurate, quick, and relatively inexpensive means for performing QCA that may help to make this technique feasible for nonresearch settings.

Cocaine-induced alterations in prostaglandin production in rabbit aorta

To determine if alterations in endothelial prostaglandin production occur after long-term cocaine use, 26 New Zealand White rabbits were randomized to a low fat diet with (n = 12) or without (n = 14) daily intravenous cocaine (2 mg/kg body weight). Rabbits were killed at 6 or 12 weeks. Segments of aorta were examined in blinded manner for histologic changes. Additional slices were incubated in oxygenated Krebs buffer and release of 6-keto-prostaglandin F1 alpha, thromboxane B2 and prostaglandin E2 was assayed by radioimmunoassay. Minimal intimal histologic changes were seen in the aorta of three cocaine-treated rabbits. At 12 weeks 6-keto-prostaglandin F1 alpha was increased in the cocaine group (p = 0.063) as compared with levels in the control group. When rabbits killed at 6 and 12 weeks were considered together, increases in thromboxane B2 (p = 0.044) and a trend to increased prostaglandin E2 (p = 0.083) were seen in the cocaine group. The ratio of thromboxane B2 to 6-keto-prostaglandin F1 alpha was increased in the cocaine group compared with that in the control group (p less than 0.02). These data suggest that an increase in prostaglandin production occurs in the vascular endothelium of rabbits ingesting cocaine before gross histologic changes are evident. In addition, thromboxane B2 increases disproportionately with respect to 6-keto-prostaglandin F1 alpha, suggesting that a milieu for thrombosis may exist in users of cocaine.

Measurement of coronary flow using high-frequency intravascular ultrasound imaging and pulsed Doppler velocimetry: in vitro feasibility studies

The recent development of intravascular ultrasound imaging offers the potential to measure blood flow as the product of vessel cross-sectional area and mean velocity derived from pulsed Doppler velocimetry. To determine the feasibility of this approach for measuring coronary artery flow, we constructed a flow model of the coronary circulation that allowed flow to be varied by adjusting downstream resistance and aortic driving pressure. Assessment of intracoronary flow velocity was accomplished using a commercially available end-mounted pulsed Doppler catheter. Cross-sectional area of the coronary artery was measured using a 20 MHz mechanical imaging transducer mounted on a 4.8 F catheter. The product of mean velocity and cross-sectional area was compared with coronary flow measured by timed collection in a graduated cylinder by linear regression analysis. Excellent correlations were obtained between coronary flow calculated by the ultrasound method and measured coronary flow at both ostial (r = 0.99, standard error of the estimate [SEE] = 13.9 ml/min) and distal (r = 0.98, SEE = 23.0 ml/min) vessel locations under steady flow conditions. During pulsatile flow, calculated and measured coronary flow also correlated well for ostial (r = 0.98, SEE = 12.7 ml/min) and downstream (r = 0.99, SEE = 9.3 ml/min) locations. That the SEE was lower for pulsatile as compared with steady flow may be explained by the blunting of the flow profile across the vessel lumen by the acceleration phase of pulsatile flow. These data establish the feasibility of measuring coronary artery blood flow using intravascular ultrasound imaging and pulsed Doppler techniques.