Public Health and Nursing

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Environmental and Occupational Pollutants and Their Effects on Health among Brick Kiln Workers
(Scientific Research, 2016-12) Sanjel, Seshananda; Thygerson, Steven M.; Khanal, Sanjay N.; Joshi, Sunil Kumar
The ever expanding traditional brick industry in Nepal is a labour intensive, low technology activity found in the Kathmandu Valley and Terai regions of Nepal. While environmental pollutants associated with brick making have been characterized, the effects of these pollutants on the workers themselves have received relatively little attention. This review attempts to summarize and interpret the available recent evidences characterizing the extent of exposure to risk factors and health problems of brick kiln workers.
Health Hazards of Solvents Exposure among Workers in Paint Industry
(Scientific Research, 2013-12) Hassan, Aida Abd El Hamid; Elnagar, Safaa Abd El Moez; El Tayeb, Ihab Mohammadi; Bolbol, Sara Abd El Halim
Background: Paints and coatings include paints, varnishes, lacquers, stains, printing inks and more. A wide variety of volatile solvents are used in paint and coating manufacturing including aliphatic and aromatic hydrocarbons, alcohols, ketones and consist of more than 30% of most of paints. At low or moderate concentrations, the organic solvents may cause transient symptoms such as euphoria, headache and dizziness. At high concentrations, anaesthesia and disturbances in respiration and circulation may occur and may lead to death. Long-term exposure may cause damage to the Central Nervous System (CNS), such as cognitive and emotional deficits. Methods: A cross sectional study was conducted among 92 male workers exposed to organic solvents on performing their job in Koratol Paint Factory in Alaama Village in Sharkia Governorate. Another group of 95 workers, not working with organic solvents were selected from the Faculty of Medicine in Zagazig University and considered as a control group. All participants in the study were subjected to a pre-designed questionnaire to collect information about personal, socio-demographic data, occupational history, use of personal protective equipments, frequently perceived health complaints which included irritation symptoms (skin, eye and nose) and Questions of the validated questionnaire for the neuropsychological symptoms (Q22). Results: The neuropsychological symptoms score (Q22) revealed that 63.04% of solvents exposed paint manufacturing workers had neuropsychological symptoms, compared to about only 2.1% in control group and the difference was statistically significant. Regarding the relation between types of job done and results of neuropsychological symptoms score (Q22) there was increased risk for neuropsychological symptoms in production group than packing group (OR = 13.94) and for the duration of work the risk increased in workers with duration over 15 years (OR = 32.84). Logistic regression analysis showed that the most important predictors of neuropsychological symptoms were the type of job performed by the workers such as production or packing and their duration of work ≥15 years. Conclusions: The paint industry workers were at increased risk of several irritant and neuropsychological symptoms which significantly related to exposure to paint and organic solvents.
Effect of Nanoparticles Reinforced Adhesive Layers on Microleakage of Tooth Restorations
(Scientific Research, 2016-06) Ebrahim, Mohamed I.; Ahmed, Mohamed Ashour; Felemban, Nayef H.
Adhesive layer is an essential part of tooth colored restorations which play an important role in decreasing the microleakage between the tooth and restoration material after polymerization shrinkage. The purpose of this study was to evaluate the effect of deferent adhesive system of bonding agent on microleakage of nanocomposite resin in class II cavities. Two different types of adhesive systems: universal adhesive (ExciTE) and a newly developed adhesive (Nano-Bond) and one type of light-cured resin restorative material (nanocomposite resin) were used in this study. These adhesives were applied to prepared tooth cavities by either manufactures’ instructions or by an experimental method (single or double application). Nanocomposite resin was then placed and light-cured for 40 seconds. Teeth were subjected to 500 thermal cycles between 5° C and 55° C and were immersed in 3% methylene blue solution for 24 hours; microleakage was observed microscopically. The data were analyzed by a two-way ANOVA. For comparison between groups, Tukey’s post-hoc test was used. Nanoparticles reinforced adhesive system shows low microleakage in compare with universal adhesive system, and application of two adhesive layers also can decrease the microleakage. The ability of stress absorption by adhesive layer after polymerization shrinkage of restoration material will reduce the microleakage.
Effects of Mild and Severe Knee Joint Pain on the Frequency of Falls and Fall Risk in Elderly Females
(Scientific Research, 2014-10) Sugiura, Hiroki; Demura, Shinichi
This study aimed to examine differences in the frequency of falls during the past year and fall risk among 392 elderly females was categorized into five groups on the basis of the knee pain experienced: no knee pain, mild unilateral knee pain, mild bilateral knee pain, severe unilateral knee pain, and severe bilateral knee pain. The subjects participated in a fall risk survey comprising 50 items representing five risk factors: “symptoms of falling”, “disease and physical symptoms”, “environment”, “behavior and character”, and “physical function”. The frequency of falls during the past year, score for each risk factor, and the total fall risk score were not significantly different between the mild unilateral and mild bilateral knee pain groups, and between the severe unilateral and severe bilateral knee pain groups. Therefore, these groups were pooled to form a mild knee pain group and a severe knee pain group and analyzed. The severe knee pain group had experienced a significantly greater number of falls during the past year compared with the no knee pain group. Furthermore, the symptom of falling score was significantly higher in the severe knee pain group than in the no knee pain group, while the disease and physical symptoms score was significantly higher in the mild and severe knee pain groups than in the no knee pain group. The physical function score and total fall risk score were significantly higher in the following order: the severe knee pain group, the mild knee pain group, and the no knee pain group. Our results indicate that for elderly females who can achieve ADL independently, the degree of knee pain (mild or severe) has a marked effect on fall risk, irrespective of laterality of the pain (unilateral or bilateral). Factors such as symptoms of falling, disease and physical symptoms, and physical function are also related to fall risk in this population. Furthermore, elderly individuals with severe knee pain experience frequent falls.
Non-Operative Management of Hip Osteoarthritis
(Scientific Research, 2015-04) Marks, Ray
This paper reviews several non-operative and non-pharmacologic management strategies advocated for alleviating the pain and disability experienced by people with hip osteoarthritis. It analyzes whether painful debilitating hip osteoarthritis, which has no effective cure and is often progressive, may be affected positively by non-operative interventions designed to control osteoarthritis pain. Finally, it provides an integrated plan of management for ameliorating hip osteoarthritis pain and disability in light of this knowledge.
Assessment of Relationship between Pain and Anxiety Following Dental Extraction—A Prospective Study
(Scientific Research, 2015-07) Sharma, Shalender; Majumder, Kaberi; Rao, J. K. Dayashankara; Arya, Varun; Siwach, Vijay; Gulia, Sunil
Objective—Anxiety and expected dental pain are the main reasons for avoiding any dental treatment by general population. In this study, we aimed to evaluate the various factors which can increase the anxiety and its association with pain perception of patients following dental extraction. Material and Methods—We had included 100 patients in our study who were undergoing orthodontic treatment and required extraction of either 34 or 44. Pain and anxiety levels after extraction were assessed with a visual analog scale (VAS) and an anxiety questionnaire consisting of eleven questions. Results—The mean VAS score for the entire study group was 16.23 ± 1.28 with statistically significant differences between genders, and was high in females and no statistically significant differences between different age groups. The mean anxiety score was 10.64 ± 3.12. This was significantly higher in women (P = 0.005), but there was no statistically significant differences between different age groups. There was a statistically significant correlation between VAS and total anxiety score (P < 0.001) as well as each question, except for question number 4, 8 and 9 in men. Conclusion—Although most patients had experienced limited pain, there was a significant gender difference in pain and anxiety level. They were anxious because they expected pain, women being more anxious than men. The most provoking factor for anxiety and pain while going for extraction in females was “being seated in dental chair”, while in men the most provoking factor was “uncertainty about proper numbness before extraction”.
Differential Diagnosis of Post-Procedural Skin Lesions: A Case Report
(Scientific Research, 2016-01) Waghray-Penmetcha, Taruna; Li, Sam; Puranik, Rohit; Torres, Maria L.
Skin reactions caused by interventional pain procedures are well documented in literature, ranging from fistula formation to urticarial allergic reactions and infections. Burn lesions may also occur, however far less common; and as pain physician we must be cognizant of this possible complication and its etiologies. This is difficult in an outpatient setting where a patient cannot be regularly monitored, their adherence to prescribed therapies is unclear, and reporting is often done via phone, ancillary staff, and outside facility records. These compounding factors require clinicians to consider a broad differential and be comfortable with instituting myriad therapies or appropriately involve outside consultation for thorough patient care.
Prescribing Pattern for Skin Diseases in Dermatology OPD at Borumeda Hospital, North East, Ethiopia
(Scientific Research, 2018-01) Tegegne, Abebaw; Bialfew, Fentaw
Introduction: Skin diseases are the major contributors of disease burden in society. Dermatological therapy ultimate goal is achieved by administering the safest and least number of drugs. The problem gets compounded with the inappropriate and irrational use of medicines. Therefore, periodic prescription audit in the form of prescribing patterns is away to improve irrational prescription. The objective of this study to assess the prescription patterns of dermatological agents in Borumeda hospital. Method: Hospital based retrospective cross sectional study in which prescribing patterns of dermatological agents are assessed. A total of 385 samples of patient record prescription from November/1/2016 to December/30/2016, and the sample were selected by systematic random sampling technique. Sample prescriptions were reviewed using structural data collection format. The Collected data was analyzed by using SPSS version 20. Result: Regarding rout of administration, the maximum number of drugs was prescribed topically (66.2%). Topical steroids were the most commonly prescribed drugs (25.3%). Use of generic prescribing in single drug prescribing was 81.7%. The prevalence of atopic dermatitis was higher (26.3%, 20.8%) in both male and female respectively followed by scabies in male with 12.2% and Acne vulgaris (12.9%) in female. Number of drugs per prescription was higher (2.46) than WHO standard (<2). Conclusion: The current study reveals that topical corticosteroids were commonly prescribed drugs in the dermatology unit and the prescribing practice imitates incidence of polypharmacy.
Evaluating the effects of pain and disorders of the knee joint on knee extension strength and daily life activities in the female elderly
(Scientific Research, 2013-10) Sugiura, Hiroki; Demura, Shinichi; Takahashi, Kenji
This study aimed at examining the differences in leg strength and activities of daily living (ADL) ability among groups with various knee problems. The subjects consisted of 328 elderly females who were classified into three groups: those without knee pain or a knee disorder, those with knee pain, and those with a knee disorder. The subjects took a knee extension strength test and an ADL survey. Knee extension strength and ADL scores (total score and each domain score of the motions of locomotion, posture change, stability, and manipulation) were selected as the evaluation parameters. The knee extension strength, total ADL score and each domain score of the motions of locomotion, posture change, and stability ranged from low to high in the following order: the group with a knee disorder, the group with knee pain, and the group without pain or a knee disorder. Moreover, manipulation scores were significantly inferior in the group with a knee disorder compared with the other two groups. In conclusion, the female elderly with knee pain or a knee disorder have inferior knee extension strength and ADL with respect to the motions of locomotion, posture change and stability. In addition, with regard to knee extension strength with respect to the above three motions, the elderly with a knee disorder have inferior scores when compared with the elderly who have only knee pain; thus, they find it difficult to perform activities involving the knee joints.
Pain Hypersensitivity: A Bio-Psychological Explanation of Chronic Musculoskeletal Pain and Underpinning Theory
(Scientific Research, 2014-04) Uddin, Zakir; MacDermid, Joy C.
Hypersensitivity is a phenomenon that has a dual role: adaptive (protective) and maladaptive (pathological) based on different aspects of the pain mechanism. The mechanism of hypersensitivity has not been fully defined. However, it is known that over-excitability (too much sensitivity) of neurons can arise in both peripheral and central components of the nervous system. Pain theories can be useful in helping to explain complex phenomenon like hypersensitivity. The Gate control theory and other more bio-psychological pain models may assist us to understand a mechanism of chronic musculoskeletal pain. This article discusses a mechanism based pain model.
Melatonin in Pain Modulation: Analgesic or Proalgesic?
(Scientific Research, 2014-04) Liu, Yongliang; He, Hongwen; Huang, Fang
Melatonin, as an endogenous hormone produced mainly in the pineal gland in a clear circadian fashion, has diverse physiological functions, such as the control of circadian rhythms, sleep regulation, antioxidant, etc. Recently, accumulating researches about melatonin and pain have been reported. In this review, comparison and summary about analgesic/proalgesic effect of melatonin in inflammatory and neuropathic pain will be made. Some possible pathways of melatonin involved in dual pain modulation might help to explain all these conflicting results in various situations.
Electrical Activities and Pressure Pain Threshold in Oral Contraceptives Users and Nonusers
(Scientific Research, 2014-04) Turcio, Karina Helga Leal; Garcia, Alício Rosalino; Zuim, Paulo Renato Junqueira; Sundefeld, Maria Lucia Marçal Mazza; Goiato, Marcelo Coelho; dos Santos, Daniela Micheline
The aim is to evaluate the influence of oral contraceptive intake and menstrual cycle on the electrical activity and pressure pain threshold from anterior temporal and masseter muscles. Twenty-eight women on reproductive age were selected, 13 OC users and 15 nonusers. They were weekly submitted to electromyography and algometry of the anterior temporal and masseter muscles during three consecutive menstrual cycles. Electrical activities at rest position and PPTs of temporal and masseter muscles were not affected by menstrual cycle or by OCs uses. Comparison between groups demonstrated that working side electrical activity was increased in OC users in both muscles, except during lutheal phase for the anterior temporal. However, comparison within weeks did not demonstrate statistical difference. It was suggested that, in healthy women, oral contraceptive use may influence electrical activity, but different phases of the cycle may not.
Adenocarcinoma of the Appendix
(Scientific Research, 2018-03) Sylla, Moussa; Ossibi, Pierlesky Elion; Tenkorang, Somuah; Dandakoye, Ismael; Majdoub, KarimIbn; Toughrai, Imane; Laalim, Said Ait; Mazaz, Khalid
Objective: To report the experience of our department on adenocarcinoma of the appendix through a series of six (6) cases. Materials and Methods: This is a retrospective study carried out from January 2010 to June 2015 collating all cases of adenocarcinoma of the appendix diagnosed at the department of visceral surgery B in Hassan II University Hospital in Fez. Results: Six cases of adenocarcinoma of the appendix were recorded during the determined period of study. The mean age was 54.67 ± 16.99 years with the extreme ages ranging from 28 to 78 years. There was a female predominance with a sex ratio of 2. All patients had no specific medical history. The revealing symptoms were the following: appendicitis syndrome (1 case), bowel obstruction (1 case), psoas abscess (1 case) and fortuitous discovery during laparotomy for another problem (3 cases). The following histological types found were: colloid adenocarcinoma (3 cases), mucinous adenocarcinoma (2 case), mucinous cystadenocarcinoma associated with a moderately differentiated adenocarcinoma of the appendix (1 case). The surgical procedure consisted of a right hemicolectomy in 3 patients. Appendectomy followed by a right hemicolectomy and drainage of psoas abscess was performed in two patients. Palliative ileocecal resection and Bouilly-Volkmann ileocolostomy was performed in one patent who had carcinosis. All patients received adjuvant chemotherapy. The following occurred during follow-up: carcinosis (2 patients), a locoregional recurrence (2 patients). Two patients never returned for follow-up. Conclusion: Tumor of the appendix is a rare and exceptional pathology. These tumors are generally discovered fortuitously or during histology of appendectomy specimens. The treatment is usually surgical.
Child Abdominal Trauma Due to Attack of Cattles While Working on Farms in Burkina Faso
(Scientific Research, 2017-11) Ouedraogo, Souleymane; Zaré, Cyprien; Zida, Maurice; Savadogo, Julien T.; Windsouri, Mamadou; Ouangre, Edgar; Bandre, Emile; Traore, Simon S.
Introduction: Cattle are strong animals very often used in agriculture in rural Africa. Unpredictable in their behavior, they regularly inflict injuries to farmers, some of whom are children in rural Africa. Objective: The purpose of this study was to describe the clinical, therapeutic and evolutionary aspects of abdominal trauma caused by bovidae to children on farms in Burkina Faso. Patients and Method: This is a descriptive study covering the period from January 2014 through December 2016 and was conducted in the General Surgery Unit of the Tenkodogo Regional Hospital in Burkina Faso. It included all patients under the age of 17, victims of abdominal trauma by cattle on farms. Result: A total of 68 patients were identified, which is 3% of all patients under 17 admitted to the service during the same period. The average age of patients was 10.5 years, with a standard variation of 3.6 years. The majority (73.5%) of the patients were boys. The main lesional mechanisms found were horn strokes (88.2%). We noted 35 eviscerations without visceral perforation, 15 intestinal perforations, 6 hepatic wounds and 5 splenic wounds. In 7 cases, there were non-penetrating wounds. All patients underwent surgical intervention under anesthesia. The average length of hospital was 6 days. Two deaths were recorded, making a mortality rate of 3%. Conclusion: Abdominal traumas of the child by attack of cattle are frequent during farm works in rural Burkina Faso. The injuries are sometimes serious. Wearing protective equipment for children should be considered during farm work.
Endoscopic Thyroid Lobectomy via Axillary-Breast-Shoulder Approach versus Open Thyroid Lobectomy
(Scientific Research, 2018-01) Reunmarkkaew, Donyarat; Sittitrai, Pichit
Introduction: The aim of the study was to compare the feasibility and safety of endoscopic thyroid lobectomy via axillary-breast-shoulder approach (ET via ABS) with a conventional open thyroid lobectomy (OT). Methods: From November 2014 to December 2015, 20 patients with unilateral benign thyroid nodules were treated with ET via ABS and another 20 patients were treated with an OT. We analyzed the clinical characteristics postoperative complications, pain, and patient satisfaction. Results: No statistically significant differences occurred between groups except the mean ages of the OT group and the ET via ABS group were 55 and 44 years, respectively (p = 0.015). The mean operative time was almost the same in both groups (116 min in the OT group and 114 min in the ET via ABS group). Blood loss was significantly higher in the OT group than in the ET via ABS group (p = 0.042) but postoperative drainage was detected more in the ET via ABS group (p < 0.001). Early postoperative pain was significantly less in the ET via ABS group (p = 0.026). The hospital stay was three days in OT group and four days in ET via ABS group (p = 0.909). Postoperative complications such as hematoma, hoarseness, dysphagia, and prolonged subcutaneous emphysema were detected only in the ET via ABS group but without statistical difference. More patients were “very satisfied” with the treatment in the ET via ABS group than in the OT group. Conclusion: The ET via ABS is as safe and effective as the OT for patients with unilateral thyroid nodules. With less early postoperative pain and higher patient satisfaction, this endoscopic thyroidectomy approach should be considered in patients who concern about cosmetic results.
Laparoscopic vs. Robotic Approach to Partial Colon Resection
(Scientific Research, 2017-08) White, Jordan L.; Buzad, Francis A.; Patel, Herschel B.
We retrospectively collected data on 130 minimally invasive colon resection cases performed by the same surgeon from April 2005 to February 2017, of which 35 were completed laparoscopically and 95 were completed robotically. The first 30 robotic cases were allocated to a Training group to account for the learning needed to stabilize operative ability. The 35 laparoscopic cases and 65 of the 95 robotic cases, starting with the 31st case, were compared. Robotic partial colon resection was significantly more capable than the laparoscopic approach in limiting blood loss (p < 0.05) during the procedure, lessening conversion to a traditional open approach (p < 0.05), and produced a quantitatively larger lymph node harvest (p < 0.05). Patients of robotic cases also had overall shorter hospital stay (p < 0.05). Laparoscopic cases were significantly shorter in terms of operation time (p < 0.05). Laparoscopic and robotic approaches had similar rates of several aspects of morbidity and mortality. The robotic approach to partial colon resection is a technically capable modality of operation intraoperatively, as shown by increased lymph node harvest and less blood loss, and may provide some benefits to patients postoperatively, evidenced by shorter hospital stays, and potentially an oncologic benefit by obtaining higher lymph node harvest in cancer cases. Another benefit of the implementation of a robotic approach is the increased number of patients that are eligible for and ultimately undergo a safe and successful minimally invasive surgery as compared to a more traditional surgical approach.
The Incidence of Splenic Injury Following Blunt Abdominal Trauma (BAT), Sultan Qaboos University Hospital Experience
(Scientific Research, 2017-07) Al-Busaidi, Abdullah; Al-Shafei, Tariq; Al-Moqbali, Huda; Al-Kindi, Sara; Al-Saadi, Mohammed; Al-Busaidi, Nadya; Al-Qadhi, Hani
The aim of the study was to review traumatic splenic injury following blunt abdominal trauma (BAT), during the period from January 2009 to January 2015 at SQUH. The data for this study was retrospectively collected. It included 768 patients admitted to SQUH general surgery department following BAT. 43 patients with splenic injury were identified (34 males, 9 females). The mean age of patients with splenic injury was 36.0 years (34.4 years for males, 42.1 years for females). The most common mechanism of injury was motor vehicle collision (90.7%). Grade I, II are the most common grades of splenic injury. Non-Omani patients accounted for (51.2%) and most of them were pedestrians at the time of trauma. Ribs fracture is the most common injury associated with splenic injury. 36 (83.7%) patients were managed conservatively and 7 (16.3%) patients were splenectomized. Angioembolization was done for 11 (30.6%) patients. Despite the small population of Oman, high incidence of motor vehicle collision (MVC) increases the incidence of splenic injury among young age group.
A Comparison of Perioperative Blood Transfusions and Other Complications Following Transverse Rectus Abdominis Myocutaneous Flaps versus Deep Inferior Epigastric Perforator Flaps
(Scientific Research, 2017-03) Amaratunga, Rajith A.; Soliman, Bishoy; Lam, Thomas C.
Objective: Abdominal based free flaps such as the Transverse Rectus Abdominis Myocutaneous (TRAM) flap and Deep Inferior Epigastric Perforator (DIEP) flap are essential tools in the reconstructive armamentarium post mastectomy. These reconstructions are often prolonged, complex and associated with complications. This study aims to compare the complication rate, particularly focusing on perioperative transfusions, between TRAM and DIEP flaps performed by the senior author in our tertiary referral centre. Methods: A retrospective review was conducted of one hundred and seven consecutive TRAM and DIEP flaps from 2000 to 2014. The two groups were analysed for demographics, preoperative risk factors and post-operative complications including blood transfusions, haematomas, flap losses, redo-anastomoses, flap infections, abdominal wound sequelae and non-surgical complications. Results: Sixty-three patients underwent 67 free/muscle sparing TRAM flaps and 35 patients underwent 40 DIEP flaps. There were no statistically significant differences in patient demographics or preoperative risk factors between the two groups. Five TRAM flap cases (7.9%) required transfusion whilst no DIEP flap cases required transfusion. This difference was not found to be statistically significant (p = 0.16). However, free/muscle-sparing TRAM flaps were found to have a significantly higher overall complication rate compared to DIEP flaps (23.8% vs. 5.7%, p = 0.02). Conclusion: The current study demonstrated no difference in perioperative transfusion requirement between TRAM and DIEP cases. There was however a significantly higher rate of overall complications associated with TRAM flaps warranting the authors to conclude that care be taken when opting for this reconstructive method.
Evidencing Personal & Professional Development, Perspective of a Surgical Trainee
(Scientific Research, 2016-03) Kaleem, A. Z.; Naheed, N.; Ahmad, S. M.
Introduction: The author strongly believes that there is a continuous need for personal and professional development in order to keep and improve an individual career path way. It is also imperative to provide evidence of these acquired skills and attributes. According to General medical council, it is a responsibility of every doctor to be competent and up to date. This should be achieved by regularly taking part in activities that maintain and further develop competence and performance. This in turn ensures safety and care to patients [1]. Methodology: The author has had excellent opportunities in his career to participate in diverse personal and professional development programmes. It was important to participate in these programmes to achieve career progression. He would like to share three recent activities from his curriculum vitae which resulted in his significant personal and professional development. The author also had his revalidation last year and found to be fit to practice for next 5 years till next revalidation. The author followed an agreed action plan with his supervisor to accomplish this work. Realistic goals and time frame was set with the help of supervisor. Subsequently, the author had a chance to critically analyse below mentioned three different activities, in order to explore all the achieved learning themes behind these events. The author was fortunate enough to be involved into three different personal and professional development programmes. Firstly, he managed a regional colorectal conference and attained an excellent management experience from that conference. He learnt a lot about better time management. He came to know about different management theories and models and is now able to use these theories for his future management responsibilities. Then he had a communication challenge and difficulty in theatre. He was able to resolve that issue with his strong communication skills. He developed his communication skills and assertiveness with the help of this first-hand experience and different communication models. Lastly, the author had a wonderful opportunity to demonstrate and develop his leadership and team working skills in an International Conference. He realized that leader needs to be a role model for his team and should be leaded by his example. He observed and demonstrated different roles of a leader according to needs of his team. He also learnt about different leadership theories and models. He also acquired a good understanding of a team development. Conclusion: It is extremely important for every health care individual to have personal and professional development. The author recommends that lessons learnt from the author’s experience and results can be applied in a broad generalised way to achieve development. It is crucial for us to keep a structured record of this development and provide evidence of the improvement. In short, it was an extremely useful exercise for the author that resulted in significant lifelong development in his management, communication and leadership attributes.
Risk Factors for Surgical Site Infection after Hip Arthroplasty: A Multicentric Study
(Scientific Research, 2016-02) Tofani, Gabriel B.; Irffi, Gustavo P.; Silva, Lucas F.; da Silva, Cynthia C. M.; Couto, Bráulio R. G. M.; Miranda, Gilberto D.; Starling, Carlos E. F.
The objective of this study is to answer three main questions: What is the risk of wound infection for patients undergoing hip arthroplasty? What are the main etiologicagents of surgical site infection (SSI)? What are the risk factors most associated with surgical site infection? Method: This was a multicentric, retrospective cohort study which analyzed data collected in five general hospitals in Belo Horizonte, Brazil, between the period of January 2009 and December 2013. The continuous parameters studied were age, length of hospital stay before surgery, duration of surgery, number of professionals at surgery and number of hospital admissions. Categorical variables were surgical wound classification (clean, clean contaminated, contaminated, dirty/infected), American Society of Anesthesiologists (ASA) score (I, II, III, IV, V), type of surgery (elective, emergency), general anesthesia (yes, no), prophylactic antibiotic (yes, no), trauma surgery (yes, no) and Nosocomial Infections Surveillance (NNIS) risk index (IRIC = 0, 1, 2, 3). Results: Estimated SSI risk was 3.2% (95% C.I. = 2.6% to 4.1%) and risk of osteomyelitis was 0.6% (95% C.I. = 0.4% to 1.1%). ASA score > 2, general anesthesia, length of hospital stay before surgery higher than four days, more than two professionals at surgical field and duration of surgery higher than five hours were risk factors for SSI after hip prosthesis (p < 0.05). The final multiple logistic regression analysis indicated that the modified NNIS risk was independently associated with surgical site infection after arthroplasty of hip. Conclusion: Despite the modified NNIS index being a risk factor for SSI, none of its independent variables was statistically significantly in the logistic model (p > 0.100). Each modified NNIS risk category increased the chance of a patient being infected by almost three times, when compared with the previous category (OR = 2.82; p = 0.011).

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