Surgical site infections (SSI) greatly concern clinicians, as they are associated with significant morbidity and mortality, prolonged hospitalization, and costs. Antibiotic prophylaxis plays a pivotal role among the procedures that are usually employed for the prevention of surgical-related infections. This narrative review aims to cover some of the particular situations when the clinician might consider individualizing antibiotic prophylaxis for a patient. With the rising incidence of multi-drug resistant bacteria carriage among not only hospitalized or institutionalized patients but also patients from the community, there might be a tendency to use extended-spectrum antibiotics for longer periods for surgical infection prevention. However, the inappropriate use of antibiotics increases the selection pressure, thus favoring the spreading of resistant bacteria. Moreover, specific patient characteristics or pathologies might need to be considered to customize the type, dose, or length of administration of an antibiotic as surgical prophylaxis. Using prosthetic material or prolonged surgeries with large fluid shifts are other situations when individualized antibiotic prophylaxis might be thought of. Keeping in mind that it is of utmost importance that everyone adheres to the current guidelines for surgical antibiotic prophylaxis, customization of local protocols according to well-thought-out strategies might prove beneficial in SSI prevention.
Background and Aim: Abdominal compartment syndrome is a life-threatening complication that can occur in trauma patients and greatly increase their mortality. Although there is a better scientific understanding of the general phenomena involved in the pathogenesis of this complication, the particular risk factors and their implications in the trauma patient population are yet to be deciphered. Methods: The authors conducted research through 3 electronic databases (PubMed, Scopus, and ScienceDirect) using the following search formula: “(ACS OR abdominal compartment syndrome) AND (*trauma*) AND (risk factor)”. Subsequently, additional search formulas were used, including the risk factors taken into consideration (i.e. “shock”, “hypotension”, “acidosis”, “base deficit”, ”coagulopathy”, “retroperitoneal hematoma”, “HOB elevation”, “fluid resuscitation”, “damage control laparotomy”). Results: Throughout the 41 articles analyzed in this paper, 7 risk factors transcended and were further discussed: head of bed elevation/patient positioning, fluid resuscitation, the “lethal triad” of acidosis hypothermia and coagulopathy, Damage Control Laparotomy, shock/hypotension, retroperitoneal hematoma and demographics (age, gender, and race). Conclusions: To summarize, many potential risk factors were evaluated for the envisagement of the present paper, but the ones that prevailed the most were excessive fluid resuscitation, shock/hypotension, retroperitoneal hematomas, and the lethal triad. Consistent with other studies, no connection was found between age, gender, or race and the development of ACS. Further studies should focus more on the likely involvement of damage control laparotomy and patient positioning, as well as hypocalcemia, in the unfolding of ACS in trauma patients.
Along with the advances in medical science, surgical methods have also undergone many advances. Today, with the advancement of technology in all fields, including medicine, robots have entered medical science. These robots have many uses as well as advantages and disadvantages that they enjoy in Iran and other countries. In this study, it was addressed. This study is a review of robotic surgery methods in Iran and other countries in the form of a review study. This study is a conceptual review. The steps performed are 1- Designing a research question, 2- Searching and extracting research- related studies, 3- Selecting related studies, 4- Tabulating and summarizing information and data, and 5- Reporting results. The results showed that robotic surgery in operations such as brain, kidney, open heart, liver, eye, laparoscopy, dental surgery, coronary artery surgery, hysterectomy, lymphadenectomy, general surgery, obstetrics, head and neck, shelf Chest, urology, endoscopy, colonoscopy, ear, nose, and throat are used and have advantages such as three-dimensional vision, flexible rotation of the instrument, reduction of surgeon hand vibration with vibration filter, ease of surgery and the ability to create the required patterns It reduces the volume of blood lost during surgery, the length of stay in the hospital, the amount of pain, and subsequently the number of analgesic doses consumed in the postoperative ward. Disadvantages include the relative increase in operating time, the high cost of robots, and the physician's lack of sensory perception of the patient's environment.
Commentary
Analysis of neuroprotective medication in patients with neurocognitive disorders: The efficacy and tolerability of highly purified animal tissues extracts
Octavian Vasiliu