Fascia iliaca and pericapsular nerve group blocks may bring pain relief in patients undergoing Hip replacement

Patients who receive hip arthroplasty may have moderate to severe pain after surgery, which might negatively impact their long-term prognosis and increase their risk of perioperative complications. Treatments for regional anaesthesia, such as fascia iliaca compartment block (FICB) and pericapsular nerve group block (PENG), improve functional ability and quality of life.

However, there is now little data to refute the analgesic benefits of these techniques. Twelve randomised controlled trials (RCTs) were included in this recently published systematic review and meta-analysis to evaluate the relative efficacy of pericapsular nerve group block (PENG) and fascia iliaca compartment block (FICB) for patients undergoing hip replacement surgery. The primary outcome was the pain score (1–10) using the visual analogue scale (VAS) or numeric rating scale (NRS) at rest and during movement after a 24-hour period. The GRADE method was used to evaluate the data, and it was found that there was intermediate quality evidence for pain ratings at rest and during movement over a period of 30 to 24 hours. PENG block indicated improved analgesia in 30 minutes during movement and during rest, and a 24 hour decrease in postoperative opioid consumption, with a fair degree of confidence in the findings. The study found that PENG block was more effective than suprainguinal or infrainguinal FICB at rest and during movement within 30 minutes. Peripheral nerve blocks are preferred over regular intravenous opioids in the better recovery after surgery protocol because they may decrease pain, speed up the mobility and usage of opioids, and lower the risk of side effects in the early postoperative phase.

Reference –

Prakash, Jay; Rochwerg, Bram1; Saran, Khushboo2; Yadav, Arun K.3; Bhattacharya, Pradip Kumar; Kumar, Amit4; Chaudhuri, Dipayan1; Priye, Shio5. Comparison of analgesic effects of pericapsular nerve group block and fascia iliaca compartment block during hip arthroplasty: A systematic review and meta-analysis of randomised controlled trials. Indian Journal of Anaesthesia 67(11):p 962-972, November 2023. | DOI: 10.4103/ija.ija_672_23.

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Thyroid test not done before IVF Procedure: AIIMS Delhi held negligent, slapped compensation

New Delhi: The State Consumer Disputes Redressal Commission, Delhi recently held the All India Institute of Medical Sciences (AIIMS) guilty of medical negligence while providing In Vitro Fertilization (IVF) treatment to a patient.

Despite undergoing the IVF procedure twice, the complainant could not conceive. She alleged that the treating doctors at the hospital failed to prescribe the necessary Thyroid test before undergoing the procedure.

AIIMS has been directed by the Commission to pay Rs 2.5 lakh compensation (including the cost of treatment spent for IVF) to the Complainant for the suffering, mental pain and agony caused.

The Commission opined that there was sheer negligence on the part of the hospital as the patient was not treated with due care and caution by the hospital and the treatment was not done in accordance with the medical practice followed by the doctors while treating the patient of similar condition and age.

The matter goes back to 2008 when the complainant approached AIIMS hospital to undergo the necessary treatment to overcome infertility and to have a child. After the preliminary tests and examinations under the guidance of the HOD Gynae, the complainant was advised to opt for In Vitro Fertilization (IVF) and accordingly, she got admitted to the hospital on 07.01.2008 and a team of doctors was engaged to start laparoscopy and a mandatory process before the IVF i.e. Mock ET on 26.03.2008. Consequently, the IVF process was conducted by the operating doctor on 01.12.2008.

Following this, the patient was discharged on the same day after charging an amount of Rs 60,000 for the said process. However, allegedly, the Thyroid-test, which is necessary in cases of fertility was not done or advised by the operating doctor before commencement of the treatment.

The second plan for IVF was adopted beginning on 20.05.2010 with the help of frozen embryo. However, the doctors failed to advise the Thyroid Test before undergoing the method adopted and therefore, no positive result came out from the second IVF process, alleged the complainant.

Thereafter, the third IVF process was proposed to be carried out on 21.04.2011. However, as the patient was putting on weight, she decided to go for the Thyroid Test through a pathology, from where she got to know that she was suffering from thyroid and therefore she consulted Dr. Ganpati, a specialist, who prescribed some medicines for the treatment of thyroid.

Once again the complainant approached AIIMS, where the operating doctor advised the Thyroid test and based on the report dated 27.06.2011. However, no such test was prescribed by them prior to such date, alleged the complainant. Losing all her faith in the hospital, the complainant deferred to go for the third IVF process.

It was alleged by the complainant that when she was admitted to AIIMS, the operating doctor should have, at the first instance, advised for the Thyroid-Test since it is crucial to know about the success rate of the IVF and the process should run accordingly. She alleged that there was clear negligence on the part of the hospital as the operating doctors also failed to conduct the required test during the second phase of IVF.

In her complaint, she pointed out that the success rate in the case of IVF is 25 to 30%. However, in the case when the patient is suffering from Thyroid, the success rate falls to 15%. However, no efforts were made by the hospital to advice for the Thyroid Test, alleged the complainant. 

Therefore, on these grounds mentioned above, the complainant alleged utter Medical Negligence on the part of the hospital and approached the State Consumer Court, Delhi. 

While considering the matter, the consumer court heard the complainant’s counsel and also perused the material available on record including the written arguments filed on behalf of the complainant and the hospital. In order to discuss in detail the scope and extent of Negligence with respect of Medical Professionals, the consumer court referred to the order in the case of Seema Garg & Anr. vs. Superintendent, Ram Manohar Lohia Hospital & Anr. decided on 31.01.2022.

In the concerned judgment, it was mentioned that in cases where the allegations are levelled against the Medical Professionals, negligence is an essential ingredient for the offence, which is basically the breach of a duty exercised by omission to do something which a reasonable man would do or would abstain from doing. However, negligence cannot be attributed to a doctor so long as he performs his duties with reasonable skill and competence and they are entitled to protection so long as they follow the same.

Referring to this order, the consumer court noted,

“In the present case also, it will have to be ascertained whether there was any lack of skill and competence on the part of the operating doctor and/or any omission to do what was actually required in the present facts and circumstances.”

The Commission observed that the complainant did not allege that the operating doctors did not have the requisite skill or competence or they were not qualified to operate on the complainant. The main complaint was that the treating doctors at AIIMS failed to do the thyroid test before doing the IVF procedure, noted the Commission.

At this outset, the Commission perused the discharge summary and noted,

“Therefore, in order to check whether there was an deficiency on the part of treating doctor, we have carefully perused the medical records filed by the Complainant and found that the treating doctor have prescribed certain tests before doing the first process of IVF and they were done before doing IVF, however, no Thyroid-test was done and prescribed by the treating doctors which can be clearly seen from the discharge summary available before us…”

Additionally, the consumer court found that the treating doctors while mentioning the history of patient have mentioned about the Thyroid-Test which was undertaken by the Complainant in the year 2004 and mentioned the readings as: T3-119.0, T4 – 6.54 and TSH – 4.38 which was normal.

Besides, the Commission also took note of the fact that the “…Thyroid function may indeed affect the process and success of in vitro fertilization (IVF) as the thyroid gland plays a crucial role in regulating metabolism and hormone production, and thyroid disorders can impact fertility in the patient. Additionally, Thyroid hormones, specifically thyroxine (T4) and triiodothyronine (T3), plays a role in regulating the menstrual cycle and ovulation. An underactive thyroid (hypothyroidism) or an overactive thyroid (hyperthyroidism) can disrupt the normal hormonal balance required for ovulation and the preparation of the uterine lining for embryo implantation and due to these reasons, it is important for individuals undergoing IVF to have their thyroid function evaluated and, if necessary, treated or managed before and during the IVF process. Further, if a thyroid disorder is diagnosed, appropriate treatment or medication may be recommended to bring thyroid function into the normal range.”

However, the Commission observed that the treating doctors have failed to diagnose the Thyroid function at the primary stage and it came to the knowledge of the treating doctor in the year 2011, when the Complainant opted to get herself checked for the Thyroid test. “Additionally, considering the age of the Complainant in the present case, it was clear to the treating doctor that the chances of getting the IVF successful in the present case is very low,” noted the Commission.

“Moreover, it is a well laid down principle that the doctor diagnosing upon a patient is the best judge of the treatment which is to be undertaken for that specific patient. There may be multiple approaches with which the patient may be treated upon, however, the doctor is expected to choose the most appropriate one in the given facts and circumstances. Hence, a higher degree of reliance is placed upon the concerned doctor, that whatever option he/she exercises will be for the benefit and interest of the patient. However, failure on the part of doctor in diagnosing the Thyroid function at the primitive stage has mentally and physically harassed the Complainant and her family,” it further added.

Finally, relying upon the Supreme Court order in the case of Jacob Mathew v. State of Punjab and Anr, Martin F. D’Souza v. Mohd. Ishfaq, and Kusum Sharma and Ors. (supra), the Commission opined that the approach in medical negligence cases should be “what was actually done by the doctor was not acceptable or generally used in the medical practices at the given point of time.”

Taking all these factors into account, the Commission opined that there was sheer negligence on the part of the hospital i.e. AIIMS

“as the patient (Complainant) was not treated with due care and caution by the Opposite Party no. 1 and the treatment was not done in accordance with the medical practice followed by the doctors while treating the patient of similar condition and age.”

Therefore, holding AIIMS negligent in providing its services to the Complainant and keeping in view the principles detailed above and the facts and circumstances of the case, the age of the patient, and other necessary and essential factors, the Commission opined it to be just and reasonable to award compensation of Rs. 2,50,000 (including the cost of treatment spent by the Complainant for IVF) to the Complainant for the suffering, mental pain and agony caused.

“The amount so awarded … be paid by the Opposite Party no. 1 being liable, within a period of three months from the date of present judgment i.e. on or before 29.02.2024, failing which, the Opposite Party no. 1 would be liable to pay the said amount alongwith the interest at the rate of 9% p.a. from 01.12.2008 (when the Complainant has undergone for the first IVF process) till the actual realization of said amount,” the Commission mentioned in its order.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/aiims-negligence-229143.pdf

Also Read: Treatment of patient based on telephonic advice from doctor constitutes negligence, opines NCDRC

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Dr YSR University of Health Sciences to hold 26th Annual Convocation In February 2024, details

Andhra Pradesh: Dr YSR University of Health Sciences has announced the conduction of the 26th Annual Convocation in the month of February 2024.

All the students declared successful in the respective examinations of the year 2021 are eligible to receive the Degree certificates “IN PERSON” or “INABSENTIA”. The last date for submission of filled in application forms is 05.01.2024. The students need to visit the official website of the university for the application form.

Filled-in application forms should be sent to the “CONTROLLER OF EXAMINATIONS” Dr. YSR University of Health Sciences, Vijayawada only on or before 05.01.2024. The envelope containing the filled-in application should be superscribed “26th Annual Convocation”.

Instructions to apply for degree certificates –

All the students declared successful in their respective regular examinations of the year 2021 pertaining to Super Specialty Degree, Post Graduate Degree, Post Graduate Diploma, and PhD courses are eligible to receive the Degree certificates “IN PERSON” or “IN ABSENTIA”.

All the Undergraduate students declared successful in their respective regular examinations of the year 2021, including internship, are eligible to apply for the award of Degrees “IN ABSENTIA” of the convocation only. Degrees will not be awarded “IN PERSON” for undergraduates.

Such students for whom compulsory internship is not applicable but have passed their respective regular examination of the year 2021 are eligible to receive the Degree Certificates “IN ABSENTIA” only.

The filled-in Application Form should be submitted in person or by post to the Controller of Examinations, Dr.YSR University of Health Sciences, A.P. Vijayawada, so as to reach on or before 05.01.2024 duly enclosing all the required documents and Demand Draft as directed in the instructions/guidelines given in the concerned application form.

Also Read:MUHS to hold its 23rd Convocation Ceremony in February, all details here

Applications received after 05.01.2024 will not be considered.

The exact date, time, and venue of the Convocation will be notified separately.

The candidates applying for Degrees “IN PERSON”, for the PhD, Super Specialty Courses, and Medal / Prize winners only will be called onto the dais to receive the Degrees / Medals / Prizes. All other candidates (post-graduates) have to receive the Degrees in their respective seats only and will not be called onto the dais during the Convocation. IN ABSENTIA Degrees will be sent to the candidate’s address by post.

Instructions/guidelines to the applicants –

Use capital letters only while filling out the application form. Applications must be routed through the Principal of the College where the candidate has studied the Super Specialty/ PG Degree/ PG Diploma/ PhD/ Under Graduate Degree Courses.

Full Name –

1. It should be written as spelled in the Intermediate or its Equivalent Certificate by those who are applying for UG Degree Certificates.

2. It should be written as spelled in the UG Degree Certificates by those who are applying for Super Specialty/PG Degree/PG Diploma/Ph.D. Certificates.

3. In case of those who want to obtain Super Specialty/PG Degree/ PG Diploma/PhD/UG Degree Certificates as per the changed Name / changed Surname, the Full Name must be written as spelled in the AP Gazette, Proceedings of the Dr. YSR University of Health Sciences or any other Competent Educational Authority.

Passport Size Photographs –

1. One photograph should be affixed on the Application Form duly attested by the Principal of the college where the applicant has studied and passed.

2. Two photographs should be kept in an envelope and are to be enclosed in the Application.

The fee to be paid online as detailed below –

The online Payment link is mentioned in the notice below for degree certificates as detailed below –

Course

Fee for obtaining
Degree Certificate

In-Person

In-Absentia

Super Specialty/
Ph.D./ MD/ MS/ MDS/MD (Ayurveda)/MD (Homeopathy)/ MD (Unani) and PG Diploma

2000/-

3000/-

MSc Applied
Nutrition

2000/-

25000/-

MSc Nursing, MPT

1500/-

2000/-

MSc (M)

1000/-

1500/-

All UG Courses

–

1000/-

It should
be filled up by those who are applying for UG Degree Certificates only.

The
following documents are to be enclosed –

Common to
all applicants –

Those
candidates who want to obtain their Degree Certificates as per the changed Name
/ changed Surname should submit an attested copy of the AP Gazette / Proceedings of
Dr. YSR University of Health Sciences or any other Educational Authority.

All
enclosures must securely be tagged to the application.

The envelope containing two (2) passport-size photographs should be kept with the application, along with enclosures

Online
payment receipt should be enclosed in the application

There is no
need to enclose a self-addressed envelope either with stamps or without stamps.

By those
who are applying for issue of Super Specialty /PG Degree / PG Diploma /PhD
Degree Certificates only respective course and UG Degree Certificate –

For Super Specialty

Attested copy of PG
Permanent Degree Certificate

For PG
Degree/Diploma

Attested copies of the Provisional Certificate of the respective course and UG Degree Certificate

For PhD

Attested copy of the
qualifying Examination Certificate (previous qualification certificate)

By those who are applying for issue of UG Degree Certificates only –

1. Attested copy of Intermediate or Equivalent Certificate.

2. Attested copy of the Internship Certificate issued by the Principal of the concerned College.

3. Attested copy of UG Degree Provisional Certificate

4. Attested copy of Temporary / Permanent Registration Certificate as proof of having registered themselves with MCI/NMC/DCI/INC etc.

5. Attested copy of individual marks memos of First to Final year UG Degree Exams (only if the Official Transcript is not yet been issued by Dr. YSR UHS)

6. Attested copy of G.O. on transfer of candidate from one college to another college during the Internship period.

7. Address and Mobile numbers of the candidates shall be written in the following space (two copies)

To view the notice, click on the link below –

https://medicaldialogues.in/pdf_upload/convocation-notification-2-229144.pdf

Also Read:PGIMER To Conduct Counselling For PhD Courses On 9th January

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COVID-19 Surge: Odisha medical colleges instructed to increase surveillance, testing

Bhubaneswar: In view of a recent surge in COVID-19 cases across India, the Odisha state government has asked all government-run medical colleges and chief district medical officers to increase surveillance, testing and preparedness to combat any surge in the state.

With Odisha reporting 14 new COVID-19 cases this month, the state government has asked all government-run medical colleges and chief district medical officers to increase surveillance, testing and preparedness for potential surge of the virus. 

Public Health Director Niranjan Mishra in a letter to all medical colleges and CDMOs said, “The recent rise in COVID-19 cases across India necessitates immediate and proactive measures to combat any surge in COVID-19 cases in the state. In continuation of the earlier communication, you are requested to implement the action points given therein and to remain alert to meet any exigency”.

Also Read:Indian-origin doctor’s pandemic rock band gains popularity, has upcoming tour

The state government said that ILI (influenza-like illness), and SARI (severe acute respiratory infection) surveillance should be increased and testing to be made available in every health institution.   

For those found positive, it said home isolation protocol is to be strictly followed and necessary treatment support should be provided besides ensuring dedicated beds and oxygen-supported beds for any admission and management as per the COVID management protocol and there should not be any unnecessary referrals.

It also asked the authorities that the COVID management strategy should be followed.

“Coordinate and collaborate with district administration for increasing IEC (Information Education Communication) and BCC (Behaviour Change Communication) for community awareness emphasising that symptomatic, elderly and vulnerable populations should adhere to the COVID-19 appropriate behaviour,” the letter said.

It also asked the authorities to ensure adequate availability of test kits, reagents drugs, and consumables to deal with the COVID situation in coordination with Odisha State Medical Corporation Limited.

This apart, the authorities were told that there should be timely data entry and reporting as per the said protocol, training and capacity building of healthcare providers and laboratory personnel and keeping a contingency plan ready to deal with any situation.

Meanwhile, one more person on Saturday tested positive for COVID-19 in the last 24 hours in the state taking the total number of coronavirus cases in Odisha to 14. However, one of the patients has now recovered and there are 13 active COVID-19 cases in the state at present, said Mishra.

Stating that all the new patients are showing mild symptoms of COVID-19, the public health director said that they are all undergoing treatment under home isolation and their health condition is stated to be stable.

The Health and Family Welfare Department has already stated that elderly people and those with co-morbidities have been advised to use facemasks while going out. The elderly people are also advised to avoid visiting crowded places.

Also Read:COVID-19 JN.1 Variant: Safdurjung hospital reserves 50 isolation beds, 9 ICU beds

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26-year-old Thanjavur Medical College Paediatrics Medico dies of heart attack after continuous 2 days of duty

Chennai: In a tragic incident, a 26-year-old PG Paediatrics medico of Thanjavur Medical College passed away on Sunday morning due to a myocardial infarction after being on continuous duty for 2 days.

The PG Paediatrics student was allegedly found dead in the hospital postgraduate duty room after he took permission to take a break as he got severe headaches while on duty on Saturday. 

Myocardial Infarction (MI), colloquially known as “heart attack,” is caused by decreased or complete cessation of blood flow to a portion of the myocardium. Myocardial infarction may be”silent,” and go undetected, or it could be a catastrophic event leading to hemodynamic deterioration and sudden death.

Also read- Chennai: 30 Year Old 1st Year Mch Gastroenterology Doctor Found Dead In His Apartment

As per DT NEXT news report, the doctor was on continuous duty for the past two days at the medical college hospital. He was suffering from a severe headache and went to his room at 3 pm to take a break on Saturday afternoon. However, he was found dead in the morning the next day. 

The tragic death of the doctor highlights the serious issue of long working hours and the resulting strain on medical professionals, leading to adverse health outcomes. 

Medical dialogues team had reported a similar incident in December, this year where a a 30-year-old doctor was found dead under mysterious circumstances at his residence in Chulamedu, Chennai. The victim was pursuing his MCh. in Surgical Gastroenterology at Madras Medical College. 

Allegations were laid against the medical college hospital that the doctor reportedly died from excessive workload. However, the hospital authorities denied the allegations and stated that such statements were false.

Expressing concern over these incidents, the Doctor’s Association for Social Equality has called on the Tamil Nadu government to promptly address the issue of extended working hours.

“The Tamil Nadu government should immediately put an end to the long working hours. For practising doctors and postgraduates, only eight hours of work should be ensured. The doctors, nurses and medical staff should be appointed according to the number of patients,” said Dr R Shanthi, a member of the Doctor’s Association for Social Equality.

Furthermore, the association urged the state government to provide a compensation of Rs 50 lakh to the families of the doctors who died on duty and has appealed to the National Medical Commission to intervene and regulate working hours to prevent further tragic incidents. 

Speaking to TNIE, Dr G Ravindranath, general secretary of the Doctors’ Association for Social Equality. said “The government should increase doctors’ strength in hospitals by patient ratio. Even today, post graduate doctors and house surgeons are doing 24 – 36 hours of duty. This is creating a huge stress among doctors.”

“In 2023 around 10 postgraduate and MBBS doctors died by suicide or other causes. The worrying fact was that these were young doctors. This is a serious issue and the health department should take steps to prevent these deaths. They should form a Doctors Welfare Board and also offer psychological counselling. Many doctors are stressed due to workload,” – Dr Keerthy Varman, past president of, the Tamil Nadu Medical Students Association informed the daily.

Also read- Mch Gastroenterology Death: Hospital Denies Accusations Of Work Overload

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Death of 10-year-old boy at Agartala Govt Medical College hospital, family alleges medical negligence

 The Tripura government on Thursday ordered an inquiry to investigate the death of a 10-year-old boy at the Agartala Government Medical College hospital allegedly due to medical negligence.

However, to maintain peace a large contingent of police and Tripura State Rifles (TSR) jawans were deployed inside the hospital.

For more details, check out the link given below:

10-Year-Old Boy Dies At Agartala Govt Medical College, Family Alleges Medical Negligence


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Toric Monofocal Intraocular Lenses may correct Keratometric Astigmatism

A recent comprehensive analysis specifically evaluated the effectiveness of toric monofocal intraocular lenses (IOLs) in correcting keratometric astigmatism cataract surgery. The findings of the study were published in Journal of Ophthalmology yielded in depth insights into visual and refractive outcomes after considering only toric IOLs which was available in the United States.

This study conducted a meticulous literature survey using in the PubMed database up to July 2022 and scrutinized 906 potentially relevant citations. After a rigorous review, 63 citations were selected for full-text analysis of which 21 studies ultimately met the stringent inclusion criteria. Also, the methodologist assigned each study a level of evidence rating with 12 studies achieving a level I rating and 9 studies rated at level II.

The eyes with toric IOLs displayed remarkable postoperative uncorrected distance visual acuity (UCDVA) when coupled with a commendable reduction in refractive astigmatism and robust rotational stability. Toric IOLs outshone their nontoric monofocal counterparts regardless of the manufacturer by exhibiting superior UCDVA and lower postoperative cylinder values. The study underscored that correcting pre-existing astigmatism with toric IOLs proved more effective and predictable than utilizing corneal relaxing incisions (CRIs), specially in cases of higher astigmatism magnitudes.

The findings suggest toric monofocal IOLs as a powerful solution for neutralizing corneal astigmatism during cataract surgery with enhanced UCDVA and also a significant reduction in postoperative refractive astigmatism compared to non-toric monofocal IOLs. The superiority of toric IOLs over CRIs is especially observed at higher magnitudes of astigmatism by cementing their status as a preferred choice in astigmatic correction during cataract surgery.

Reference:

Al-Mohtaseb, Z., Steigleman, W. A., Pantanelli, S. M., Lin, C. C., Hatch, K. M., Rose-Nussbaumer, J. R., Santhiago, M., Olsen, T. W., Kim, S. J., & Schallhorn, J. M. (2023). Toric Monofocal Intraocular Lenses for the Correction of Astigmatism during Cataract Surgery. In Ophthalmology. Elsevier BV. https://doi.org/10.1016/j.ophtha.2023.10.010

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Perioperative oral care management effective after pancreaticoduodenectomy

Perioperative oral care management may prevent surgical site infections after pancreaticoduodenectomy suggests a new study published in the Surgery.

Pancreaticoduodenectomy has been associated with a high mortality rate and significant postoperative morbidity. Recently, perioperative oral care management has been reported to be effective in preventing postoperative pneumonia and surgical site infection. In this study, they examined the effect of perioperative oral care management in reducing complications after pancreaticoduodenectomy, including surgical site infection.

This retrospective multicenter study included 503 patients who underwent pancreaticoduodenectomy at 8 facilities between January 2014 and December 2016. Among these, 144 received perioperative oral management by dentists and dental hygienists (oral management group), whereas the remaining 359 did not (control group). The oral care management program included oral health instructions, removal of dental calculus, professional mechanical tooth cleaning, removal of tongue coating, denture cleaning, instructions for gargling, and tooth extraction. The participants were matched using propensity scores to reduce background bias. Various factors were examined for correlation with the development of complications.

Results:

The incidence of organ/space surgical site infection was significantly lower in the oral management group than in the control group (8.0% vs 19.6%, P = .005). Multivariable logistic regression analysis revealed that hypertension and lack of perioperative oral management were independent risk factors for organ/space surgical site infection. Lack of perioperative oral management had an odds ratio of 2.847 (95% confidence interval 1.335-6.071, P = .007).

Perioperative oral care management reduces the occurrence of surgical site infections after pancreaticoduodenectomy and should be recommended as a strategy to prevent infections in addition to antibiotic use.

Reference:

Yamguchi T, Mori K, Kojima Y, Hasegawa T, Hirota J, Akashi M, Soutome S, Yoshimatsu M, Nobuhara H, Matsugu Y, Kato S, Shibuya Y, Kurita H, Yamada SI, Nakahara H; Joint Research Committee of Japanese Society of Oral Care. Efficacy of perioperative oral care management in the prevention of surgical complications in 503 patients after pancreaticoduodenectomy for resectable malignant tumor: A multicenter retrospective analysis using propensity score matching. Surgery. 2023 Dec 6:S0039-6060(23)00848-6. doi: 10.1016/j.surg.2023.11.008. Epub ahead of print. PMID: 38061914.

Keywords:

Perioperative, oral care, management, prevent, surgical, site, infections, after, pancreaticoduodenectomy, Yamguchi T, Mori K, Kojima Y, Hasegawa T, Hirota J, Akashi M, Soutome S, Yoshimatsu M, Nobuhara H, Matsugu Y, Kato S, Shibuya Y, Kurita H, Yamada SI, Nakahara H

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Proinsulin-to–C-peptide ratio may help identify individuals at highest risk of type 2 diabetes: Study

UK: A recent study published in Diabetes Care has revealed the usefulness of the proinsulin–C–peptide (PI-to-CP) ratio for identifying African American individuals at the greatest risk for β-cell dysfunction and ultimately type 2 diabetes (T2D).

African-American adults tend to have higher acute insulin response to glucose, lower insulin sensitivity, and lower hepatic insulin clearance. Catharine A. Couch, Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, and colleagues conducted the study to test the hypothesis that the proinsulin–to–C-peptide ratio, as an index of proinsulin secretion, would be higher and associated with indices of β-cell function in African American people relative to European-American adults without type 2 diabetes.

For this purpose, 114 African-American and European-American adult women and men were included. A 2-h oral glucose tolerance test was conducted to measure insulin, glucose, proinsulin, and C-peptide and derive indices of β-ce9ll response to glucose.

The Matsuda index was calculated as an insulin sensitivity measure. The disposition index (DI) was calculated for each phase of β-cell responsivity. DI is the product of insulin sensitivity and β-cell response. Pearson correlations were used to determine the relationship of the PI-to-CP ratio with each β-cell response phase (basal, Φb; dynamic, Φd; static, Φs; total, Φtot), insulin sensitivity, and disposition indices (DId, DIs, DItot). Multiple linear regression analysis was used to evaluate independent contributions of BMI, race, and glucose tolerance status on PI-to-CP levels before and after adjustment for insulin sensitivity.

The study led to the following findings:

  • African American participants had higher fasting and 2-h PI-to-CP ratios.
  • The fasting PI-to-CP ratio was positively associated with Φb, and the fasting PI-to-CP ratio and 2-h PI-to-CP ratio were inversely associated with DId and insulin sensitivity only in African-American participants.

“The findings reveal that the proinsulin-to–C-peptide ratio could be helpful in the early identification of β-cell dysfunction in African American individuals,” the researchers concluded.

Reference:

Catharine A. Couch, Francesca Piccinini, Lauren A. Fowler, W. Timothy Garvey, Barbara A. Gower; Proinsulin–to–C-Peptide Ratio as a Marker of β-Cell Function in African American and European American Adults. Diabetes Care 1 December 2023; 46 (12): 2129–2136. https://doi.org/10.2337/dc22-1763

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Is maltodextrin safe preoperative medication for diabetics undergoing minimally invasive colorectal surgery?

Recent research paper compares the effects of preoperative oral maltodextrin and plain water on blood sugar levels in patients undergoing elective laparoscopic or robotic colorectal surgery. The primary objective was to compare blood sugars at 2 hours of anesthesia, with a subgroup analysis among diabetic patients. Secondary outcomes included blood sugars at different time intervals during surgery, thirst scores before induction, gastric aspirate after intubation, and blood sugars at 8-hour intervals postoperatively for 24 hours. The study included 150 patients, and they were randomly assigned to receive either maltodextrin or plain water. The blood glucose level at 2 hours was significantly lower in the maltodextrin group. Additionally, blood glucose levels during and after surgery were consistently lower in the maltodextrin group. The maltodextrin group also reported lower thirst discomfort scores, and the gastric aspirate volume was lower in this group as well. Among diabetic patients, the maltodextrin group showed significantly lower blood glucose levels at various time points during and after surgery compared to the plain water group, with no incidents of hypoglycemia. The study compared its findings with previous research, noting that few randomized trials have compared the effects of oral carbohydrates in diabetic patients. The study also addressed limitations, such as not measuring gastric volume using ultrasound and not assessing muscle strength for the impact of carbohydrates in preventing muscle breakdown after surgery. In conclusion, the study found that oral maltodextrin administration resulted in lower blood sugars during and after surgery compared to plain water, with consistent results among diabetic patients. The paper suggests that larger prospective studies are needed to further establish the safety and effectiveness of oral maltodextrin in the preoperative setting, including different surgical profiles of patients.

Reference –

Kumar, Lakshmi; Ashok, Amaldev; Sudhakar, Abish1; Sreekumar, Gayathri. Preoperative maltodextrin in minimally invasive colorectal surgery: Is it safe for diabetics? A randomised controlled trial. Indian Journal of Anaesthesia 67(12):p 1084-1089, December 2023. | DOI: 10.4103/ija.ija_436_23

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