Background
The rate of surgical site infection (SSI) differ with variable nature with appendicitis with a global incidence of up to 11%. Several randomised trials describe a significant reduction in incisional SSI using wound edge protectors (WEP), mainly in elective procedures. This study was designed to analyse WEP use in emergency open appendicectomy.
Method
This randomised controlled trial enrolled 200 patients who underwent emergency open appendicectomy. Permuted block randomisation was used to assign subjects to either mechanical retraction or double ring WEP. The primary endpoints were SSI rates and cost analysis between the methods.
Results
The incidence of SSI was similar, n = 7 (7.4%) in the control group and n = 8 (8.4%) in the WEP group, and demonstrates no statistically significant difference (p > 0.05). Cost analysis showed a statistically significant (p < 0.001) higher total cost in the WEP group, MYR 456.00 (414.75, 520.00) as compared to the control group, MYR 296.00 (296.00, 300.00). However, the median cost of managing patients complicated with SSI was significantly lower at MYR 750.50 (558.75, 946.50) in the WEP group when compared to the control group MYR 1453.00 (1119.00, 2592.00) (p = 0.008).
Conclusion
The use of WEP does not reduce the incisional SSI rate, and it is not cost-effective for application in all open appendicectomies. However, when faced with incisional SSI, the use of WEP had a significantly lower cost in incisional SSI management. Selective WEP use is economical in clinically suspected perforated appendicitis when laparoscopic appendicectomy approach is unsuitable.
Anal squamous cell carcinoma is a cancer strongly associated among the immunocompromised and those infected with Human Papilloma Virus. We present a case of locally advanced recurrent anal cancer in a retroviral disease patient and the treatment planning involved in managing this patient.
Syndrome of Inappropriate anti diuretic hormone (SIADH) is one of the commonest cause of hyponatremia among medical inpatients. Over recent years, the evolution of SARS-COV-2 infection has led to atypical presentations of acute symptomatic hyponatremia secondary to isolated SIADH exclusive of pneumonia. We report an unusual case series of acute symptomatic hyponatremia secondary to SIADH in Category 2 COVID-19 infection. In our case series, all the patients presented with symptoms of acute severe hyponatremia and were incidentally screened positive for the SARS-COV-2 virus without respiratory tract symptoms and normal chest imaging. They were fully vaccinated and boosted at least three months before the presentation. Clinical and biochemical workups confirmed SIADH in all three patients. They were treated with hypertonic saline initially, followed by fluid restriction as per recommendations. It was postulated that the most likely mechanism responsible for the inappropriate ADH secretion is mediated by the increased inflammatory cytokines, especially interleukin-6 and the direct effect of the SARS-COV2 infection. In the context of the COVID-19 pandemic, atypical presentations of acute symptomatic hyponatremia without an apparent cause could be an isolated manifestation of SARS-COV-2 infection. Awareness of this condition is essential for the early institution of the treatment protocol for this reversible and life-threatening disorder
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