Background: The CD4 count is like a snapshot of how well the immune system is functioning. The progressive failure of the immune system caused by the human immunodeficiency virus (HIV) can increase the possibility of developing surgical site infections (SSI) after surgery. Study about the incidence of SSI and their correlation with CD4 count in HIV positive patients has not been done in India. The present study was aimed to find the incidence and microbiological profile of SSI among HIV positive patients, and the correlation between SSI and CD4 count.Methods: One hundred forty-six HIV positive patients >18 years of age scheduled for surgery were included. CD4 count of each patient was noted. The primary outcome measure was the incidence of SSI, whereas secondary outcome measures were the correlation of SSI with CD4 count and microbiological profile of infective material. Intergroup comparison of categorical, and continuous variables was done using the chi-square test/Fisher’s exact test and unpaired ‘t’ test respectively.Results: The incidence of SSI in HIV positive patients was 14/146 (9.6%). The incidence of SSI was significantly higher among patients with CD4 count <200 (60.0%) as compared to patients with CD4 count >500 (0.9 %). Mean±SD of CD4 count in patients without SSI and with SSI was 712.5±238.9 and 330.1±118.1 (cells/mm3) respectively (p<0.001). Klebsiella pneumoniae was the most common organism isolated in this study.Conclusions: SSI is frequent in HIV positive patients whose CD4 count is <200 cells/mm3.
Fire and explosions in the operation theatre during surgery in the era of cautery usage have been reported since many years. Significant complications or death can ensue as a result of such fires or explosions and surgeons should be aware of these hazards. A 38 year old female patient on the 6th day of admission, developed abdominal distension. Patient was managed conservatively with flatus tube insertion and serial x-ray monitoring. On the 8th day, repeat x-ray showed gas under diaphragm. Emergency laparotomy was undertaken. On opening the peritoneum using cautery, a hissing escape of gas was heard and this caught fire. On attempting to stem gas flow from the peritoneal hole, the operating surgeon sustained burn to his index finger and the glove melted. The peritoneal cavity was surprisingly free of any spilled contents. Small bowel was opened through a small enterotomy and decompressed. The colon steadfastly refused to collapse. This necessitated a transverse colotomy which, after decompression, was converted into a loop transverse colostomy. She underwent colonoscopy after three weeks wherein the colon was found to be free of any obstruction. The colostomy was closed. If there is free gas on entering a peritoneum, it will be wiser to avoid electro surgery. Instead, scissors or a scalpel should be used.
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