Deep Sternal Wound Infections after Coronary Artery Bypass Grafting: Analysis of 29 Cases from Iraq

Raghda Basil Ismael Alkhateeb1, Asmaa Saleem Esmail Ah-Ghurabi2,

Laith Saleh Alkaaby3, Abdulsalam Y. Taha4

1 Department of Cardiac Surgery, Slemani Cardiac Hospital, Sulaymaniyah, Iraq

2 The Diabetes Center in Sulaymaniyah, Sulaymaniyah, Iraq

3 Department of Cardiac Surgery, Iraqi Center for Heart Diseases, Baghdad, Iraq

4 Department of Thoracic and Cardiovascular Surgery, College of Medicine, University of Sulaimani, Sulaymaniyah, Iraq

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How to cite this paper: Alkhateeb, R.B.I., Ah-Ghurabi, A.S.E., Alkaaby, L.S. and Taha, A.Y. (2022) Deep Sternal Wound Infections after Coronary Artery Bypass Grafting: Analysis of 29 Cases from Iraq. World Journal of Cardiovascular Surgery, 12, 153-172. https://doi.org/10.4236/wjcs.2022.127012

Received: April 24, 2022

Accepted: July 26, 2022

Published: July 29, 2022

Copyright © 2022 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/

Abstract

      Background: Deep sternal wound infection (DSWI), or mediastinitis, is a devastating complication of coronary artery bypass grafting (CABG). This prospective study aimed to assess our management of DSWI in view of the published literature. Methods: Over 2-years (ending in January 2016), 29 patients (20 males) developed DSWI amongst 520 patients who underwent standard CABG surgeries (5.6%). Pre-, intra- and postoperative variables were documented. Whenever possible, the infections were culture-verified. Besides antibiotics, patients received one or more of the following therapies: drainage, debridement, closed irrigation, sternal re-wiring, vacuum-assisted closure (VAC), and bone resection. Results: the male to female ratio was 2.2:1. Mean age was 58.1 ± 7.3 years. The mean body mass index (BMI) was 27.9 ± 3.4 kg/m2 . There were 18, 16 and 11 patients with diabetes mellitus (DM), hypertension and chronic obstructive pulmonary disease (COPD) respectively. Cardiopulmonary bypass (CPB) was utilized in 26 (89.7%) patients with a mean time of 117.5 ± 23.3 minutes. Most surgeries (n = 21, 72.4%) lasted 5 - 6 hrs. According to Pairolero classification, there were 3 (10.3%) Type I, 22 (75.9%) Type II and 4 (13.8%) Type III infections. Four (13.8%) cases were culture-verified. Twenty-three (79.3%) DSWIs were surgically managed. Sternal re-wiring was performed in 14 (48.3%) cases while VAC was added to other therapies in 2 (6.9%) patients. DSWIs completely resolved in 18 (62.0%) patients within 3 - 24 weeks while two (6.9%) patients died within 30 days. Conclusion: We have identified six independent risk factors for DSWI (male gender, obesity, DM, hypertension, COPD and CPB), five of them are modifiable.

Keywords

      Deep Sternal Wound Infection, Mediastinitis, Coronary Artery Bypass Grafting, Median Sternotomy, Vacuum-Assisted Closure, Wound Debridement

Comparative Effects of Allium sativum (Garlic) and Allium porrum (Leek) on Lacerated Wound Isolates

Ruth Asikiya Afunwa*, Tobias Chukwujekwu Okonkwo, Roselyn Nneka Egbuna, Chidozie Ikegbune

Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Chukwuemeka Odumegwu Ojukwu University, Igbariam, Nigeria

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How to cite this paper: Afunwa, R.A., Okonkwo, T.C., Egbuna, R.N. and Ikegbune, C. (2022) Comparative Effects of Allium sativum (Garlic) and Allium porrum (Leek) on Lacerated Wound Isolates. Open Journal of Internal Medicine, 12,

184-193. https://doi.org/10.4236/ojim.2022.124020

Received: August 31, 2022

Accepted: November 11, 2022

Published: November 14, 2022

Copyright © 2022 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).

http://creativecommons.org/licenses/by/4.0/

Abstract

Background: The pharmacological properties of Allium family have been reported to include antibacterial, antioxidant, anticancer, anti-aging and antilipidemic properties. This investigation was conducted to evaluate the antibacterial properties of ethanolic and aqueous extracts of Allium sativum and Allium porrum on both Gram-positive and Gram-negative organisms from chronic wound infections. Methods: Ten (10) isolates were obtained from infected open wounds from patients at Chukwuemeka Odumegwu Ojukwu University teaching Hospital Amakwu and Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra state, Nigeria. Gram reaction and other biochemical tests namely: Indole, Citrate, Catalase, coagulase and oxidase tests were done for identification of the isolates. The isolates are K. pneumoniae (three), S. aureus (two), Enterococcus (two), P. aeruginosa (two) and E.coli (one). The antibacterial properties of ethanolic and aqueous extracts of Allium sativum and Allium porrum were determined using the agar well diffusion method while Gentamicin (10 mcg) and Tetracycline (30 mcg) were used as positive controls. Result: The results of the study showed that the ethanolic extract of Allium sativum (500 mg/ml and 250 mg/ml) respectively had an inhibitory effect on all the bacteria isolates under study, except a strain of P. aeruginosa which was also resistant to Allium porrum and the conventional antibiotics (Gentamicin and Tetracycline) used as positive controls. The ethonolic extract of Allium porrum (500 mg/ml and 250 mg/ml) respectively inhibited all the bacteria under investigation except one strain of P. aeruginosa and E. coli. Worthy of note is that the extracts of both plants inhibited two (2) strains of K. pneumoniae and one (1) strain of S. aureus that were resistant to Gentamicin and Tetracycline. The combination of these two plant extracts did not produce any synergistic effects. Conclusion: The present study provides evidence that extracts of Allium sativum and Allium porrum possess antibacteria properties and could serve as alternatives to conventional antibiotics in the treatment of bacterial infections from wounds.

Keywords

Wound, Infection, Garlic, Leek, Antibiotics

Burn Management at the 37 Military Hospital—A Tertiary Hospital in Accra, Ghana

Kwesi Okumanin Nsaful1*, Edward Asumanu2, Yaa Konadu Asante-Mante1, Jeffery Eduku Mozu1, Jennifer Maame Efua Owusu1, Emmanuel Yaw Botchway1, Amma Gyamfuawaa Afriyie1, Stephen Mawuli Dei1, Edmund Tettey Nartey3, Richard Osei Boateng4

1 Plastics and Burn Centre, 37 Military Hospital, Accra, Ghana

2 General Surgery Unit, 37 Military Hospital, Accra, Ghana

3 Statistics and Data Analysis Department, Korle Bu Teaching Hospital, Accra, Ghana

4 Records and Data Collection Division, 37 Military Hospital, Accra, Ghana

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How to cite this paper: Nsaful, K.O., Asumanu, E., Asante-Mante, Y.K., Mozu, J.E., Owusu, J.M.E., Botchway, E.Y., Afriyie, A.G., Dei, S.M., Nartey, E.T. and Boateng, R.O. (2022) Burn Management at the 37 Military Hospital—A Tertiary Hospital in Accra, Ghana. Modern Plastic Surgery, 12, 1-12. https://doi.org/10.4236/mps.2022.121001

Received: November 28, 2021

Accepted: January 22, 2022

Published: January 25, 2022

Copyright © 2022 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).

http://creativecommons.org/licenses/by/4.0/

Abstract

      Burn injuries have been and remain a very significant source of mortality and morbidity in low- and middle-income countries. As a country in this category, Ghana, is not exempted. Ghana has a population of 31 Million with only 21 Plastic Reconstructive and Burn surgeons. Moreover, the country can boast of only 3 major Burn centres. This notwithstanding the country in particular and Africa, in general, carries an extraordinary burden of Burn injuries with devastating consequences. Burn data from the 37 Military Hospital were analyzed from March 2018 to September 2019—a period of 18 months. In all, 217 burn cases were seen representing about 2.1% of all trauma and surgical cases. Our burn data analyzed the peculiarities of epidemiology, types of burn, the pattern of injuries, and the outcome of burn care at the 37 Military Hospital. Flame is emerging as the predominant cause of burns, most frequently occurring from the use of Liquid Petroleum Gas. In the pediatric population, however, the most frequent cause of burns is hot water burns. The mortality rate among the burn population was 1.8% (4 mortalities). This paper aims to point out management methods adopted by our unit which helped to improve burn outcomes and to reduce mortality.

Keywords: Burns, Wound Healing, Wound Dressing, Burn Blisters, Antibiotics

Hydration and pressure ulcer prevention: a pilot study

ABSTRACT: Links between nutrition and pressure ulcer (PU) prevention and wound healing are well known and documented (Saghaleini et al, 2018). Less well documented is the link between hydration and pressure care. It was recognised that many patients admitted to acute hospitals are dehydrated (El-Sharkawy et al, 2015); this is particularly relevant to Gastroenterology patients based on the classifications of dehydration (Posthauer, 2016), although all patients are at risk. Dehydration status is not routinely assessed without painful and costly blood tests. Through the use of an adapted version of the GULP Dehydration risk screening tool (Food First Nutrition and Dietetics Team, 2012) and the implementation of a hydration-focussed care plan, it may be possible for a nurse-led assessment to identify dehydration risk and plan care accordingly. A pilot study showed that 50% of the sample group gained an improved level of hydration throughout their hospital admission and a decrease in their Waterlow score.

KEY WORDS Dehydration risk assessment GULP risk assessment Hydration Pressure ulcer prevention Nurse-led care

KAREN GREEN    Deputy Sister and Chief Nurse   Fellow, University Hospitals of Leicester NHS Trust, Leicester, UK

Maggot debridement therapy for individuals with diabetic foot ulceration: a service evaluation

Objective: To examine the use of maggot debridement therapy (MDT) for individuals with diabetic foot ulcers (DFU) after a change in prescribing policy.

Method: A self completion survey/structured questionnaire to assess healthcare professionals' existing knowledge of MDT was given to those specialist services providing wound care treatments for DFUs.

Results: The results showed that those responding had a basic understanding of MDT and its use. However, further education is required for the type of wounds that maggots can be applied to, and what enzymes are produced. Enablers and barriers to MDT use also included policy and procedures, time constraints and the 'yuck factor'.

Conclusion: While there is good clinical evidence to support the use of MDT, there is a lack of evidence examining the factors that influence healthcare professionals’ decisions to recommend this treatment.

KEY WORDS  Maggot debridement therap  Lucillia sericata   Diabetic foot ulcer  Attitudes/knowledge  Service evaluation

CRAIG FAIREY Tissue Viability Podiatrist, Sound Primary Care Network, Oakside Surgery, Honicknowle Green Medical Centre, UK SAMANTHA HOLLOWAY Reader, Centre for Medical Education, School of Medicine, Cardiff University, Wales, UK

Management of complex pressure ulcer affecting paraplegic patient: a case study

Background: Pressure damage in paraplegic patients is difficult to manage due to their limited mobility. Topical Negative Pressure Therapy (TNPT) has successfully been used for different types of wounds, including cavity wounds, leg ulceration and pressure ulcers (PU). The introduction of TNPT with instillation (TNPTi) has increased the categories of wounds that can be treated. Aim: To describe the wound management of an unstageable pressure damage with underlying osteomyelitis. Methods: Observation of the care provided to a patient presenting with an unstageable pressure damage on admission. On further investigation osteomyelitis was found. Results: Following 3 months of the application of TNPTi, the wound size had reduced significantly, making it suitable for flap surgery. The benefits of undertaking flap surgery after an overall short time thanks to this treatment includes also the psychological and social aspects of the patient’s life. This also reflected in a positive impact on the patient's wellbeing and reduced length of hospitalisation. Conclusions: The use of TNPTi positively affected the healing process of an unstageable PU presenting with osteomyelitis. Further studies are needed to validate the effectiveness this treatment regimen.

ALBERTO SPITILLI Specialist Nurse in Tissue Viability, Oxford University Hospital NHS Foundation TRUST

KEY WORDS Osteomyelitis Pressure ulcer Topical negative pressure therapy (TNPT) Paraplegic