Dr Paws’ Post

Infected F/BEVAR Explant I tried to post this last week but Linkedin continues to tag the video to have "sensitive content" so it gets removed from the feed. I have tried to remove the operative clips so may be video may not be tagged as being objectionable. Once again our decision to explant and stay out of the very purulent sac was based on the sac aspirant being frankly purulent and the microbiology consisting of gram positives, gram negatives and yeast (likely foregut source). Patient was treated with broad spectrum IV antibiotics and antifungals for a week prior to explant. This is our second instance of infection in a F/BEVAR in over 150 implants. Unfortunately graft infection, although rare, is something that we need to be prepared for. Strategies discussed on this thread are all appropriate options in different settings. I would love to hear more thoughts. Please follow the link below to see full video with operative clips. https://lnkd.in/g-inGmgX #aortaed #unmvascularsurgery

Conjunctivitis (pink eye) is a common, contagious eye disease, especially when the #Monsoons are upon us! In a person with a pink eye, the conjunctiva (the transparent protective membrane that lines the eyelid and eyeball) gets inflamed, appearing red and swollen. Most #conjunctivitis is viral and caused by adenoviruses--the pink eye resolves on its own in a week or two. Yet, people may resort to unsupervised use of steroid-based eye drops. Misuse of eye drops containing a combination of topical #corticosteroids and #antibiotics can lead to serious complications. Topical antibiotics, meant to tackle bacterial infections, are *ineffective* against viral conjunctivitis and their frequent usage fuels antibiotic resistance (#AMR). In a letter published in the Indian Journal of Ophthalmology, Drs. Amrita Mohanty, bhupesh bagga, Dr Joveeta Joseph , and Mr. Ahmad A. Pasha describe a cluster of seven cases in which patients with conjunctivitis developed severe MK within 10 days of unsupervised use of topical corticosteroid–antibiotic combination eye drops. https://lnkd.in/gdVK2d-a

Infected F/BEVAR Explant Dear friends, Thank you again for the academic discussion about this case. Our decision to explant and stay out of the very purulent sac was based on the sac aspirant being frankly purulent and the microbiology consisting of gram positives, gram negatives and yeast (likely foregut source). Patient was treated with broad spectrum IV antibiotics and antifungals for a week prior to explant. Intraoperatively we noticed unexpected progression of infection transmurally into the supraceliac aorta. Our initial plan was to create a stump with the celiac beveled into it however the aorta, that looked ok on preop imaging, would not even hold a clamp and sutures kept tearing till I went about 6 centimeter above the celiac after temporary clamping above the branching allograft. There was pus within the wall of supraceliac aorta, something I have not seen before. Plan is to continue outpatient antibiotic and antifungal treatment for minimum of 6 months and continue interval imaging. This is our second instance of infection in a F/BEVAR in over 150 implants. Unfortunately graft infection, although rare, is something that we need to be prepared for. Strategies discussed on this thread are all appropriate options in different settings. I would love to hear more thoughts. #aortaed #unmvascularsurgery Gustavo Oderich MD Jesse Manunga Peter Gloviczki, MD, PhD Rafael Demarchi Malgor, MD, MBA FACS Faisal Aziz MD, MBA, FACS, Distinguished-FSVS Naveed Saqib Muhammad Aftab MD, FACS, FACC Ross Clark, MD, MBA, RPVI Firas Mussa

The use of antimicrobials underpins modern medicine. Without effective antibiotics, even minor surgery and routine operations could become high-risk procedures if serious infections cannot be treated. Microorganisms which become resistant to antimicrobials, so-called ‘superbugs,’ do not respond or respond less well to available treatments. The emergence and spread of these superbugs affects: ✔️Global public health ✔️Animal health ✔️Food security ✔️The economy ✔️Sustainable development Read more in the latest Policy paper Confronting antimicrobial resistance 2024 to 2029 Updated 8 May 2024 https://lnkd.in/gxtHhKn9

In addition to atopic dermatitis, there are other diseases that condition the barrier with which we interact with the outside world: our skin. One of them is psoriasis, and the best way to treat it is to improve our understanding about its pathophysiology. Anti-inflammatory treatments improve as we are able to better understand these processes. #immunology #skin #psoriasis #inflammation

Long awaited study is now out! Pre-operative Alcohol Skin Solutions in Fractured Extremities (PREPARE) Which do you prefer for closed #fracture skin prep? Iodine + EtOH or chlorhexidine?

🔬Excited to share our latest research on electrospun fiber dressings for inflammatory skin diseases! 🌟 Managing inflammatory skin diseases often involves inconvenient, greasy semi-solid formulations that require frequent reapplication. Our study offers an innovative solution: electrospun dressings for sustained tofacitinib release. We fabricated and examined uniaxial, coaxial, and layer-by-layer fiber dressings, with the layer-by-layer system demonstrating a delayed release. Permeation studies on porcine skin revealed no significant differences between the fiber dressings, underscoring the importance of such studies, which are often overlooked in fiber dressing research. These comfortable and easy-to-apply dressings offer comparable efficacy to creams and could improve long-term patient compliance. Future research will focus on in vivo experiments to further assess efficacy, safety, and bioavailability. Special thanks to Andreas Maltschik, Sibel Guler, Katerina Vangelofski, Luna Gade, Holger Grohganz, and my supervisors Thomas Rades and Andrea Heinz for their invaluable contributions to this study. Thanks also to the LEO Foundation // LEO Fondet for funding. 📎 Read more about our innovative approach to improving the treatment of inflammatory skin diseases and stay tuned for future updates on this exciting development! https://lnkd.in/dT9d4Bt2 #Electrospinning #InflammatorySkinDiseases #DrugDelivery #Tofacitinib #PharmaceuticalScience

#piezocleanbydrgiacomotarquini IMMEDIATE IMPLANTS IN INFECTED SOCKETS Immediate post-extraction implant placement has success rates similar to those obtained when the implant is placed on a deferred basis (Chen, IJOMI 2004). Some Authors (Novaes, IJOMI 1995) defended the possibility of the placement of immediate implants if sockets associated with chronic periapical infection, as long as a proper postoperative antibiotic coverage is performed. A recent systematic review by Kaur (Kaur, 2021) demonstrated equal predictability for successful osseointegration and long term functioning of immediate implants in infected as well as in healthy extraction sites. Along with AB prophylaxis and socket debridement by means of carbide burs and/or bone curettes, ultrasonic cavitation can be used to disrupt bacterial biofilm, thus contributing to locally reduce the bacterial load in infected sockets (Tarquini, Implant Tribune). Ultrasonic cavitation (defined as a the formation of vapor phase bubbles within a liquid, usually due to rapid changes in localized pressure) has demonstrated to be highly effective in removing biofilms from a substrate at the microscopic level: cavitation bubbles are in fact capable of yielding microstreaming, shock waves, highspeed jets and liquid heating wich cause biofilm disruption.The present article has showed the use of the novel ultrasonic cavitation device “PIEZOCLEAN by Dr. Giacomo Tarquini” as an adjunct to manual/mechanical debridement in order to reduce the chance of post-operative infections during immediate implant placement in infected sockets.

The Sun Protection Factor (SPF) is a scientifically quantified measure of the efficacy of sunscreen in shielding the skin from harmful ultraviolet B (UVB) radiation. UVB radiation is a subset of solar radiation responsible for causing sunburn and contributing to skin damage and potential long-term health issues like skin cancer. The SPF value denotes the ratio of the time required for UVB radiation to cause redness on the skin when sunscreen is applied versus when it is not. This ratio is determined by controlled laboratory testing. For instance, if it typically takes 10 minutes for unprotected skin to redden, and a sunscreen with SPF 30 is applied, it should theoretically take 300 minutes (30 times longer) for the skin to redden under similar conditions. SPF values range from a minimum of 2 to 50+ (the "+" sign indicating higher values). Higher SPF values correspond to greater protection against UVB radiation. However, it's crucial to note that no sunscreen can entirely block UVB rays. Even with SPF 50+, a small percentage of UVB radiation can still penetrate the skin. Thus, SPF serves as a relative measure of protection rather than an absolute barrier.