Evaluation of Viscoelastic Coagulation Parameters using Thromboelastography to Predict Thrombotic Events in Post-Operative Onconcology Patients

International Journal of Medicine and Medical Sciences | Vol. 13, No. 8, August 2023 | pp. 57–64

DOI: 10.46882/2023/IJMMS/130057

Original Research Article

Evaluation of Viscoelastic Coagulation Parameters using Thromboelastography to Predict Thrombotic Events in Post-Operative Onconcology Patients

Ibrahim K. Diallo¹, Victoria N. Eke², Jean-Baptiste M. Diop¹*

¹Department of Haematology, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta Diop, Dakar, Senegal.

²Department of Hematology and Blood Transfusion, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.

Abstract:

Surgical oncological interventions trigger an acute hypercoagulable state, increasing the risk of venous thromboembolism (VTE). This prospective cohort study evaluated the performance of Thromboelastography (TEG) compared to conventional coagulation assays (CCA) for predicting post-operative deep vein thrombosis (DVT) and pulmonary embolism (PE) in cancer patients. We evaluated 140 adult patients undergoing major pelvic or abdominal surgery for confirmed malignancies. Baseline and post-operative day 3 TEG parameters (reaction time [R], maximum amplitude [MA], and coagulation index [CI]) and CCA profiles (D-dimer, fibrinogen, and prothrombin time) were tracked. Lower limb duplex ultrasonography screening was performed on post-operative day 7 to detect VTE. Within 14 days post-surgery, VTE was confirmed in 15.0% (21/140) of the patients. In the thrombotic cohort, post-operative day 3 TEG profiles showed hypercoagulability, characterized by a significantly shortened R-time (3.2 ± 0.5 minutes vs. 5.8 ± 1.1 minutes in non-VTE patients, p < 0.001) and an elevated MA value (74.5 ± 4.2 mm vs. 61.2 ± 3.5 mm, p < 0.001). Pre-operative CCA parameters did not show significant predictive differences between groups (p > 0.05). Receiver Operating Characteristic (ROC) analysis showed that a day 3 TEG MA cutoff value > 70 mm predicted VTE development with a sensitivity of 90.5%, a specificity of 84.0%, and an Area Under the Curve (AUC) of 0.91 (95% CI = 0.85–0.96). Viscoelastic testing using TEG provides superior prediction of post-operative thrombotic risks in cancer patients compared to standard assays, serving as a valuable tool to guide extended chemical thromboprophylaxis protocols.

Keywords: Thromboelastography, Surgical Oncology, Venous Thromboembolism, Hypercoagulability, Maximum Amplitude, Thromboprophylaxis

Manuscript Timeline: Received: May 15, 2023; Revised: June 22, 2023; Accepted: July 10, 2023; Published: August 16, 2023.

Citation: Diallo IK, Eke VN, Diop JBM. Evaluation of Viscoelastic Coagulation Parameters using Thromboelastography to Predict Thrombotic Events in Post-Operative Onconcology Patients. International Journal of Medicine and Medical Sciences, 2023, 13(8): 57–64. DOI: 10.46882/2023/IJMMS/130057

International Journal of Medicine and Medical Sciences | Vol. 13, No. 9, September 2023 | pp. 65–72

DOI: 10.46882/2023/IJMMS/130065

Original Research Article

A Retrospective Assessment of Surgical Site Infection Trends and Microbiological Profiles following Elective Cholecystectomy

Blessing N. Chukwu¹, Patrick E. Lawson², Evelyn M. Kamau¹*

¹Department of Surgery, Faculty of Clinical Sciences, University of Port Harcourt, Port Harcourt, Nigeria.

²Department of Community Health, College of Health Sciences, Moi University, Eldoret, Kenya.

Abstract:

Surgical site infections (SSIs) complicate elective gastrointestinal surgeries, increasing healthcare costs and delaying recovery. This retrospective clinical study analyzed the five-year trend (2018–2022) and specific microbiological patterns of SSIs following elective open and laparoscopic cholecystectomy procedures at a regional referral hospital. We extracted data from 850 patient files meeting standard exclusion and inclusion criteria. Post-operative wound infections were identified and classified using the Centers for Disease Control and Prevention (CDC) definitions. Out of 850 cholecystectomies performed, 42 cases of SSIs were confirmed, representing an overall incidence rate of 4.94%. The incidence was significantly higher in open cholecystectomies (7.2%) compared to laparoscopic approaches (2.1%, p < 0.01). Microbiological characterization of wound swabs showed that Escherichia coli was the most common pathogen (38.1%), followed by Klebsiella pneumoniae (23.8%), Pseudomonas aeruginosa (16.7%), and Staphylococcus aureus (14.3%). Antibiogram mapping revealed high resistance rates among Gram-negative isolates to cefuroxime (72.4%) and amoxicillin-clavulanic acid (65.5%), while excellent susceptibility profiles were maintained for piperacillin-tazobactam (91.4%) and amikacin (94.8%). Logistic regression demonstrated that an operative duration > 120 minutes (OR = 2.9, 95% CI = 1.4–5.8, p < 0.01) and conversion from laparoscopic to open surgery (OR = 3.4, p < 0.01) were independent risk factors for SSI. Laparoscopic cholecystectomy significantly reduces the risk of post-operative wound infections. The high resistance to common cephalosporins highlights the need to update perioperative antibiotic prophylaxis guidelines based on local susceptibility patterns.

Keywords: Surgical Site Infection, Cholecystectomy, Laparoscopy, Escherichia coli, Antibiotic Resistance, Perioperative Prophylaxis

Manuscript Timeline: Received: June 11, 2023; Revised: July 20, 2023; Accepted: August 14, 2023; Published: September 15, 2023.

Citation: Chukwu BN, Lawson PE, Kamau EM. A Retrospective Assessment of Surgical Site Infection Trends and Microbiological Profiles following Elective Cholecystectomy. International Journal of Medicine and Medical Sciences, 2023, 13(9): 65–72. DOI: 10.46882/2023/IJMMS/130065

International Journal of Medicine and Medical Sciences | Vol. 13, No. 10, October 2023 | pp. 73–80

DOI: 10.46882/2023/IJMMS/130073

Original Research Article

Evaluation of Spirometric Parameters and Chronic Airway Symptoms among Commercial Flour Mill Workers

Festus M. Tetteh¹, Kingsley C. Amadi², Arthur J. Bond¹*

¹Department of Physiology, School of Biomedical Sciences, University of Ghana, Accra, Ghana.

²Department of Medicine, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.

Abstract:

Occupational inhalation of respirable organic flour dust induces chronic airway inflammation, leading to progressive ventilatory changes. This cross-sectional analytical study evaluated the prevalence of respiratory symptoms and alterations in pulmonary function indices among commercial flour mill workers. We matched 150 male flour millers exposed to organic dust for at least 2 years with 150 unexposed healthy male control subjects based on age, height, and body mass index. Respiratory symptom profiles were captured using a standardized questionnaire, and lung parameters were measured via computerized spirometry. Flour millers demonstrated a significantly higher prevalence of chronic productive cough (36.7% vs. 9.3%, p < 0.01), persistent wheezing (22.7% vs. 4.7%, p < 0.01), and exertional dyspnea (28.0% vs. 6.7%, p < 0.01) than the control group. Spirometric evaluation showed significant reductions in Forced Vital Capacity (FVC) (3.28 ± 0.38 L vs. 3.88 ± 0.42 L, p < 0.01) and Forced Expiratory Volume in 1 second (FEV1) (2.38 ± 0.31 L vs. 3.21 ± 0.35 L, p < 0.01) in the exposed group. The FEV1/FVC ratio was also significantly lower in flour millers (72.56 ± 4.8% vs. 82.73 ± 3.4%, p < 0.05), indicating an obstructive pattern of respiratory impairment. Stratified analysis revealed a significant inverse correlation between the duration of occupational exposure and FEV1 reductions (r = -0.55, p < 0.01). Occupational exposure to flour dust significantly impairs lung indices and increases respiratory symptoms. Implementing engineering controls such as local dust extraction systems and requiring personal protective respirators are necessary to protect worker health.

Keywords: Flour Dust, Occupational Exposure, Spirometry, Forced Expiratory Volume, Airway Obstruction, Respiratory Symptoms

Manuscript Timeline: Received: July 14, 2023; Revised: August 22, 2023; Accepted: September 10, 2023; Published: October 13, 2023.

Citation: Tetteh FM, Amadi KC, Bond AJ. Evaluation of Spirometric Parameters and Chronic Airway Symptoms among Commercial Flour Mill Workers. International Journal of Medicine and Medical Sciences, 2023, 13(10): 73–80. DOI: 10.46882/2023/IJMMS/130073

International Journal of Medicine and Medical Sciences | Vol. 13, No. 11, November 2023 | pp. 81–88

DOI: 10.46882/2023/IJMMS/130081

Original Research Article

Bacterial Pathogens and Antimicrobial Susceptibility Trends in Wound Infections among Diabetic Foot Ulcer Patients

Elizabeth A. Cole¹, Moses Z. Tarawallie², Victoria N. Okoye¹*

¹Department of Medical Microbiology, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.

²Department of Medicine, Connaught Hospital, Freetown, Sierra Leone.

Abstract:

Diabetic foot ulcers (DFUs) are prone to polymicrobial infections, which can lead to osteomyelitis and lower limb amputation if treated with ineffective antibiotics. This prospective cross-sectional study identified the predominant bacterial pathogens and mapped their antimicrobial resistance trends in patients presenting with infected DFUs. Deep tissue biopsies or wound swabs were collected from 140 diabetic patients presenting with Wagner grade 2 to 4 foot ulcers. Bacterial isolation was achieved using standard microbiological criteria, and antimicrobial susceptibility testing was performed using the disk diffusion technique. A total of 185 bacterial isolates were recovered, showing a polymicrobial infection rate of 32.1%. Gram-negative bacilli predominated at 58.4%, with Pseudomonas aeruginosa (24.3%) and Escherichia coli (18.9%) being the most frequent, while Staphylococcus aureus was the most common Gram-positive isolate (35.1%). Antibiogram mapping revealed alarming resistance rates among S. aureus isolates to erythromycin (75.4%) and clindamycin (41.5%), with 38.5% confirmed as Methicillin-Resistant Staphylococcus aureus (MRSA). Gram-negative bacilli showed high resistance to ciprofloxacin (62.8%) and ceftazidime (58.3%), while remaining highly susceptible to amikacin (91.6%) and imipenem (94.4%). Logistic regression showed that a duration of diabetes > 10 years was strongly associated with MRSA infection (OR = 3.2, 95% CI = 1.5–6.8, p < 0.01). Infected DFUs in this region show high rates of multi-drug resistant pathogens. Treatment should be guided by wound culture results rather than empirical protocols to improve healing outcomes and reduce amputation rates.

Keywords: Diabetic Foot Ulcer, Pseudomonas aeruginosa, Staphylococcus aureus, MRSA, Antimicrobial Resistance, Wound Biopsy

Manuscript Timeline: Received: August 18, 2023; Revised: September 25, 2023; Accepted: October 12, 2023; Published: November 15, 2023.

Citation: Cole EA, Tarawallie MZ, Okoye VN. Bacterial Pathogens and Antimicrobial Susceptibility Trends in Wound Infections among Diabetic Foot Ulcer Patients. International Journal of Medicine and Medical Sciences, 2023, 13(11): 81–88. DOI: 10.46882/2023/IJMMS/130081

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