Which of the following components of an infection prevention bundle has the most significant impact in reducing surgical site infections in elective colorectal surgery patients? A. Preoperative shower with 4% chlorhexidine gluconate B. Mechanical bowel preparation C. Intraoperative abdominal irrigation with antibiotic D. Mechanical bowel preparation combined with oral antibiotics E. Dedicated instruments for wound closure ANSWER: D Surgical site infections (SSIs) after colorectal surgery are a significant cause of morbidity and mortality and remain an important national quality indicator. Mechanical bowel preparation plus oral antibiotics was a mainstay in colorectal surgery for decades, but several publications questioned the efficacy of mechanical bowel preparation. Numerous randomized controlled trials failed to show any decrease in SSIs or anastomotic leak. A major criticism of these trials was omission of the oral antibiotic portion of the standard bowel preparation. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) retrospectively evaluated 4999 patients who underwent colectomy. Patients who had a combined mechanical bowel preparation and oral antibiotics had a lower 30-day rate of superficial SSIs, anastomotic leak, and 30-day readmission, compared with mechanical bowel preparation alone. Infection prevention bundles are used to reduce the rates of infection related to central line insertions and mechanical ventilation. Several interventions in the preoperative and perioperative arenas are proposed to reduce the rates of SSI in colorectal patients, and institutions have grouped them together in an infection prevention bundle. One group studied the impact of each component of the infection prevention bundles: mechanical bowel preparation plus oral antibiotics, preoperative chlorhexidine shower, preoperative hair clipping, skin preparation with a standard chlorhexidine alcohol solution, intraoperative antibiotic irrigation, and a clean closure protocol with dedicated instruments. Multivariate analysis showed that the mechanical bowel preparation with oral antibiotics had the greatest effect on reducing SSIs.

Orthopedic Notes Share https://twitter.com/DrATEFAHMED/status/1649888770655748100?s=20 #orthopedicsurgeon #orthopedicsurgery #orthopedics #orthopedic #orthopedicinstruments #orthopedicbed #orthopedicspecialist #orthopedicmattress #orthopedicsurgeons #orthopedicdoctor #orthopedicshoes #orthopedicmassage #veterinaryorthopedics #orthopedicphysicaltherapy #doctor #spine #chiropractor #physicaltherapy #chiropractic #arthritis #medstudent #rehab #medicine #medical #neckpain #patientcare #clinical #osteopathy #ortho #painfree #asthma #physician #injuryprevention #sciatica #echocardiography #medicaluniversity #onlinepharmacy #medical_student #physiotherapy_world #nasal #medicaltreatment #medicalnews #usmleprep #physioterapy source (https://www.youtube.com/watch?v=QNgfzEtufk0) Share this:

A 64-year-old woman presents with nephrolithiasis and primary hyperparathyroidism. Her family history is unremarkable A Tc-99 sestamibi scan demonstrates a focus of activity near the left lower pole of the thyroid gland. The next step in her management should be A. left neck exploration. B. confirmatory 24-hour urinary calcium level. C. neck ultrasound. D. observation with repeat calcium and parathormone levels in 6 months. E. contrast-enhanced dynamic CT scan of the neck and chest (4-dimensional CT). https://twitter.com/DrATEFAHMED/status/1645517671960641552?s=20 ANSWER: C The diagnostic workup for primary hyperparathyroidis (pHPTH) is relatively simple biochemically. The serum calcium level will be elevated with a concomitant inappropriately elevated parathormone level (PTH). Confirmatory testing can include elevated levels of urinary calcium excretion, effectively ruling out familial hypocalciuric hypercalcemia. A normal Vitamin D level will exclude low levels as a cause of the elevated PTH level. Other associated biochemical findings can include depressed serum phosphate with a serum chloride-to-phosphate ratio of greater than 33. Once the biochemical diagnosis of pHPTH is made, further testing is unnecessary and the decision for surgery is made in concert with a surgeon familiar with endocrine surgery. Criteria for surgical intervention are well established in pHPT. In general, the symptomatic patient or the patient with evidence of organ dysfunction from hypercalcemia should have a parathyroidectomy. The decision for further imaging is based solely on the operative technique planned. If traditional 4-gland neck exploration is planned, no further imaging is necessary. In the hands of an experienced surgeon, additional imaging only increases costs without significant benefit. If a patient is a candidate for focused parathyroidectomy, or "minimally invasive" parathyroidectomy, imaging techniques to localize a solitary adenoma are appropriate. The sensitivity of Tc-99 sestamibi scan ranges from 65 to 85% and varies across institutions widely. More importantly, the relatively low specificity of any single imaging test to diagnosis a solitary adenoma, as opposed to multiple adenomas or hyperplastic disease, is not sufficient to guide focused surgical techniques. Most experienced surgeons use a 2-imaging test algorithm, and if concordant and confirmatory of solitary adenoma, focused exploration may be appropriate. It is inappropriate to offer focused parathyroidectomy based on a single positive image or discordant imaging results. The most commonly used imaging tests to guide exploration options, from least expensive to most expensive, are neck ultrasonography, Tc- 99 sestamibi scanning, and contrast-enhanced CT scan of the neck. Ultrasonographic imaging of the neck is inexpensive,reliable in experienced hands, and office based. It has the added benefit of ruling out any additional thyroid pathology in the setting of planned neck exploration

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Primary biliary cirrhosis https://youtube.com/shorts/5DCct-WAW0Y https://twitter.com/DrATEFAHMED/status/1625575139835273234?s=20&t=4ABDHwR_PoPnoQS6QYy-Wg #liver #gallstones #gallbladder #gallbladdercancer #cirrhosis #biliary #fibrosis #doctor #medicalstudent #medical #mrcs #FRCS #USMLE #medicalexam #medicalstudents #medicalvideo #trendingvideo #surgery @UnivSurg @AmCollSurgeons

#Bile #Duct #cancer #cholangiocarcinoma https://youtube.com/shorts/ipk7gjb33bs https://twitter.com/DrATEFAHMED/status/1625205459069112335?s=20&t=u1NhHpLNuYjTi89CKAN-tg #biliary #duct #bile #gallbladder #cancer #tumor #doctor #medical #medicalstudent #mrcs #frcs #usmlestep2 #mrcs #Doctors #Trending #Orthopedics #surgery #surgeons #medicalstudent #medicaleducation

Criteria for #forceps #delivery https://youtube.com/shorts/8LN6yWPo5VE https://twitter.com/DrATEFAHMED/status/1625190780884205569?s=20&t=u1NhHpLNuYjTi89CKAN-tg #anatomy #doctor #medical #medicalstudent #mrcs #frcs #usmlestep2 #mrcs #Doctors #Trending #Orthopedics #surgery #surgeons #medicalstudent #medicaleducation #medicalmiracle #nurselife #medicalvideo #surgicalanatomy #book

Atlas of Gastrointestinal Surgery, Volume 2 2nd Edition Pdf (dratef.net) please share and be shared https://t.me/no1doctors/9993 The first edition of this superb, two-volume atlas on surgery of the biliary tract, pancreas and liver was published 23 years ago. Dr. Cameron has revisited and updated this classic work to include laparoscopic techniques and to demonstrate the current status of gastrointestinal surgical procedures. Written for the experienced surgeon, this two-volume work is beautifully illustrated with anatomical watercolour paintings by co-author Corinne Sandone that elevate the work to a level not seen in other atlases. The goal of this volume is to present the alimentary tract procedures performed – and in some instances initiated – at the Johns Hopkins Hospital in such a fashion that other alimentary tract surgeons can learn these techniques and perform them successfully. Volume 2 includes operative procedures on the stomach, duodenum, small bowel, colon, rectum, and anus. https://t.me/no1doctors/9993 https://t.me/no1doctors/9992

Complications in Bariatric Surgery @dratefahmed (dratef.net), https://t.me/no1doctors/10012 Pdf ( dratef.net). Please share and be shared. This text focuses on the complications following bariatric surgery. The focus is on the immediate and long term complications that would be important to both the general surgeon and those surgeons with specialty experience in bariatric surgery. Sections address the nutritional deficiencies following bariatric surgery with specific attention to Roux en Y gastric bypass and pancreatico-biliary diversion as well as the correction of these deficiencies with medical intervention as well as the indications for surgical revision or reversal. The text reviews the work-up of a bariatric patient with abdominal pain including the appropriate imaging and threshold for operative intervention and the techniques to achieve optimal visualization during this difficult situation. This section focuses on the operative management of anastomotic and staple line leaks and how to definitively manage these surgical emergencies as well as achieve source control and stabilization. Later chapters focus on specific complications following bariatric surgery with specific focus on RYGB, vertical sleeve gastrectomy (VSG), biliary pancreatic diversion, and gastric band. Complications include gastric fistula, gastric staple line disruption following VSG, gastro-jejunal leak following RYGB, relux following bariatric surgery, and failure of weight loss following bariatric surgery. These sections are written by experts in the field of bariatrics and include evidence based medicine as well as expert opinion on the management of bariatric complications. The sections provide a review of the literature and references at the close of each section. @dratefahmed (dratef.net) https://t.me/no1doctors/10010