داود کاظمی

A review of surgical site infections in surgery

Definition of surgical site infections and methods of diagnosis, treatment and prevention

A literature review using various publications related to surgical site infections

Surgical site infections are defined as infections that occur at the surgical incision or deeper tissues of the surgical site in a certain period of time following surgery. These infections lead to increased morbidity, mortality, hospitalization, re-admission rates, post-discharge care and costs of surgery. Bacterial contamination of the incision site is the most important cause of these infections. Surgical site infections are divided into three categories based on the depth and type of infected tissue: superficial incisional infections, deep incisional infections, and infections related to organs or internal spaces of the body. Various patient-related and procedure-related factors are involved as risk factors of these infections. Diagnosis of surgical site infections is based on patient history and results of clinical examination, surgical wound evaluation, and laboratory tests. Wound management and judicious use of antibiotics according to the type of bacteria involved in the infection are considered as the two most important aspects of treatment plan. Prevention is the best strategy to deal with surgical site infections. Prevention strategies are divided into preoperative, intraoperative, and postoperative methods. The purpose of these measures is to prevent surgical wound contamination and increase patient resistance against infection. Accurate patient selection, adherence to aseptic principles, use of appropriate surgical technique, and complete aftercare of the patient and surgical wound, along with prophylactic use of antibiotic drugs, are the most important preventive measures against surgical site infections. Classification of surgical site infections, their etiology, risk factors, diagnosis and treatment methods and preventive measures are discussed in this review article.

After defining various types of surgical site infections, different methods of diagnosis, treatment and prevention are discussed and it is concluded that preventive strategies are the ideal method to control surgical site infections.

A review of the principles of antibiotic use in surgery

Explain the principles of antibiotic use in surgery

A literature review using various publications related to the use of antibiotics in surgery

Antibiotics are drugs used to treat bacterial infections. These drugs are divided into different groups based on their origin, spectrum of effect, clinical application and mechanism of action. Antibiotics are used in surgery for prevention of surgical site infections or treatment of established infections. Classification of surgeries into clean, clean-contaminated, contaminated and dirty procedures is considered the most important factor in choosing the type of antibiotic use. Antibiotics are not required for clean surgeries except in certain circumstances. Prophylactic antibiotics are used in clean-contaminated and contaminated surgeries to prevent postoperative infection. In dirty surgeries with an established infection, these drugs are used therapeutically. Prophylactic antibiotics are administered intravenously before the start of surgery to create a therapeutic concentration in the target tissues and prevent their infection. Therefore, drugs that can be injected intravenously are used for prophylaxis. Also, antibiotics are selected based on the natural flora of target tissues or operative site. Prophylactic drug administration is stopped at the end of the operation or continues up to 24 hours after the operation. Therapeutic use of antibiotics is started before surgery and continues during and after the operation until complete treatment of infection. Antibiotics are selected based on microbial culture and determination of antibiotic sensitivity. Presently, the use of novel methods has allowed topical application of antibiotics in surgery. This review article describes general characteristics of antibiotics and explains principles of their prophylactic and therapeutic use in surgery.

Antibiotics should be used judiciously to prevent antibiotic resistance while increasing their effectiveness in prevention and treatment of infections.

A review of operating room sterilization and disinfection methods

Explain various methods of operating room sterilization and disinfection

A literature review using various publications related to operating room sterilization and disinfection

An operating room is a restricted location in a hospital where surgery is performed. The history of operating room construction as a specialized facility for performing surgery dates back to the 18th century. Before that, surgeries were usually performed at patient's or surgeon's place of residence. Early operating rooms did not have ideal structural conditions and were mostly built as a place to demonstrate surgical operations. With the identification of microorganisms, especially bacteria, as the causative agents of postoperative infections, the design of operating rooms was altered to control these infections. Surgery is an invasive treatment method and exposes the patient to surgical site infections. These infections are caused by contamination of the surgical wound by microorganisms, especially bacteria. Natural flora of the patient, surgical equipment, surgical team and physical environment of the operating room are considered as sources of infective bacteria. Operating rooms can be contaminated by unfiltered air, ventilation systems, disinfectants, discharges from infected wounds, transport of patients and collection bags, excessive traffic in the operating room, clothes, shoes, hands and gloves of surgical team members, non-sterile surgical equipment and contaminated surfaces. Therefore, to prevent surgical site infections, apart from the surgical site, surgical equipment and surgical team, the physical environment of the operating room must also be designed, maintained and disinfected using appropriate methods. This review article describes general principles of operating room design and ventilation along with daily cleaning, disinfection and sterilization methods.

Daily cleaning and disinfection of the operating room is mandatory as one of the most important aspects of prevention of surgical site infections and should be conducted by experienced and trained staff.

The use of seeds to create genetic mutation brings problems because the use of seeds increases the duration of the research, and the study of traits requires plant cultivation, making it impossible to test more than once a year. Another point is the presence of shimmer in mutant plants. Biotechnology techniques, especially tissue culture, solve these problems today. In this method, a repeatable and efficient regeneration system is needed to create mutations in rice plants to obtain fertile plants from the changed tissues.

To determine the appropriate dose of mutation induction to create genetic changes in the callus tissue obtained from the mature and immature embryos of Nemat and Taram rice varieties, a factorial experiment was carried out within a completely randomized design using doses of 20, 30, 40, 50 and 60 Gy (GY) of Gamma radiation in four replications. For callus generation, MS medium with 0.5 mg/liter 2, 4-D and 1 mg/liter Kasein was suitable for both cultivars. Also, for the regeneration of calluses obtained from both types of embryos of the Tarom cultivar, MS base medium containing 4 mg/liter of BAP, 0.5 mg/liter of IAA, 0.5 mg/liter of NAA, and 5 mg/liter of Kasien were used. In the final stage, 30-day-old calluses were subjected to gamma radiation treatment with five doses of 20, 30, 40, 50 and 60 Gy. They were compared with the control treatment in the regeneration stage regarding moisture percentage, growth rate and regeneration percentage.

After irradiation, the effect of variety on regeneration percentage, growth rate based on weight and callus diameter, the effect of embryo type on regeneration percentage and moisture percentage, the effect of radiation on all studied traits, the effect of variety × embryo only for regeneration percentage and moisture percentage, the effect of variety × radiation for all traits and the effect of embryo × radiation and cultivar × embryo × radiation were significant only for the percentage of reproduction. The LD50 obtained in Nemat and Tarom cultivars with mature embryos was related to doses of 26.78 and 41.83 Gray, respectively; with immature embryos, it was 14.55 and 35.30 Gray, respectively.

The difference in this experiment can not only be caused by genetic differences, but it can also be due to the difference in callus humidity and the effect of gamma rays.

Punica granatum L. peel is a rich source of phenolic compounds such as punicalagin and ellagic acid that represent a major part of the fruit and many fruit by-products in Asian countries, mainly Iran.

The purpose of this study is to design a value-added pomegranate peel product.

For this purpose, a safe and environmentally friendly method of resin column chromatography was used to enrich the hydroalcoholic extract of pomegranate peel with punicalagin. The enrichment conditions were optimized in terms of column condition and the amount of extract used. The results were monitored and confirmed by HPLC-PDA. In order to improve the physicochemical properties of the enriched extract, the obtained extract was loaded onto nano-phytosome by thin-film hydration method. FT-IR confirmed the nano-phytosome structure.

The resin column was optimized at a 3:1 resin-to-extract ratio in an optimum contact time duration of 30 minutes (80.50 %) and a 2.63-fold increase in the phenolic compounds compared to the crude extract. The results indicated that encapsulation efficiency was equal to 58 %, the particle size was equal to 154.0 to 216.5 nm, and one-year stability was achieved with an optimal polydispersity index of 0.215-0.287 in terms of particle size.

The enrichment of the crude extract before formulation and fabrication polyphenol enriched extract is a promising strategy to transform of pomegranate peel into a valuable product.

Fractures are important orthopaedic problems of birds of prey or raptors which are mainly caused by trauma. An adult female golden eagle (Aquila chrysaetos) was referred to the surgery division of the faculty of veterinary medicine, Islamic Azad University of Tabriz in November 2019. Traumatic injury of the upper left wing area was detected in clinical and orthopaedic examination and comminuted fracture of the humeral diaphysis was observed in radiography. Considering the type and anatomic location of the fracture, surgical treatment was conducted by means of internal fixation and intramedullary pinning. Surgical exposure of the humeral diaphysis was achieved by dorsal approach and a suitably sized intramedullary pin was inserted in a retrograde fashion inside the medullary cavity. Bone healing was evaluated post-operatively using serial radiographs. Complete bone healing occurred after 71 days and the intramedullary pin was removed. The bird returned to its normal pre-injury state following treatment and no complications resulting from the fracture or its surgical treatment was observed. Successful treatment of fractures in birds of prey is possible by adherence to principles of orthopaedic surgery and considering the unique features of these animals leading to the protection of these valuable species of wildlife in our country.

This research was conducted to compare the histopathologic characteristics of wound healing in the canine urinary bladder following full thickness incision using conventional and electrical scalpel. For this purpose, 24 adult healthy mixed breed dogs were randomly allocated to two groups of 12 dogs each. Cystotomy was performed for a length of 4 cm using conventional and electrical scalpel in control and treatment groups on the ventral surface of the bladder and the incision was routinely sutured. The incised area of bladder was harvested for histopathologic evaluation on days 0 (immediately after surgery), 3, 7, 14, 21 and 28 after surgery. The degree of haemorrhage, tissue trauma, inflammation, re-epithelialization, healing of mucosal and muscular layers and fibrotic reaction were graded and studied at the aforementioned time intervals. The results indicated that there were differences in urinary bladder wound healing during the course of the first 3 weeks in a way that tissue trauma was minimal and the speed of re-epithelialization, disappearance of inflammation and wound healing was faster in the control group while less haemorrhage was observed in the treatment group. Overall despite the differences observed, the process of wound healing had occurred similarly after the 28-day period in the two treatment groups and therefore the use of electrical scalpel in canine cystotomy is recommended to decrease haemorrhage and operation time without any deleterious effects on wound healing

IntroductionMany different cities in variant periods confront to respond the increasing population and development, in order to prevent inappropriate development, and tend to draw their patterns of growth and urban development. Now that in recent decades with the emergence of new attitudes to urban development infill development has been considered as part of this paradigm that the current policies in the country regardless of this attention to this postulate, only responds the accountability immediate needs of society and therefore ignores the consequences of such decisions in future developments as well as their impacts. Hence smart growth concepts provide appropriate development and urban growth patterns providing housing programs in order to supply affordable residential units are among the major necessities. But should be noted that these concepts without regard to localization these concepts has the consequences much worse will follow. Hence precise concepts, challenges, strategies of these models for localizing them should be surveyed.MethodologyThe main objective of this article is recognition the housing policies of Maskan Mehr in Iran as the most important general policies in housing and urban development and scientific criticism of its necessity and the limits of urban development as well as presenting infill development as a smart growth model or an adaptive strategy in this urban smart growth policies. So first, paid for the need to develop horizontal city that has persisted in Maskan Mehr so that if these growth are really necessary or it can replace with another growth pattern and model and then explain the process and the framework of infill development and will ultimately feasibility infill development as alternative housing solution has been considered. This phase revealed infill development by using current infrastructure and preventing sprawl growth try to decrease cost of growth and development but there is some physical and ordinance challenge to use of this pattern of growth.First of all, the article argues about the necessity of the mentioned approach in city growth and if this growth is an adaptive policy to respond the physical, social and economic necessity, or it is just a temporary solution to housing problems. In this phase the study is based upon two models of urban growth. 1) The sprawl growth as a current model of growth in Iranian cities; and 2) The infill development that is based on smart growth and new urbanism. In a comparative assessment, it should be found that, according to the case-study, which model is suitable for urban growth. So if the approach of Maskan Mehr is based on the sprawl growth, it is suitable; otherwise it will cause a lot of economic, physical and social effect. Actually sprawl growth accurse in exterior land, but infill development means development of a vacant parcel, or an assemblage of vacant parcels, within an established area of the city, and which is bordered along at least three-quarters of the parcel’s, or combined parcels’, perimeter by developed land. Moreover, such parcels generally have different utilities and street access available adjacent to the parcel, and has other public services and facilities available near-by. Generally, these sites are vacant because they were once considered of insufficient size for development, because the existing buildings located on the site were demolished, or because there were various sites, more suitable or less costly ones for development. Then the frameworks, necessities, challenges and action plans for infill development will be considered. And finally it finds that the zones include suitable physical potentials to localization of infill development in Natanz, Iran.Results and DiscussionPrimeval result of this article shows that the infill development can manage as a guidance urban growth to reduce the costs and effects of widespread growth and extol the optimal usage of current infrastructure and facilities. In this case study, Maskan Mehr localization, necessary attentions have not been paid; and definitely it leads to increase the costs of building new infrastructures and other facilities such as roads, structure, primary facilities, commercial zones etc. But in current city boundary, there are a lot of arid lands where the residents have moved immigrated to other places and Brownfield early was farmland or forest. This site makes possible for urban management policies to use this opportunity in order to guide city growth into infill development.ConclusionOverall results of this study show that the cities can load growth into infill development strategy their current facilities and urban structure support it, by the way Maskan Mehr as the current housing policy beyond the structure and facilities is formed in current city, and double the cost to provide infrastructure and urban services will impose to urban management authorities. Hence the direct public investment flows towards infill development, while optimum use of the existing capacity, the cost of urban growth will considerably be reduced in all aspects such as environmental, economic categories, as well as the social ones.