Issue 5 (October)

Background

Cardiac implantable electronic devices (CIED) represent established life-sustaining interventions for various cardiac conditions, but post-placement infections are associated with high morbidity and mortality. Although pre-procedural antibiotic prophylaxis effectively reduces CIED infection rates, limited data exist on post-procedural antibiotic use, especially beyond 24 hours. This study assesses the efficacy of post-procedural antibiotic usage in preventing CIED placement-related infections.

Methods

We conducted a systematic review and meta-analysis, including studies that examined the comparative outcomes among patients. The study cohorts were divided into two groups: (1) those who underwent preoperative antibiotic prophylaxis followed by a continuation of 24 hours or more postoperatively (intervention group); and (2) those who received either preoperative-only antibiotic prophylaxis or preoperative prophylaxis with a duration of less than 24 hours postoperatively (control group). Risk of bias was assessed with ROBINS-I and ROB-2 tools. Risk ratio (RR) was pooled using random-effect or fixed-effect meta-analyses with inverse variance method.

Results

Our analysis of ten studies, including four randomized controlled trials and six cohort studies with 27,375 participants, revealed no statistically significant differences in outcomes between two groups. These outcomes included (CIED) infection rates (RR 0.83, 95% CI 0.47, 1.44), mortality (RR 1.22, 95% CI 0.66, 2.25), pocket hematoma (RR 1.01, 95% CI 0.54, 1.92) and re-intervention (RR 0.71, 95% CI 0.20, 2.50). The larger randomized controlled trial had an obvious impact on the overall findings.

Conclusions

The present systematic review and meta-analysis found no advantage in extending postoperative antibiotic prophylaxis for more than 24 hours following (CIED) implantation. These findings align with prevailing guidelines which support antibiotic stewardship practices. This approach has the ability to reduce adverse drug events, curb the potential for antibiotic resistance and alleviate the financial burdens associated with prolonged postoperative antibiotic prophylaxis.

This review focuses on the mechanisms and methods involved in oral mucosal absorption, with a particular emphasis on drug delivery systems. It begins by discussing the protective role of saliva in the oral cavity, highlighting its importance in maintaining the health of the oral tissues and facilitating drug delivery. The review then delves into the mechanisms of oral mucosal absorption, including passive diffusion, which is the primary mechanism for drug transfer across the oral mucosa. It also explores the use of hydrophilic polymeric matrices as vehicles for oral transmucosal drug delivery systems, which are favored due to the water-rich environment of the oral cavity. The review further discusses the methods used to assess oral mucosal permeation, including both in vivo and in vitro approaches. In vivo methods, such as the buccal absorption test, are used to determine the bioavailability of drugs via this route, while in vitro methods are employed for high-throughput permeability screening. The review concludes by addressing the challenges and limitations associated with oral mucosal drug delivery, such as the difficulty in studying regional variation in drug absorption and the limitations of in vitro permeability models in predicting in vivo situations.

The pyrrolizine nucleus is a bicyclic ring system that consists of a pyrrole ring fused to another pyrrolidin ring. It constitutes the basic skeleton in many natural and synthetic compounds with diverse biological activities such as the anti-inflammatory, nootropic, antiemetic, antibacterial, antiviral, anticonvulsant, antiarrhythmic, and anticancer activities. At least two of these derivatives, ketorolac and mitomycin C, have been approved for the treatment of inflammation and cancer, respectively. Licofelone, a dual inhibitor of COX and 5-LOX, was also evaluated in clinical trials for the treatment of osteoarthritis. On the other hand, a large number of the pyrrolizine-based derivatives have displayed anticancer activity against different types of cancer cells. In this review, the pyrrolizine-based derivatives with anticancer activity were classified based on their chemical structure into substituted, fused, and spiro-pyrrolizine. The mechanisms of action of these compounds included alkylation of the DNA, inhibition of COX, or alteration of the permeability of the cytoplasmic membrane in cancer cells. In addition, other pyrrolizines were found to act by inhibiting DNA replication, rRNA, Rac1 kinase, thioredoxin reductase, or oncogenic kinases. The last section of this review also focuses on the reported X-ray crystal structures of these compounds with different proteins. The binding modes and interactions of ketorolac and licofelone were illustrated in this review. To sum up, we anticipate that the data compiled in this review will be useful to researchers in the design of pyrrolizines with potent biological activities.

Backgrounds

The purpose of the meta-analysis was to evaluate and compare the effect of laparoscopy versus open appendectomy on wound infection in elderly subjects.

Methods

The results of this meta-analysis were analyzed, and the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated using dichotomous or contentious random or fixed effect models.

Results

For the current meta-analysis, 6 examinations spanning from 2004 to 2021 were included, encompassing 42675 people; of them, 15486 had a laparoscopy, and 27189 had an open appendectomy.

Laparoscopy had a significantly lower surgical site infection (OR, 0.27; 95% CI, 0.22-0.32, p<0.001) and intra-abdominal abscess (OR, 0.36; 95% CI, 0.31-0.42, p<0.001) compared to open appendectomy in elderly subjects.

Conclusions

The information that was looked at showed that in older people, laparoscopy had a much lower rate of surgical site infections and intra-abdominal abscesses than open appendectomy. However, given the small number of studies included, attention should be given to their values.

Backgrounds

The purpose of the meta-analysis was to evaluate and compare the effects of negative-pressure wound therapy (NPWT) with conventional therapy (CT) on wound infection and graft take rates in split-thickness skin (STS) after grafting surgery (GS).

Methods

The results of this meta-analysis were analyzed, and the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated using dichotomous or contentious random or fixed effect models. For the current meta-analysis, 16 examinations spanning from 2002 to 2023 were included, encompassing 1301 people with STSs after GS.

Results

NPWT had a significantly lower wound infection (OR, 0.29; 95% CI, 0.17-0.48, p<0.001), and higher graft take rate (MD, 8.70; 95% CI, 5.76-11.63, p<0.001) compared to CT in STSs after GS subjects.

Conclusions

The examined data revealed that NPWT had a significantly lower wound infection and a higher graft take rates compared to CT in STSs after GS subjects. However, given that several examinations had a small sample size, consideration should be given to their values.