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The prescription of preoperative complementary tests aims to decrease morbidity and mortality associated to the perioperative period.To assess the practice and the financial cost of the systematic prescription of preoperative tests.This was a retrospective study including all patients older than three years, scheduled for elective surgery from November 2018 to January 2019. Two attendings analyzed the data collected during the pre-anesthetic assessment and evaluated the usefulness of the ordered preoperative tests. The overall cost of prescribed preoperative tests and the cost generated by inappropriate prescriptions were also estimated.This study included 1006 patients. The average age was 46.9 ± 22.05 years old. Five hundred and twenty three of them (51.98%) have no medical history. Among the planned procedures, 6.46% had an intermediate or major bleeding risk. Preoperative prescriptions were ordered by surgeons in 99% of cases. Prescriptions were justifiable in only 9.42% of cases. Abnormal findings were noted in 4.98% of the patients. The total cost was almost 80992 Dinars (≈ 24543 €). Complying the guidelines would save 70245 Dinars (≈ 21286 €) during the three months' study.The routine prescription of preoperative complementary tests results in a significant additional economic cost. Developing national guidelines would change this attitude of unnecessary prescription.

Hyper-immunoglobulin M syndrome is an X-linked primary immunodeficiency disease caused by mutations in the CD40 ligand gene. The CD40 ligand has been recently highlighted as playing a key role in the pathogenesis of primary biliary cholangitis. In the present study, we assessed an extensive set of serum autoantibodies in a series of well-defined patients with hyper-immunoglobulin M syndrome. Serum, liver-related and liver-not-related autoantibodies IgG, IgM and IgA were tested by ELISA and standard indirect immunofluorescence in HEp-2 cells in 13 Tunisian patients (8 males and 5 females, aged 1–12 years) with hyper-immunoglobulin M syndrome during 1995–2012 and, as controls, 21 age- and gender-matched blood donors. The level of IgM antibody against MIT3 was significantly higher in patients than in controls (35.8 vs 10.7, P=0.002). Half of the hyperimmunoglobulin M syndrome patients were found to be anti-MIT3 IgM positive vs none of the controls (P

Mehdi Trifa,1,2 Dmitry Tumin,1,3 Hina Walia,1 Kathleen L Lemanek,4 Joseph D Tobias,1,3 Tarun Bhalla1,3 1Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA; 2Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia; 3Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA; 4Department of Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, Columbus, OH, USA Background: The use of complementary and alternative medicine (CAM) therapies has increased in children, especially in those with chronic health conditions. However, this increase may not translate into acceptance of CAM in the perioperative setting. We surveyed caregivers of patients undergoing surgery to determine their knowledge and acceptance of hypnotherapy, acupuncture, and music therapy as alternatives to standard medication in the perioperative period. Materials and methods: An anonymous, 12-question survey was administered to caregivers of children undergoing procedures under general anesthesia. Caregivers reported their knowledge about hypnotherapy, music therapy, and acupuncture and interest in one of these methods during the perioperative period. CAM acceptance was defined as interest in one or more CAM methods.Results: Data from 164 caregivers were analyzed. The majority of caregivers were 20–40 years of age (68%) and mothers of the patient (82%). Caregivers were most familiar with acupuncture (70%), followed by music therapy (60%) and hypnotherapy (38%). Overall CAM acceptance was 51%. The acceptance of specific CAM modalities was highest for music therapy (50%), followed by hypnotherapy (17%) and acupuncture (13%). In multivariable logistic regression, familiarity with music therapy was associated with greater odds of CAM acceptance (odds ratio=3.36; 95% CI: 1.46, 7.74; P=0.004).Conclusion: Overall CAM acceptance among caregivers of children undergoing surgery was 51%, with music therapy being the most accepted CAM method. Familiarity with music therapy was the only factor that was independently associated with accepting CAM in the perioperative period. The low acceptance for acupuncture and hypnosis in the perioperative situation may be related to insufficient parental knowledge and information. Keywords: complementary and alternative medicine, perioperative, children, caregiver, hypnotherapy, acupuncture, music therapy

We describe a case of osteomyelitis, in a 7-month-old boy, caused by S. pneumoniae involving the pelvic bone with a purulent collection in the adductor muscle. Osteomyelitis diagnosis was suspected using ultrasound and CT scan investigations. This showed a periosteal elevation in the Case Study Ben Marzouk et al.; IJMPCR, 3(3): 68-72, 2015; Article no.IJMPCR.2015.038 69 pelvis and an abscess of the adductor muscle. Culture of the perioperative specimens isolated serotype 19A S. pneumoniae with reduced susceptibility to penicillin and macrolides. The patient was treated successfully with amoxicillin-clavulanate during five weeks, associated with gentamicin during the first week.

Introduction: Anesthesiologists use sugammadex to reverse neuromuscular blockade (NMB) produced by rocuronium and vecuronium. Its mechanism involves encapsulation of the neuromuscular blocking agent. Sugammadex dosing is based on the depth of NMB, assessed by measuring the train-of-four (TOF). Methods: We retrospectively reviewed procedures under general anesthesia in patients older than 1 year of age if they included sugammadex reversal of rocuronium-induced NMB. Documentation of TOF monitoring before and after reversal was noted, along with the dose of sugammadex administered. TOF was considered correctly documented if the anesthesia provider recorded the number of twitches before and after NMB reversal, or if they recorded 4 twitches before NMB reversal. We defined appropriate sugammadex dosing if it was within 10% of the recommended dose for the depth of NMB. We repeated this review after staff education and creating a reminder in the electronic health record system. Results: We included 100 patients in the preintervention analysis, of whom 30% had correct TOF documentation. Among patients with TOF assessment before sugammadex administration, the dose was appropriate in 34 of 40 cases. In the postintervention analysis, we reviewed 75 cases and found that correct documentation improved to 45% (P = 0.024). Among postintervention cases with TOF documented before sugammadex administration, sugammadex dosing was appropriate in 62 patients. Conclusion: Documentation of TOF was low (30%) before intervention and improved to only 45% after the interventions, suggesting that additional interventions are needed. Even before the intervention, with or without TOF documentation, the dose of sugammadex was generally consistent with recommendations.

Sugammadex is a novel pharmacologic agent, which reverses neuromuscular blockade (NMB) via a mechanism that differs completely from acetylcholinesterase inhibitors. By encapsulating rocuronium, sugammadex can provide recovery of neuromuscular function even when there is a profound degree of NMB. We report anecdotal experience with the use of sugammadex to reverse NMB to facilitate intraoperative neurophysiological monitoring (motor evoked potentials) in an adolescent with scoliosis during posterior spinal fusion. Its potential application in this unique clinical scenario is discussed, and potential dosing schemes are reviewed.