Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Epidemiology of Diabetes Mellitus in Al-Baidha Governorate, Yemen

Objectives: To identity the magnitude of diabetes and its epidemiological profile at Al-Baidha Governorate, Yemen, and assess the potential role of the inter-family marriage in increasing the risk of diabetes. &#x0D; Method: This is a descriptive and analytic epidemiological study of 2458 diabetic patients profile reported at Al-Baidha Governorate population in Yemen covering the period (2007-2009). Data sources included reviewing the patients’ files and health statistical reports of the governorate Health office. Additional primary data on family history and diabetes treatment types were collected by a group of researchers (medical students) through conducting home visits for the diabetic patients during the study period. &#x0D; Results: The percentage of diabetes mellitus is estimated to be 14.8% among males and 10.2% of females. The percentage of diabetes appeared to be increasing among urban areas (20.7%) than that of rural areas (4.3%). The overall age-adjusted proportions obtained from the study showed that 564 (23.2%) individuals were less than 30 years of age and the majority1864 (76.8%) were above 30. The study demonstrated that 2071 (84.3%) diabetic individuals are on oral hypoglycemic agents and that 381 (15.7%) were on insulin injections. Tracing the family history of 801 diabetic men and women demonstrated that the father was diabetic in 39.8%, mother in 26.8%, Grandfather 14.8%, grandmother 10.5% and second degree relative 8.4%. Also, the study showed that 58% of diabetic patients have marriage with first degree or second-degree relatives. &#x0D; Conclusion: The results of this study indicated that diabetes has become a major health problem in Yemen. Further studies are needed to clarify the potential role of interfamily marriage and genetic susceptibility in the aetiology of diabetes.&#x0D; Keywords: Diabetes, Aetiology, Odds Ratio, Chi-Squares Tests, Yemen&#x0D; </jats:p

PATHOPHYSIOLOGY OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS AND DRUG RESISTANCE

Methicillin- resistant Staphylococcus aureus (MRSA) is one of the most successful modern pathogens of community and hospital acquired bacterial infections. MRSA can lead to diverse infection such as bacteremia, endocarditis, skin and soft tissue infections, bone and joint infections and hospital- acquired infections . As well as genetically diverse, the epidemiology of MRSA is primarily characterized by the serial emergence of epidemic strains. MRSA still poses a formidable clinical threat, with persistently high morbidity and mortality. They are also becoming increasingly multi-drug resistant and have recently developed resistance to vancomycin, which has been used successfully to treat MRSA for many years . Successful treatment remains challenging and requires the evaluation of novel antimicrobials. In&nbsp;&nbsp; Conclusion the emergence of CA-MRSA and VRSA isolates is changing the management of clinical infections potentially caused by S. aureus. Rapid methods for accurate detection of MRSA are needed to promptly identify patients and implement contact precautions as well as appropriate treatment. Molecular genotyping techniques have an important role in evaluating possible outbreaks and for understanding of the emergence and evolution of MRSA strain

PATHOPHYSIOLOGY OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS AND DRUG RESISTANCE

Methicillin- resistant Staphylococcus aureus (MRSA) is one of the most successful modern pathogens of community and hospital acquired bacterial infections. MRSA can lead to diverse infection such as bacteremia, endocarditis, skin and soft tissue infections, bone and joint infections and hospital- acquired infections . As well as genetically diverse, the epidemiology of MRSA is primarily characterized by the serial emergence of epidemic strains. MRSA still poses a formidable clinical threat, with persistently high morbidity and mortality. They are also becoming increasingly multi-drug resistant and have recently developed resistance to vancomycin, which has been used successfully to treat MRSA for many years . Successful treatment remains challenging and requires the evaluation of novel antimicrobials. In&nbsp;&nbsp; Conclusion the emergence of CA-MRSA and VRSA isolates is changing the management of clinical infections potentially caused by S. aureus. Rapid methods for accurate detection of MRSA are needed to promptly identify patients and implement contact precautions as well as appropriate treatment. Molecular genotyping techniques have an important role in evaluating possible outbreaks and for understanding of the emergence and evolution of MRSA strain

Role of quantitative chemical shift magnetic resonance imaging and chemical shift subtraction technique in discriminating adenomatous from non adenomatous adrenal solid lesions

Purpose: To evaluate role of quantitative assessment of chemical shift MR imaging and chemical shift subtraction technique in differentiating adenomatous from non-adenomatous adrenal lesions with comparison of accuracy level of each technique. Materials and methods: A prospective study was carried out from 4-2014 to 5-2016 using 1.5T MRI. In-phase/opposed phase MRI sequences were applied for 52 patients having 58 adrenal lesions, 18 were hyper functioning and 40 were non-functioning. Lesions signal changes between in- and opposed phase sequences and post processing was done to calculate different quantitative chemical shift parameters using spleen, paraspinal muscle, and liver as a reference tissues. Additionally subtraction chemical shift MR technique on selected 16 cases was applied. Results: Signal intensity index and the two formulas of adrenal to spleen ratio were more accurate than other quantitative chemical shift MRI parameters in discrimination between adenomatous and nonadenomatous adrenal lesions with selected cutoff value 23.4% for the signal intensity index, 0.72 and −27.82% for adrenal to spleen ratio% using the old and new formulas respectively. Chemical shift subtraction technique expressed significant difference between adenomas and non-adenomatous adrenal lesions where adenomas had ratio of 108.87 or more, and the non-adenomatous lesions had ratio of 47.74 or less with selected cutoff value 173.0475. Conclusion: The signal intensity index and adrenal to spleen ratio are the most reliable quantitative chemical shift MRI methods in differentiation of adrenal adenomas from other non-adenomatous adrenal solid lesions. Chemical shift subtraction MRI is a recent technique that gives highly confident discrimination between two categories of pathology without using of any reference organ