The Effect of Isotoma longiflora Leaves Extract to The Cornea Neovascularization of Wistar Rats Chemical Trauma Model

Eye chemical trauma was an eye trauma caused by a substance with a pH<7 (acid) and pH>7 (alkali). Chemical trauma can be caused by pesticides. In Indonesia, 78.9% of farmers had eye complaints due to pesticides exposure. The occurrence of alkali chemical trauma of eye could cause cornea neovascularization (CNV). Alkali chemical trauma caused intense inflammation resulting a vascularization of the cornea that was supposed to be avascular. The purpose of this study was to find out the effect of Isotoma longiflora leaves extract the cornea neovascularization of wistar rats chemical trauma model. This research used true experimental design method with post-test only controlled group design. The sample of this study were 30 male wistar rats (Rattus norvegicus) divided into six groups, 1 positive control group (dexamethasone 0.1%), 1  negative control group (DMSO 0,1%), and 4 treatment groups of Isotoma longiflora leaves extract (0.25 mg/ml, 0.5 mg/ml, 1 mg/ml, 2 mg/ml). The result of Shapiro-Wilk and Levene's test showed that p>0.05 that means the data was normally distributed and has the same variant. One Way ANOVA test results obtained significant differences between groups on the 7th day (p=0.001). The result of Post Hoc LSD test showed that group P3 and P4 were significantly different to negative control, P1 and P2 groups. P3 and P4 groups with 1 mg/ml and 2 mg/ml Isotoma longiflora leaves extract could inhibit cornea neovascularization

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

EFEK EKSTRAK DAUN KITOLOD (Isotoma longiflora) TERHADAP NEOVASKULARISASI KORNEA TIKUS WISTAR MODEL TRAUMA KIMIA

Trauma kimia mata adalah trauma pada mata yang disebabkan oleh substansi dengan pH7 (basa). Trauma kimia dapat disebabkan oleh pestisida. Di Indonesia, 78,9% petani mengalami keluhan pada mata akibat paparan pestisida. Kejadian trauma kimia basa pada mata dapat menyebabkan cornea neovascularization (CNV). Trauma kimia basa menyebabkan inflamasi hebat sehingga terbentuk vaskularisasi pada kornea yang seharusnya dalam keadaan avaskular. CNV berhubungan dengan produksi faktor angiogenik lokal dan mediator inflamasi. Tujuan dari penelitian ini adalah untuk mengetahui efek ekstrak daun kitolod (Isotoma longiflora) terhadap neovaskularisasi kornea tikus wistar model trauma kimia. Penelitian ini menggunakan metode true experimental design dengan rancangan post-test only control group design. Sampel penelitian ini ialah tikus putih jantan galur wistar (Rattus norvegicus). Jumlah sampel penelitian ini sebanyak 30 ekor yang dibagi menjadi 6 kelompok, masing-masing 4 tikus uji dan 1 tikus cadangan. Kelompok pertama merupakan kelompok positif yang diberikan trauma kimia mata pestisida Rotraz 200EC dan terapi dexamethasone 0,1%, kelompok kedua merupakan kontrol negatif diberikan trauma kimia mata pestisida Rotraz 200EC dan DMSO 0,1%, kelompok P1 sampai P4 diberikan trauma kimia mata pestisida Rotraz 200EC dan ekstrak daun kitolod dengan dosis berturut-turut 0,25 mg/ml; 0,5 mg/ml; 1 mg/ml; dan 2 mg/ml

The Effect of Isotoma longiflora Leaves Extract to The Cornea Neovascularization of Wistar Rats Chemical Trauma Model

Eye chemical trauma was an eye trauma caused by a substance with a pH&lt;7 (acid) and pH&gt;7 (alkali). Chemical trauma can be caused by pesticides. In Indonesia, 78.9% of farmers had eye complaints due to pesticides exposure. The occurrence of alkali chemical trauma of eye could cause cornea neovascularization (CNV). Alkali chemical trauma caused intense inflammation resulting a vascularization of the cornea that was supposed to be avascular. The purpose of this study was to find out the effect of Isotoma longiflora leaves extract the cornea neovascularization of wistar rats chemical trauma model. This research used true experimental design method with post-test only controlled group design. The sample of this study were 30 male wistar rats (Rattus norvegicus) divided into six groups, 1 positive control group (dexamethasone 0.1%), 1  negative control group (DMSO 0,1%), and 4 treatment groups of Isotoma longiflora leaves extract (0.25 mg/ml, 0.5 mg/ml, 1 mg/ml, 2 mg/ml). The result of Shapiro-Wilk and Levene's test showed that p&gt;0.05 that means the data was normally distributed and has the same variant. One Way ANOVA test results obtained significant differences between groups on the 7th day (p=0.001). The result of Post Hoc LSD test showed that group P3 and P4 were significantly different to negative control, P1 and P2 groups. P3 and P4 groups with 1 mg/ml and 2 mg/ml Isotoma longiflora leaves extract could inhibit cornea neovascularization.</jats:p

Efek Ekstrak Daun Kitolod (Isotoma longiflora) Terhadap Neovaskularisasi Kornea Tikus Wistar Model Trauma Kimia

Trauma kimia mata dapat disebabkan oleh pestisida. Di Indonesia, 78,9% petani mengalami keluhan pada mata akibat paparan pestisida. Kejadian trauma kimia basa pada mata dapat menyebabkan cornea neovascularization (CNV). Trauma kimia basa menyebabkan inflamasi hebat sehingga terbentuk vaskularisasi pada kornea yang seharusnya dalam keadaan avaskular. Tujuan dari penelitian ini adalah untuk mengetahui efek ekstrak daun kitolod (Isotoma longiflora) terhadap neovaskularisasi kornea tikus wistar model trauma kimia. Penelitian ini menggunakan metode true experimental design dengan rancangan post-test only controlled group design. Sampel penelitian ini tikus wistar jantan (Rattus norvegicus) sebanyak 30 ekor yang dibagi menjadi enam kelompok, yaitu 1 kelompok kontrol positif (dexamethasone 0,1%), 1 kelompok kontrol negatif (DMSO 0,1%), dan 4 kelompok perlakuan ekstrak daun kitolod (0,25 mg/ml; 0,5 mg/ml; 1 mg/ml; 2 mg/ml). Hasil uji Shapiro-Wilk dan Levene’s test menunjukkan nilai p>0,05 yang artinya data terdistribusi normal dan memiliki varian yang sama. Hasil uji One Way ANOVA didapatkan perbedaan signifikan antarkelompok pada hari ke-7 (p=0,001). Hasil uji Post Hoc LSD didapatkan kelompok P3 dan P4 berbeda signifikan dengan kelompok kontrol negatif, P1 dan P2. Kelompok P3 dan P4 dengan dosis ekstrak daun kitolod 1 mg/ml dan 2 mg/ml mampu menghambat neovaskularisasi korne

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

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

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

Treating MERS-CoV during an outbreak

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. Funding: DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally