UJI AKTIVITAS ANTIMIKROBA EKSTRAK DAN FRAKSI ALGA Turbinaria ornata (Turner) J.Argadh DARI PERAIRAN DESA TUMBAK, MINAHASA TENGGARA TERHADAP Staphylococcus aureus, Escherichia coli dan Candida albicans

ABSTRACTAlgae are chromista that live in the ocean, some are stranded on the beach, attached to rocks with a kind of root adhesives. Algae produce many compounds, which can be used as antimicrobial and anticancer. This study aims to determine the antimicrobial activity of the extracts and fractions of Turbinaria ornata algae collected from the of Ponteng Island waters, Tumbak, Southeast Minahasa against Staphylococcus aureus, Escherichia coli and Candida albicans. Turbinaria ornata algae were extracted using maceration method with 96% of ethanol solvent and fractionation using a partition method with n-hexane, chloroform and methanol as well as antimicrobial testing using the Kirby Bauer diffusion method. The results of this study indicate that ethanol extract of algae Turbinaria ornata has moderate category of antimicrobial activity in methanol, n-hexane and chloroform fractions with an average inhibition of 7.33 mm against Staphylococcus aureus, Escherichia coli and Candida albicans. Keywords: Antimicrobials, Extraction, Fractionation, Turbinaria ornata  ABSTRAKAlga merupakan chromista yang hidup lautan ada yang terdampar di pinggir pantai, melekat pada batu-batuan dengan alat pelekat semacam akar. Alga banyak menghasilkan senyawa yang dapat digunakan sebagai antimikroba dan antikanker, Penelitian ini bertujuan untuk mengetahui aktivitas antimikroba ekstrak dan fraksi alga Turbinaria ornata yang dikoleksi dari perairan pulau Ponteng, desa Tumbak, Minahasa Tenggara terhadap Staphylococcus aureus, Escherichia coli dan Candida albicans. Alga Turbinaria ornata diekstraksi menggunakan metode maserasi dengan pelarut etanol 96% dan fraksinasi menggunakan metode partisi dengan pelarut n-heksan, kloroform dan metanol serta pengujian antimikroba menggunakan metode difusi agar Kirby Bauer. Hasil dari penelitian ini menunjukkan bahwa ekstrak etanol Alga Turbinaria ornata memiliki aktivitas antimikroba  kategori sedang pada fraksi metanol, n-heksan dan kloroform dengan daya hambat rata-rata 7,33 mm terhadap Staphylococcus aureus, Escherichia coli dan Candida albicans. Kata kunci: Antimikroba, Ekstraksi, Fraksinasi, Turbinaria ornat

Active transmission of Trypanosoma brucei gambiense Dutton, 1902 sleeping sickness in Abraka, Delta State, Nigeria

Active surveillance of Human African trypanosomiasis (HAT) or sleeping sickness was undertaken in 3 agrarian villages in Ethiope East Local Government Area of Delta State, Nigeria. Card Agglutination Trypanosomiasis Test (CATT) was used qualitatively for mass screening with undiluted fresh whole blood (WB) and quantitatively for diagnosis in serum dilution tests. Thereafter, palpation for enlarged cervical lymph gland (ECLG) was followed by parasitological examination of aspirate using wet film, haematocrit centrifugation technique (HCT) and mini-anion exchange centrifugation technique (mAECT). Only one confirmed case of sleeping sickness was diagnosed out of the 491 samples screened. The results showed 43 (9.8%) serological positive cases in WB/ CATT test. 12 (27.9%) suspected cases that reacted at &lt1/4 titre in serum dilution test were highly suspected serological positive but parasitological negative cases. The study indicates that there is ongoing active transmission of Gambian type sleeping sickness in Abraka focus of Nigeria. The highly suspected cases will be followed up. Many cases might have gone undetected and more villages within the same focus were not covered. Moreover, a large-scale multi-disciplinary disease surveillance, vector and animal reservoir studies are required to determine the true situation of HAT in this focus. KEY-WORDS: Transmission, Gambian Trypanosomiasis, Screening, Blood, Serum, Diagnosis

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global access to technologies to support safe and effective inguinal hernia surgery:prospective, international cohort study

Technological advancement is important to improve healthcare quality and safety, especially in surgery1. For patients with an inguinal hernia, mesh and minimally invasive surgery are the two main technologies that have improved healthcare quality and safety2,3. The use of mesh is proven to reduce recurrence4,5. This avoids the need for further repairs, which are technically more challenging and have a higher risk for patients6. The use of minimally invasive surgery has proven advantages in bilateral hernias and in female patients2,3 and is recommended in unilateral repair where appropriate expertise is available2,3.Access to these technologies and the expertise required are not widely or equitably distributed at a global level. As it is the case for other technologies, countries in the Global South have more limited access1. At the same time, in this part of the globe, there is a higher prevalence and a higher burden of disease associated with inguinal hernias7. Several barriers to implementation in the Global South have been identified previously, including costs, distribution, and training8,9. To overcome these, studies reporting the use of mesh based on mosquito net mesh and evaluating training programmes have been conducted10,11. With these efforts and with global investment in new technologies and the expansion of existing technologies, it was expected that there would be an increase in their use in low–middle-income countries. Data assessing this variability have not been collected in a standardized way and are usually reported from single-country or single-region studies5,12. Therefore, identification of areas where improvement is most needed will be key to better inform policymakers.The overarching aim of this study was to evaluate access to technologies that are relevant to the treatment of inguinal hernia patients to identify the areas where improvement is needed. Therefore, the primary aim of this study was to evaluate the use of mesh and predictors of mesh use in elective inguinal hernia repairs and the secondary aims of this study were to evaluate the use of minimally invasive surgery and predictors of minimally invasive surgery use and to evaluate the safety associated with the use of mesh and the use of minimally invasive surgery

Global guidelines for emergency general surgery:systematic review and Delphi prioritization process

BackgroundExisting emergency general surgery (EGS) guidelines rarely include evidence from low- and middle-income countries (LMICs) and may lack relevance to low-resource settings. The aim of this study was to develop global guidelines for EGS that are applicable across all hospitals and health systems.MethodsA systematic review and thematic analysis were performed to identify recommendations relating to undifferentiated EGS. Those deemed relevant across all resource settings by an international guideline development panel were included in a four-round Delphi prioritization process and are reported according to International Standards for Clinical Practice Guidelines. The final recommendations were included as essential (baseline measures that should be implemented as a priority) or desirable (some hospitals may lack relevant resources at present but should plan for future implementation).ResultsAfter thematic analysis of 38 guidelines with 1396 unique recommendations, 68 recommendations were included in round 1 voting (410 respondents (219 from LMICs)). The final guidelines included eight essential, one desirable, and three critically unwell patient-specific recommendations. Preoperative recommendations included guidance on timely transfers, CT scan pathways, handovers, and discussion with senior surgeons. Perioperative recommendations included surgical safety checklists and recovery room monitoring. Postoperative recommendations included early-warning scores, discharge plans, and morbidity meetings. Recommendations for critically unwell patients included prioritization for theatre, senior team supervision, and high-level postoperative care.ConclusionThis pragmatic and representative process created evidence-based global guidelines for EGS that are suitable for resource limited environments around the world

Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45·6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84·5 (95% CI 84·1–84·9), which varied between HIC (88·5 [89·0–88·0]), MIC (81·8 [82·5–81·1]), and LIC (66·8 [64·9–68·7]) settings. In the third phase, 1217 (74·6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51·4%) were from HIC, 538 (44·2%) from MIC, and 54 (4·4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3·6% (95% CI 3·0–4·1; p<0·0001) increase in SVR. This was consistent in HIC (4·8% [4·1–5·5]; p<0·0001), MIC (2·8 [2·0–3·7]; p<0·0001), and LIC (3·8 [1·3–6·7%]; p<0·0001) settings. Interpretation The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs. Funding National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, NIHR Academy, Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic.publishedVersio

Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study

Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restrictions. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.Kroon, Hidde, a, Dudi Venkata, Nagendra, a, Sammour, Tarik CovidSurg Collaborative, Dajti, I ... Dudi-Venkata, NN ... Kroon, H ... Sammour, T ... et al