Atopobiosis and Dysbiosis in Ocular Diseases: Is Fecal Microbiota Transplant and Probiotics a Promising Solution?

Purpose: To highlight the role of atopobiosis and dysbiosis in the pathomechanism of autoimmune uveitis, therefore supporting fecal microbiota transplant (FMT) and probiotics as potential targeted-treatment for uveitis. Methods: This review synthesized literatures upon the relation between gut microbiota, autoimmune uveitis, FMT, and probiotics, published from January 2001 to March 2021 and indexed in PubMed, Google Scholar, CrossRef. Results: The basis of the gut–eye axis revolves around occurrences of molecular mimicry, increase in pro-inflammatory cytokines, gut epithelial barrier disruption, and translocation of microbes to distant sites. In patients with autoimmune uveitis, an increase of gut Fusobacterium and Enterobacterium were found. With current knowledge of aforementioned mechanisms, studies modifying the gut microbiome and restoring the physiologic gut barrier has been the main focus for pathomechanism-based therapy. In mice models, FMT and probiotics targeting repopulation of gut microbiota has shown significant improvement in clinical manifestations of uveitis. Consequently, a better understanding in the homeostasis of gut microbiome along with their role in the gut–eye axis is needed to develop practical targeted treatment. Conclusion: Current preliminary studies are promising in establishing a causative gut–eye axis relationship and the possibility of conducting FMT and probiotics as targeted treatment to mitigate autoimmune uveitis, to shorten disease duration, and to prevent further complications

The Effect of Near-work Activity Time to The Incidence of Myopia in Children

Myopia has been a global problem leading to visual impairment and blinding complications with associated factors including time spent outdoor and near-work activity time. Excessive near-work activities are inevitable in children nowadays. However, the association between near-work activity time and myopia are still inconsistent between studies. The aim of this study is to review whether excessive near-work activities is associated with myopia incidence. A literature search on six different database (Pubmed, Cochrane Library, Scopus, Clinical Key, Google Scholar, and EBSCOhost). Articles matched with inclusion criteria were appraised using Therapeutic Study Critical Appraisal Tool by CEEBM, University of Oxford. Three cohort trials were obtained from the literature search. Incidence of myopia and the hazard ratio (HR) in Ku et al, Tsai et al, and You et al are 27.7%, HR 1.31 (95% CI 1.03-1.68) for ≥2 hours/day cram school attendance; 25.2% HR 1.12 (95%CI 1.02-1.22) for ≥5 hours/week after-school program; 16% HR 1.05 (0.96-1.16) for ≥2.95 ± 1.72 hours/day near work time, respectively. The protective factor pointed out by the studies was outdoor time. Tsai et al showed HR 0.90 (95%CI 0.82-0.99, p<0.001) for ≥30 minute time spent on outdoor activities after school on weekdays; and Ku et al showed a protective dose-response relationship (p<0.001) between increased outdoor activity time and myopia. Near-work activity is a strong risk factor candidate for myopia incidence, while outdoor activity is a strong protective candidate.  Hubungan Aktivitas Jarak Dekat terhadap Insidens Miopia pada Anak  Miopia merupakan penyakit mata terbanyak yang dapat mengakibatkan kebutaan. Faktor yang berpengaruh antara lain aktivitas luar ruangan dan aktivitas jarak dekat. Pada era milenial olahraga luar ruangan jarang dilakukan dan aktivitas jarak dekat sangat melekat dengan kehidupan sehari-hari. Studi ini bertujuan untuk meninjau hubungan aktivitas jarak dekat dengan insidens miopia. Pencarian melalui enam basis data ilmiah (Pubmed, Cochrane Library, Scopus, Clinical Key, Google Scholar, and EBSCOhost) menghasilkan tiga studi kohort yang selanjutnya ditelaah menggunakan Therapeutic Study Critical Appraisal Tool by CEEBM, University of Oxford. Insidens miopia dan hazard ratio (HR) aktivitas jarak dekat pada Ku et al, Tsai et al, dan You et al adalah 27,7%, HR 1,31 (95% CI 1,03-1,68) untuk ≥2 jam/hari les akademik; 25,2% HR 1,12 (95% CI 1,02-1,22) untuk ≥5 jam/minggu program akademik; 16% HR 1,05 (0,96-1,16) untuk ≥2,95 ± 1,72 jam/hari aktivitas jarak dekat. Aktivitas luar ruangan merupakan faktor protektif terhadap insidens miopia dengan HR 0,90 (95% CI 0,82-0,99, p<0,001) untuk ≥30 menit kegiatan luar ruangan pada hari kerja. Terdapat hubungan dosis-respons protektif (p<0,001) antara aktivitas luar ruangan dan miopia. Aktivitas jarak dekat merupakan faktor risiko kuat untuk miopia sedangkan aktivitas luar ruangan merupakan faktor protektif.  &nbsp

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research