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

Moisture gradients, form a vapor cycle within the viscous boundary layer as an organizing principle to worker termites

Studies of termite mound building have considered the mud they prepare, its properties and its composition. Here we consider the behaviors of the mound building termites Macrotermes michaelseni, (Sjostedt), in the presence of the viscous boundary layer (VBL), which spontaneously forms over any surface that air passes over. We looked how soil moisture and air vapor are coupled to form a feedback loop and a spatiotemporal precursor to worker termites in the presence of mound material. We explored residency and activities of workers when presented with a VBL and either varying substrate temperature gradients or a soil moisture transition within the soil substrate. We report the emergence of a ‘vapor conveyor’, which forms around a neutral evaporative equilibrium point (NEEP) at the soil/air interface, where the soil-borne moisture temperature (along the gradient) and the 100% saturated air-borne vapor temperature coincide within the VBL, forming a bubble of neutral mass transfer which, we propose, worker termites are sensitive to as viscosity changes within. We found, on average, that 67% (std. dev 27%) of behavioral events (clustering, excavation, and deposition) occurred within 10C either side of the NEEP. We found negative correlation (-0.78) between the substrate temperature gradient (0.1-0.9 0C mm-1) and the extents of behavioral activity, suggesting coupling between soil-borne moisture and air-borne vapor advection within the VBL. We recorded unique behaviors relating to interaction with the viscosity of vapor saturated air at this scale. We speculate that workers may exploit the VBL to overcome a classic trade-off, i.e. how to push activities forward into potentially desiccating environments, while conserving moisture in both the termites and the soil they build with

MARK&apos;s Quadrant scoring system: a symptom-based targeted screening tool for gastric cancer

Abstract Background Gastric cancer is notably one of the leading causes of cancer-related death in the world. In Malaysia, these patients present in the advanced stage, thus narrowing the treatment options and making the surgery nearly impossible for successful curative resection. Failure to identify high-risk patients and delay in diagnostic endoscope procedure contributed to the delay in diagnosis. The aim of the study was to develop and validate a scoring system (MARK&apos;s Quadrant) which can identify symptomatic patients who are at risk for gastric cancer

Meta-analysis of CTLA-4 Gene A/G +49 Polymorphism and Susceptibility to Graves' Disease

Cytotoxic T - Lymphocyte Antigen-4&nbsp;(CTLA-4) gene located on 2q33 in human which plays an important role in the down regulation of CD28 interaction with the ligands on the surface of antigen-presenting cells (APCs). CTLA4 molecule is a susceptible gene for the severity of Graves’ disease (GD). Recent research studies showed that the association between the CTLA4 exon-1 49A/G single nucleotide polymorphism (SNP) and the developing Graves’ disease. So, the present study is planned to perform the meta-analysis to explore the association between the SNP49 and GD susceptibility in human beings to the society. SNP public databases and SNP databases showed that the genetic association of diseases such as obesity, diabetes, osteoporosis, asthma, hypertension, renal failure, heart diseases and thyroidism etc

Laparoscopic staging in gastric cancer: An essential step in its management

Aim: The role of laparoscopy in staging of gastric cancer is widely accepted; however, in Malaysia its usage has been limited. Patients can be classified as resectable or unresectable, which helps in avoiding an unwanted laparotomy and the morbidities associated with it. The aim of this study was to assess the value of laparoscopy in staging of gastric cancer in comparison with CT scan. Materials and Methods: Patients with carcinoma of the stomach after a complete preoperative work-up underwent laparoscopy prior to surgical exploration. TNM staging was used to compare laparoscopy with CT, with the histopathological report used as the gold standard. Results: Forty cases were included in this study. The sensitivity of laparoscopy for T3 tumours appears to be significant when compared to that of CT. Laparoscopy detected 90.3% of the cases as against the 58% detected with CT. There was not much difference in the N factor. With regard to M factor, the sensitivity was 100% for laparoscopy in comparison with CT. Conclusions: Laparoscopy has been shown to be sensitive in detecting metastasis in gastric cancer in comparison to CT, thus helping in avoiding unwanted laparotomy and thus providing a more systemic approach in managing gastric cancers