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

STABILITY ANALYSIS OF OPEN STOPES AND BACKFILL IN LONGHOLE STOPING METHOD FOR ASIKOY UNDERGROUND COPPER MINE

Within the scope of this study, forwarded to analyse the whole underground stability of the open stopes and pillars in the longhole stoping with post backfill method which is applied at Asikoy underground mine, a series of rock mechanics tests were carried out on the core samples taken from the ore (chalcopyrite), surrounding rock (basalt) and backfill material and the geomechanical properties of the samples were determined. In order to calculate the stress and deformation around underground openings, Phase(2) which is a two-dimensional elastoplastic finite elements program was used and the stability analysis was performed separately for the open stopes and pillars

Longwall Production with Subsidence

Subsidence is a ground settlement that occurs on the surface after the underground mine excavation. The amount of the subsidence is particularly high for caving method applied in the thick coal seams. Subsidence amount depends on the thickness of bed, the slope of bed, and geological formations. This phenomenon also changed the width of the affected area. In particular, the control of the subsidence in the mines close to the residential area is very important. This section will be described in general and the effects of subsidence

Determination of Optimum Production Capacity and Mine Life Considering Net Present Value in Open Pit Mining at Different Overall Slope Angles

In modern mining industry, with increasing competitive environment and unit costs, it is necessary to evaluate mineral resources optimally from the aspects of economy, safety and environment. On the other hand, production increase is another reality and obligation for today's mining operations. The activities related to the extraction of ore deposit consist of risky operations, which are a great hazard for capital investments that will take many years. Therefore, in terms of feasibility, it is very important to determine optimum production capacity and a mine life in the mine planning. In open pit mine planning, many factors affect total fixed and operating costs, such as haulage costs, particularly when the mine goes deeper, geomechanical features of the ore body and surrounding rocks, diggability and slope stability related to overall slope angle. In this study, with the help of the developed software, by encompassing all these parameters and considering Net Present Value (NPV), it is targeted to determine optimum open pit production capacity and economic mine life, which are the major parameters in feasibility studies of mining projects

Selection of ore transport system for a metalliferous underground mine / Dobór systemu transportu rud w kopalni podziemnej rud metalu

The conditions of increasing competition in today's mining industry, deepening of mines and also decreasing ore reserve and quality parameters (grade, caloric, ppm, etc.) compels to reduce unit cost for maximum benefit. In this context, optimization of machinery and equipment in technical and economical sense is required in terms of economic mining. In underground mining, as ore transport operation significantly affects profitability, optimization of the system gains importance technically and economically. In this paper, the authors studied production capacities up to 1,000,000 ton/year and orebody depths up to 1,000 m according to different haulage systems; conventional shall hoisting, declined mine truck haulage and flexowell vertical belt applications. In model study, unit transport costs of each alternative depending on the production capacity and mine depth have been calculated

SELECTION OF ORE TRANSPORT SYSTEM FOR A METALLIFEROUS UNDERGROUND MINE

The conditions of increasing competition in today's mining industry, deepening of mines and also decreasing ore reserve and quality parameters (grade, caloric, ppm, etc.) compels to reduce unit cost for maximum benefit. In this context, optimization of machinery and equipment in technical and economical sense is required in terms of economic mining. In underground mining, as ore transport operation significantly affects profitability, optimization of the system gains importance technically and economically. In this paper, the authors studied production capacities up to 1,000,000 ton/year and orebody depths up to 1,000 m according to different haulage systems; conventional shall hoisting, declined mine truck haulage and flexowell vertical belt applications. In model study, unit transport costs of each alternative depending on the production capacity and mine depth have been calculated

Instagram: A platform for caudal epidural injection?

Aim: Caudal epidural injection (CEI) is a widely used procedure in pediatric anesthesia for perioperative pain and in adults for chronic radicular pain. Social media platforms, including Instagram, are being increasingly utilized for the dissemination of information in various fields, including medicine. The aim of this study was to evaluate the information content and sources of CEI on Instagram.Method: This study presents an analysis of Instagram contents containing the keywords #caudalepiduralinjection, #caudalepidural, #caudalepiduralblock, #caudalinjection, and #caudalblock on May 1, 2023. The results were classified into four groups based on the source: posts generated by physicians, organizations, patients, or unspecified sources. The posts were further classified into two categories: educational or experience. User influence was also assessed based on the number of followers and posts.Results: A total of 204 posts were assessed. 72 different accounts were identified and the distribution of these accounts is as follows: physicians accounted for 29.16% (n=21), patients accounted for 51.38% (n=37), medical organizations accounted for 11.11% (n=8), and the remaining 8.33% (n=6) were not otherwise specified. Among the posts, 92 (45.09%) were posted by the patients, 71 (34.80%) were posted by physicians, 25 (12.25%) by medical organizations, and 16 (7.84%) were not specified. There was a significant difference in the number of posts created by patients versus physicians (p=0.036). Furthermore, there was a significant difference in the number of followers between physicians and all other groups analyzed. There were no posts regarding the use of CEI in pediatric anesthesia when searching for posts on CEIs.Conclusions: When searching for posts related to CEIs, it is more likely to encounter posts authored by patients, thus resulting in the educational content created by physicians being overshadowed and buried among numerous other posts. We suggest posting educational medical content with the hashtag #MedEd in an attempt to make educational content more easily accessible. These findings highlight the importance of raising awareness about CEIs on Instagram. Pain medicine societies and specialists should actively contribute by sharing credible posts on CEIs

The effects of upper extremity aerobic exercise in patients with spinal cord injury: a randomized controlled study

WOS: 000404953900009PubMed ID: 27824234BACKGROUND: Immobility and secondary complications, including cardiopulmonary disease, pressure ulcers, and pain, occur in patients with spinal cord injury (SCI). These patients also have difficulty coping with the strain of daily activities. Thus, it is important for SCI patients to engage in aerobic exercise in order to be able to cope adequately with the strain of activities and SCI-related complications. AIM: The aim of this study was to investigate the effects of arm aerobic exercise on the parameters of cardiopulmonary function, quality of life, degree of disability, psychological state, and metabolic syndrome. DESIGN: This study was a single blind, randomized, controlled trial. SETTING: This study was conducted in a university hospital. POPULATION: SCI patients were randomly assigned to an intervention group (N.= 17) or a control group (N.= 16). Arm ergometer exercises (three days/week; 1.5 hours/week 50-70% pVO(2)) and general exercises (two sessions/day; 5 days/week), were assigned to the intervention group for 12 weeks. The control group was assigned general exercises only during this trial. METHODS: Before the rehabilitation (Week 0), after six weeks, and after the rehabilitation (Week 12), all patients were evaluated for functional status (maximal oxygen uptake [ pVO(2)], power output [ PO], and Functional Independence Measurement), pulmonary function (FEV1%, FVC%, FEV1/FVC%), quality of life (World Health Organization Measure of Quality of Life, short form, Turkish version), metabolic syndrome parameters (triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting blood sugar, waist circumference, and systolic and diastolic blood pressure), degree of disability (Craig Handicap Assessment and Reporting Technique, short form), and psychological status (Center for Epidemiologic Studies Depression Scale and Hospital Anxiety and Depression Scale). RESULTS: At the end of the study, increases of 39.6% and 45.4% in the pVO(2) and PO levels, respectively, were found. Additionally, no statistically significant difference was found in the intervention group after the rehabilitation compared to the levels before rehabilitation (P 0.05). The control group, on the other hand, showed no clinically significant differences in any of the parameters (P> 0.05). CONCLUSIONS: Short-term arm aerobic exercise performed by patients with SCI improves their exercise capacities. These patients require longer rehabilitation programs to receive more benefits from aerobic exercise training. CLINICAL REHABILITATION IMPACT: Adding arm cranking exercise training to the rehabilitation program of patients with spinal cord injury demonstrated improved exercise capacity; however, further studies are needed to assess the effects of exercise training on other health issues

Foam Posturography: A Cheaper Way to Analyze Postural Stability in Peripheral Vestibular Disorders

WOS: 000326204800014Objective: The aim of this study was to assess the diagnostic accuracy of static posturography with the foam rubber in unilateral and bilateral vestibulopathy in addition to the gait tests. Methods: The study included 62 patients with peripheral vestibulopathy (unilateral n:41, bilateral n:21) and 45 healthy controls. Neurological and neurotological examinations including tonal audiometry, caloric tests and static posturography [mean center of gravity (COG) sway velocity, shift in COG alignment, tandem walk (step width, walking speed, and end sway velocity)] were performed in all patients. Results: When compared with healthy individuals, COG sway velocity of the foam posturography [(Foam) Eyes Open and Closed)] and the step width in the tandem walk test was found to be statistically increased both in patients with uni- and bilateral peripheral vestibulopathy (p0.05). Conclusion: Static posturography with foam rubber is valuable for demonstrating balance impairments in peripheral vestibular disorders. However, a significant shift to the affected side in unilateral or a shift in the antero-posterior direction in bilateral vestibulopathy may not be found especially after the acute phase