Motor and Somatosensory Evoked Potential Monitoring Without Wakeup Test during Scoliosis Surgery

Background: Available evidence suggests that Transcranial electric motor evoked potentials and somatosensory evoked potential are safe methods to check the integrity of the spinal cord during spine deformity correction surgery. We compare the efficacy of Transcranial electric motor evoked potentials and somatosensory evoked potential to detect the nerve injury during Scoliosis surgery. Objectives: To demonstratethe advantages of combined motor and sensory evoked potential monitoring during Scoliosis surgery. Methods: We analyzed records of 65 (48 female and 17 male) Scoliosis surgery cases of Transcranial electric motor evoked potential and Somatosensory evoked potential.Mean age was 15.6 years. Patients who showed significant (at least 55%) of unilateral or bilateral amplitude loss , for at least five to ten minutes during the intervention in scoliosis surgery under total intravenous anesthesia will be included. Results: From 65 patients during surgery seventeen patients have a significant or complete drop of baseline amplitude on transcranial electric motor evoked potentials. Thirteen patients have the complete return of baseline amplitude by surgeon intraoperative intervention, whereas four patients havea reversal of motor response after 8 hours post-operatively. Transcranial electric motor evoked potential monitoring was 100% specific and 100% sensitive, whereas Somatosensory evoked potential was 100% specific and 85% sensitive. Conclusions: SSEPs and MEPs , in combination give accurate and quick information of nerve or spinal cord insult intraoperatively

Interactive Influence of Nutrient Density and Feeding Pattern on Production Performance of Broiler Breeders

Background: In addition to energy and protein, the minerals also play a vital role in the production performance of birds. The present study was conducted to examine the effect of high energy feed and separate calcium feeding on feed cleanup time and production parameters in broiler breeder pullets. Methods: Nine hundred female birds of the same age (26 week) were divided in nine groups having one hundred birds in each group.  Three different dietary treatments were offered. The group A, B and C were given feeds having 2750, 2900, 2950 Kcal ME / kg and 14.5%, 15%, 15.5% CP respectively along with 165, 155 and 150 grams peak feed allowance at 60 % production.  The second and third groups were given 10 g separate calcium source in the evening.  The experiment continued for a period of twelve weeks.Results: The feed intake was significantly lower in group C as compared to A and B. A significantly lower feed cleanup time and higher hatchability percentage was observed in group B compared to groups A and C. The FCR eggs was significantly lower for groups B and C compared to group A.  The FCR chicks was significantly lower in group B and C compared to group A.  The cost of feed to produce chicks was significantly lower for group B compared to group A and C. Feed consumed to produce one chick was higher for group A compared to groups B and C.  The feed cost to produce one chick was highest for group A and lowest for group B.Conclusion: These results suggested that feed B has lowest feed consumption, cost to produce one chick and feed cleanup time while highest hatchability hence it can be used in the broiler breeder industry to decrease the cost of production and increase profitability

Beyond climate change : Examining the role of environmental justice, agricultural mechanization, and social expenditures in alleviating rural poverty

Extreme weather events and extreme poverty are two sides of the same coin, with far-reaching consequences for emerging nations like Pakistan. Rural people are more likely to experience poverty and inequality as climate change worsens. This research aspires to close the gap between environmental ethics and justice by investigating how climate change issues contribute to poverty in Pakistan. The study used Robust Least Squares (RLS) regression to analyze the impact of water scarcity, extreme temperatures, and excessive rainfall on rural poverty in Pakistan from 1990Q1 to 2022Q4. Further, the study examines the effect of environmental justice in�terventions, access to healthcare and education, agricultural value-added and agricultural mechanization on the country’s rural poverty. Results reveal that climate change contributes to rural poverty in Pakistan, while environmental justice initiatives, healthcare access, and agricultural automation alleviate poverty incidence. The Impulse Response Function (IRF) estimates suggested that rural poverty will be exacerbated over the next decade by water scarcity, high temperatures, and low agricultural value added but alleviated by excessive rainfall, environmental justice intervention, healthcare access, and agricultural mechanization. According to Variance Decomposition Analysis (VDA) projections, agricultural value added will substantially impact rural poverty by 2032, increasing it by 11.431%. Addressing these problems requires policymakers to prioritize the interests of the most marginalized groups by fostering fair results. Policies should cut GHG emissions and encourage sus�tainable development to combat climate change. Modernizing farming techniques and expanding access to healthcare are also necessary for increasing efficiency and production. It is essential to execute environmental justice interventions so that all communities have access to environmental resources and protections equitably. Promoting equitable outcomes and reducing poverty in Pakistan’s climate change context may be achieved by closing the gap between environmental ethics and justice

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.Peer reviewe

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

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