Antibiotic Use in Caesarean Section among Obstetricians and Gynaecologists in the Second Largest City in Indonesia: Penggunaan Antibiotik pada Operasi Sesar oleh Dokter Obstetri dan Ginekologi di Kota Terbesar Kedua di Indonesia

Objective: To evaluate the pattern of antibiotic use incesarean section `by obstetricians in Surabaya, Indonesia.Methods: This was a descriptive observational study witha cross-sectional method. Study data were obtained fromonline interviews using electronic forms. This study useda total sampling method taken from obstetricians andgynecologists in Surabaya, Indonesia. The primary outcomeof this study was a pattern of antibiotic use, includingprophylactic use, selection of antibiotics, the timing ofadministration, additional antibiotics during and aftersurgery, and consideration of choice.Results: The majority of antibiotics used in CS are in linewith the guidelines. The types of prophylactic antibiotics(iv) used are varied; the majority were cefazoline (74.5%),ceftriaxone (14.5%), and cefotaxime (11.6%). Most antibioticswere administered <30 minutes before surgery. 2.5% ofobstetricians routinely added antibiotics during a cesarean,while 33% were based on a particular condition such asprolonged surgery, massive bleeding, or risk of infections.The selection of antibiotics by obstetricians was based onprotocols followed in the hospital (44.5%).Conclusion: This study demonstrates that most obstetriciansutilized antibiotic prophylaxis appropriately and followedguidelines for Cesarean Section.Keywords: antibiotic, cesarean section, maternal health,obstetricians.AbstrakTujuan: Untuk mengevaluasi pola penggunaan antibiotikpada seksio sesarea oleh dokter kandungan di Surabaya,Indonesia.Metode: Ini merupakan studi deskriptif observasionaldengan metode pengambilan data potong lintang. Datastudi diperoleh dari wawancara online dengan menggunakanformulir elektronik. Studi ini menggunakan total samplingdari dokter obstetri dan ginekologi di Surabaya, Indonesia.Hasil utama dari penelitian ini adalah pola penggunaanantibiotik, termasuk penggunaan profi laksis, pemilihanantibiotik, waktu pemberian, antibiotik tambahan selamadan setelah operasi, dan pertimbangan pilihan antibiotiktersebut.Hasil: Mayoritas antibiotik yang digunakan pada seksiosesarea sesuai dengan pedoman. Jenis antibiotik profi laksis(iv) yang digunakan bervariasi, mayoritas adalah cefazoline(74,5%), ceftriaxone (14,5%), dan cefotaxime (11,6%).Sebagian besar antibiotik diberikan <30 menit sebelumoperasi. 2,5% dokter kandungan rutin menambahkanantibiotik saat operasi sesar, sedangkan 33% didasarkanpada kondisi tertentu seperti operasi yang berkepanjangan,perdarahan masif, atau risiko infeksi. Pemilihan antibiotikoleh dokter kandungan berdasarkan protokol yang diikutidi rumah sakit (44,5%).Kesimpulan: Studi ini menunjukkan bahwa sebagian besardokter kandungan menggunakan profi laksis antibiotikdengan tepat dan mengikuti pedoman untuk operasi seksiosesaria.Kata kunci: antibiotik, dokter kandungan, kesehatan ibu,operasi sesar

Kinetic and thermodynamic study of oxidative degradation of acid yellow 17 dye by Fenton-like process: Effect of HCO3−, CO32−, Cl− and SO42− on dye degradation

We report here the degradation of AY-17 dye using Fenton-like process (H2O2/Fe3+). The maximum degradation (83%) of AY17 dye is achieved at pH 3 in 60 min, with optimum concentrations of AY 17 (0.06 mM), H2O2 (0.9 mM), and Fe2+ (0.06 mM). The scavenging effects of HCO3−, CO32−, Cl− and SO42− on dye degradation are also examined. The activation energy (Ea), activation enthalpy (rH*), and activation entropy (rS*) are calculated for the dye degradation using pseudo-first-order kinetics at various temperature.               KEY WORDS: Acid Yellow 17, H2O2/Fe3+, Fenton-like process, Oxidative degradation, Scavenging effects Bull. Chem. Soc. Ethiop. 2019, 33(2), 243-254.DOI: https://dx.doi.org/10.4314/bcse.v33i2.

Technical challenges of working with extracellular vesicles

Extracellular Vesicles (EVs) are gaining interest as central players in liquid biopsies, with potential applications in diagnosis, prognosis and therapeutic guidance in most pathological conditions. These nanosized particles transmit signals determined by their protein, lipid, nucleic acid and sugar content, and the unique molecular pattern of EVs dictates the type of signal to be transmitted to recipient cells. However, their small sizes and the limited quantities that can usually be obtained from patient-derived samples pose a number of challenges to their isolation, study and characterization. These challenges and some possible options to overcome them are discussed in this review

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

Background 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

Global injury morbidity and mortality from 1990 to 2017: Results from the global burden of disease study 2017

Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care

The burden of unintentional drowning: Global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study

__Background:__ Drowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study's objective is to describe unintentional drowning using GBD estimates from 1990 to 2017. __Methods:__ Unintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning. __Results:__ Globally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531 956 (uncertainty interval (UI): 484 107 to 572 854) to 295 210 (284 493 to 306 187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0 (3.8 to 4.1) per 100 000 per annum in 2017. Unintentional drowning-associated mortality was generally higher in children, males and in low-SDI to middle-SDI countries. China, India, Pakistan and Bangladesh accounted for 51.2% of all drowning deaths in 2017. Oceania was the region with the highest rate of age-standardised YLLs in 2017, with 45 434 (40 850 to 50 539) YLLs per 100 000 across both sexes. __Conclusions:__ There has been a decline in global drowning rates. This study shows that the decline was not consistent across countries. The results reinforce the need for continued and improved policy, prevention and research efforts, with a focus on low-and middle-income countries