Enhancement of empathy in children through interventions

This is a quasi-experimental study; a four-month intervention-program designed to boost the empathetic attitude in public school students of Pakistan. The empathy towards bullying was assessed in experimental (199) and control (184) groups.  The study had three phases. In the first phase the students  were  engaged in different activities to foster empathy which established that empathetic score of students increased and the score of bullying tendencies decreased after the use of interventions. The activity began with a story, followed by a group discussion, highlighting the different aspects of human feelings, emotions and behaviors, alongside encouraging children to give their feedback. In the second phase 98 students were selected from treated group, boys (N= 53) and girls (N= 45). Six more interventions were applied including  reciting stories, question-answer sessions related to stories, followed by asking about the lessons students learnt from these stories. These conversations ended on  brief lectures of trainers about empathy guided by the researcher during the training of trainers. After completion of this session, in the third phae, for qualitative assessment selected students from treated group were asked to write a story about empathy. The study found that the boys and girls grasped the concept of empathy differently. For boys described empathy as being helpful while girls as a means of getting happiness; but both did not associate empathy with kindness. Also, the boys believed that parents are the first to notice changes in their personality while girls think its their teachers. Moreover, for adopting the attitude of empathy, unlike boys, girls showed more collective rather than personalized  approach. &nbsp

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

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

Practice and effect of pesticide use on farmers’ health in Sindh, Pakistan

Objectives: To identify the frequency and mode of pesticide application, its adverse health effects, and to assess farmers’ knowledge and practice of precautionary measures. Methods: The cross-sectional study was conducted in Matli, Badin in the Sindh province of Pakistan from February to April 2020, and comprised farmers. Data was collected through face-to-face interview using a validated questionnaire. Data was analysed using SPSS 22. Results: Of the 332 farmers, 329(99.1%) were males. The overall mean age was 31.18±12.79 years (range: 21-30 years). Also, 269(81%) of them had not attended formal schooling, and the mean duration of farming practice was 1.64±0.859 years.` Further,  136(41%) participants did not follow the recommended frequency of pesticide application, accidental ingestion was reported by 208(62.7%) participants, and inhalation by 203(61.1%). Dumping of pesticide containers in open fields was a common practice for 247(74.4%) subjects, and 223(67.2%) showed interest in safety training sessions. Conclusions: Farmers of Sindh were found to be seriously exposed to pesticide risk because of inadequate knowledge. Key Words: Developing country, Farmers, Pakistan, Personal protective equipment, Pesticides. Continue..

Roeder’s Knot: Solution to Intra-Corporeal Knot Tying

&nbsp;Background: To evaluate the security and diversity of application of Roeder's knot. Methods: In this prospective study patients (n=771) undergoing laparoscopic surgery, along with application of Roeder's knot, were included. The formula for making the Roeder’s knot was (1:3:1) ‘one hitch, three winds and one locking hitch’. Loop was made around a post and then a simple knot was made. With the shorter end, three winds were made around both posts and were secured with the last half hitch. Excess length of the string was trimmed . Knot was held in the grasper and was slided down the trocar into the abdominal cavity. Once inside the abdominal cavity, the structure to be ligated, was placed through the loop. Free end of the string was passed thorough the eye of a knot pusher and knot pusher was slided through the trocar and knot was tightened. End of the knot was trimmed with scissors . For a structure that is not blind ended (eg. an artery or cystic duct), the thread was passed under the structure. Both ends were taken out, loop was tied in a similar manner and was then tightened with knot pusher. To tie the knot, over a suture, needle was brought outside and procedure was repeated.Results: Roeder’s knot was placed in a total of seven hundred and seventy one cases out of total 1883 procedures performed during the study period. The time to assemble the knot was 33 seconds. The time to place a pre-tied knot was two minutes three seconds. The time to assemble and place Roeder’s knot in laparoscopic appendectomies averaged about 2 minutes 36 seconds. It took an average of 3 minutes 40 seconds to assemble and place it in laparoscopic cholecystectomies. While time to place a traditional square knot intra-abdominally averaged about 4 minutes and 39 seconds. In all 771 cases where the Roeder’s knot was placed,an incidence of knot slippage or hematoma formation was not observed. Roeder’s knot was applied in all appendectomies, laparoscopic cholecystectomies in which cystic duct diameter was greater than clips and hernial sac not reduced completely. Conclusion: Roeder's knot is easy to assemble and place, secure and is a cost effective alternate to intra-corporeal suturing and staples during laparoscopic surgeries

Chemical Markers and Pharmacological Characters of <i>Pelargonium graveolens</i> Essential Oil from Palestine

Pelargonium graveolens leaves are widely used in traditional medicine for relieving some cardiovascular, dental, gastrointestinal, and respiratory disorders. They are also used as food and tea additives in Palestine and many other countries. Consequently, this investigation aimed to describe the chemical markers, cytotoxic, antioxidant, antimicrobial, metabolic, and cyclooxygenase (COX) enzymes inhibitory characteristics of P. graveolens essential oil (PGEO) from Palestine utilizing reference methods. There were 70 chemicals found in the GCMS analysis, and oxygenated terpenoids were the most abundant group of the total PGEO. Citronellol (24.44%), citronellyl formate (15.63%), γ-eudesmol (7.60%), and iso-menthone (7.66%) were the dominant chemical markers. The EO displayed strong antioxidant activity (IC50 = 3.88 ± 0.45 µg/mL) and weak lipase and α-amylase suppressant effects. Notably, the PGEO displayed high α-glucosidase inhibitory efficacy compared with Acarbose, with IC50 doses of 52.44 ± 0.29 and 37.15 ± 0.33 µg/mL, respectively. PGEO remarkably repressed the growth of methicillin-resistant Staphylococcus aureus (MRSA), even more than Ampicillin and Ciprofloxacin, and strongly inhibited Candida albicans compared with Fluconazole. The highest cytotoxic effect of the PGEO was noticed against MCF-7, followed by Hep3B and HeLa cancer cells, with IC50 doses of 32.71 ± 1.25, 40.71 ± 1.89, and 315.19 ± 20.5 µg/mL, respectively, compared with doxorubicin. Moreover, the screened EO demonstrated selective inhibitory activity against COX-1 (IC50 = 14.03 µg/mL). Additionally, PGEO showed a weak suppressant effect on COX-2 (IC50 = 275.97 µg/mL). The current research can be considered the most comprehensive investigation of the chemical and pharmacological characterization of the PGEO. The results obtained in this study demonstrate, without doubt, that this plant represents a rich source of bioactive substances that can be further investigated and authenticated for their medicinal potential

فاعلية أنموذج تسريع التفكير في اكتساب المفاهيم الأحيائية لدى طلاب الصف الثاني المتوسط والمهارات العقلية لديهم The Effectiveness of The Model to Accelerate Thinking of Acquiring the Biological Concepts of the Second Grad Students average and the Mental Skills

The aim of the research to identify the effectiveness of the model to accelerate thinking in: 1. Acquire biological concepts among second-grade students in biology. 2.the mental skills of students in the second grade intermediate in biology. In order to verify the objectives of the research, the following two hypotheses were formulated: There are no statistical differences at the level of significance (0.05) between the average score of experimental students who study biology according to the model of acceleration of thinking and the average grades of control group students who study the same subject according to the usual method of testing the acquisition of concepts. 2. There are no significant differences at the level of significance (0.05) between the average score of students in the experimental group who study biology on the model of accelerating the thinking and the average grades of control group students who study the same article according to the usual method of mental skills. In order to verify the validity of the two hypotheses, a two-month trial was conducted. The following procedures were adopted: The experimental design of the experimental groups and the post-test controls was used to acquire the biological concepts and the mental skills. According to this design, the "Medium Banner of Islam for Boys" was chosen by the General Directorate of Education in the holy governorate of Karbala by the mean method. The school (106) students divided into three divisions (A - B - C), randomly selected (A), the number of students (35) students to represent the experimental group, who studied on the model acceleration of thinking, and in the same way was chosen Division (C) The number of students (34) students Such as the control group who studied according to the normal method. The two groups were then statistically compensated for a set of variables: the age of time calculated in months, the educational achievement of the parents, previous achievement in biology, previous information, intelligence. The scientific material was determined in the last three grades (seventh, eighth and ninth) of the biology book (2016, i7), which is to be taught for the second intermediate grade by the Iraqi Ministry of Education for the academic year 2016-2017. The content of the chapters was analyzed and a number of concepts (37) main concepts and (23) sub-concepts. According to these concepts, a number of behavioral goals were formulated, reaching (164) behavioral goals. In accordance with these objectives, (16) daily teaching plan for the experimental group and (16) p Of teaching daily to the control group. The researcher has developed according to conceptual map (15) a main and branch concept and gave each concept three experimental paragraphs according to the three cognitive processes (definition - discrimination - application) The test clauses were 45 multi-choice test pieces with four alternatives. The apparent honesty, the validity of the content (construction), the coefficient of difficulty, the coefficient of ease, the coefficient of discrimination, the effectiveness of the wrong alternatives for each of the test paragraphs were found, and the stability coefficient of the test was found in two ways: (0.85), corrected by Spearman-Brown (0.92), and Kyoder Richardson-20 (0.83) The second tool consisted of testing the mental skills, which consisted of (9) skills, each skill (4) test paragraphs, and thus the total number of test paragraphs (36) test paragraph of the type of multiple choice of four alternatives, The reliability of the content, the coefficient of difficulty, the coefficient of ease, the coefficient of discrimination, the effectiveness of the wrong alternatives and the stability coefficient were two ways: the midterm split (77%) and the Spearman-Brown equation (0.86) and the Kieder Richardson-20 equation (0.84(. The experiment was applied in the second semester of the academic year (2016 - 2017) and over the course of (8 weeks). The actual teaching started on Wednesday, 1/3/2017 and ended on Sunday, 2017). After using the appropriate statistical means, the results showed that the students of the experimental group who studied on the model of acceleration of thinking on the students of the control group studied according to the normal method in the tests of the acquisition of biological concepts and mental skills. In the teaching of biology for the second grade average because of the P In addition to suggesting a similar study on other variables and for other stages of study. هدف البحث إلى التعرف على فاعلية أنموذج تسريع التفكير في : 1- اكتساب المفاهيم الأحيائية لدى طلاب الصف الثاني المتوسط في مادة علم الأحياء. 2- المهارات العقلية لدى طلاب الصف الثاني المتوسط في مادة علم الأحياء. ولغرض التحقُق من هدفي البحث صيغتْ الفرضيتان الصفريتان الآتيتان : 1- لا توجد فروق ذات دلالة احصائية عند مستوى دلالة (0.05) بين متوسط درجات طلاب المجموعة التجريبية الذين يدرسون مادة علم الأحياء على وفق أنموذج تسريع التفكير وبين متوسط درجات طلاب المجموعة الضابطة الذين يدرسون المادة نفسها على وفق الطريقة الاعتيادية في اختبار اكتساب المفاهيم. 2- لا توجد فروق ذات دلالة احصائية عند مستوى دلالة (0.05) بين متوسط درجات طلاب المجموعة التجريبية الذين يدرسون مادة علم الأحياء على وفق أنموذج تسريع التفكير وبين متوسط درجات طلاب المجموعة الضابطة الذين يدرسون المادة نفسها على وفق الطريقة الاعتيادية في المهارات العقلية. وللتحقق من صحة الفرضيتين الصفريتين أُجريت تجربة استغرقت شهرين كاملين, إذ تمَ اعتماد الإجراءات الآتية : استخدم التصميم التجريبي ذا الضبط الجزئي للمجموعتين التجريبية والضابطة ذوات الاختبار البعدي لاكتساب المفاهيم الأحيائية والمهارات العقلية, وعلى وفق هذا التصميم تمَ اختيار (متوسطة راية الإسلام للبنين) التابعة الى المديرية العامة للتربية في محافظة كربلاء المقدسة بالطريقة القصدية, إذ بلغ عدد طلاب الصف الثاني المتوسط في المدرسة (106) طلاب موزعين على ثلاث شعب (أ - ب - ج), اختيرت شعبة (أ) عشوائياً والبالغ عدد طلابها (35) طالباً لتمثل المجموعة التجريبية, الذين درسوا على وفق أنموذج تسريع التفكير, وبالطريقة نفسها اختيرت شعبة (ج) والبالغ عدد طلابها (34) طالباً لتمثل المجموعة الضابطة الذين درسوا على وفق الطريقة الاعتيادية, ثم كوفئت المجموعتان احصائياً في مجموعة من المتغيرات هي : العمر الزمني محسوباً بالشهور, التحصيل الدراسي للوالدين, التحصيل السابق في مادة علم الأحياء, المعلومات السابقة, الذكاء. وقد تحددت المادة العلمية بالفصول الثلاثة الأخيرة (السابع والثامن والتاسع) من كتاب مادة علم الأحياء (2016,ط7) المقرر تدريسه للصف الثاني المتوسط من قبل وزارة التربية العراقية للعام الدراسي (2016- 2017 م), وقد تمَ تحليل محتوى الفصول واستخراج عدداً من المفاهيم الرئيسة والفرعية, إذ استخرج (37) مفهوماً رئيساً و(23) مفهوماً فرعياً, وعلى وفق هذه المفاهيم تم صياغة عدداً من الأهداف السلوكية بلغت بصيغتها النهائية (164) هدفاً سلوكياً, وعلى وفق هذه الأهداف تم صياغة (32) خطة تدريسية يومية للمجموعتين التجريبية والضابطة, بلغت (16) خطةً تدريسيةً يوميةً للمجموعة التجريبية و(16) خطة تدريسية يومية للمجموعة الضابطة. وقد تم اعداد أداتين للبحث هما اختبار اكتساب المفاهيم الأحيائية بالاعتماد على المفاهيم الرئيسة والفرعية, إذ حدد الباحث على وفق الخارطة المفاهيمية (15) مفهوماً رئيساً وفرعياً وأعطى لكل مفهوم ثلاث فقرات اختبارية على وفق العمليات المعرفية الثلاثة : (تعريف - تمييز - تطبيق) ليصبح عدد فقرات الاختبار (45) فقرة اختبارية من نوع الاختيار من متعدد ذي أربعة بدائل, وتم ايجاد الصدق الظاهري وصدق المحتوى (البناء) ومعامل الصعوبة ومعامل السهولة ومعامل التمييز وفعالية البدائل الخاطئة لكل فقرة من فقرات الاختبار, وايجاد معامل الثبات للاختبار بطريقتين هما : التجزئة النصفية والذي بلغ (0.85) وعند تصحيحه بمعادلة سبيرمان – براون بلغ (0.92), ومعادلة كيودر ريتشاردسون- 20 والذي بلغ (0.83) أما بالنسبة للأداة الثانية فتمثلت باختبار المهارات العقلية الذي تكون من (9) مهارات, لكل مهارة (4) فقرات اختبارية, وبذلك بلغ العدد الكلي لفقرات الاختبار (36) فقرة اختبارية من نوع الاختيار من متعدد ذي أربعة بدائل, وحَسَبَ الباحث أيضأً الصدق الظاهري, وصدق المحتوى, ومعامل الصعوبة, ومعامل السهولة, ومعامل التمييز, وفعالية البدائل الخاطئة ومعامل الثبات بطريقتين هما : التجزئة النصفية والذي بلغ (77%) وعند تصحيحه بمعادلة سبيرمان - براون بلغ (0.86), ومعادلة كيودر ريتشاردسون- 20 والذي بلغ (0.84). طُبِقَت التجربة في الفصل الدراسي الثاني للعام الدراسي (2016- 2017 م) وعلى مدى (8 أسابيع), إذ كانت بداية التدريس الفعلي يوم (الأربعاء) الموافق (1/3/2017 م) ونهايته يوم (الأحد) الموافق (30/4/2017 م), وبعد استخدام الوسائل الإحصائية المناسبة أظهرت النتائج تفوق طلاب المجموعة التجريبية الذين درسوا على وفق أنموذج تسريع التفكير على طلاب المجموعة الضابطة الذين درسوا على وفق الطريقة الاعتيادية في اختباري اكتساب المفاهيم الأحيائية والمهارات العقلية , وفي ضوء النتائج أوصى الباحث بمحاولة اعتماد أنموذج تسريع التفكير في تدريس مادة علم الأحياء للصف الثاني المتوسط لما له من فاعلية في رفع مستوى اكتساب المفاهيم الأحيائية والمهارات العقلية للطلاب, وكذلك اقترح إجراء دراسة مماثلة على متغيرات أُخر ولمراحل دراسية أُخر

Anterior versus posterior approach to treat cervical spondylotic myelopathy, clinical and radiological results with long period of follow-up

Background: Cervical spondylotic myelopathy increases with age, but not all cases are symptomatic. It is usually diagnosed clinically and radiologically (X-ray and magnetic resonance imaging). Surgical treatment is indicated in severe symptomatic cases, while treatment controversy exists in the presence of less severe cases. Anterior and posterior approaches are generally used for decompression with no significant differences in the results of both. Methods: A total of 287 patients of cervical spondylotic myelopathy were treated at our hospital between January 2004 and December 2015. Only 140 patients were eligible for our study. They had at least 5 years of follow-up using full clinical scores and radiological evaluation. They were divided into two groups: group I with 73 patients (aged 23–79 years) underwent posterior decompression, lateral mass instrumentation, and fusion, while group II with 67 patients (aged 33–70 years) underwent anterior decompression, instrumentation, and fusion. Neck Disability Index, local score, and X-ray were used in the evaluation of the patients. Results: Preoperative mean ± standard deviation of Neck Disability Index of both the groups was 32.06 ± 6.33 and 29.88 ± 5.48, which improved in the last visit (>5 years) to 5.81 ± 7.39 and 2.94 ± 5.48 for groups I and II, respectively (p value <0.05). The local score of groups I and II was (P = 1, F = 21, G = 31, E = 19) and (P = 1, F = 12, G = 36, E = 18), which on discharge day improved to (P = 1, F = 4, G = 12, E = 55) and (P = 0, F = 3, G = 6, E = 58) at last follow-up, respectively. Fusion rate was nearly equal for both the groups during all the follow-up intervals and it was 91.1% and 91.7% in the last follow-up. Conclusion: There were no significant differences in the clinical and radiological results between the anterior and posterior approaches used in the surgical treatment of spondylotic cervical myelopathy. However, statistically significant results of Neck Disability Index of anterior approach were not clinically important and may be due to changes in the size and shape of the neck in group II

PakSurg 1: Determining the epidemiology and risk factors of surgical site infections in Pakistan-a multicentre, prospective cohort study

Introduction: Surgical site infections (SSIs) are among the the most common postoperative complications, despite being highly preventable. Multiple studies have explored the incidence and risk factors of SSIs globally. However, nationally representative data capable of informing evidence-based guidelines remain limited in Pakistan. Hence, the aim of this study is to identify the incidence and risk factors of developing SSIs following surgery and to explore existing SSI prevention practices in Pakistan.Methods and analysis: This study is a multicentre, prospective cohort study across various sites in Pakistan. All consecutive adult patients undergoing inpatient elective surgery in a 1 month patient recruitment window from one or more of the nine eligible subspecialties will be included in the study. Patients with preoperative infections, emergency surgeries or intraoperative mortality are to be excluded. The following surgical subspecialties are included: breast surgery, cardiac surgery, colorectal surgery, cranial surgery, general surgery, obstetrics and gynaecology, orthopaedics surgery, spine surgery and vascular surgery. Each mini-team of up to three collaborators can select one of the nine subspecialties and a 1 month patient recruitment window from 20 September 2022 to 31 March 2023. Multiple mini-teams from the same sites can recruit patients across the same subspecialty in distinct patient recruitment windows. Additionally, multiple mini-teams from the same sites can recruit patients across different subspecialties in the same or distinct patient recruitment windows. The primary outcome is 30 day SSIs. Secondary outcomes include 30 day antibiotic-resistant SSIs, organ-space infections, other healthcare associated infections, reinterventions and all-cause mortality.Ethics and dissemination: Approval was received by the Aga Khan University (AKU) Ethics Review Committee (ERC) and the National Bioethics Committee (NBC) Pakistan. The results from this study will be disseminated by the steering committee in journal publications, conference presentations and on other academic platforms. Evidence-based guidelines that result from these data will be disseminated to all surgical care providers in Pakistan through national networks