Effect of routine pre-operative urethral catheterization of women undergoing minor gynaecological surgeries on urinary symptoms and urinary infections: a randomized control study

Background: The prevalence of urinary tract infection increases in young sexually active women, and women with previous UTI. Routine urethral catheterization performed for bladder evacuation before minor gynecological procedures and it is not clear whether this routine urethral catheterization associated with increased incidence of bacteriuria or UTIs or not. This study designed to detect the effect of routine uretheral catheterization for women undergoing minor gynecological surgeries on urinary symptoms and urinary infections.Methods: Two hundred and forty women infertile women scheduled for uterine assessment by diagnostic hysteroscopy before in-vitro fertilization in assisted reproduction unit of Ahmadi Hospital, Kuwait Oil Company were included in this study. Participants were randomized into; group I (catheterized group) and group II (non-catheterized group). Participants’ urine samples compared pre-operatively and post-operatively and they asked to complete about their pre and post-operative urinary symptoms.Results: Post-operative dysuria, frequency and urgency were significantly higher in catheterized group (22 (18.33%), 26 (21.66%) and 18 (15%); respectively) compared to non- catheterized group [5 (4.16%), 7 (5.83%) and 4 (3.33%); respectively]. Relative risk of dysuria, frequency and urgency after catheterization were 4.4, 3.7 and 4.5; respectively (95% CI; 1.7-11.2, 1.67-8.22 and 1.56-12.9; respectively). Asymptomatic bacteriuria, UTIs and subsequent need for antimicrobial therapy were also significantly high in catheterized group [15 (12.5%), 18 (15%) and 18 (15%); respectively) compared to non-catheterized group (3 (2.5%), 2 (1.96%) and 2 (1.96%); respectively]. Relative risk of asymptomatic bacteriuria and UTIs after catheterization in women undergoing minor gynecological procedures were 5 and 9; respectively (95%CI; 1.48-16.8 and 2.1-37.9).Conclusions: Catheterization in women undergoing minor gynecological surgery was associated with increased risk of dysuria, frequency, urgency, ASB, UTIs and subsequent antimicrobial therapy. Surgeons should revise the practice of routine preoperative catheterization for women undergoing minor gynecological procedures

Agronomical, physiological and molecular evaluation reveals superior salt-tolerance in bread wheat through salt-induced priming approach

Salt stress significantly limit wheat crop productivity worldwide. Exposure to non-lethal levels of salt stress, referred to as "salt-priming", allows plants to persist subsequent lethal conditions; the priming effect continues even after an extended salt stress-free period. This study attempted to evaluate the effectiveness of the salt-induced priming approach to cope with the toxic effects of long-term salinity stress in wheat. After 22 days of gradual salt acclamation to reach 250 mM NaCl, plants were recovered for eight days and finally shocked with 250 mM NaCl (priming+shock) for 7 days. After that, physiological parameters and gene expression of six salt-responsive genes were assessed. Additionally, 120 days after germination (at the end of the season), agronomic traits were recorded. Analysis of the agronomical traits revealed higher productivity in the salt-pretreated group (priming+shock) plants than the non-pretreated (shock only). Consistently, salt-pretreated plants maintained higher photosynthetic pigments level and decreased proline and MDA content than non-pretreated, suggesting enhanced salt tolerance. Moreover, salt-pretreated plants sustained high expressional levels of salt-responsive genes (TaNHX1, TaSOS1, TaSOS4, TaHKT1, TaHKT2, and TaAKT1) comparing with non-pretreated, indicating a vital role in ion homeostasis and conferring salt tolerance. Ultimately, this finding could facilitate novel smart approaches to improve wheat productivity under salt stress

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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The Potential of a Novel Concept of an Integrated Bio and Chemical Formulate Based on an Entomopathogenic Bacteria, <i>Bacillus thuringiensis</i>, and a Chemical Insecticide to Control Tomato Leafminer, <i>Tuta absoluta</i> ‘(Meyrick)’ (Lepidoptera: Gelechiidae)

Tomato leafminer, Tuta absoluta (Meyrick), (Lepidoptera: Gelechiidae), poses severe threats to sustainable tomato production globally with a high capacity to develop resistance to pesticides. Recently, the management programs for this cosmopolitan pest have relied on combinations of chemical insecticides which exacerbate the problems of cross-resistance and adverse environmental effects. A novel concept of integrated formulates through combining a chemical insecticide model of lambda-cyhalothrin with Bacillus thuringiensis (Bt) products as the formulation core was explored and evaluated. The susceptibility of the second instar larvae of tomato leafminer to the original formulation of lambda-cyhalothrin, Dipel, XenTari, and Agree products was assessed and compared to the combined formulations. The positive and negative impacts of lambda-cyhalothrin on the viability and pathogenicity of Bt strains were tracked and documented. The physicochemical properties of the combined formulates were examined and compared to the international standards of pesticide formulations. The proposed integrated combined formulates of Dipel, XenTari, and Agree biopesticides with lambda-cyhalothrin showed an enhancing effect and had a higher potential than the originally manufactured formulations alone for about a 3.67–10.08-fold impact on larval mortality. Lambda-cyhalothrin had no significant adverse effect on either the viability of Bt strains or the physicochemical properties of combined co-formulates. Therefore, such integrated combined formulates would have the potential to be involved as an alternative or a complementary approach in pest management and pest resistance management tools for sustainable pest management

Heme iron polypeptide (proferrin®-ES) versus iron saccharate complex (ferrosac) for treatment of iron deficiency anemia during pregnancy

Objectives: Anemia is one of the world's leading causes of considerable perinatal morbidity and mortality. This study designed to compare the efficacy and safety of Heme iron polypeptide (Proferrin®-ES) versus iron saccharate complex (Ferrosac) in treatment of iron deficiency anemia during pregnancy. Methods: Two hundred and sixty (260) pregnant women with hemoglobin level below 10 gm/dl due to iron deficiency anemia were included in this study and randomized to receive either; intravenous Iron Saccharate (IV group) or oral Proferrin®-ES (PO group) for correction of iron deficiency anemia during pregnancy. Treatment efficacy checked by comparing pre-treatment values of hemoglobin, serum ferritin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and reticulocytes count by the 3-months` post-treatment values. Results: The 3-months` post-treatment hemoglobin level increased compared to the pre-treatment level without any significant difference between the two studied groups (from 8.5 ± 3.5 to 11.3 ± 1.3 gm/dl in PO group and from 8.7 ± 2.5 to 11.7 ± 0.9 gm/dl in IV group). In addition; the 3-months` post-treatment ferritin level, increased compared to the pre-treatment level without any significant difference between the two studied groups (from 19.4 ± 4.9 to 118.8 ± 7.1 ug/l in PO group and from 15.3 ± 5.6 to 122.3 ± 6.4 ug/l in IV group). 1.6% (2/124) of the studied women developed gastrointestinal intolerance and upset with oral Proferrin®-ES (insignificant difference and excluded from the study) and no other side effects recorded with oral Proferrin®-ES. Conclusion: HIP (Proferrin®-ES) is an effective, safe, well tolerable oral iron preparation as well as intravenous iron saccharate complex for treatment of iron deficiency during pregnancy; it increases the hemoglobin and replaces the depleted iron store

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit