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

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 &lt; 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

Synthesis and Characterization of Carboxymethyl Chitosan Nanogels for Swelling Studies and Antimicrobial Activity

Nanogels of a binary system of carboxymethyl chitosan (CMCh) and poly- (vinyl alcohol) PVA, were successfully synthesized by a novel in situ process. They were also characterized by various analytical tools like Fourier transform infrared spectroscopy (FTIR), transmission electron microscopy (TEM) and X-ray diffraction (XRD). They were studied for their unique swelling properties in water and different pH solutions. They were also investigated for their great ability to capture or isolate bacteria and fungi from aquatic environments

Porous membrane modifier as a new trend for deoiling process

Porous membranes are prepared through micro phase separation of immiscible polymers consisting of hydrophobic polymer (polystyrene) and hydrophilic polymer (poly(2-vinylpyridine)). The greatest difficulties during petrolatum deoiling are related to the filtration stage for obtaining microcrystalline wax. The present study deals with the addition of porous membrane as modifier for the crystal structure of solid hydrocarbons, which will be the cornerstone in rearrangement and reformulation of new hard crystals in deoiling process. XRD and SEM photographs were used to evaluate the crystallinity and crystal sizes of the separated hard waxes

Environmentally friendly road construction

Environmental pollution is a major problem in developing countries like Egypt. Reuse of waste polymers is considered an attractive solution for environmental white pollution and reducing of the costs of road pavement and maintenance. This research aims to prepare environmentally friendly hot mix asphalt (HMA) for paving using some industrial wastes as polypropylene and polyester fibers. The solid materials in the mix include normal and highly porous aggregates. 5% and 10% of waste polymers by weight of the asphalt were used to prepare special binders. The samples were tested for their physical properties, chemical properties, aging, scanning electron microscopy (SEM) and thermo-gravimetric analysis (TGA). The results revealed that the prepared HMA using 5% of waste polymer had high performance as compared to the ordinary one and the waste polymer could be used in road construction

Antimicrobial Activity of Hybrids Terpolymers Based on Magnetite Hydrogel Nanocomposites

In the past few years, the development of hydrogel properties has led to the emergence of nanocomposite hydrogels that have unique properties that allow them to be used in various different fields and applications such as drug delivery, adsorption soil containing, tissue engineering, wound dressing, and especially antimicrobial applications. Thus, this study was conducted in order to fabricate a novel crosslinked terpolymer nanocomposite hydrogel using the free radical copolymerization method based on the usage of 2-acrylamido-2-methylpropane sulfonic acid (AMPS), acrylamide (AAm), acrylonitrile (AN), and acrylic acid (AA) monomers and iron oxide (Fe3O4) magnetic nanoparticles and using benzoyl peroxide as an initiator and ethylene glycol dimethacrylate (EGDMA) as a crosslinker. The structure of the synthesized composite was confirmed using Fourier transform infrared (FTIR) spectroscopy and x-ray powder diffraction (XRD) measurements. Furthermore, the surface morphology and the magnetic nanoparticle distributions were determined by scanning electron microscopy (SEM) measurement. In addition, the swelling capacity of the hydrogel nanocomposite was measured using the swelling test. Lastly, the efficiency of the produced composite was evaluated as an antimicrobial agent for Gram-positive and Gram-negative bacterial strains and a fungal strain

Thermo-mechanical properties improvement of asphalt binder by using methylmethacrylate/ethylene glycol dimethacrylate

Various polymer-modified asphalt compositions for paving and roofing applications are known since several years ago. The degree to which a polymer improves the asphalt’s properties depends on the compatibility of the polymer and the asphalt. Highly compatible polymers are more effective in providing property improvements. In this research, the influence of in situ polymerization of methylmethacrylate monomer with asphalt in presence of ethylene glycol dimethacrylate (EGDM) as a crosslinker on the rheological and thermal properties of asphalt binder of type penetration grade 60/70 was studied. To achieve this aim, MMA/EGDM(MC) in different ratios as 5, 10 and 15% (w/w) were used to modify the thermo-mechanical properties of asphalt via forming chemical bond, and the changing in mechanical and thermal properties, of the mixes as well as the storage stability were studied. Also, the morphology (SEM), thermal characterization (TGA), dynamic mechanical analysis (DMA), bending and rheological tests were detected. The obtained experimental results revealed that the addition of MC causes both the rheological and thermal properties of the binder to improve and the prepared PMAs has high temperature susceptibility and low curing time. The improvement in the properties of the virgin asphalt will be effective in using this soft type in coating applications instead of highly expensive oxidized one

Green Route Synthesis and Molecular Docking of Azines Using Cellulose Sulfuric Acid under Microwave Irradiation

A novel catalytic approach for the synthesis of symmetric and asymmetric azines has been developed. The environmentally benign protocol was achieved via condensation of 1-[(2-thienyl)ethylidene]hydrazine (1) with different aromatic aldehydes 2a&ndash;h and acetyl heterocyclic compounds (4, 6, 8, 10, and 12) in the presence of cellulose sulfuric acid (CSA) as the green catalyst. These procedures offer an interesting method for the large-scale industrial manufacture of azines due to their high percentage yield, mild reaction conditions, broad substrate range, and utilization of an economical and environmentally acceptable catalyst. Additionally, the molecular docking of the products to the monoamine oxidase (MAO-A) target protein was achieved to highlight the possible binding interaction with the amino acid residues Arg51, Glu43, Gly22, Gly49, Gly443, Ala272, Ile335, and Tyr407 at the point of binding. The binding interaction energy was discovered to be (&minus; 6.48 kcal/mol) for the protein MAO-A (PDB ID: 2Z5X). The most effective azine derivatives 7 and 13 revealed some major conserved interactions between the MAO-A protein&rsquo;s binding site amino acid residues and the PDB co-crystal ligand 2Z5X. Moreover, azine derivatives 3a and 3f showed the lowest binding activity with the target MAO-A

Green Route Synthesis and Molecular Docking of Azines Using Cellulose Sulfuric Acid under Microwave Irradiation

A novel catalytic approach for the synthesis of symmetric and asymmetric azines has been developed. The environmentally benign protocol was achieved via condensation of 1-[(2-thienyl)ethylidene]hydrazine (1) with different aromatic aldehydes 2a–h and acetyl heterocyclic compounds (4, 6, 8, 10, and 12) in the presence of cellulose sulfuric acid (CSA) as the green catalyst. These procedures offer an interesting method for the large-scale industrial manufacture of azines due to their high percentage yield, mild reaction conditions, broad substrate range, and utilization of an economical and environmentally acceptable catalyst. Additionally, the molecular docking of the products to the monoamine oxidase (MAO-A) target protein was achieved to highlight the possible binding interaction with the amino acid residues Arg51, Glu43, Gly22, Gly49, Gly443, Ala272, Ile335, and Tyr407 at the point of binding. The binding interaction energy was discovered to be (− 6.48 kcal/mol) for the protein MAO-A (PDB ID: 2Z5X). The most effective azine derivatives 7 and 13 revealed some major conserved interactions between the MAO-A protein’s binding site amino acid residues and the PDB co-crystal ligand 2Z5X. Moreover, azine derivatives 3a and 3f showed the lowest binding activity with the target MAO-A