N-Acetyl-4-(benzene­sulfonamido)benzene­sulfonamide

In the mol­ecule of the title compound, C14H14N2O5S2, the dihedral angle between the aromatic rings is 77.75 (9)°. The acetamide group is planar [maximum deviation = 0.002 (3) Å] and oriented at dihedral angles of 13.49 (21) and 73.94 (10)° with respect to the aromatic rings. An intra­molecular C—H⋯O inter­action results in the formation of a six-membered ring. In the crystal structure, inter­molecular N—H⋯O and C—H⋯O inter­actions link the mol­ecules into a three-dimensional network, forming R 2 2(20) ring motifs

Bis[tris­(1,10-phenanthroline)nickel(II)] tris­[dicyanidoargentate(I)] nitrate 4.2-hydrate

The title compound, [Ni(C12H8N2)3]2[Ag(CN)2]3(NO3)·4.2H2O, crystallizes with two independent [Ni(phen)3]2+ cations (phen is 1,10-phenanthroline; both Ni atoms have threefold symmetry and N6 donor sets), three near-linear [Ag(CN)2]− anions, one nitrate anion (N site symmetry 3) and 4.2 water mol­ecules of crystallization, some of which are disordered. The [Ag(CN)2]− anions are situated within cavities created by the phenanthroline ligands of adjacent [Ni(phen)3]2+ cations. Some short C—H⋯O and C—H⋯N inter­actions may help to establish the packing

In Vitro Release Studies of Diclofenac Potassium Tablet from Pure and Blended Mixture of Hydrophilic and Hydrophobic Polymers

The purpose of the present study was to evaluate the effect of pure and blended mixtures, with different compositions of hydroxy propyl methyl cellulose (HPMC) and carnauba wax (CW) on the release of diclofenac potassium from matrix tablets. Fifteen different matrix tablet formulations were prepared by direct compression process by using Carver Hydraulic laboratory press having 13 mm flat dies set at constant pressure. The paddle dissolution apparatus II (Curio DL 2020) was used to assess the dissolution of drug in phosphate buffer, pH 7.4 for 8 h. The release data was fitted to different release models. Zoom stereo micrography was done to evaluated the release mechanism of drug from polymers. The interaction of polymer mixture and different ratios of drug in polymer mixture was determined by Fourier transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC). The type and content of polymer in the matrix system influenced the release characteristics. Higher polymeric content in the matrix decreased the drug release rate because of increased tortuosity and decreased porosity. Retardation of drug release from pure carnauba was higher as compared to that with pure HPMC matrices. The polymers blends controlled drug release pattern effectively. The drug released showed better linearity with Higuchi release kinetics. The Korsmeyer equation revealed n value ranged from 0.388-0.627 or non - Fickian transport mechanism of drug release was predominant. The FTIR and DSC suggested that there were no chemical interaction between drug and polymers.Colegio de Farmacéuticos de la Provincia de Buenos Aire

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

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

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

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

Comparative Clinical Study on the Effectiveness of Homeopathic Combination Remedy with Standard Maintenance Therapy for Dengue Fever

Purpose: To investigate the effectiveness of homeopathic combination remedy compared with standard maintenance therapy for the treatment of dengue fever. Method: A total of 50 patients with dengue fever were divided into two equal groups. Group 1 was treated with homeopathic combination remedy for consecutive 6 days while standard maintenance therapy was similarly given to Group 2 patients. Their full blood count (FBC) including platelet count (PLT), white blood cell count (WBC) and hematocrit level (HCT) were recorded The parameters were monitored daily in order to determine between the two groups. Results: Following the six-day homeopathic combination remedy, PLT count increased from (95.60 ± 0.04) x 103 to (311 ± 0.13) x 103/µL, and WBC from (79.5 ± 0.05) x 104 to (90.3 ± 0.02) x 104/µL. However, HCT decreased from 48.02 ± 6.70 to 42.32 ± 3.42 %. On the other hand, standard maintenance therapy increased PLT count from (73.44 ± 0.04) x 103 to (239.00 ± 0.04) x 103/µL and WBC from (53.50 ± 0.02) x 104 to (79.40 ± 0.02) x 104/µL, but decreased HCT from 42.30 ± 2.48 to 39.68 ± 4.35 %. A significant difference was seen in the PLT count, WBC and HCT level between the two therapies (p = 0.012, 0.003 and 0.021, respectively). Conclusion: The homeopathic combination appeared to be a more potent treatment against dengue fever; however, further studies are required to demonstrate this clearly