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

Replication materials

Analysis material

Holding the door slightly open: Germany's migrants' return intentions and realizations

Return migration intentions are complex and are not necessarily followed by future return migration. Our study compares successful return or repeated migration with self-declared return intentions. We take advantage of the latest German Socio-Economic Panel survey dropout studies and fieldwork to observe a wider return migration window than reported in the literature to answer the question of whether return migration intentions eventually coincided with actual emigration behaviors. We also examine the validity of return migration estimates. This paper explores whether return intentions eventually materialize, whether they can eventually predict actual return behaviors, and if the determinants of actual and predicted return based on intentions are similar. Overall, our results support that migration intentions can predict actual return behavior. While our results show discrepancies in the predictors of return intentions and actual returns, they show emigration intentions as good predictors of actual future emigration. Moreover, we find that life satisfaction significantly impacts the individual intention to remigrate.Corrected Versio

Holding the door slightly open: Germany’s migrants’ return intentions and realizations

Return migration intentions are complex and are not necessarily followed by future return migration. Our study compares successful return or repeated migration with self-declared return intentions. We take advantage of the latest German Socio-Economic Panel survey dropout studies and fieldwork to observe a wider return migration window than reported in the literature to answer the question of whether return migration intentions eventually coincided with actual emigration behaviors. We also examine the validity of return migration estimates. This paper explores whether return intentions eventually materialize, whether they can eventually predict actual return behaviors, and if the determinants of actual and predicted return based on intentions are similar. Overall, our results support that migration intentions can predict actual return behavior. While our results show discrepancies in the predictors of return intentions and actual returns, they show emigration intentions as good predictors of actual future emigration. Moreover, we find that life satisfaction significantly impacts the individual intention to remigrate

Local Fiscal Effects of Immigration in Germany

We investigate the impact of immigration on public budgets using administrative data from German districts (Kreise). While previous literature suggests that the fiscal benefits of migration depend on government spending responses to immigration, the local-level effects in Germany remain relatively unexplored. Our study analyzes how immigration influences public spending, the provision of public goods, and public revenues from 2010 to 2019. Employing the post-double selection LASSO method for model identification and instrument generation, our results suggest that an increase in the foreign population proportion at the district level does not significantly affect public investment spending or collected tax revenues. Overall, along with 2011 results at the community level (Gemeinde), this research discusses the importance of distinguishing between different local levels, migration groups, and expenditure categories, when studying the gains and burdens of immigration in Germany

COVID-19-Related Acute Respiratory Distress Syndrome in a Pregnant Woman Supported on ECMO: The Juxtaposition of Bleeding in a Hypercoagulable State

A 40-year-old pregnant woman at 28 weeks of gestation was diagnosed with severe acute respiratory failure syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). She had severe hypoxemia despite the use of mechanical ventilation and muscle relaxant infusion. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) was used, and she had a cesarian section while on ECMO support. She developed disseminated intravascular coagulation (DIC) with overt bleeding. This was managed by a multidisciplinary team (MDT) and a change of the ECMO circuit resulted in a dramatic improvement of her coagulation profile. Both the mother and the baby were discharged and went home in good condition

Colistin-, cefepime-, and levofloxacin-resistant Salmonella enterica serovars isolated from Egyptian chicken carcasses

Abstract Objectives The emergence of multidrug-resistant (MDR) Salmonella strains, especially resistant ones toward critically important antimicrobial classes such as fluoroquinolones and third- and fourth-generation cephalosporins, is a growing public health concern. The current study, therefore, aimed to determine the prevalence, and existence of virulence genes (invA, stn, and spvC genes), antimicrobial resistance profiles, and the presence of β-lactamase resistance genes (bla OXA, bla CTX-M1, bla SHV, and bla TEM) in Salmonella strains isolated from native chicken carcasses in Egypt marketed in Mansoura, Egypt, as well as spotlight the risk of isolated MDR, colistin-, cefepime-, and levofloxacin-resistant Salmonella enterica serovars to public health. Methods One hundred fifty freshly dressed native chicken carcasses were collected from different poultry shops in Mansoura City, Egypt between July 2022 and November 2022. Salmonella isolation was performed using standard bacteriological techniques, including pre-enrichment in buffered peptone water (BPW), selective enrichment in Rappaport Vassiliadis broth (RVS), and cultivating on the surface of xylose-lysine-desoxycholate (XLD) agar. All suspected Salmonella colonies were subjected to biochemical tests, serological identification using slide agglutination test, and Polymerase Chain Reaction (PCR) targeting the invasion A gene (invA; Salmonella marker gene). Afterward, all molecularly verified isolates were screened for the presence of virulence genes (stn and spvC). The antimicrobial susceptibility testing for isolated Salmonella strains towards the 16 antimicrobial agents tested was analyzed by Kirby–Bauer disc diffusion method, except for colistin, in which the minimum inhibition concentration (MIC) was determined by broth microdilution technique. Furthermore, 82 cefotaxime-resistant Salmonella isolates were tested using multiplex PCR targeting the β-lactamase resistance genes, including bla OXA, bla CTX-M1, bla SHV, and bla TEM genes. Results Salmonella enterica species were molecularly confirmed via the invA Salmonella marker gene in 18% (27/150) of the freshly dressed native chicken carcasses. Twelve Salmonella serotypes were identified among 129 confirmed Salmonella isolates with the most predominant serotypes were S. Kentucky, S. Enteritidis, S. Typhimurium, and S. Molade with an incidence of 19.4% (25/129), 17.1% (22/129), 17.1% (22/129), and 10.9% (14/129), respectively. All the identified Salmonella isolates (n = 129) were positive for both invA and stn genes, while only 31.8% (41/129) of isolates were positive for the spvC gene. One hundred twenty-one (93.8%) of the 129 Salmonella-verified isolates were resistant to at least three antibiotics. Interestingly, 3.9%, 14.7%, and 75.2% of isolates were categorized into pan-drug-resistant, extensively drug-resistant, and multidrug-resistant, respectively. The average MAR index for the 129 isolates tested was 0.505. Exactly, 82.2%, 82.2%, 63.6%, 51.9%, 50.4%, 48.8%, 11.6%, and 10.1% of isolated Salmonella strains were resistant to cefepime, colistin, cefotaxime, ceftazidime/clavulanic acid, levofloxacin, ciprofloxacin, azithromycin, and meropenem, respectively. Thirty-one out (37.8%) of the 82 cefotaxime-resistant Salmonella isolates were β-lactamase producers with the bla TEM as the most predominant β-lactamase resistance gene, followed by bla CTX-M1 and bla OXA genes, which were detected in 21, 16, and 14 isolates respectively). Conclusion The high prevalence of MDR-, colistin-, cefepime-, and levofloxacin-resistant Salmonella serovars among Salmonella isolates from native chicken is alarming as these antimicrobials are critically important in treating severe salmonellosis cases and boost the urgent need for controlling antibiotic usage in veterinary and human medicine to protect public health. Graphical Abstrac

Psychiatric impact of the novel coronavirus disease 2019 on previously mentally healthy survivors

Abstract Background The prolonged psychiatric disorders rate following coronavirus disease 2019 (COVID-19) could surpass that of severe acute respiratory syndrome (SARS) as well as Middle East Respiratory Syndrome (MERS) as a result of variations in viral disease treatment as well as societal circumstances throughout the outbreaks. This work aimed to investigate the COVID-19 prolonged psychiatric effects on survivors without psychiatric diseases before infection. Methods This cross-sectional research was conducted on 1254 patients of which 700 patients (55.8%) were positive for psychiatric complications based on the general health (GHQ-28) questionnaire and 554 patients (44.1%) were negative, aged above 18 years old who had been infected with COVID19 (PCR swab confirmed) and recovered since less than 6 months without previous history of any psychiatric disease. Results Smoking, medical comorbidities, hospitalization, and cortisone in treatment were significantly higher in GHQ-28 positive than GHQ-28 negative (p < 0.05). Psychiatric disorders and Beck’s Depression Inventory (BDI) grades showed a significant association between smoking and hospitalization and Taylor Manifest Anxiety scales and smoking, hospitalization, and treatment with cortisone). Smoking, medical comorbidities, hospitalization, and cortisone in treatment were the most significant predictors of positive GHQ-28. However, multivariate analysis demonstrated that medical comorbidities, hospitalization, and cortisone in treatment were the best independent predictors of GHQ-28 positive (p = 7.055, p = 0.007, p = 0.043, p = 0.047, respectively). Conclusions COVID-19 cases without pre-existing psychological disorders exhibited a significant increase in psychiatric disorders occurrence 6 months following recovery. Anxiety disorders represented the predominant mental diagnoses documented

Antioxidant and Antibacterial Effect of Fruit Peel Powders in Chicken Patties

Meat industries are eager to find natural low-cost additives for improving the health benefits and shelf life of meat products. The present study elucidated the effect of four different fruit peel powders, namely lemon, orange, grapefruit, and banana (1% each), on the oxidative stability, microbial quality, physicochemical properties, and sensory attributes of chicken patties during 3 months of storage at −18 °C. The total phenolics and flavonoids as well as the antioxidant activity of the fruit peel powders were analyzed. The lemon peel powder contained the highest bioactive substance (90.5 mg gallic acid/g total phenolics and 35 mg rutin/g total flavonoids) and had the highest free radical scavenging activity (90%). The fruit peel powders used, especially the banana peel powder, induced an increase in protein (22.18 g/100 g) and a decrease in fat (10.52 g/100 g) content. Furthermore, all the fruit peel powders exhibited significant antioxidant and antibacterial activities compared with the control samples. The sensory attributes were improved in all treated groups, especially in the lemon peel powder-treated patties. Consequently, the obtained results support the application of fruit peel powders, as natural sources of antioxidants with antibacterial effects, as health-promoting functional additives during the manufacturing of meat products