Effect of clindamycin vaginal pessary before cesarean section on postpartum infectious morbidity

Background: Post-cesarean section (CS) infections, namely, endometritis, fever and wound infection are considered a major health problem which necessitates effective interventions. Antibiotic prophylaxis before CS cannot completely eliminate the risk of postpartum infections. Preoperative antiseptic vaginal cleansing is one of the commonest methodsto reduce infectious morbidities after CS. Aim of the work: The aim of this work is to evaluate the effect of prophylactic administration of clindamycin vaginal suppository before elective CS on postpartum infectious morbidity. Methods: 196 patients were included in this intervention. They were divided equally into two groups (each 98 patients); intervention group (which received clindamycin 100 mg vaginal suppository at bedtime for 3 nights before CS) and control group (which received nothing). Both groups were followed till the end of puerperium for the development of postpartum infections namely, endometritis, fever, and wound infection. Results: There was statistically significant decrease in the frequency of endometritis, fever, and wound infection in the intervention group when compared to control group. Also, there was highly statistically significant decrease in the frequency of overall post-CS infectious morbidity in the intervention group when compared to control group. There was statistically significant difference between both groups as regard white blood cells count and C-reactive protein level 24 hours after cesarean section. Conclusion: Prophylactic administration of clindamycin vaginal suppository before elective CS reduces the risk of postpartum infections namely endometritis, fever, wound infection and overall post-CS infectious morbidity. Preoperative clindamycin vaginal suppository could be  protective against post-CS infectious morbidities

Bacteriolytic Activity of Coliphages on Diarrhea Associated E. coli

There has been an alarming increase in drug-resistant strains of diarrheagenic Escherichia coli (DEC) in developing as well as developed countries. Several cases of antimicrobial resistance in DEC have been observed in different parts of the world as a result, there has been a renewed interest in alternative antimicrobial treatments, including bacteriophages. This study was conducted to isolation and characterization of a lytic coliphage from sewage water capable to infect a variety of multidrug resistance DEC strains isolated from children suffering diarrhea, as first step to further usage a lytic coliphage in future.in this study, a coliphage was isolated using spotting method and titrated, using agar overlay technique. The host range of coliphages was assessed on a lawn of E coli bacteria. This study included determination of the latent periods and burst size of coli phage then determines the stability of coliphages to physical and chemical condition (temperature, pH and sunlight exposure).The results shown that, five phages isolate (A, B, C, D and E) were exhibiting a potent lytic activity with clear plaques (1-4mm in diameter). Fifty percent of the E coli strains were infected by phage isolates. It seems, very likely, that the coliphages belonging to 3 different groups (1, 2 and3). The phage growth cycle with a detected latent period of 20 min, a burst size of 160 plaque forming units per infected cell, it was found that the phage could survive at varied pH conditions with reduction in its numbers. A temperature of above 60°C and direct sunlight beyond 8 days was found to be deleterious for survival of the phage. Keywords: key words, coliphages, E. coli, diarrhe

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

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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. Funding: National Institute for Health and Care Research