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

Gradual acclimation to repeated handling prior hormonal protocol as an alternative to reduce stress in beef cattle.

Edição dos resumos da 37ª Annual Meeting of the Brazilian Embryo Technology Society, 2024, Atibaia, SP

A CACTA-like transposon in the Anthocyanidin synthase 1 (Ans-1) gene is responsible for apricot fruit colour in the raspberry (Rubus idaeus) cultivar ‘Varnes’

Cultivated raspberries (Rubus idaeus L.) most commonly bear small, red, highly aromatic fruits. Their colour is derived predominantly from anthocyanins, water soluble polyphenolic pigments, but as well as red forms, there exist cultivars that display yellow- and apricot-coloured fruits. In this investigation, we used a multi-omics approach to elucidate the genetic basis of the apricot fruit colour in raspberry. Using metabolomics, we quantified anthocyanins in red and apricot raspberry fruits and demonstrated that, in contrast to red-fruited raspberries, fruits of the apricot cultivar ‘Varnes’ contain low concentrations of only a small number of anthocyanin compounds. By performing RNASeq, we revealed differential expression patterns in the apricot-fruited ‘Varnes’ for genes in the anthocyanin biosynthesis pathway and following whole genome sequencing using long-read Oxford Nanopore Technologies sequencing, we identified a CACTA-like transposable element (TE) in the second exon of the Anthocyanidin synthase (Ans) gene that caused a truncated predicted ANS protein. PCR confirmed the presence in heterozygous form of the transposon in an unrelated, red-fruited cultivar ‘Veten’, indicating apricot fruit colour is recessive to red and that it may be widespread in raspberry germplasm, potentially explaining why apricot forms appear at regular intervals in modern raspberry breeding populations.publishedVersio

Weaning systems in Nelore female offspring and effects of fetal programming on serum concentrations of testosterone, IGF-1 and insulin in males of the next progeny.

Abstract: Fetal programming refers to any stimulus or injury during fetal development that can influence the health and future performance of the progeny, including critical aspects for reproduction such as sexual precocity and hormonal development. Based on this, the experiment aims to evaluate the effects of early weaning (150 days/early vs. 240 days/conventional) of calves of Nelore cows (primiparous and multiparous) on serum concentrations of testosterone, IGF- 1 and insulin in males of the next progeny (effect on fetal programming). Fifty-six calves, with an initial average age of 12.5 months, were subjected to the effects of early or conventional weaning. Of these, 29 came from primiparous females, 14 from the early weaning group and 15 from the conventional weaning group. The other 27 animals were sired by multiparous females, 13 of which belonged to the early weaning group and 14 to the conventional weaning group. Blood samples were collected at 12.5, 14.3, 15.5, and 17.3 months of age by jugular venipuncture in 10 mL siliconized vacuum tubes, without anticoagulant, to determine serum concentrations of testosterone, IGF-1, and insulin. Statistical analyses were performed using SAS software (Version 9.2; SAS Institute), and analyzed using ANOVA using a mixed model (PROC MIXED). When a significant treatment effect was detected, the means were compared using Fisher's method of least significant difference for multiple comparisons. Differences were considered when P ≤ 0.05. There was no effect of mother category (primiparous or multiparous), type of weaning (early or conventional), or interactions between these variables on serum testosterone and IGF-1 concentrations (p>0.05). However, the age of the animals influenced the concentrations of these hormones (p0,05). No entanto, a idade dos animais influenciou as concentrações desses hormônios (p<0,01), sendo os dados expressos como média ± erro padrão: 1,1c ± 0,1, 4,5b ± 0,5, 3,6b ± 0,4 e 7,1a ± 0,7 ng/mL de testosterona e 229,6c ± 8,7, 238,6c ± 8,4, 271,9b ± 7,4 e 293,3a ± 6,4 ng/mL de IGF-1, quando avaliados em 12,5, 14,3, 15,5 e 17,3 meses de idade, respectivamente. Em relação à insulina, houve interação entre a categoria de mãe e o tipo de desmame (p=0,02), sendo que ao realizar o desmame antecipado, os animais provenientes de multíparas apresentaram 1,24a ± 0,1 e os filhos de primíparas 0,8b ± 0,1 uIU/mL. Por outro lado, não houve diferença quando utilizado desmame convencional (0,8 ± 0,1 e 1,0 ± 0,1, para animais oriundos de multíparas e primíparas, respectivamente). De forma geral, houve redução da concentração de insulina (p<0,01), conforme os animais ficaram mais velhos: 5,0a ± 0,4, 3,4b ±0,3, 3,1c ± 0,5 e 2,6c ± 0,3, quando avaliados em 12,5, 14,3, 15,5 e 17,3 meses de idade, respectivamente. Com base nesses resultados, observa-se que as alterações no ambiente fetal, decorrentes da maior disponibilidade de nutrientes ao feto devido à interrupção antecipada da lactação, não resultaram em mudanças significativas nas concentrações séricas de testosterona e IGF-1 da progênie, sugerindo que no presente estudo, o desenvolvimento reprodutivo hormonal dos touros foi mais dependente do desenvolvimento fisiológico relacionado à idade. O desmame antecipado promoveu maior concentração de insulina em bezerros provenientes de vacas multíparas, sugerindo um impacto positivo na alocação de nutrientes durante o início da gestação. Por outro lado, essa diferença não foi observada em bezerros de vacas primíparas, indicando que o desmame antecipado pode não ter sido suficiente para beneficiar significativamente essa categoria, a qual além de estar em desenvolvimento, precisa nutrir tanto a si mesmas quanto ao feto, enfrentando uma maior competição por recursos nutricionais.Edição dos anais do 26º Congresso Brasileiro de Reprodução Animal, Curitiba, 2025

Effects of fetal programming through early and conventional weaning on subsequent progeny of Nellore males from primiparous and multiparous females on weight and puberty.

Abstract: Factors that affect the health and performance of the pregnant mother may have long-term effects on the offspring, resulting from stimuli or injuries during critical periods of gestation that modulate fetal development and interfere with the performance of the progeny, a concept called fetal programming. The objective of the present study was to evaluate the effects of fetal programming through early and conventional weaning on the weight and onset of puberty of subsequent male offspring sired by primiparous or multiparous females. Throughout the experiment, the females remained on Brachiaria spp. pastures and received protein supplementation at the rate of 1 g/kg of body weight per animal per day (41.05 and 31.65% of crude protein and 47.32 and 72.62% of total digestible nutrient, during the rainy and dry seasons, respectively). Fifty-six Nellore males were evaluated. During the fetal development of these animals, their primiparous or multiparous mothers weaned calves at 150 or 240 days (early or conventional weaning, respectively). Thus, of the 56 animals used, 29 came from primiparous females, 14 from the early weaning group and 15 from the conventional weaning group. The other 27 animals were sired by multiparous females, 13 from the early weaning group and 14 from the conventional weaning group.Weight (kg) and semen collections were performed at 12.5, 14.3, 15.5 and 17.3 months of age, using a digital scale and the electroejaculation technique, respectively. The animals were classified as pubertal when they presented at least 10% subjective motility and 50 million sperm in the ejaculate. Statistical analyses were performed using SAS software (Version 9.2; SAS Institute), using the ANOVA test applying a mixed model (PROC MIXED). When a significant treatment effect was detected, the means were compared by Fisher's method of least significant difference for multiple comparisons. For weight, the results were expressed as mean ± standard error, and for puberty, the percentages of each subpopulation in the sample were calculated. The effects of mother, weaning, age and interaction between them were analyzed and considered as significant difference when P≤0.05. For weight, there was an effect for mother category (p=0.01), with the data expressed as mean ± standard error: 332.8a ± 5.2 and 311.0b ± 4.6 kg in males from multiparous and primiparous hens, respectively. Furthermore, there was also an age effect (p0.05), however there was an age effect (p0,05), porém houve efeito de idade (p<0,01), acumulando o percentual de 7,2b, 28,7b, 48,2ab e 71,2a% quando os animais foram avaliados em 12,5, 14,3, 15,5 e 17,3 meses de idade, respectivamente Como já era esperado, os resultados do presente estudo demonstram que os animais adquiriram mais peso ao passar dos meses. Além disso, a prole de vacas multíparas foi beneficiada quando analisado o peso desses animais. Entretanto, apesar do peso ser comumente associado com a entrada dos animais à puberdade, por indicar os animais mais adaptados às condições ambientais em que vivem, os quais são previstos apresentarem espermatogênese mais desenvolvida, os animais provenientes de multíparas não se tornaram púberes mais precocemente. Os dados de puberdade evidenciam que realizar desmame de forma antecipada ou convencional em ambas as classes de mães, não propiciou efeito de programação fetal na prole subsequente de machos da raça Nelore.Edição dos anais do 26º Congresso Brasileiro de Reprodução Animal, Curitiba, 2025

Existe efeito de programação fetal na prole subsequente de machos da raça Nelore sobre a funcionalidade de membrana mitocondrial, ao realizar desmame antecipado e convencional em fêmeas primíparas e multíparas?

Programação fetal refere-se ao conceito no qual fatores que afetam a saúde e o desempenho da mãe gestante podem ter efeitos a longo prazo na prole, por meio de estímulo ou lesão durante períodos críticos da gestação os quais modulam o desenvolvimento fetal e interferem no desempenho da progênie

A prole de machos da raça Nelore sofre influência da programação fetal sobre a funcionalidade de membrana plasmática, ao realizar desmame antecipado e convencional em fêmeas primíparas e multíparas?

O conceito de programação fetal, refere-se a qualquer estímulo ou lesão durante períodos críticos da gestação que modulam o desenvolvimento fetal e promovem efeitos a longo prazo sobre o desempenho da progênie.Realização do evento 13 a 15 de junho de 2024

Sistemas de desmame em crias de fêmeas da raça Nelore e efeitos na programação fetal sobre as concentrações séricas de testosterona, IGF-1 e insulina nos machos da próxima progênie.

Resumo: A programação fetal refere-se a qualquer estímulo ou lesão durante o desenvolvimento do feto que pode influenciar a saúde e o desempenho futuro da progênie, incluindo aspectos críticos para reprodução como a precocidade sexual e o desenvolvimento hormonal. A partir disso, o experimento tem como objetivos avaliar os efeitos da antecipação do desmame (150 dias/antecipado vs. 240 dias/convencional) das crias de vacas da raça Nelore (primíparas e multíparas) sobre as concentrações séricas de testosterona, IGF-1 e insulina nos machos da próxima progênie (efeito na programação fetal). Foram submetidos aos efeitos do desmame antecipado ou convencional 56 bezerros, com idade média inicial de 12,5 meses. Dentre eles, 29 são provenientes de fêmeas primíparas, sendo 14 do grupo de desmame antecipado e 15 do grupo de desmame convencional. Os outros 27 animais foram gerados por fêmeas multíparas, sendo 13 pertencentes ao grupo de desmame antecipado e 14 ao grupo de desmame convencional. As colheitas de sangue aconteceram aos 12,5, 14,3, 15,5 e 17,3 meses de idade, realizadas por venopunção jugular em tubos a vácuo siliconizados de 10 mL, sem anticoagulante, para determinar as concentrações séricas de testosterona, IGF-1 e insulina. As análises estatísticas foram realizadas por meio do software SAS (Versão 9.2; SAS Institute), analisados por meio de ANOVA utilizando modelo misto (PROC MIXED). Quando detectado efeito significativo de tratamento, as médias foram comparadas pelo método de Fisher de menor diferença significativa para múltiplas comparações. Foram considerados como diferença quando P ≤ 0,05. Não houve efeito da categoria de mãe (primípara ou multípara), tipo de desmame (antecipado ou convencional), ou das interações entre essas variáveis sobre as concentrações séricas de testosterona e IGF-1 (p>0,05). No entanto, a idade dos animais influenciou as concentrações desses hormônios (p0.05). However, the age of the animals influenced the concentrations of these hormones (p<0.01), with data expressed as mean ± standard error: 1.1c ± 0.1, 4.5b ± 0.5, 3.6b ± 0.4 and 7.1a ± 0.7 ng/mL of testosterone and 229.6c ± 8.7, 238.6c ± 8.4, 271.9b ± 7.4 and 293.3a ± 6.4 ng/mL of IGF-1, when evaluated at 12.5, 14.3, 15.5 and 17.3 months of age, respectively. Regarding insulin, there was an interaction between the category of mother and the type of weaning (p=0.02), and when early weaning was performed, animals from multiparous mothers presented 1.24a ± 0.1 and those from primiparous mothers presented 0.8b ± 0.1 uIU/mL. On the other hand, there was no difference when conventional weaning was used (0.8 ± 0.1 and 1.0 ± 0.1, for animals from multiparous and primiparous mothers, respectively). In general, there was a reduction in insulin concentration (p<0.01) as the animals aged: 5.0a ± 0.4, 3.4b ± 0.3, 3.1c ± 0.5 and 2.6c ± 0.3, when evaluated at 12.5, 14.3, 15.5 and 17.3 months of age, respectively. Based on these results, it is observed that changes in the fetal environment, resulting from greater availability of nutrients to the fetus due to early interruption of lactation, did not result in significant changes in serum testosterone and IGF-1 concentrations of the progeny, suggesting that in the present study, the hormonal reproductive development of bulls was more dependent on age-related physiological development. Early weaning promoted higher insulin concentrations in calves frommultiparous cows, suggesting a positive impact on nutrient allocation during early gestation. On the other hand, this difference was not observed in calves from primiparous cows, indicating that early weaning may not have been enough to significantly benefit this category, which, in addition to being in development, needs to nourish both themselves and the fetus, facing greater competition for nutritional resources.Edição dos anais do 26º Congresso Brasileiro de Reprodução Animal, Curitiba, 2025

Efeitos da programação fetal por meio do desmame antecipado e convencional na progênie subsequente de machos da raça Nelore, provenientes de fêmeas primíparas e multíparas, sobre o peso e a puberdade.

Resumo: Fatores que afetam a saúde e o desempenho da mãe gestante podem ter efeitos a longo prazo na prole, decorrentes de estímulos ou lesões durante períodos críticos da gestação os quais modulam o desenvolvimento fetal e interferem no desempenho da progênie, conceito o qual é denominado de programação fetal. O objetivo do presente estudo foi avaliar os efeitos da programação fetal por meio do desmame antecipado e convencional sobre o peso e a entrada à puberdade da prole subsequente de machos, gerada por fêmeas primíparas ou multíparas. Durante todo o experimento, as fêmeas permaneceram em pastagens de Brachiaria spp. e receberam suplementação proteica na oferta de 1g/kg de peso corporal por animal por dia (41,05 e 31,65% de proteína bruta e 47,32 e 72,62% de nutriente digestível total, durante a estação chuvosa e seca, respectivamente). Foram avaliados 56 machos da raça Nelore. Durante o desenvolvimento fetal destes animais, suas mães, primíparas ou multíparas, desmamaram bezerros com 150 ou 240 dias (desmame antecipado ou convencional, respectivamente). Desta forma, dos 56 animais que foram utilizados, 29 foram provenientes de fêmeas primíparas, sendo 14 do grupo desmame antecipado e 15 do desmame convencional. Os outros 27 animais foram gerados por fêmeas multíparas, sendo 13 pertencentes ao grupo desmame antecipado e 14 do desmame convencional. O peso (kg) e as colheitas de sêmen aconteceram aos 12,5, 14,3, 15,5 e 17,3 meses de idade, utilizando uma balança digital e a técnica de eletroejaculação, respectivamente. Os animais foram classificados como púberes ao apresentarem no mínimo 10% de motilidade subjetiva e 50 milhões de espermatozoides no ejaculado. As análises estatísticas foram realizadas por meio do software SAS (Versão 9.2; SAS Institute), utilizando o teste de ANOVA aplicando modelo misto (PROC MIXED). Quando detectado efeito significativo de tratamento, as médias foram comparadas pelo método de Fisher de menor diferença significativa para múltiplas comparações. Para peso os resultados foram expressos como média ± erro padrão e para puberdade foram calculadas as porcentagens de cada subpopulação na amostra. Foram analisados os efeitos de mãe, desmame, idade e interação entre eles e considerados como diferença significativa quando P≤0,05. Para peso, houve efeito para categoria de mãe (p=0,01), sendo os dados expressos como média ± erro padrão: 332,8a ± 5,2 e 311,0b ± 4,6 kg nos machos provenientes de multíparas e primíparas, respectivamente. Além disso, houve também efeito de idade (p0,05), porém houve efeito de idade (p0.05), however there was an age effect (p<0.01), accumulating the percentage of 7.2b, 28.7b, 48.2ab and 71.2a%when the animals were evaluated at 12.5, 14.3, 15.5 and 17.3 months of age, respectively. As expected, the results of the present study demonstrate that the animals gained more weight as the months passed. Furthermore, the offspring of multiparous cows benefited when the weight of these animals was analyzed. However, although weight is commonly associated with the animals' entry into puberty, since it indicates which animals are better adapted to the environmental conditions in which they live, and which are expected to have more developed spermatogenesis, animals from multiparous cows did not become pubertal earlier. The puberty data show that early or conventional weaning in both classes of mothers did not provide a fetal programming effect on the subsequent offspring of males of the Nelore breed.Edição dos anais do 26º Congresso Brasileiro de Reprodução Animal, Curitiba, 2025

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially