SummaryBackgroundSurgical 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.MethodsThis 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.FindingsBetween 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).InterpretationCountries 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.FundingDFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant,...

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AbstrakPopulasi penderita diabetes melitus tipe 2 terus meningkat akibat meningkatnya angka resistensi insulin yang ditandai dengan sekresi insulin yang meningkat. Resistensi insulin dipengaruhi oleh beberapa faktor yaitu kurangnya aktivitas fisik, obesitas serta diet tidak sehat. Salah satu ciri diet tidak sehat adalah tingginya konsumi karbohidrat. Padahal, masyarakat Indonesia cenderung menyukai makanan sumber karbohidrat yang memiliki indeks glikemik tinggi seperti nasi sehingga kenaikan glukosa darah secara cepat menyebabkan sekresi insulin yang lebih banyak dan cepat dan berakibat pada keadaan resistensi insulin. Tujuan dari penelitian ini yaitu mengetahui efektivitas beras herbal forte sebagai pengganti karbohidrat utama pada keadaan hiperinsulinemia yang diderita oleh 15 orang pasien diabetes melitus tipe 2 di Puskesmas Sumbersari Jember. Penelitian ini merupakan uji klinik dengan metode quasi experimental dan dengan rancangan crossover desaign. Pada penelitian ini, sampel diwawancarai karakteristik (usia, jenis kelamin) dan pola konsumsi awal menggunakan food recall 24 jam sebanyak tiga kali di waktu yang berbeda. Sampel bertindak sebagai kelompok control sekaligus kelompok perlakuan. Kelompok kontrol tidak menerima perlakuan apapun, sementara kelompok perlakuan menerima beras herbal forte sebanyak 100 gram selama 7 hari berturut -turut di pagi hari (jam 6.30 WIB). Setelah periode washing out selama 9 hari, kelompok perlakuan berubah menjadi kelompok kontrol. Pada akhir periode kelompok perlakuan maupun kelompok kontrol (7 hari), dilakukan pengambilan data glukosa darah puasa dan insulin puasa yang kemudian dihitung menggunakan rumus HOMA-IR. Hasil penelitian berdasarkan uji paired t test nilai p=0,001 pada perbandingan keadaan kelompok kontrol dan kelompok perlakuan. Kesimpulan dari penelitian ini adalah adanya perubahan keadaan resistensi insulin dengan penggantian makanan berdasarkan indeks glikemik. Kata kunci:beras herbal forte, indeks glikemik, resistensi insulin Abstract The population of type 2 diabetes mellitus sufferer continuously increases due to the increase of insulin resistance characterised by the rise of the secretion insulin. Insulin resistance is affected by several factors such as the lack of physical activity, obesity, and unhealthy diet. One of the characteristics of the unhealthy diet is the high consumption of carbohydrates.Whereas Indonesian prefers to have carbohydrate sources from food which has high glycemic index such as rice so thatit makes the glucose in the blood increased rapidly. This condition causes more and faster insulin secretion and can affect insulin resistance. The purpose of this

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