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,...

Abstract.Objectives: Acute coronary syndrome as an acute oxygenated blood deprivation to the heart muscle due to atherosclerotic plaque rupture in the coronary artery followed by thrombosis is possibly associated with changes in the Earth's local time varying magnetic field as they strongly influence hormonal and other regulatory systems' activity. This study analyses the correlation between prevalence of the acute coronary syndrome and the changes in the local time varying aspects of the magnetic field. Methods: Seven-hundred patients admitted to Cardiology Department of Hospital of Lithuanian University of Health Sciences Kaunas Clinics within 2016 due to acute coronary syndrome were retrospectively included into the study. The number of cases per week was compared with the weekly changes of the local Earth magnetic field. The one-year period was divided into two periods: the first-half of the year (weeks 1 to 26) and the second-half of the year (weeks 27 to 52) and more detailed analyses were performed accordingly to the significance of the left main artery lesion. Mean power of local magnetic field fluctuations in Lithuania, measured in pT2 in five different frequency ranges where overlaps between the Schumann resonance and EEG frequency ranges (named as SDelta (0-3.5 Hz), STheta (3.5-7 Hz), SAlpha (7-15 Hz), SBeta (15-32 Hz) and SGamma (32-66 Hz) to distinguish them from the EEG bands). Results: Statistically significant weak and moderate correlations between weekly prevalence of acute coronary syndrome admissions and the magnetic field intensities changes were found. Higher intensities in the SBeta and SGamma ranges were associated with a higher number of admissions throughout the year in females and the SGamma range was associated with higher number of admission only during the second-half of the year in males. A higher intensity magnetic field in SDelta, STheta, SAlpha and SBeta ranges was associated with a higher admissions number due to left main artery lesions in males, while a higher intensity in the SGamma range was associated with higher number of admissions due to left main artery lesions in females through the year. Conclusion: Significant correlation between acute coronary syndrome and changes in the local Earth time varying magnetic field intensities was found. Some frequency ranges are associated with an episode of an acute coronary syndrome. Left main artery lesions significantly correlated with magnetic field changes in most of the frequency ranges in males while only one of the frequency ranges in females.

Introduction The development of interventional cardiology increases the number of invasive procedures which are inevitably associated with increased exposure to ionizing radiation and associated risks. A percutaneous coronary intervention (PCI) substantiated by evaluation of the coronary artery lesion’s functional significance is recommended by both European and American cardiologists. Nevertheless, the prevalence of physiology-guided PCIs does not exceed 10% all over the globe. Aim To identify the physiology evaluation method which is associated with the lowest exposure to ionising radiation. Material and methods Anonymised data of 421 patients with stable angina pectoris for whom elective coronary artery angiography followed by physiological assessment of intermediate coronary artery stenosis was performed were prospectively included in this study. Only diagnostic-procedure-related data of dose of ionizing radiation were analysed. Physiological assessment of coronary artery lesions was performed by fractional flow reserve (FFR), quantitative flow ratio (QFR), or instantaneous wave-free ratio (iFR). Results Compared to FFR as a reference, fluoroscopy time (FT) was almost half in QFR and almost double in iFR, p < 0.001. QFR was associated with more than 3 times shorter FT compared to iFR. The dose area product was 663.87 ±260.51 cGy/cm 2 ( p = 0.03) lower in QFR compared to iFR. Conclusions QFR is associated with significantly reduced exposure to ionising radiation compared to both FFR and iFR. Therefore, wider QFR application in clinical practice could eliminate any additional exposure to ionising radiation and increase the prevalence of physiology-guided coronary artery revascularization.

Objectives: Atrial fibrillation is the most frequent cardiac arrhythmia affecting over 3 percent and appears to be increasing in general population. In addition to widely discussed such risk factor as obesity, arterial hypertension, electrolytes disbalances and dysfunction of thyroid, there is more and more evidence of human heath interactions with environment parameters such as humidity, temperature, the lunar and the solar activity. Atrial fibrillation, a disorder of heart conductive system, in several studies have been indicated as affected by local Earth magnetic field changes. The study was aimed to analyse possible correlations between the power in the local Earth time-varying magnetic field and admission due to atrial fibrillation. Methods: Two-hundred-fifty-one patients diagnosed with acute atrial fibrillation and treated in

IntroductionAs coronary artery disease is the most frequent cause of cardiac arrest, early invasive strategies may be beneficial for such patients. This study analyses the impact of in-hospital treatment on short-term outcomes of out-of-hospital cardiac arrest (OHCA) survivors.Material and methodsPatients admitted to the Cardiac Intensive Care Unit of our hospital within 2-year period were prospectively included in the study.ResultsOne hundred thirty-one patients were included in the study, which showed that in-hospital mortality increases uniformly with the severity of the coronary artery lesion (p = 0.044), but an effect of revascularization on number of deaths was not observed (p = 0.64). The presence of coma (p = 0.005) and the combination of male sex and age above 60-year as 2.2-fold (p = 0.048) increasing in-hospital mortality were found. The highest mortality rate occurred during the first 3 days and the death rate of the patients who survived this period is low. We found reduced left ventricular ejection fraction (OR = 6.54; 95% CI: 1.98–21.63; p = 0.002), non-ventricular fibrillation initial rhythm (OR = 2.94; 95% CI: 1.25–6.90; p = 0.014), unconscious at admission (OR = 6.46; 95% CI: 1.96–21.24; p = 0.002) and post-resuscitation coma (OR = 6.00; 95% CI: 2.63–13.66; p < 0.001) or encephalopathy (OR = 2.71; 95% CI: 1.9–6.72; p = 0.031) to be significant prognostic factors for higher in-hospital mortality rate.ConclusionsWe recommend immediate coronary interventions for all survivors of OHCA regardless of their state of consciousness and absence of ischaemic changes on ECG. Early intensive treatment for OHCA patients is indispensable, as the highest mortality rate is within the first 3 days after an event.

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