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,...

It has been proposed that nephrotic syndrome is a consequence of an imbalance between oxidant/antioxidant statuses. The present study aimed to assess oxidant and antioxidant status in relation to dyslipidemia in children during remission and relapse phases of steroid sensitive nephrotic syndrome (SSNS). The study dealt with 40 children diagnosed as SSNS. They were categorized into two subgroups. The first subgroup included 25 children during remission stage. The second subgroup included 15 children during relapse. Control group consisted of age and gender-matched 15 healthy children. Significantly higher serum levels of malondialdehyde, oxidized LDL, total cholesterol, LDL cholesterol, triglycerides, apolipoprotein A-I, and apolipoprotein-B were observed in patients with SSNS especially in the relapsers. The serum levels of albumin, glutathione peroxidase activity, vitamin C, A, and E, and HDL cholesterol were significantly lower in patients especially among relapsers. In conclusion, a strong relationship between the oxidant/ antioxidant status and dyslipidemia is documented in patients with SSNS, especially among relapsers. No normalization of the biochemical indices was observed despite the use of glucocorticoids. Therefore, the combined use of steroid, antioxidant therapy, and lipid lowering therapy can be recommended in such children.

A new hybrid composite containing cerium oxide nanoparticles (CeO2NPs) and gold nanoparticles (AuNPs)-decorated functionalized glassy carbon microspheres (FGCM) was synthesized (Au/CeO2@FGCM) and used for voltammetric sensing of quercetin.

In this work, a sensitive and simple electrochemical sensor was constructed for the quantitative analysis of valrubicin (VLB), as a chemotherapy drug, in biological samples based on MWCNTs-OH, CeO 2 NPs, AuNPs and functionalized glassy carbon microspheres (FGCM) modified electrode (AuÀ CeO 2 @MWCNT-OH/ FGCME). The new nanocomposite AuÀ CeO 2 @MWCNT-OH/FGCM produced an electrocatalytic effect towards the electrochemical oxidation of VLB. The electrochemical behavior of the AuÀ CeO 2 @MWCNT-OH/FGCME was also investigated using EIS and CV. The experimental and operation parameters that affect the sensitivity of the sensor were optimized. SWV was utilized for the electrochemical analysis of VLB. The oxidation peak currents were linearly dependent on the concentration of VLB in the range of 7.10 × 10 À 8 M to 5.8 × 10 À 7 M. The detection limit of VLB was found to be 1.56 × 10 À 9 M which was more sensitive than the reported method. The possible coexistence biological matrix had no interference effect on the determination of VLB. The fabricated sensor was also effectively employed to the sensitive detection of VLB in human body fluids. The interaction of VLB with salmon testes and calf thymus double-stranded DNA (st-DNA and ct-DNA) on AuÀ CeO 2 @MWCNT-OH/ FGCME has been further studied by cyclic voltammetry. The corresponding binding constant (K), surface concentration (Γ) and Gibbs free energy (ΔG°) were computed for the free VLB and the bound VLB-dsDNA complex. The obtained results revealed that VLB binds to DNA with a high binding constant as well as the K value for VLB-st-DNA (K = 1.81 × 10 5 M À 1) is higher than that of VLB-ct-DNA (K = 4.99 × 10 4 M À 1).

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Background: Pin site infection is the most common complication of external fixator. Aim of the study: To evaluate the effect of nursing management on pin site infection incidence among patients with external fixators. Subjects and Methods: A sample of 80 patients (males and females) attended to the trauma department that their ages ranged from 18 to 65 years old, had open or closed fracture in lower and/or upper limbs that were indicated for external fixation application. The study was conducted in traumatology department at Assiut University Hospital. Tools: (I): Patient assessment sheet. Tools: (II) Checketts and Otterburn's Grading System. Results: Only four (5.0%) patients developed pin site infection, whose grade was grade I. There was highly statistical significant relation between pin site infection and smoking p 0,001. Conclusion: After providing nursing management for patients with external fixators most of studied patients didn't develop pin site infection. Recommendation: Increase patients' awareness about the importance of pin site care and periodic check up to prevent developing any complications which can effect on their quality of life.