Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low-or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI).Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression.
Summary Background 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.
The phytochemical screening and comparative study of antimicrobial activity of Aloe vera extracts was carried out. The phytochemical screening revealed the following metabolites: saponins, alkaloids, glycosides, tannins, protein, and flavonoids. While cardiac glyocosides and steroids were absent. The antimicrobial activities of the gel in 10% DMSO, methanol and aqueous extracts of green rind and leaf pulp were carried against some pathogenic clinical isolates, namely, Bacillus subtilis, Staphylococcus aureus, Proteus mirabilis and Candida albicans. The DMSO extract of the gel and the methanol extract of the green rind showed greater potency against tested microorganisms in the order B. Subtilis> S. aureus> C. albicans and S. aureus>C. albicans>B. subtilis>P. mirabilis respectively with different zones of inhibition ranging from 18 to 35 mm gel, 15 to 18 mm for leaf pulp methanol, 20 to 32 mm green rind methanol, also 12 to 14 mm and 14 to 23 mm for leaf pulp aqueous and green rind aqueous respectively. The minimum inhibitory concentration (MIC) of the extracts against organisms ranged from 6.25 to 25 mg/ml while the minimum bactericidal concentration (MBC) was within the range of 12.5 to 50 mg/ml. The study revealed that the green rind methanol extract and gel have greater medicinal potential against B. subtilis.
Background The agricultural food products industry in Bangladesh depends on utilizing antimicrobials indiscriminately as growth promoters and for controlling infectious diseases. Thus, there is always a risk of antimicrobial agent accumulation in food sources that originate from agricultural production. Methods In the present study, we collected data from published articles between January, 2013 and December, 2019 on antimicrobial residues in human food sources such as meat, milk, eggs, and fishes. Results Liver contained the highest percentage of antimicrobial residues (74%; 95% CI: 59.66–85.37) against the in vitro enteric pathogen Escherichia coli in layer chickens. Similar results were demonstrated in liver (68%; 95% CI: 53.30–80.48) and kidney (66%, 95% CI: 51.23–78.79) of layer chickens against Bacillus cereus and Bacillus subtilis . Amongst all antibiotics, the highest concentrations of ciprofloxacin were detected in kidney (48.57%; 95% CI: 31.38–66.01), followed by liver (47.56; 95% CI: 40.88–54.30) of broiler chickens. Ciprofloxacin was also present in liver (46.15%; 95% CI: 33.70–58.96) of layer chickens. The percentage of ciprofloxacin in thigh and breast meat in broiler bird were 41.54% (95% CI: 34.54–48.79) and 37.95% (95% CI: 31.11–45.15) respectively. Enrofloxacin was the second most dominant antimicrobial agent and was present in the liver of both types of poultry (Broiler and Layer chickens: 41.54%; 95% CI: 29.44–54.4 and 437.33%; 95% CI: 30.99–44.01). The prevalence rates of enrofloxacin in thigh and breast meat of broiler chickens were 24.10% (95% CI: 18.28–30.73) and 20.51% (95% CI: 15.08–26.87), respectively. Tetracycline, a commonly used antibiotic in livestock, was present in the liver (49.23%; 95% CI: 36.60–61.93) of layer chickens. In case of aquaculture food products, the highest amount of amoxicillin (683.2 mg/kg) was detected in Tilapia fish ( Oreochromis niloticus ), followed by 584.4 mg/kg in climbing perch ( Anabas testudineus ) and 555.6 mg/kg in Rui fish ( Labeo rohita ). Among the five types of fishes, Rui fish (0.000515 mg/kg) contained the highest concentrations of chloramphenicol antibiotic residues. Conclusions The presence of antimicrobial residues in meat, milk, egg, and fish is a serious public health threat due to the potential induction of antimicrobial resistance. It can negatively impact the food supply chain, especially with the current strain that it is already facing with the current COVID-19 pandemic. The findings of the present study highlight the ongoing risk of residual antimicrobial agents in food of animal origin in Bangladesh and countries with similar practices. This can draw the attention of public health officials to propose plans to mitigate or stop th...
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