Search

Abstract Background The World Health Organization (WHO) cautions against unnecessary prolongation of postoperative antibiotics to prevent surgical site infections (SSI), however this practice is still common in many countries. This study aims to describe drivers of prolonged postoperative antibiotic prescribing and clinicians’ perspectives on antibiotics resistance and stewardship in Ethiopia. Methods We conducted semi-structured interviews of 16 surgeons and nine surgical ward nurses at three academic referral hospitals in Addis Ababa. Audio recordings were transcribed verbatim and coded. Codes were inductively and iteratively derived between two researchers, tested for inter-rater reliability (IRR), and the codebook was consistently applied to all transcripts. Thematic analysis was performed to understand drivers of prolonged prophylactic antibiotic use in surgical patients. Results Interviews revealed factors contributing to postoperative prophylactic antibiotics overprescribing, including inadequate infection prevention and control (IPC) practices, wide variability in local prescribing practices, and distrust in the applicability of WHO guidelines. Antimicrobial resistance was also identified as a major concern by staff. Barriers to improving stewardship included a lack of multidisciplinary teamwork to inform prescribing decisions, while solutions included constructing appropriate context-specific guidelines and improving evidence-based practices through input from local stakeholders, including surgeons, clinical pharmacists, and nurses. Conclusions Study participants perceived that existing evidence and guidelines did not apply in their settings due to high rates of surgical site infections and gaps in perioperative IPC practices (e.g., availability of water for handwashing, sterility breaches). These gaps were a key contributor to prophylactic antibiotic overprescribing, reinforcing the need to strengthen upstream and perioperative surgical antisepsis processes. The findings of this study underscore the importance of engaging multidisciplinary teams in strengthening antimicrobial stewardship efforts, aligning processes to achieve compliance with best practices, and the need for rigorous, contextually appropriate studies from these settings to inform policy.

The study’s objective was to evaluate the feasibility and dispersion of an open approach to the transversus abdominis plane (TAP) block in eight adult equine cadavers. A ventral midline incision was made, starting 2 cm cranial to the umbilicus and extending 25 cm cranially. In total, 0.5 mL/kg of new methylene blue (NMB) was injected per horse, divided into six injections. Using an 18 g, 8 cm Tuohy needle, three injections were made per side. The needle was guided blindly into the TAP using palpation. A 60 mL syringe was attached directly to the needle, depositing ~0.08 mL/kg at each site. The time to complete the injections was recorded for each cadaver. Following injection, the ventral body wall was dissected to determine if the dye was present within the TAP space as well as to measure the extent of the dispersion of the dye, the cranial to caudal extent, and the width of the dye’s spread. Complete deposition of NMB into the TAP (six of six sites) was achieved in 5/8 horses. The median time needed to perform all the injections was 263 s. Increased adiposity (retroperitoneal fat) was associated with unsuccessful injections. This approach to the TAP was easily and quickly performed, though less successful in horses with increased retroperitoneal fat and increased BCS.

Abstract Background Acute colitis is a serious cause of morbidity and death in horses. Recent studies have compared clinical features of coronavirus and salmonellosis, but no study has compared clinical features of enteric salmonellosis, coronavirus, and neorickettsiosis. Hypothesis/Objectives To identify risk factors for laminitis and nonsurvival to discharge in horses with enteric salmonellosis, coronavirus, or neorickettsiosis. Animals Eighty‐five horses hospitalized for acute colitis from 2011 to 2019. Methods Retrospective case series. Medical record review (2011‐2019) of adult (≥2 years) horses with colitis. Primary outcomes were laminitis and survival to discharge. Multivariable logistic regression was performed to assess association between variables and the development of laminitis. Stepwise Cox regression was performed to assess association between variables and survival. Results Seventeen of 85 (20%) horses developed laminitis during hospitalization. Neorickettsiosis cases (11/26, 42%) were more likely to develop laminitis than coronavirus (0/16, 0%) cases (odds ratio [OR] 24.48; 95% confidence interval [CI]: 1.33‐451.74, P = .03). There was no significant difference in laminitis between salmonellosis and neorickettsiosis cases (OR 0.27; 95% CI: 0.07‐1.07, P = .06). Admission heart rate (OR 1.08; 95% CI: 1.02‐1.15, P = .01), total solids (OR 0.17; 95% CI: 0.06‐0.54, P = .003), band neutrophils (OR 1248.47; 95% CI: 6.62‐235 540, P = .008), and bicarbonate concentration (OR 0.68; 95% CI: 0.5‐0.92, P = .01) were predictive of development of laminitis during hospitalization. Sixty‐three of 85 (74%) horses survived to discharge: 16/16 (100%) coronavirus cases, 17/26 (65%) neorickettsiosis cases, 14/20 (70%) salmonellosis cases, and 16/23 (70%) unknown cases. Packed cell volume (hazard ratio [HR] 1.17; 95% CI: 1.09‐1.26, P

Background Information on differences in paroxysmal supraventricular tachycardia (PSVT) diagnosis, healthcare resource use, expenditures, and treatment among women versus men is limited. Methods and Results Study participants identified in the IBM MarketScan Commercial Research Databases were aged 18 to 40 years with newly diagnosed PSVT (International Classification of Diseases, Ninth Revision [ICD‐9]: 427.0; International Classification of Diseases, Tenth Revision [ICD‐10]: I47.1) from October 1, 2012, through September 30, 2016, observable 1 year preindex and postindex diagnosis. Study outcomes were mean annual per‐patient healthcare resource use and expenditures before and after diagnosis. Among 5466 patients newly diagnosed with PSVT, most (66.9%) were women. Compared with men, women with PSVT tended to have higher rates of anxiety (13.9% versus 10.9%; P

Lower survival has been reported in foals than adults with small intestinal strangulating obstruction (SISO), but age-dependent outcomes have not been examined directly. Hospital records were collected from five US academic referral hospitals. It was hypothesized that foals would exhibit lower survival than case-matched adults. Foal cases 6-months-of-age or younger, and adult cases between 2- and 20-years-of-age were collected. Data revealed 24 of 25 (96.0%) foals and 66 of 75 (88.0%) adults that were recovered from surgery for SISO survived to hospital discharge. Sixteen of the total 41 (39.0%) foals studied were euthanized intraoperatively, whereas 30 of 105 (28.6%) adults were euthanized intraoperatively. Common lesions in foals that were recovered from surgery were volvulus (n = 13) and intussusception (n = 5), whereas common lesions in adults were volvulus (n = 25) and strangulating lipoma (n = 23). This study was limited by incomplete medical records, relatively small sample size, and lack of long-term follow-up. Unexpectedly, short-term survival tended to be higher in foals than adults and may have been partly driven by case selection prior to referral or surgery or decision-making intraoperatively. More optimism toward surgical treatment of foals with SISO may be warranted.

Benthic algal vegetation was investigated at 10 sites in Isfjorden, Svalbard. Five sites were visited during summer 2010 and five during summer 2012. Both the littoral and sublittoral vegetation were sampled, the littoral by hand-picking and use of a throwable rake and the sublittoral using a triangular dredge. A total of 88 different taxa were registered, comprising 17 Chlorophyta, 40 Ochrophyta, 30 Rhodophyta and the Xantophyceae Vaucheria sp. The green algae Ulvaria splendens (Ruprecht) Vinogradova was recorded in Svalbard for the first time. Most of the sites consisted of hard bottom substrate, but one site, Kapp Wijk, consisted of loose-lying calcareous red algae (rhodoliths) and had species not recorded elsewhere. The sublittoral at the other sites was dominated by kelp. Molecular analysis confirmed the presence of the red alga Ceramium virgatum and a dwarf form of the brown alga Fucus vesiculosus. This study provides a baseline for future studies investigating changes in the vegetation due to environmental changes.

Hugo Maia Jr1,2, Clarice Haddad1, Julio Casoy1, Rebeca Maia1, Nathanael Pinheiro3, Elsimar M Coutinho11Centro de Pesquisa e Assistência em Reprodução Humana (CEPARH), 2Itaigara Memorial Day Hospital, 3IMAGEPAT, Salvador, Bahia, BrazilObjective: To investigate the effect of a levonorgestrel-releasing intrauterine system (Mirena®) on aromatase and cyclooxygenase-2 (Cox-2) expression in the endometrium of patients with adenomyosis who were submitted to endometrial resection at the time of insertion, compared to a group not submitted to endometrial resection and a group of controls with adenomyosis not submitted to any previous hormonal treatment.Patients and methods: Patients with adenomyosis (n = 89) were included in this study. Twenty-two patients had been using Mirena® for 5 years but had not been submitted to endometrial resection prior to insertion of the device. Twenty-four patients were submitted to endometrial resection at the time of Mirena® insertion. The remaining 43 patients with adenomyosis had undergone no previous hormonal treatment and served as a control group. Cox-2 and aromatase expression were determined in the endometrium by immunohistochemistry.Results: Use of Mirena® for 5 years reduced aromatase expression in the endometrium; however, this reduction was significantly greater in the uteri previously submitted to endometrial resection. The reduction in Cox-2 expression was significant only in the uteri submitted to endometrial resection followed by the insertion of Mirena®.Conclusion: Endometrial resection followed by the insertion of Mirena® was associated with greater rates of amenorrhea in patients with adenomyosis, which in turn were associated with a more effective inhibition of aromatase and Cox-2 expression in the endometrium.Keywords: aromatase, Mirena®, adenomyosis, Cox-2, endometrium, levonorgestrel

Introduction: Although postoperative antibiotic prophylaxis has not been shown to prevent surgical site infections, prolonged antibiotic administration is common in low- and middle-income countries. We developed a quality improvement program to reduce unnecessary postoperative antibiotics through hospital-specific guideline development and the use of a brief, multidisciplinary discussion of antibiotic indication, choice, and duration during clinical rounds. We assessed reduction in the number of patients receiving ≥24 h of antibiotic prophylaxis after clean and clean-contaminated surgery. Methods: We piloted the program at a referral hospital in Ethiopia from February to September 2023. After a 6-week baseline assessment, multidisciplinary teams adapted international guidelines for surgical prophylaxis to local disease burden, medication availability, and cost restrictions; stakeholders from surgical departments provided feedback. Surgical teams implemented a "timeout" during rounds to apply these guidelines to patient care; compliance with the timeout and antibiotic administration was assessed throughout the study period. Results: We collected data from 636 patients; 159 (25%) in the baseline period and 477 (75%) in the intervention period. The percentage of patients receiving ≥24 h of antibiotic prophylaxis after surgery decreased from 50.9% in the baseline period to 40.9% in the intervention period (p = 0.027) and was associated with a 0.5 day reduction in postoperative length of stay (p = 0.047). Discussion: This antibiotic stewardship pilot program reduced postoperative antibiotic prophylaxis in a resource-constrained setting in Sub-Saharan Africa and was associated with shorter length of stay. This program has the potential to reduce unnecessary antibiotic use in this population. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) cautions against unnecessary prolongation of postoperative antibiotics to prevent surgical site infections (SSI), however this practice is still common in many countries. This study aims to describe drivers of prolonged postoperative antibiotic prescribing and clinicians' perspectives on antibiotics resistance and stewardship in Ethiopia. Methods: We conducted semi-structured interviews of 16 surgeons and nine surgical ward nurses at three academic referral hospitals in Addis Ababa. Audio recordings were transcribed verbatim and coded. Codes were inductively and iteratively derived between two researchers, tested for inter-rater reliability (IRR), and the codebook was consistently applied to all transcripts. Thematic analysis was performed to understand drivers of prolonged prophylactic antibiotic use in surgical patients. Results: Interviews revealed factors contributing to postoperative prophylactic antibiotics overprescribing, including inadequate infection prevention and control (IPC) practices, wide variability in local prescribing practices, and distrust in the applicability of WHO guidelines. Antimicrobial resistance was also identified as a major concern by staff. Barriers to improving stewardship included a lack of multidisciplinary teamwork to inform prescribing decisions, while solutions included constructing appropriate context-specific guidelines and improving evidence-based practices through input from local stakeholders, including surgeons, clinical pharmacists, and nurses. Conclusions: Study participants perceived that existing evidence and guidelines did not apply in their settings due to high rates of surgical site infections and gaps in perioperative IPC practices (e.g., availability of water for handwashing, sterility breaches). These gaps were a key contributor to prophylactic antibiotic overprescribing, reinforcing the need to strengthen upstream and perioperative surgical antisepsis processes. The findings of this study underscore the importance of engaging multidisciplinary teams in strengthening antimicrobial stewardship efforts, aligning processes to achieve compliance with best practices, and the need for rigorous, contextually appropriate studies from these settings to inform policy. [ABSTRACT FROM AUTHOR]

We chose the Jatobá Basin (JB) in the Borborema Province in northeastern Brazil to address two outstanding problems, basin tectonic inversion and stress propagation, because (a) evidence of tectonic inversion is conspicuous in the JB, and (b) the basin sits on intracontinental northeastern Brazil, far from plate boundaries and the most obvious stress sources. We found robust evidence of oblique reverse faulting inside the basin, putting sediments of the JB's depocenter hundreds of meters above the hard granitic host basement. We also found sound evidence of hydrographic flow reversal, that is, earlier basement‐to‐basin runoff, followed by basin‐to‐basement runoff. This change means that formerly the basement stood higher than the basin, and later the basin was uplifted (inverted) to currently stand hundreds of meters higher than the basement, especially where the gravity anomaly map shows the deepest depocenter. Coarse conglomerates, sourced in the uplifted basin and blanketing the adjacent basement for kilometers, are only cut by the current hydrographic network. From these main lines of evidence, we infer recent basin tectonic inversion (Quaternary, i.e., <2.6 Ma?). The WSW‐ENE orientation of the maximum compressive stress needed to invert the basin likely results from Mid‐Atlantic and Andean pushes. We conclude that lithospheric plates can deform in their cores because of stresses propagating from plate boundaries to distant plate interiors, where the lithosphere has been locally weakened and strain has concentrated. Key Points: The Jatobá Basin in NE Brazil has been tectonically inverted despite sitting far away from plate boundariesHydrographic flow has been inverted, from basement‐to‐basin to basin‐to‐basement by post‐rift differential upliftA weakened lithosphere can deform in its interiors far away from plate boundaries where major topographic forces act [ABSTRACT FROM AUTHOR]

Background: Worldwide, approximately one in six inpatient antibiotic prescriptions are for surgical-infection prophylaxis, including postoperative prophylaxis. The WHO recommends against prolonged postoperative antibiotics to prevent surgical-site infection. However, in many low- and middle-income countries, postoperative antibiotic prophylaxis is common due to perceptions that it protects against surgical-site infection and data informing recommendations against antibiotic administration are largely derived from high-income countries. The aim of this study was to describe postoperative antibiotic-prescribing patterns and related surgical-site infection rates in hospitals in low- and middle-income countries. Methods: Patients from 19 hospitals in Ethiopia, Madagascar, India, and Bolivia with wound class I and II operations were included. Data on antibiotic administration, indication, surgical-site infection, length of hospital stay, and adherence to perioperative infection-prevention standards were collected by trained personnel. The association between postoperative antibiotic prophylaxis for greater than or equal to 24 h and surgical-site infection was analysed via modified robust Poisson regression, controlling for patient and procedural factors and degree of adherence to perioperative infection-prevention practices. Results: Of 8714 patients, 92.9% received antibiotics for prophylaxis after surgery and 27.7% received antibiotics for greater than or equal to 24 h. Patients receiving postoperative prophylaxis for greater than or equal to 24 h did not have lower surgical-site infection rates (Relative risk 1.09 (95% c.i. 0.89 to 1.33); P = 0.399), but the length of hospital stay was 1.4 days longer (P < 0.001). Conclusion: Prolonged postoperative antibiotics did not reduce surgical-site infection, but pervasive use was associated with a longer length of hospital stay, in resource-limited healthcare systems. With the growing threat of antimicrobial resistance, surgical initiatives to implement antimicrobial stewardship programmes in low- and middle-income countries are critical. This cohort study evaluated whether postoperative antibiotic prophylaxis decreased the risk of surgical-site infections in 19 hospitals in low- and middle-income countries, where postoperative prophylaxis is common. Administering postoperative prophylaxis for greater than or equal to 24 h was not associated with a lower risk of surgical-site infection. [ABSTRACT FROM AUTHOR]

We demonstrated a possible future wherein coral reefs shift to an algae-dominated state that retains low coral cover and a functional biomass of herbivorous fishes that sustains a reef fish fishery. We evaluate the effect of no-take marine protected areas (MPAs) and increased coastal nutrients under two Intergovernmental Panel on Climate Change climate scenarios for years 2000-2100, which are implemented as coral bleaching events. Coral mortality from bleaching events drove a lagged increase in herbivorous fish populations via a shift from coral-dominated to algae-dominated habitats. Biomass and catch of piscivorous fish declined significantly, with the fishery shifting to the harvest of herbivorous fish. No-take MPAs for 20% of reef areas represented a threshold that had a positive effect on herbivorous fishes but no influence on the steep declines of corals and piscivorous fishes. Contemporary no-take MPAs protect less than 1% of coral reef areas around the Hawaiian Islands; substantial management action would be required to approach the 20% area threshold. Nous faisons la demonstration d'un avenir possible ou les recifs de corail passent a un etat domine par les algues qui retient une faible couverture de corail et une biomasse fonctionnelle de poissons herbivores qui soutient une peche aux poissons de recifs. Nous evaluons l'effet d'aires marines protegees (AMPs) ou l'exploitation est interdite et de l'augmentation des nutriments cotiers dans deux scenarios climatiques du le Groupe d'experts intergouvernemental sur l'evolution du climat pour les annees 2000 a 2100, qui se traduisent par des episodes de blanchissement de corail. La mortalite de corail resultant des episodes de blanchissement cause une augmentation decalee des populations de poissons herbivores par le biais du passage d'habitats domines par le corail a des habitats domines par les algues. La biomasse et les prises de poissons piscivores baissent de maniere significative en raison de la transition des peches vers des especes herbivores. Des AMP ou l'exploitation est interdite sur 20% des zones de recifs representent un seuil ayant un effet positif sur les poissons herbivores, mais aucune influence sur les baisses marquees de coraux et de poissons piscivores. Les AMP ou l'exploitation est interdite actuelles protegent moins de 1% des zones de recifs de corail autour des iles Hawaiiennes; d'importantes mesures de gestion seraient necessaires pour s'approcher du seuil de 20% de ces zones. [Traduit par la Redaction], Introduction Coral reefs are globally in decline, with trajectories further threatened by diseases, pollution, coral bleaching, unsustainable fishing practices, and ocean acidification (Miller et al. 2009; Selig et al. 2010; [...]

Fabricio Beltrame,1,2 Bianca Nascimento-Carlos,3 Jaqueline S da Silva,1,3 Rodolfo Couto Maia,4 Tadeu Lima Montagnoli,3,4 Eliezer J Barreiro3,4 ,† Gisele Zapata-Sudo1– 4 1Programa de Pós-Graduação em Medicina (Cardiologia), Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; 2Instituto do Coração Edson Saad, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; 3Programa de Pós-Graduação em Farmacologia e Química Medicinal, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; 4Programa de Pesquisa em Desenvolvimento de Fármacos, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil†Professor Eliezer Barreiro passed away on April 8, 2024Correspondence: Gisele Zapata-Sudo, Universidade Federal do Rio de Janeiro, Instituto do Coração Edson Saad, Faculdade de Medicina, Centro de Ciências da Saúde, Bloco J, Sala 11, Rio de Janeiro, RJ, 21941-902, Brasil, Tel/Fax +55-21-39386505, Email gsudo@icb.ufrj.br; gzsudo@gmail.comBackground and Purpose: Current treatments for acute myocardial infarction (AMI) include pain relief and attempts to improve survival. This study investigated the effects of two new ligands of the adenosine receptor, LASSBio-1027 and LASSBio-1860, on cardiac function in an experimental model of AMI.Methods: AMI was induced in Wistar rats by ligating the anterior descending coronary arteries. Infarcted animals were treated orally with vehicle (DMSO), LASSBio-1027 (30 and 70 μmol/kg), or LASSBio-1860 (70 μmol/kg) for seven days. Hemodynamic parameters were observed using echocardiography, whereas inflammation and fibrosis were detected using histological analysis.Results: MI increased the filling pressure from 23.0 ± 1.6 and 14.0 ± 2.0 to 37.0 ± 3.7 and 33.2 ± 8.0, respectively indicating diastolic dysfunction. However, treatment with LASSBio-1027 (70 μmol/kg) and LASSBio-1860 (70 μmol/kg) reduced this parameter to 23.9 ± 5.4 and 17.1 ± 6.7. An impairment in ejection fraction from 57.1 ± 3.2 to 36.6 ± 2.0% was observed after MI, partially recovered to 47.0 ± 7.4% by LASSBio-1027 and fully restored to 61.8 ± 4.3% after 7 days of treatment with LASSBio-1860. After MI, collagen deposition in LV free wall was increased to 31.4 ± 11.0% and treatment with LASSBio-1027 reduced to 23.4 ± 6.0 and 19.7 ± 8.0% at 30 and 70 μmol/kg, respectively. Similarly, LASSBio-1860 reduced collagen levels to 63.1 ± 2.0%.Conclusion: Fibrosis and inflammatory components of MI reduced following treatment with agonist of adenosine receptor subtype A2A. Cardiac remodeling induced by LASSBio-1027 and LASSBio-1860 may be responsible for the improvement in cardiac function in AMI through the activation of A2A adenosine receptors.Keywords: cardiac remodeling, inflammation, myocardial infarction, adenosine receptors