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Surgical site infection (SSI) is the most common complication of abdominal surgery, with substantial costs to patients and health systems. Heterogeneity in costing methods in existing SSI studies makes multi-country comparison challenging. The objective of the study was to assess the costs of SSI across middle-income countries. Centres from a randomized controlled trial assessing interventions to reduce SSI (FALCON, ClinicalTrials.gov , NCT03700749NCT) were sampled from two upper-middle- (India, Mexico) and two lower-middle- (Ghana, Nigeria) income countries. The Key resource use In Wound Infection (KIWI) study collected data on postoperative resource use and costs from consecutive patients undergoing abdominal surgery with an incision >5 cm (including caesarean section) that were recruited to FALCON between April and October 2020. The overall costs faced by patients with and without SSI were compared by operative field contamination (clean-contaminated vs contaminated-dirty), country and timing (inpatient vs outpatient). A total of 335 patients were included in KIWI; SSI occurred in 7% of clean-contaminated cases and 27% of contaminated-dirty cases. Overall, SSI was associated with an increase in postoperative healthcare costs by 75.3% (€412 international Euros) after clean-contaminated surgery and 66.6% (€331) after contaminated-dirty surgery. The highest and lowest cost increases were in India for clean-contaminated cases (€517) and contaminated-dirty cases (€223), respectively. Overall, inpatient costs accounted for 96.4% of the total healthcare costs after clean-contaminated surgery and 92.5% after contaminated-dirty surgery. SSI was associated with substantial additional postoperative costs across a range of settings. Investment in health technologies to reduce SSI may mitigate the financial burden to patients and low-resource health systems. [ABSTRACT FROM AUTHOR]

Aim: Surgical site infection (SSI) is the commonest postoperative complication worldwide, representing a major burden for patients and health systems. Rates of SSI are significantly higher in low‐ and middle‐income countries (LMICs) but there is little high‐quality evidence on interventions to prevent SSI in LMICs. Method: FALCON is a pragmatic, multicentre, 2 x 2 factorial, stratified randomized controlled trial, with an internal feasibility study, which will address the need for evidence on measures to reduce rates of SSI in patients in LMICs undergoing abdominal surgery. To assess whether either (1) 2% alcoholic chlorhexidine versus 10% povidone‐iodine for skin preparation, or (2) triclosan‐coated suture versus non‐coated suture for fascial closure, can reduce surgical site infection at 30‐days post‐surgery for each of (1) clean‐contaminated and (2) contaminated/dirty surgery. Patients with predicted clean‐contaminated or contaminated/dirty wounds with abdominal skin incision ≥ 5 cm will be randomized 1:1:1:1 between (1) 2% alcoholic chlorhexidine and noncoated suture, (2) 2% alcoholic chlorhexidine and triclosan‐coated suture, (3) 10% aqueous povidone–iodine and noncoated suture and (4) 10% aqueous povidone–iodine and triclosan‐coated suture. The two strata (clean‐contaminated versus contaminated/dirty wounds) are separately powered. Overall, FALCON aims to recruit 5480 patients. The primary outcome is SSI at 30 days, based on the Centers for Disease Control definition of SSI. Conclusion: FALCON will deliver high‐quality evidence that is generalizable across a range of LMIC settings. It will influence revisions to international clinical guidelines, ensuring the global dissemination of its findings. [ABSTRACT FROM AUTHOR]

Reason for performing study Injury to the tendons and ligaments of the equine stifle is a common cause of lameness in horses. Individual radiographic localisation of each tendon and ligament of the stifle has not been previously reported or demonstrated in multiple radiographic projections. Objective To create a series of radiographs identifying the origins and/or insertions of the tendons and ligaments of the equine stifle. Study design Descriptive study of radiographic anatomy. Methods The location of all entheses were determined by gross dissection. The proximal tibia and fibula, distal femur, patella and menisci were isolated from one horse and used as a template. A series of 4 radiographs was obtained with each enthesis identified with barium paste. The radiographic landmarks for each enthesis were described and the best projection(s) for evaluation of each structure of interest identified. Results Forty-eight radiographic images were produced that demonstrated the best radiographic projections to define each enthesis. Conclusions Radiography is the imaging modality most frequently used to evaluate the equine stifle. The images presented here will serve as a guide for evaluating radiographs of the equine stifle, particularly identifying avulsions and enthesopathies of ligamentous and tendinous origins and insertions. [ABSTRACT FROM AUTHOR]

For studies relying on rater judgments of a vulnerable population, such as returning combat veterans, high consistency between primary and secondary raters is necessary. This study examined the inter-rater reliability of a primary and two secondary raters on scoring simulated driving assessments. Seven volunteer drivers were rated in two rounds (Round 1 n=4, Round 2 n=3). Driver performance was rated for two driving scenarios, a) ten-minute city/highway scenario, and b) six-minute suburban/residential scenario to measure driving errors. Based on a set 90% cut point for intra-class correlations (ICC), we examined each rated variable for each rater pairing. After round 1, secondary raters did not achieve the 90% cut point and participated in further training. Analysis of inter-rater reliability following round 2 showed improved inter-rater reliability, i.e., 99.3% for city/highway and 98% for the suburban/residential conditions. Our results suggest that by pinpointing incongruencies in raters' assessment of driving errors, strategies including problem identification, verifying driving errors via the simulator playback function, and establishing parameters for rating each error, can resolve such inconsistencies to significantly improve their inter-rater reliability. [ABSTRACT FROM AUTHOR]

Relapses or flares of systemic lupus erythematosus (SLE) are frequent and observed in 27-66% of patients. SLE flares are defined as an increase in disease activity, in general, requiring alternative treatment or intensification of therapy. A renal flare is indicated by an increase in proteinuria and/or serum creatinine concentration, abnormal urine sediment or a reduction in creatinine clearance rate as a result of active disease. The morbidity associated with renal flares is derived from both the kidney damage due to lupus nephritis and treatment-related toxic effects. Current induction treatment protocols achieve remission in the majority of patients with lupus nephritis; however, few studies focus on treatment interventions for renal flares in these patients. The available data, however, suggest that remission can be induced again in a substantial percentage of patients experiencing a lupus nephritis flare. Lupus nephritis flares are independently associated with an increased risk of deterioration in renal function; prevention of renal flares might, therefore, also decrease long-term morbidity and mortality. Appropriate immunosuppressive maintenance therapy might lead to a decrease in the occurrence of renal and extrarenal flares in patients with SLE, and monitoring for the early detection and treatment of renal flares could improve their outcomes. [ABSTRACT FROM AUTHOR]

Summary 1 The present study compared the effect of the administration of tachykinin NK1 - and NK2 -receptor antagonists alone and in combination on exogenous and endogenous tachykinin-induced contractions using three different guinea-pig airway preparations: isolated bronchus, isolated perfused lung and in vivo . 2 In the isolated bronchi, the tachykinin NK1 -receptor antagonist CP 99994 (0.01–1 μ m)produced concentration-dependent inhibition of contractions induced the tachykinin NK1 -receptor agonists substance P (SP) and [Met-OMe11 ] SP ([Met-OMe11 ]SP), whereas the tachykinin NK2 -receptor antagonist SR 48968 (0.1 μ m) had no effect. SR 48968 (0.001–0.01 μ m)concentration-dependently inhibited contractions induced by the tachykinin NK2 -receptor agonists neurokinin A (NKA) and [β -Ala8 ]-neurokinin A (4–10) ([βAla8 ]-NKA) whereas CP 99994 (0.1 μ m) did not inhibit the contractions. The contractile activity of capsaicin, an agent that releases endogenous tachykinins from sensory C-fibres, was inhibited in a concentration dependent manner by SR 48968 (0.001–0.03 μ m) but not by CP 99994 (0.1 μ m). Combination of CP 99994 and SR 48968 caused increased inhibitory effects on the concentration–response curves to SP, [Met-OMe11 ]SP, NKA, [β -Ala8 ]-NKA and capsaicin. 3 In isolated perfused lungs, SR 48968 concentration (0.01–10 μ m) dependently inhibited NKA-, [β -Ala8 ]-NKA- and capsaicin-induced bronchoconstriction whereas CP 99994 (30 μ m) had no effect on SP-, NKA-, [β -Ala8 ]-NKA- and capsaicin-induced bronchoconstriction. Combination of inactive concentrations of CP 99994 and SR 48968 produced an increased inhibitory effect on all previous stimuli-induced bronchoconstriction. 4 In in vivo... [ABSTRACT FROM AUTHOR]