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Background: Surgical-related incidents are a common cause of in-hospital adverse events. Surgical patient safety would benefit from evidence-based practices, but a comprehensive collection of patient safety recommendations is still lacking. This study aimed to compile and assess the perioperative patient safety recommendations for adults., Method: A systematic review of clinical practice guidelines was conducted using Medline, Embase, Cochrane, Virtual Health Library Regional Portal, and Trip Database from 2012 to 2022. Eligibility criteria followed a PICAR strategy for patient safety recommendations in the perioperative care continuum. Guidelines were appraised for quality, particularly focusing on the 'rigour of development' domain of the AGREE-II tool for those containing strong recommendations. Descriptive analyses were conducted, emphasizing guideline quality, recommendation strength, and the supporting level of evidence., Results: From the 267 guidelines, 4666 perioperative patient safety recommendations were extracted, of which 44.9% (2095) were strongly recommended. Of these, 322 had the highest level of evidence, but only 18 guidelines met high standards in the AGREE-II 'rigour of development' domain. A subset of 78 recommendations ranked the highest in the strength of recommendation, level of evidence, and rigour of development of their guidelines. A gap was found within pre-admission and post-discharge care recommendations., Discussion: This review highlights the noteworthy variability in the methodological quality of the guidelines, and a discordance between strength of recommendation and evidence level of the available perioperative patient safety recommendations. These findings provide valuable information for advising policy decisions and promoting best practices to enhance global surgical safety., Registration: PROSPERO (CRD42022347449)., (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)

Background: Angiostrongylus cantonensis is a metastrongylid nematode that has a heteroxenous cycle, where snails act as intermediate hosts and the rodents Rattus rattus and Rattus novergicus are the definitive hosts. However, humans may act as accidental hosts presenting an atypical form of parasitism. This fact has motivated research to better understand systems of relationships involving A. cantonensis, targeting the control of species of gastropods that act as intermediary hosts., Methods: For this, six groups were formed: three control groups (uninfected) and three infected groups, exposed to approximately 1200 L1 larvae of A. cantonensis. At the end of each week (1, 2, and 3 weeks), snails were dissected without anesthesia and the gonad-digestive gland (DGG) complex was separated for determination of oxygen consumption through high-resolution titration-injection respirometer (Oroboros, Oxygraph; Innsbruck, Austria)., Results: The results indicate suppression of mitochondrial oxidative metabolism of the host and compromised in different mitochondrial respiratory states. This effect, mainly observed in the group exposed to 1 week of infection, showed a decrease of approximately 38% (2.78 ± 0.37 pmol O2/mg of tissue; P < 0.05), 41% (2.76 ± 0.34 pmol O2/mg of tissue; P < 0.05) e 46% (2.91 ± 0.36 pmol O2/mg of tissue; P < 0.05) in the basal oxygen consumption after sequential addition (P + M), succinate and (ADP) in the respiratory medium, differing significantly from the control group., Conclusion: The results presented indicate that the prepatent infection by this metastrongylid impairs the aerobic oxidative metabolism of its host, causing a reduction in basal oxygen consumption. This effect, observed at the start of development of the parasites, indicates that this stage is the most critical for the success of the infection, and can be explained by a reduction of the mitochondrial density of the tissue analyzed, or also by suppression of enzyme centers related to the oxidative reactions.

The effect of concurrent infection by Echinostoma paraensei and Angiostrongylus cantonensis on the activity of the enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and the concentration of total proteins, uric acid and urea in the hemolymph of Biomphalaria glabrata were investigated. Additionally, histopathological studies were conducted to better understand the dynamics of ontogenic development of both helminths in the host and the possible biochemical effects. Co-infections by helminths and other parasites often occur due to the wide distribution of helminths and the chronic nature of the infection. The biochemical parameters were measured at the end of the seventh week after exposure. The co-infection resulted in a significant decrease in the total proteins concentration in the hemolymph of snails as well as an increase in the nitrogen excretion products, these results showed that the infection leads to exhaustion of free circulating and stored carbohydrates and the infected snails make use alternative substrates, such as free amino acids. So, the protein degradation to release free amino acids causes a decrease in the content of total proteins in the snail host and an amino acids deamination process, increasing the content of ammonium, which needs to be detoxified. This occurs by increasing the urea and uric acid contents. This observation is corroborated by the increase of ALT and AST activities, enzymes directly related to amino group from an amino acid to an α- ketoacid an important step to generate new carbon skeleton for glucose synthesis de novo, as well as new intermediates to the Krebs cycle. Additionally, reduction in the recovery of L3 from the co-infected group (A + E) was observed, since in this association the burden was higher than in the other. Histopathological results showed a change in the distribution of A. cantonensis in the presence of E. paraensei, indicating that the presence of this trematode impairs the dynamic transmission of A. cantonensis.