Global incidence of surgical site infections following caesarean section: a systematic review and meta-analysis.

BACKGROUND: Surgical site infection (SSI) is a health-threatening complication following caesarean section (CS); however, to the authors' knowledge, there is no worldwide estimate of the burden of post-CS SSIs. Therefore, this systematic review and meta-analysis aimed to estimate the global and regional incidence of post-CS SSIs and associated factors. METHODS: International scientific databases were searched systematically for observational studies published from January 2000 to March 2023, without language or geographical restrictions. The pooled global incidence rate was estimated using a random-effects meta-analysis (REM), and then stratified by World-Health-Organization-defined regions as well as by sociodemographic and study characteristics. Causative pathogens and associated risk factors of SSIs were also analysed using REM. Heterogeneity was assessed with I2. RESULTS: In total, 180 eligible studies (207 datasets) involving 2,188,242 participants from 58 countries were included in this review. The pooled global incidence of post-CS SSIs was 5.63% [95% confidence interval (CI) 5.18-6.11%]. The highest and lowest incidence rates for post-CS SSIs were estimated for the African (11.91%, 95% CI 9.67-14.34%) and North American (3.87%, 95% CI 3.02-4.83%) regions, respectively. The incidence was significantly higher in countries with lower income and human development index levels. The pooled incidence estimates have increased steadily over time, with the highest incidence rate during the coronavirus disease 2019 pandemic (2019-2023). Staphylococcus aureus and Escherichia coli were the most prevalent pathogens. Several risk factors were identified. CONCLUSION: An increasing and substantial burden from post-CS SSIs was identified, especially in low-income countries. Further research, greater awareness and the development of effective prevention and management strategies are warranted to reduce post-CS SSIs.

A comparative study on sealing ability of mineral trioxide aggregate, calcium enriched cement and bone cement in furcal perforations.

AIM: The aim of this study was to compare the bacterial leakage of mineral trioxide aggregate (MTA), calcium enriched cement (CEM), and bone cement (BC) as repair materials in furcal perforations. METHODS: The pulp chambers of 57 human mandibular molar teeth were accessed and the root canal orifices were located. The roots were horizontally sectioned in the middle third. Composite resin was used to fill the root canal orifices and the apical end of the roots. The 1 mm furcation perforations were performed in the center of the pulp chamber floor, using diamond fissure burs. Fifty one teeth were divided into 3 groups. Six teeth were used as controls. Perforation defects were repaired with either MTA, CEM, or BC. A bacterial leakage model utilizing phenol red with 3% lactose broth was used for evaluation. The upper pulp chambers were subsequently filled with 5µL bacterial suspension containing Enterococcus faecalis. Then the top of the assembly was covered with aluminum foil to avoid unintentional contamination. The entire apparatus was incubated at 37°C, and bacterial leakage was evaluated daily by checking the turbidity in the culture medium of the lower part of the chamber. The bacterial inoculation was renewed every day, for 30 days. Leakage was noted when color conversion of the culture media was observed and was statistically analyzed using the Chi-square test with significance set at P< 0.05. RESULTS: Sixteen (94%) of the 17 samples of the MTA group, thirteen (81%) of the 17 samples of the CEM group and sixteen (94%) of the 17 samples in BC group were fully contaminated at 30 days. There was no statistically significant difference between the three study groups (P>0.05). CONCLUSION: According to the present study, in teeth with furcation perforations, the coronal seal produced by MTA preparations was equally to that produced by CEM cement and Bone cement.

A in-vitro comparative study on bacterial leakage of mineral trioxide aggregate, calcium enriched cement and bone cement in furcal perforations.

AIM: The aim of this study was to compare the bacterial leakage of mineral trioxide aggregate (MTA), calciem enriched cement (CEM), and bone cement (BC) as repair materials in furcal perforations. METHODS: The pulp chambers of 57 human mandibular molar teeth were accessed and the root canal orifices were located. The roots were horizontally sectioned in the middle third. Composite resin was used to fill the root canal orifices and the apical end of the roots. The 1mm furcation perforations were performed in the center of the pulp chamber floor, using diamond fissure burs. Fifty one teeth were divided into 3 groups. Six teeth were used as controls.Perforation defects were repaired with either MTA, CEM, or BC. A bacterial leakage model utilizing phenol red with 3% lactose broth was used for evaluation. The upper pulp chambers were subsequently filled with 5µL bacterial suspension containing Enterococcus faecalis. Then the top of the assembly was covered with aluminum foil to avoid unintentional contamination. The entire apparatus was incubated at 37°C, and bacterial leakage was evaluated daily by checking the turbidity in the culture medium of the lower part of the chamber. The bacterial inoculation was renewed every day, for 30 days. Leakage was noted when color conversion of the culture media was observed and was statistically analyzed using the Chi--square test with significance set at P< 0.05. RESULTS: Sixteen (94%) of the 17 samples of the MTA group , thirteen (81%) of the 17 samples of the CEM group and sixteen (94%) of the 17 samples in BC group were fully contaminated at 30 days. There was no statistically significant difference between the three study groups (P > 0.05). CONCLUSION: According to the present study, in teeth with furcation perforations, the coronal seal produced by MTA preparations was equally to that produced by CEM cement and Bone cement.

Accuracy of serum pepsinogens I and II, gastrin-17 and anti-helicobacter pylori antibodies in histological diagnoses of atrophic gastritis.

AIM: Atrophic gastritis is defined as a chronic inflammatory process in gastric mucosa leading to loss of glandular cells. It is considered a precancerous condition, thus its early diagnosis is of importance. Although histo-pathologic studies remain as the gold standard of diagnosis, non-invasive methods suitable for screening purposes are being developed. This includes measurement of serum gastric profile. METHODS: Two hundred and fifty 250 patients who were planned to undergo upper gastrointestinal endoscopy were randomly selected to be included in this study. Serum levels of pepsinogen I and II, gastrin-17 and anti-Helicobacter pylori (Hp) antibody were measured and the results were compared with that of histopathologic assessment of biopsy specimens obtained during endoscopy. RESULTS: IgG anti-Hp, PGII and PGI/PGII ratio showed correlation with age. PGI/PGII ratio showed best sensitivity (96.1%) and negative predictive value (97.7%). PGI has the highest specificity (94.6%), and PGII also had a high negative predictive value (90.7%). IgG anti-Hp showed poor sensitivity and specificity (58.8% and 26.5%, respectively). CONCLUSIONS: Pepsinogen I/II ratio appears to be the most suitable single measurement for screening purposes in atrophic gastritis.

Chronic kidney disease after hematopoietic cell transplantation: frequency, risk factors, and outcomes.

BACKGROUND: Occurrence of chronic kidney disease (CKD) after hematopoietic cell transplantation (HCT) is rare with relatively few reported cases. The aim of this study was to evaluate the frequency of CKD among patients who received HCT for hematologic and nonhematologic disorders. OBJECTIVE: We performed a prospective study to evaluate the frequency of CKD and its risk factors. Between 1997 and 2006 there were 1693 patients engrafted at the Bone Marrow Transplant Research Center. METHOD: CKD was defined as a doubling of serum creatinine level from the baseline and after 1 year from receiving a transplantation. The risk of CKD in relation to a non-based total body irradiation conditioning regimen, the type of graft (allograft autograft), and the incidences of graft-versus-host disease (GVHD), drug toxicity, and veno occlusive disease (VOD) were examined in 1963 HCT patients. RESULTS: Kidney involvement developed in 66 patients (4%). By 6-12 months after HCT, approximately 33% of these patients developed CKD (23 patients: 19 allograft and 4 autograft). In most CKD patients, the cause was idiopathic. In 23 patients who developed CKD, 5 patients had acute kidney injury during the transplantation period with GVHD. Other renal involvements were as follows: hypertension (17%), proteinuria (15%), hydronephrosis (2%), hematuria (18%), and diabetes (3%). CONCLUSION: The frequency of CKD in this study seems to be high. It is important to know the specific type of kidney damage, to determine when to be aware of the time of occurrence of renal complications and to understand the best methods to treat patients with renal injury secondary to nephrotic syndrome and idiopathic CKD.

Recognition of internal structure of unknown objects with simultaneous neutron and gamma radiography.

Generally speaking in customary industrial and medical radiography, there is no tendency to reveal the nature of the samples. Ordinarily, the main objective of taking a radiograph is to show the position and dimension of unknown parts, inside the test object and to determine cracks, defects, etc. Whereas in radiography many important factors such as material cross-sections and build-up factors are also involved. In this paper, by using both neutron and gamma radiography techniques, some mathematical relations were successfully generated, in order to calculate the neutron and gamma total macroscopic cross-sections of some unknown elements in the presence of the other elements. For this work, some test pieces were defined and made of lead, silver, copper, Nickel, tin, graphite and polyethylene. The neutron radiography facility at Tehran Research Reactor (TRR) was used as mixed neutron and gamma radiography source (Proceedings of the Second World Conference on Neutron Radiography, Paris, France, pp. 25-32). On testing of a correction of the above-mentioned generated relations, a new technique of simultaneous neutron and gamma radiography was also investigated.

Use of atrial and bifocal cardiac pacemakers for treating resistant dysrhythmias.

Several permanent cardiac pacing techniques have been utilized to control resistant cardiac arrhythmias. SA block, sinus arrest and intermittent ventricular tachycardia was controlled by the use of an atrial 'J' catheter and a rate programmable demand pacemaker. When these arrhythmias were associated with AV conduction delay they were managed with an AV sequential pacemaker with the additional insertion of a ventricular pacing lead. Appropriate adjustment of the AV sequential interval inhibited reciprocal AV or VA reentry thus controlling reciprocal tachycardia. Frequent ventricular premature systoles or intermittent ventricular tachycardia with in appropriately delayed sinus or subsidiary escape cycle lengths appear best managed by an AV sequential pacemaker by adjusting the atrial return cycle. Intractable atrial reentry tachycardias appear best managed by paired or rapid atrial stimulating pacemakers. Development of variable atrial rate, AV sequential and atrial return cycle activating pacemakers offer an effective control of resistant cardiac arrhythmias.