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.

Body composition assessment in athletes with spinal cord injury: comparison of field methods with dual-energy X-ray absorptiometry.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To compare relative body fatness (%Fat) estimates from field methods (skinfold thickness measurement (SKF) and bioelectrical impedance analysis (BIA)) with measures by dual-energy X-ray absorptiometry (DXA). SETTING: University of Illinois, Urbana-Champaign, IL, USA. METHODS: Field methods used both three- and seven-site SKF prediction equations and BIA generalized, spinal cord injury (SCI)-specific and athlete-specific equations. DXA was used as the reference method. College-aged varsity athletes with SCI (women=8, men=8; time since injury 16.2+/-5.7 years; injury level range T5-L5) were recruited. RESULTS: Mean BMI was 20.8+/-2.6 and 22.5+/-2.1 kg m(-2), and mean DXA %Fat was 31.9+/-3.8 and 20.6+/-8.4%, for women and men, respectively. All field methods under-predicted the %Fat when compared with DXA (ranges in mean differences: SKF women 2.9-8.2%, SKF men 6.9-12.4%; BIA women 0.5-3.9%, BIA men 0.3-7.0%). None of the field methods accurately predicted the %Fat compared with DXA (total error (TE): SKF women 7.4-12.1%, SKF men 8.4-15.2%; BIA women 5.1-9.3%, BIA men 6.7-10.7%). Of the SKF and BIA prediction equations, Evans et al.'s three-site SKF (r=0.95, P<0.001, standard error of the estimate (SEE)=2.8 %Fat) prediction equation provided the best fit for this population. CONCLUSION: Further studies with larger samples are necessary to develop appropriate prediction equations for field methods in the athletic SCI population.

Comparison between two different hemichromes of hemoglobins (HbA and HbS) induced by n-dodecyl trimethylammonium bromide: chemometric study.

The interaction of n-dodecyl trimethylammonium bromide (DTAB) with oxyhemoglobin A and oxyhemoglobin S is investigated using UV-visible absorption spectra and chemometric resolution techniques. Oxyhemoglobins (A and S) induced to partial oxidized form (ferrihemoglobin) by DTAB and finally transform to fully oxidized hemichrome. Hemichrome mole fractions of HbS are more than HbA because of more hydrophobic interaction of DTAB-HbS in second set of binding site relative to DTAB-HbA. The visible spectra between 500 and 650 nm are used for identifying the present components in solution because each species of hemoglobin has a specific spectrum in this region. The number of components and mole fraction of mentioned species were determined by employing chemometric resolution techniques. Subspace comparison was used for determination of the number of components in each concentration of hemoglobin and DTAB. After the determination of components, multivariate curve resolution-alternating least square (MCR-ALS) by initial estimates of spectral profiles and proper constraints, was used to resolve the data matrix into pure concentration and spectral profiles. The results show that both number and mole fraction of components which were formed during hemoglobin (HbA and HbS) oxidation by DTAB were initial hemoglobin concentrations independent. Furthermore, in average the mole fraction of hemichrome of HbS is 14.4% more than HbA. On the other hand, the mole fraction of HbA ferrihemoglobin is 15.6% higher than HbS averagely.

Location of body fat and body size impacts DXA soft tissue measures: a simulation study.

OBJECTIVE: The aim of this study was to determine the ability of dual X-ray absorptiometry (DXA) to detect exogenous fat in men and women simulating typical sex-specific weight changes. SUBJECTS: A diverse sample including 29 elderly (52-83 years) and 61 young (18-40 years) individuals (45 women, 45 men) of varying body mass index (BMI; M+/-s.d.: 26.1+/-4.9 kg/m2, range=16.4-39 kg/m2). METHODS: Whole body (WB) DXA scans (Hologic QDR 4500A) were completed with Scan 1 performed as a normal baseline scan, Scan 2 with 1 kg packet of lard placed on each thigh and Scan 3 with two 1 kg lard packets placed on the abdomen (men) or chest and abdomen (women). RESULTS: Measurement error of fat mass (FM) was more pronounced in the trunk as lard packets were detected with 59% accuracy (error=0.82+/-0.42 kg, P<0.001), whereas 94% of thigh lard (error=0.11+/-0.45 kg, P<0.001) was determined to be FM, while the remainder in both conditions was determined to be mineral free lean mass. Initial FM (r=0.37, P<0.001) for thigh loading and trunk bone mineral content (r=0.30, P<0.01) for trunk-loaded conditions had the most impact on measurement error of WB FM. CONCLUSIONS: Regional differences impact measurement error of simulated changes in FM with greater measurement error in the trunk compared to the thigh region and initial FM and higher levels of bone mineral content in the trunk region impacting error.

The association between regional body composition and metabolic outcomes in athletes with spinal cord injury.

STUDY DESIGN: Cross-sectional study comparing athletes with spinal cord injury (SCI) and age and body mass index matched able-bodied controls (AB). OBJECTIVE: To examine the impact of exercise training on the relation between whole body, regional and intermuscular adipose tissue (IMAT) and glucose tolerance, insulin action and lipid profile. SETTING: University Research Laboratory, USA. METHODS: Fourteen college-aged athletes with SCI (seven men; duration of injury 16.5+/-5.7 years, level of injury T5-L5) and 17 sedentary AB (eight men) were assessed for body composition via dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging. Insulin sensitivity index (ISI) was determined via 2-h oral glucose challenge; standard lipid profile was determined from fasting blood samples. RESULTS: Although ISI was 30% higher in SCI, there were no significant differences between groups in glucose and insulin responses or in lipid measures. Adjusting for absolute and relative thigh IMAT area, fasting insulin (13.8+/-5.3 microIU, 16.3+/-5.6 microIU; P<0.05; SCI vs AB respectively) and ISI (4.0+/-1.4, 3.1+/-1.3; P<0.05) were significantly better among SCI athletes compared to AB. Measures of adiposity did not correlate with glucose response or most lipid measures. Within SCI and AB, respectively, ISI correlated strongly (all P<0.05) with absolute (r = -0.70, -0.54) and relative IMAT (r = -0.54, -0.50), than with trunk (r = -0.62, -0.64) and whole body fat mass (r = -0.61, -0.64). CONCLUSION: Habitual physical activity can maintain insulin sensitivity in SCI compared to sedentary AB controls. Total body fat mass, central adiposity and thigh IMAT appear to impact risk for metabolic disease in SCI individuals with IMAT playing a larger role in SCI than AB.

Gender differences in QTc interval in young, trained individuals with lower spinal cord injury.

STUDY DESIGN: Cross-sectional comparison. OBJECTIVE: To examine gender differences in rate-corrected QT interval (QTc), an index of ventricular depolarization/repolarization, in young, trained men and women with lower spinal cord injury (SCI) and able-bodied (AB) controls. SETTING: University of Illinois at Urbana-Champaign, Exercise and Cardiovascular Research Lab, USA. METHODS: Subjects consisted of 16 athletes with SCI (eight men and eight women) and 16 age-matched AB active controls (eight men and eight women). QT interval dynamics was derived from ECG recordings and rate corrected using the Bazett formula. RESULTS: Men with SCI had QTc similar to that of AB men (369.3+/-7.5 versus 357.9+/-3.0 ms, P>0.05). Women with SCI had QTc similar to that of AB women (400.0+/-4.6 versus 385.2+/-6.5 ms, P>0.05). AB women had longer QTc interval than AB men, and SCI women had longer QTc than SCI men (P<0.05). CONCLUSIONS: Gender differences in ventricular depolarization/repolarization are present in trained individuals with SCI. Thus, similar to their AB gender-matched peers, women with SCI have longer QTc intervals and may be at greater risk for the development of untoward cardiac arrhythmias than men with SCI.