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.

Risk factors for mortality of 557 adult patients with COVID 19 in Babol, Northern Iran: a retrospective cohort study.

BACKGROUND: This study was aimed to investigate the risk factors for mortality in patients with COVID-19. METHODS: For this retrospective cohort study, we included 121 deceased and 436 discharged cases with COVID-19 in Babol, Northern Iran. The cases were between March 1 to April 1, 2020. RESULTS: Multivariate Poisson regression analysis revealed that older age (aRR: 1.03, 95% CI: 1.01, 1.05, p < 0.001), hospital length of stay (aRR: 0.94, 95% CI: 0.90, 0.97, p = 0.003), ICU admission (aRR: 4.34, 95% CI: 2.95, 6.37, p < 0.001), cerebrovascular disease (aRR: 1.96, 95% CI: 1.20, 3.19, p = 0.007), ventilator-associated pneumonia (VAP) (aRR: 2.09, 95% CI: 1.22, 3.55, p = 0.006), septic shock (aRR: 2.98, 95% CI: 1.44, 6.19, p = 0.003), acute respiratory distress syndrome (ARDS) (aRR: 3.80, 95% CI: 2.28, 6.31, p < 0.001), acute kidney failure (AKF) (aRR: 1.45, 95% CI: 1.12, 3.76, p = 0.021), acute heart failure (AHF) (aRR: 1.63, 95% CI: 1.01, 2.62, p = 0.043) and lymphocyte count (aRR: 3.01, 95% CI: 1.99, 4.57, p < 0.001) were associated with mortality. CONCLUSION: Findings showed that elderly with comorbidities such as cerebrovascular diseases had an increased risk of death. Some complications such as: pneumonia, septic shock, ARDS, AHF, and AKF played crucial roles as well death (Tab. 2, Ref. 25).

Endometriosis fertility index for predicting non-assisted reproductive technology pregnancy after endometriosis surgery: a systematic review and meta-analysis.

BACKGROUND: Results of studies that have assessed the accuracy of the endometriosis Fertility Index (EFI) for predicting non-assisted reproductive technology (ART) pregnancy are inconsistent. OBJECTIVE: We intended to evaluate the accuracy of EFI for the prediction of non-ART pregnancy. SEARCH STRATEGY: Embase, Medline, Scopus and Web of Science were searched up to 5 October 2019. SELECTION CRITERIA: We included studies that used EFI to predict non-ART pregnancy in women with surgically documented endometriosis. DATA COLLECTION AND ANALYSIS: A total of 5547 studies were identified, from which we included 17 studies on 4598 women in the meta-analysis. Eight studies were classified as good quality, and the rest were considered to be of fair quality. Only five (29.41%) studies used appropriate approaches to account for potential confounders. Pooled effect sizes with corresponding 95% CI were calculated using random-effects model. MAIN RESULTS: The cumulative non-ART pregnancy rate at 36 months was 10% (95% CI: 3, 16%; P < 0.001) for women with an EFI of 0-2, which significantly increased to 69% (95% CI: 58, 79%; P < 0.001) for women with an EFI of 9-10. Compared with women with an EFI of 3-4 (18%, 95% CI: 12, 24%; P < 0.001), the combined cumulative non-ART pregnancy rates were 44% (95% CI: 26, 63%; P < 0.001) for women with an EFT of 5-6 and 55% (95% CI: 47, 64%; P < 0.001) for women with an EFI of 7-8. Paired comparison by the chi-square test showed a significant difference between all categories (P < 0.001). The odds ratio (OR) for EFI was 1.33 (95% CI: 1.17, 1.49, P < 0.001) and the summary area under the curve (AUC) was 72% (95% CI: 65, 80%, P < 0.001). CONCLUSION: The current findings highlighted the good performance of the EFI score in predicting the non-ART pregnancy rate. However, these findings should be considered with caution because of the substantial heterogeneity between studies. TWEETABLE ABSTRACT: Review findings show the merits of Endometriosis Fertility Index as having a prognostic ability for non-assisted reproductive technology pregnancy.