File Name: emergence and selection of antimicrobial is a very serious concern article 2018.zip
Metrics details. Antimicrobial resistance AMR is an increasing threat to global health. The disease is primarily controlled by antimicrobial treatment, but this is becoming increasingly difficult due to AMR. Our objectives were to assess the prevalence and geographic distribution of AMR in Salmonella enterica serovars Typhi and Paratyphi A infections globally, to evaluate the extent of the problem, and to facilitate the creation of geospatial maps of AMR prevalence to help targeted public health intervention.
Enhanced recovery after surgery is well established in specialties such as colorectal surgery. It is achieved through the introduction of multiple evidence-based perioperative measures that aim to diminish postoperative organ dysfunction while facilitating recovery.
This review aims to present consensus recommendations for the optimal perioperative management of patients undergoing thoracic surgery principally lung resection. A systematic review of meta-analyses, randomized controlled trials, large non-randomized studies and reviews was conducted for each protocol element.
Smaller prospective and retrospective cohort studies were considered only when higher-level evidence was unavailable. The quality of the evidence base was graded by the authors and used to form consensus recommendations for each topic. Recommendations were developed for a total of 45 enhanced recovery items covering topics related to preadmission, admission, intraoperative care and postoperative care.
Most are based on good-quality studies. In some instances, good-quality data were not available, and subsequent recommendations are generic or based on data extrapolated from other specialties. In other cases, no recommendation can currently be made because either equipoise exists or there is a lack of available evidence. Recommendations are based not only on the quality of the evidence but also on the balance between desirable and undesirable effects.
Key recommendations include preoperative counselling, nutritional screening, smoking cessation, prehabilitation for high-risk patients, avoidance of fasting, carbohydrate loading, avoidance of preoperative sedatives, venous thromboembolism prophylaxis, prevention of hypothermia, short-acting anaesthetics to facilitate early emergence, regional anaesthesia, nausea and vomiting control, opioid-sparing analgesia, euvolemic fluid management, minimally invasive surgery, early chest drain removal, avoidance of urinary catheters and early mobilization after surgery.
These guidelines outline recommendations for the perioperative management of patients undergoing lung surgery based on the best available evidence. As the recommendation grade for most of the elements is strong, the use of a systematic perioperative care pathway has the potential to improve outcomes after surgery. In a meta-analysis of 38 studies, ERAS pathways were seen to be effective in reducing hospital length of stay LOS and postoperative complication rates [ 11 ].
Colorectal cancer surgery accounted for the majority of the studies included in this meta-analysis, and the specialty has been at the forefront of the development of ERAS pathways since their inception [ 3 , 12—15 ]. The benefits described are achieved by attenuating the homeostatic disturbance and stress response associated with surgery, which is characterized by catabolism and increased oxygen demand, thereby diminishing postoperative organ dysfunction and facilitating recovery [ 14—16 ].
An enhanced recovery pathway addresses the entire patient journey from referral to discharge. Multiple small improvements and efficiencies are adopted in an evidence-based manner by a multidisciplinary team. Individual care elements may not necessarily have significant benefits when studied in isolation, but their combination with other elements of the pathway is thought to have a synergistic effect [ 14 ].
More recently, overall compliance with ERAS protocols has been shown to be associated with better patient outcomes [ 17—19 ]. At the same time, some elements such as minimally invasive surgery and early mobilization appear to be more influential than others [ 17 , 19 ].
More recently, specific ERAS pathways for thoracic surgery have been published, most of which demonstrating benefits such as reduced opiate usage, minimization of fluid overload, reduced LOS, decreased hospital costs and reduced pulmonary and cardiac complications [ 19 , 24—30 ]. An initial systematic review of ERAS pathways in elective lung cancer surgery cautioned against the over-interpretation of results, as the included studies were mainly non-randomized and had methodological flaws [ 31 ].
A subsequent review and meta-analysis demonstrated that ERAS pathways in lung cancer surgery are associated with reduced complications, a shorter LOS and cost savings [ 32 ]. The authors noted significant heterogeneity between protocols and highlighted the need to develop standardized, evidence-based guidelines for thoracic surgery. Standardized perioperative care helps to ensure that all patients receive optimal treatment.
The goal of this article is to critically review existing evidence and make recommendations for elements of perioperative care in lung surgery. The authors convened in May to discuss topics for inclusion. After the topics were agreed upon, they were allocated among the group according to expertise. Reference lists of all eligible articles were crosschecked for other relevant studies.
Titles and abstracts were screened by individual reviewers to identify potentially relevant articles. Discrepancies in judgement were resolved by the lead T. Meta-analyses, systematic reviews, randomized controlled studies, non-randomized controlled studies, reviews and case series were considered for each individual topic.
GRADE system for rating quality of evidence [ 33 ]. GRADE system for rating strength of recommendations [ 33 ]. Strong recommendations indicate that the panel is confident that the desirable effects of adherence to a recommendation outweigh the undesirable effects. Weak recommendations indicate that the desirable effects of adherence to a recommendation probably outweigh the undesirable effects, but the panel is less confident.
Recommendations are based not only on the quality of evidence—high, moderate, low and very low—but also on the balance between desirable and undesirable effects.
Of note, this would be considered a modified GRADE evaluation since we did not consider resource utilization when making our recommendations [ 34 ]. The evidence base, recommendations, evidence level and recommendation grade are provided for each individual ERAS item below. Preoperative counselling helps to set expectations about surgical and anaesthetic procedures and may diminish fear, fatigue and pain and enhance recovery and early discharge [ 35 ].
Verbalized education, leaflets and multimedia information containing explanations of the procedure and cognitive interventions may improve pain control, nausea and anxiety after surgery [ 36 ] and general anaesthesia [ 37 ].
Patient empowerment through diary keeping also appears to improve postoperative pain control but did not influence LOS in surgical cancer patients in 1 randomized controlled trial RCT [ 38 ]. Similar results have been demonstrated in patients provided with preoperative video information prior to lung resection [ 39 ]. Paradoxically, 1 RCT demonstrated lower levels of postoperative satisfaction following lung resection when patients were given written information [ 40 ].
It is uncertain if formal education is superior to informal education [ 41 ], but ideally patients should receive information in both written and oral form. The patient and a relative or care provider should meet with all members of the team including the surgeon, anaesthetist and nurse.
Most studies show that counselling provides beneficial effects with no evidence of harm. In particular, pain control appears better following lung resection. It is recommended that patients should routinely receive dedicated preoperative counselling.
Nutritional components of ERAS include preoperative fluid and carbohydrate loading, avoidance of fasting and early recommencement of oral diet and oral nutritional supplements ONS [ 42 ].
Carbohydrate loading and early enteral diet are dealt with later in these guidelines. Malnutrition is an important potentially modifiable risk factor for adverse outcomes after major surgery. However, it is uncertain whether modifying or optimizing perioperative nutritional state results in a reduction in complications. In rehabilitation programmes for chronic obstructive pulmonary disease COPD , ONS is recommended and improves patient quality of life and muscle function [ 46 ].
In addition, malnutrition and loss of muscle mass are frequent in cancer patients and can have a negative effect on clinical outcomes [ 48 ]. A recent meta-analysis concluded no benefit of preoperative immune-enhancing nutrition IEN in abdominal surgery over standard ONS, although postoperative IEN may improve outcomes [ 42 , 52 , 53 ], particularly in patients with pre-existing malnutrition.
There were benefits in terms of a reduced complication rate although this was mainly due to a difference in air leak and maintenance of postoperative plasma albumin levels [ 54 ]. Routine nutritional screening is useful. Patients should be screened preoperatively for nutritional status and weight loss. If deemed at risk, they should be given active nutritional support. ONS can be used to supplement total intake. There is not enough evidence to recommend IEN over ONS preoperatively, but there may be a role in the malnourished patient postoperatively.
Smoking is associated with a high risk of postoperative complications, but the pulmonary effects of smoking can be improved within 4 weeks of cessation [ 55 ]. Paradoxically, recent quitters i. Further large studies could not corroborate this paradoxical effect [ 57 , 58 ]. Rather, while confirming that smoking increased the risks of hospital death and pulmonary complications after lung cancer resection, these risks were mitigated slowly by preoperative cessation.
More recently, smoking has not been shown to be a risk factor for pulmonary complications if patients are subjected to intense perioperative physiotherapy regimes [ 59 ]. There is also evidence that delaying surgery can result in upstaging and decreased long-term survival in lung cancer patients [ 60 ].
Continued smoking at the time of lung cancer surgery is also associated with poor postoperative quality of life and fatigue [ 61 ] and reduced long-term survival [ 62 ]. While smoking cessation interventions such as behavioural support, pharmacotherapy and nicotine replacement are known to result in short-term smoking cessation and long-term abstinence rates [ 63 , 64 ], there is weak evidence to show that these smoking cessation measures actively decrease postoperative morbidity.
The use of varenicline is associated with an increase in long-term smoking cessation but there is no evidence of a reduction in postoperative morbidity [ 64 , 65 ]. However, smoking cessation appears to be cost-effective prior to lung surgery [ 66 ]. Smoking is associated with an increased risk of postoperative morbidity especially pulmonary complications and mortality and ideally should be stopped at least 4 weeks before surgery. The effects of alcohol abuse on the liver, pancreas and neurological system are well known.
In the perioperative period, the chronic effects of alcohol intake on cardiac function, blood clotting and immune function, in combination with the surgical stress response, contribute to excess morbidity. Alcohol abuse in patients undergoing lung cancer surgery is associated with increased postoperative pulmonary complications and mortality [ 67—69 ], and reduced long-term survival [ 70 ]. Prior to elective surgery, intensive preoperative interventions aimed at complete alcohol cessation, for at least 4 weeks to reduce postoperative complications, but do not significantly reduce mortality or LOS.
However, only a small number of studies are available, and the mechanism by which such interventions reduce complications is unknown. Therefore, the optimal timing of such interventions has yet to be determined [ 71 ]. Alcohol is associated with increased perioperative morbidity and mortality and should be avoided for at least 4 weeks before surgery in patients who abuse alcohol.
Preoperative anaemia is associated with postoperative morbidity and mortality [ 72 ] and reduced long-term survival [ 73 ]. A comprehensive review of blood management has advocated preoperative screening for anaemia [ 74 ]. Anaemia should be identified and corrected for iron deficiency and any underlying disorder before elective surgery.
The risks of surgery are increased with the severity of the anaemia [ 75 ]. The speed of response to iron therapy oral or intravenous is greater in more severe iron deficiency anaemia.
Therefore, prompt identification and treatment is important in reducing the need for erythropoiesis-stimulating agents or blood transfusion. Both erythropoiesis-stimulating agents and perioperative blood transfusion have been associated with poorer outcomes for cancer patients [ 76 , 77 ]. Long-term cancer survival including survival in lung cancer patients is also reduced following perioperative transfusion [ 76 , 78 ].
Recent guidelines have shown no strong evidence of a benefit from preoperative blood transfusion to improve surgical outcomes in cardiac surgery patients , and in the absence of other blood management measures, preoperative transfusion does not reduce total transfusion requirements. Where transfusion is considered to be unavoidable, there is no evidence to suggest advantages of pre- over intraoperative transfusion [ 75 ].
If possible, the focus should be on preventing further blood loss intraoperatively. Preoperative anaemia is associated with an increase in postoperative morbidity and mortality and should be identified, investigated and corrected preoperatively.
Iron therapy is the preferred first-line treatment for the correction of iron deficiency anaemia. Where possible, blood transfusion or erythropoiesis-stimulating agents should not be used to correct preoperative anaemia. Poorer preoperative exercise capacity is associated with worse long- and short-term clinical outcomes including postoperative complications, LOS [ 79 , 80 ] and survival [ 81 , 82 ] following curative lung cancer surgery.
Preoperative physical conditioning, or prehabilitation, is the process of enhancing the functional and physiological capacity of an individual to enable them to withstand a stressful event and may aid recovery after surgery [ 83 ]. It is the process on the continuum of care that occurs between cancer diagnosis and surgical treatment [ 84 ].
Once production of your article has started, you can track the status of your article via Track Your Accepted Article. Help expand a public dataset of research that support the SDGs. Infectious diseases constitute one of the main challenges to medical science in the coming century. The impressive development of molecular megatechnologies and of bioinformatics have greatly increased our knowledge of the evolution, transmission and pathogenicity of infectious diseases. Research has Research has shown that host susceptibility to many infectious diseases has a genetic basis.
; – Antimicrobial resistance (AMR) poses a serious global threat of growing These factors contribute to genetic selection pressure for the emergence of Currently, medical experts are raising real concern for a return to the Another very significant trait of AMR that was absent in the.
The popularity of fermented foods and beverages is due to their enhanced shelf-life, safety, functionality, sensory, and nutritional properties. The latter includes the presence of bioactive molecules, vitamins, and other constituents with increased availability due to the process of fermentation. Many fermented foods also contain live microorganisms that may improve gastrointestinal health and provide other health benefits, including lowering the risk of type two diabetes and cardiovascular diseases.
For the last 70 years, doctors have prescribed drugs known as antimicrobial agents to treat infectious diseases. These are diseases that occur due to microbes, such as bacteria, viruses, and parasites. Some of these diseases can be life-threatening. However, the use of these drugs is now so common that some microbes have adapted and started to resist them.
The occurrence of antibiotics in treated wastewater effluent has been a concern worldwide for various reasons: most importantly development of antibiotics resistance by bacteria and other microorganism, impact of antibiotics on animal life in surface water and likely consequences on humans if treated wastewater is used for drinking water supply through the process of managed aquifer recharge MAR. Another potential area of concern is the uptake of these antibiotics by crops irrigated by treated wastewater. In Oman, wastewater treatment and reuse is pursued vigorously as a government policy. Treated wastewater is used for crop irrigation following government regulations, MAR is being contemplated and practiced in small scale and release of such waters in the ocean takes place from time to time. Some tests have been conducted on the wastewater effluent around the world to verify and detect the concentration of antibiotics in wastewater effluent.
Enhanced recovery after surgery is well established in specialties such as colorectal surgery.
Обычно лучистые и ясные, сейчас его глаза казались усталыми, тусклыми. Сколько я уже тут кручусь. Однако считать ему не хотелось.
Стратмор молчал. Положение оказалось куда серьезнее, чем предполагала Сьюзан. Самое шокирующее обстоятельство заключалось в том, что Танкадо дал ситуации зайти слишком .
Он слишком долго говорил ей полуправду: просто есть вещи, о которых она ничего не знала, и он молил Бога, чтобы не узнала. - Прости меня, - сказал он, стараясь говорить как можно мягче. - Расскажи, что с тобой случилось.
- Сегодня не его дежурство. - Похоже, что-то стряслось, - сказала Сьюзан. - Наверное, увидел включенный монитор. - Черт возьми! - выругался коммандер.
Она знала, что есть только один способ доказать свою правоту - выяснить все самой, а если понадобится, то с помощью Джаббы. Мидж развернулась и направилась к двери. Откуда ни возьмись появился Бринкерхофф и преградил ей дорогу. - Куда держишь путь. - Домой! - солгала Мидж.
Волевой подбородок и правильные черты его лица казались Сьюзан высеченными из мрамора. При росте более ста восьмидесяти сантиметров он передвигался по корту куда быстрее университетских коллег. Разгромив очередного партнера, он шел охладиться к фонтанчику с питьевой водой и опускал в него голову.
В подавленном настроении Сьюзан приняла ванну. Она окунулась в мыльную пену и попыталась забыть о Стоун-Мэнор и Смоки-Маунтинс.
An antibiotic is a type of antimicrobial substance active against bacteria.Г‰mile B. 19.12.2020 at 01:15
ikafisipundip.org the problem of antibiotic-resistant bacteria have become global public health threats. found in contaminated areas has serious implications for the the selection of antibiotic resistant bacterial cells. It should be noted that the de novo emergence of bacterial resistance.Delmiro J. 22.12.2020 at 19:54
The aggregate data supporting findings contained within this manuscript will be shared upon request submitted to the corresponding author.