Explore the vast range of titles available.

Despite the One Health progress made in some African countries in addressing zoonotic disease outbreaks, many still lack formal and funded One Health programs. Countries lack diagnostic capacity for zoonotic diseases, coordinated surveillance mechanisms, multisectoral response strategies and skilled workforce. With the devasting impacts of zoonotic disease outbreaks, recent epidemics have caused a loss of lives and negatively impacted the economy. Strengthening One Health approach across African Union (AU) Member States will improve the continent’s ability and capacity to efficiently prevent, detect, and respond to emerging and re-emerging zoonotic diseases. The policy and practice changes needed to address zoonotic diseases require strong political commitment, financial investments, and institutionalised national One Health programs. The African Union endorses a One Health approach in which multiple sectors work jointly to raise awareness, gather credible data, implement programs, and promote evidence-based policy and practice in improve human, animal, and environmental health. The African Union working through its technical agencies set up an interagency multidisciplinary group “the One Health Coordinating Group on Zoonotic Diseases” to strengthen coordinated surveillance, prevention and control of zoonotic diseases on the continent. There is an urgent need to strengthen the coordination of One Health activities across the African continent. The African Union will leverage its unique political position on the continent to raise awareness, secure commitments, and influence policy at the head of state level. This manuscript highlights the opportunity to improve and strengthen One Health coordination and harmonisation of efforts through a continental strategy for zoonotic disease control.

BackgroundUsage of intraoperative indocyanine green (ICG) to assess skin flaps prior to abdominal wall closure has been shown to decrease postoperative wound-related complications. Primary outcome assessed is the utility of ICG in intraoperative decision making. Secondary outcomes analyzed are the incidence of surgical site occurrence (SSO) and hernia recurrence rates.MethodsA retrospective study using the MedStar Georgetown University Hospital database was conducted, incorporating all consecutive patients undergoing complex incisional hernia repair from 2008 to 2018. 146 patients underwent perforator-sparing component separation (PSCST), 88 underwent flap assessment using intraoperative ICG angiography; they were then analyzed based on patient comorbidities, Ventral Hernia Working Group grade, operative factors, and complications.ResultsA total of 146 patients were analyzed with no statistical difference in patient characteristics between the SPY and no SPY group except in BMI (30.2 vs. 33.2 kg/m2, p = 0.036). The no SPY group also had higher numbers of patients undergoing concurrent panniculectomy (12 vs. 1, p < 0.001), and extensive lysis of adhesions (30 vs. 31, p = 0.048). Of the 88 patients undergoing intraoperative SPY, 37 (42%) patients had a change of intraoperative management as defined by further subcutaneous skin flap debridement. Despite this change, there was no statistical difference in incidence of SSO between SPY and no SPY (24.3% vs. 11.8%, p = 0.12), and no difference in hernia recurrence rates 5.6% (n = 5) versus 13.7% (n = 8), p = 0.09.ConclusionIntraoperative ICG assessment of subcutaneous skin flaps with a perforator-sparing component separation does not result in a decrease in surgical site occurrences.

Esophageal achalasia is a primary motility disorder of unknown origin. The goal of treatment is to eliminate the resistance caused by a non-relaxing lower esophageal sphincter, therefore allowing passage of food and liquid from the esophagus into the stomach. A myotomy with a partial fundoplication (anterior Dor or posterior Toupet) is considered the standard of care for patients with achalasia. In the following review, we describe the indications and technique for a posterior partial fundoplication (Toupet).

Background Sleeve gastrectomy to Roux-en-Y bypass conversion is a commonly performed procedure, yet data are limited on outcomes and their predictors. The purpose of this study is to characterize the long-term outcomes of patients after sleeve-to-bypass conversion and identify predictors of post-conversion outcomes. Methods We performed a retrospective cohort study of patients who underwent sleeve-to-bypass conversion for obesity across four hospitals from 06/2017 to 04/2023. Predictors of the below-average percent excess weight loss (%EWL; relative to pre-conversion weight) at 1 and 2 years following conversion were identified using multivariate logistic regression models adjusting for comorbidities, demographics, and neighborhood socioeconomic status. Results 150 Patients undergoing sleeve-to-bypass conversion were identified. 99 had 1-year data and 63 had 2-year data. Mean %EWL at 1- and 2-years following conversion were 40.2% and 37.4%, respectively. EWL > 40% after sleeve gastrectomy was an independent predictor of the below-average %EWL 1-year post-conversion (OR 10.0, 95% CI 2.2–63.0, p  < 0.01), and BMI > 40 kg/m 2 at the time of conversion was an independent predictor of both 1- and 2-year below-average %EWL post-conversion ( p  = 0.01 and 0.05, respectively). Insignificant predictors of the below-average %EWL after conversion included: weight regain after sleeve, time between sleeve and conversion, alimentary limb length, and any bariatric surgery prior to sleeve gastrectomy. Conclusion Patients should be counseled that the typical expected %EWL for sleeve-to-bypass conversion is less than the 50% EWL benchmark of success for index bariatric operations. The main predictors of a suboptimal conversion outcome are > 40% EWL after sleeve or > 40 BMI kg/m 2 at the time of conversion. Most variables in our analysis were not predictors of post-conversion %EWL, including weight regain between sleeve and conversion, alimentary limb length, and time interval between procedures, which suggests that these factors should not play a large role when considering sleeve-to-bypass conversion.

Antimicrobial resistance (AMR) is a major global health issue that exacerbates the burden of infectious diseases and healthcare costs. However, the scarcity of national-level AMR data in African countries hampers our understanding of its scale and contributing factors in the region. To gain insights into AMR prevalence in Africa, we collected and analyzed retrospective AMR data from 14 countries. We estimated bacterial AMR prevalence, defined as the proportion of resistant human isolates tested from antimicrobial susceptibility (AST) data collected retrospectively for 2016-2019 from 205 laboratories across 14 African countries. We generated 95% confidence intervals (CIs) for aggregated AMR estimates to account for data quality disparities across countries; the median data quality score was 73.1%, ranging from 56.4% to 80.8%. We assessed 819,584 culture records covering 9,266 pathogen-drug combinations, of which 187,832 (22.9%) were positive cultures with AST results. The most frequently cultured specimens were urine (32.0%) and purulent samples (28.1%), and the most frequently isolated pathogens were Escherichia coli (22.2%) and Staphylococcus aureus (15.0%). Aggregated AMR estimates did not change significantly across the years studied (p > 0.337); however, there were significant variations in AMR prevalence estimates in culture-positive samples across countries, regions, patient departments (inpatient/outpatient), and specimen sources (p < 0.05). Male sex (adjusted odds ratio [aOR] 1.15; 95% CI [1.09,1.21]; p < 0.0001), ages above 65 (aOR 1.28; 95% CI [1.16-1.41]; p < 0.0001), and inpatient department (aOR 1.24; 95% CI [1.13-1.35]; p < 0.0001) were associated with higher AMR prevalence among culture-positive samples. The lack of routine testing, as reflected in the low data volume from most contributing laboratories, and the absence of patient clinical information, represent significant limitations of this study. Analysis of the largest retrospective AMR dataset in Africa indicates high variability in AMR prevalence across countries, coupled with differences in AMR testing capacities, data quality, and AMR estimates. Gaps in AST practices and inadequate digital infrastructures for data collection and reporting represent barriers to estimating the true AMR burden in the region. These barriers warrant large-scale investments to expand healthcare access and strengthen bacteriology laboratory capacities.

This qualitative study explores experiences of bias, discrimination, and mistreatment among Black surgical trainees using an anonymous reporting system implemented across multiple academic surgical programs in the United States. Over six months, Black surgical trainees submitted anonymous reports detailing mistreatment and bias. Thematic analysis was used to identify key patterns, guided by both predefined concepts and emergent themes. The analysis was conducted by multiple team members with backgrounds in surgical education and qualitative research. Six key themes were identified: microaggressions, abuse of power, professional barriers, identity and visibility, support and advocacy, and impacts on well-being. Trainees reported significant emotional and career-related effects, with many seeking mentorship or support, though institutional responses were often inadequate. This study highlights systemic issues within surgical training and underscores the need for targeted interventions to promote equity, safety, and inclusivity in surgical education. •Black Residents experience microaggressions, abuse of power, professional barriers throughout surgical training.•These experiences negatively affect well-being and career aspirations.•Reported concerns are often not addressed by surgical leadership.•Targeted interventions to promote equity, safety, and inclusivity in surgical education are needed.

[...]victims experience both professional and personal consequences that may have career-long or even life-long impact. [...]HCPs may begin practicing defensive medicine, costing the healthcare system countless dollars ordering unnecessary tests to ensure that they do not commit another error.2,6 The experience of SVS is not unique to any specific level of training, position, or healthcare environment, though it may manifest differently. [...]a 2006 survey showed that 60% of residents who reported an error screened positive for depression.3 Specific coping and recovery mechanisms observed in SVs can vary widely. Concerns over receiving a mental health diagnosis, and particularly having that affecting state medical licensing, may prevent some HCPs from seeking support services outside the hospital. [...]it is imperative that health systems offer HCPs prompt on-site support.

BackgroundThe healthcare system plays a pivotal role in environmental sustainability, and the operating room (OR) significantly contributes to its overall carbon footprint. In response to this critical challenge, leading medical societies, government bodies, regulatory agencies, and industry stakeholders are taking measures to address healthcare sustainability and its impact on climate change. Healthcare now represents almost 20% of the US national economy and 8.5% of US carbon emissions. Internationally, healthcare represents 5% of global carbon emissions. US Healthcare is an outlier in both per capita cost, and per capita greenhouse gas emission, with almost twice per capita emissions compared to every other country in the world.MethodsThe Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the European Association for Endoscopic Surgery (EAES) established the Sustainability in Surgical Practice joint task force in 2023. This collaborative effort aims to actively promote education, mitigation, and innovation, steering surgical practices toward a more sustainable future.ResultsSeveral key initiatives have included a survey of members' knowledge and awareness, a scoping review of terminology, metrics, and initiatives, and deep engagement of key stakeholders.DiscussionThis position paper serves as a Call to Action, proposing a series of actions to catalyze and accelerate the surgical sustainability leadership needed to respond effectively to climate change, and to lead the societal transformation towards health that our times demand.

Abstract Background Laparoscopic sleeve gastrectomy (SG) continues to grow in popularity as a primary bariatric procedure. The purpose of this study is to determine if leak rates and need for subsequent interventions are changed by the standardized use of a closed suction calibration system (CSCS) at a high-volume urban hospital.MethodsA retrospective review was conducted between January 1, 2016, and December 31, 2018, on SG patients. All cases performed in 2018 were completed with a closed suction calibration system. Patient demographics, comorbidities, operative variables, and outcomes were collected. Descriptive statistics and chi-squared test were used to compare the two groups. Logistic regression models were adjusted for patient- and procedure-specific factors.ResultsFour hundred ninety cases were performed before and 195 after institution of the CSCS. Groups were similar in most characteristics, including median body mass index (BMI) (46.4 vs 45.8 kg/m2, p = 0.79). Those in the closed suction cohort were more likely to have OSA requiring therapy (32.4% vs 46.6%, p < 0.01) and to have their cases performed robotically (55.4% vs 39.6%, p = 0.02). Post introduction of the CSCS, the overall leak rate was 0% (1.4% vs 0%, p = 0.09); overall need for postoperative interventions decreased (9.6% vs 2.6%, p = 0.009). After adjustment, a 69% decrease was observed in need for related additional intervention [aOR 0.31 (0.12–0.81), p = 0.017].ConclusionThe use of a standardized closed suction calibration system resulted in overall decreased leak rates, which was associated with a clinically significant decrease in additional interventions.

Antimicrobial consumption (AMC) measures the level and types of antibiotics consumed in a specific setting. Monitoring AMC is critical component of antimicrobial resistance (AMR) containment strategies. However, AMC data at both facility and national-levels are scarce in Africa, which limits our understanding of the rate, patterns and drivers of antibiotic consumption, and prevents the establishment of evidence-based antimicrobial stewardship. We determined facility and national-level rates and patterns of AMC from data retrospectively collected between 2016 and 2019 in 327 pharmacies from 14 countries AMC data collection followed a backfilling strategy leveraging from public and private central medical stores, wholesalers, distributors or import services as data sources. Participating hospital and community pharmacies were selected based on their location in or proximity to hospitals capable of producing AMR data. Levels of AMC were determined as defined daily dose (DDD) and DDD per inhabitant (DID). AMC patterns were analysed according to the WHO Access, Watch, and Reserve (AWaRe) Categories, the Anatomical Therapeutic Chemical (ATC) classes and the individual antibiotic molecules included in the Drug Utilisation 75% (DU75). The availability of antibiotics was examined against the WHO and the National Essential Medicine Lists (EML). National AMC data was available in 11 of the 14 participating countries, revealing a collective AMC of 8.42 DID varying from 2.8 to 115.5 at individual country level. AMC was also determined in 327 hospital and community pharmacies. Nine of 11 (82%) countries with national data available, and 219 of the 327 (72%) participating pharmacies achieved the WHO AWaRe target of at least 60% of antibiotic consumption from Access drugs. Eighty percent of country-level AMC was accounted for by five ATC sub-classes classes of antibacterial for systemic use. Facility-level antibiotic consumption was dominated by a narrow scope of less than five drugs, taking advantage of only 10% of all possible WHO-recommended Access drugs within ATC classes. Collectively, the 14 national EML included 70% of Access, 60% of Watch and less than 5% of Reserve antibiotics listed in the WHO EML. Forty-eight uncategorized and 50 categorized non-WHO-recommended drugs were included in national EMLs or documented to be circulating in countries. The relatively low AMC and the poorly diversified subset of antibiotics available in countries underscores that strategies to expand equitable access to adequate treatment of bacterial infections should complement current efforts to promote the judicious use of antimicrobials. Interventions to increase the volume of analysable data on AMU, AMC and AMR, should be prioritized in national AMR action plans as well as in wider infrastructural and economic development plans.