Liver transplantation is a highly complex and challenging field of clinical practice. Although it was originally developed in western countries, it has been further advanced in Asian countries through the use of living donor liver transplantation. This method of transplantation is the only available option in many countries in the Asia-Pacific region due to the lack of deceased organ donation. As a result of this clinical situation, there is a growing need for guidelines that are specific to the Asia-Pacific region. These guidelines provide comprehensive recommendations for evidence-based management throughout the entire process of liver transplantation, covering both deceased and living donor liver transplantation. In addition, the development of these guidelines has been a collaborative effort between medical professionals from various countries in the region. This has allowed for the inclusion of diverse perspectives and experiences, leading to a more comprehensive and effective set of guidelines.
Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.
The Global Alliance for Infections in Surgery appreciates the great effort of the task force who derived and validated the Sepsis-3 definitions and considers the new definitions an important step forward in the evolution of our understanding of sepsis. Nevertheless, more than a year after their publication, we have a few concerns regarding the use of the Sepsis-3 definitions.
BACKGROUND: To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression.
METHODS: The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study.
RESULTS: Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p
In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.
Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.
BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world.
METHODS: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery.
RESULTS: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p
Conference abstracts: Malaysia in affiliation
(1). PO-211. AGE-SPECIFIC STRESS-MODULATED
CHANGES OF SPLENIC IMMUNOARCHITECTURE
IN THE GROWING BODY. Marina Yurievna Kapitonova, Syed Baharom Syed Ahmad Fuad, Flossie Jayakaran; Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia
syedbaharom@salam.uitm.edu.my
(2). PO-213. A DETAILED OSTEOLOGICAL STUDY OF THE ANOMALOUS GROOVES NEAR THE
MASTOID NOTCH OF THE SKULL. ISrijit Das, 2Normadiah Kassim, lAzian Latiff, IFarihah Suhaimi, INorzana Ghafar, lKhin Pa Pa Hlaing, lIsraa Maatoq, IFaizah Othman; I Department of Anatomy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 2 Department of Anatomy, Universiti Malaya, Kuala Lumpur, Malaysia. das_sri jit23@rediffmail.com
(3). PO-21S. FIRST LUMBRICAL MUSCLE OF THE
PALM: A DETAILED ANATOMICAL STUDY WITH
CLINICAL IMPLICATIONS. Srijit Das, Azian Latiff, Parihah Suhaimi, Norzana Ghafar, Khin Pa Pa Hlaing, Israa Maatoq, Paizah Othman; Department of Anatomy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia. das_srijit23@rediffmail.com
(4). PO-336. IMPROVEMENT IN EXPERIMENTALLY
INDUCED INFRACTED CARDIAC FUNCTION
FOLLOWING TRANSPLANTATION OF HUMAN
UMBILICAL CORD MATRIX-DERIVED
MESENCHYMAL CELLS. lSeyed Noureddin Nematollahi-Mahani, lMastafa Latifpour, 2Masood Deilami, 3Behzad Soroure-Azimzadeh, lSeyed
Hasan Eftekharvaghefi, 4Fatemeh Nabipour, 5Hamid
Najafipour, 6Nouzar Nakhaee, 7Mohammad Yaghoobi, 8Rana Eftekharvaghefi, 9Parvin Salehinejad, IOHasan Azizi; 1 Department of Anatomy, Kerman University of Medical Sciences, Kerman, Iran; 2 Department of Cardiosurgery, Hazrat-e Zahra Hospital, Kerman, Iran; 3 Department of Cardiology, Kerman University of Medical Sciences, Kerman, Iran; 4 Department of Pathology, Kerman University of Medical Sciences, Kerman, Iran; 5 Department of Physiology, Kerman University of Medical Sciences, Kerman, Iran; 6 Department of Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran; 7 Department
of Biotechnology, Research Institute of Environmental Science, International Center for Science, High Technology & Environmental Science, Kerman, Iran; 8 Students Research Center, Kerman University of Medical Sciences, Kerman, Iran; 9 Institute of Bioscience, University Putra Malaysia,
Kuala Lumpur, Malaysia; 10 Department of Stem Cell, Cell Science Research Center, Royan Institute, ACECR, Tehran, Iran. nnematollahi@kmu.ac.ir
(5).