SummaryBackgroundSurgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world.MethodsThis international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231.FindingsBetween Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001).InterpretationCountries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication.FundingDFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant,...

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abnormality detected. Although outer retinal damages are common in laser-related injury, intraretinal fluid with cystoid change is an uncommon presentation. 7 Literature searchThe PubMed, EMBASE, and Web of Science databases were searched for articles published between 1998 and May 2020 using keywords: 'laser' and 'eye injury' and 'ocular injury' or 'laser eye injury' or 'laser ocular injury' or 'laser retinal injury' or laser macular injury' or 'laser induced maculopathy or 'laser induced retinopathy' or 'laser pointer'. Of 4969 articles yielded, 4637 duplicated or irrelevant articles were excluded and 332 articles were included. References in the included articles were reviewed to identify additional relevant studies. Of the 332 articles, those written in languages other than English were excluded, as were statements, editorials, and letters to the editor. Eventually, 157 articles were reviewed. Internationally adopted guidelines and safety manuals regarding laser use were referenced.

A 30-year-old man presented to the ophthalmology clinic with a 1-week history of right eye blurred vision. He reported application of massage gun over bilateral periocular regions for 3 months. The best-corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye. Slit-lamp examination revealed bilateral iris atrophy at the inferonasal region. In the right eye, there was anterior subcapsular and cortical cataract at the visual axis, associated with mild phacodonesis. There were dot opacities in the left eye lens without lens subluxation. The patient received right phacoemulsification with a multifocal intraocular lens implanted. To the best of our knowledge, this is the first case of bilateral traumatic cataract with symmetrical iris atrophy after repetitive periocular massage with a massage gun reported in the literature.

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