Critically ill surgical patients are always at increased risk of actual or potentially life-threatening health complications. Central/peripheral venous lines form a key part of their care. We review the current evidence on incidence of central and peripheral venous catheter-related bloodstream infections in critically ill surgical patients, and outline pathways for prevention and intervention. An extensive systematic electronic search was carried out on the relevant databases. Articles were considered suitable for inclusion if they investigated catheter colonisation and catheter-related bloodstream infection. Two independent reviewers engaged in selecting the appropriate articles in line with our protocol retrieved 8 articles published from 1999 to 2011. Outcomes on CVC colonisation and infections were investigated in six studies; four of which were prospective cohort studies, one prospective longitudinal study and one retrospective cohort study. Outcomes relating only to PICCs were reported in one prospective randomised trial. We identified only one study that compared CVC- and PICC-related complications in surgical intensive care units. Although our search protocol may not have yielded an exhaustive list we have identified a key deficiency in the literature, namely a paucity of studies investigating the incidence of CVC- and PICC-related bloodstream infection in exclusively critically ill surgical populations. In summary, the diverse definitions for the diagnosis of central and peripheral venous catheter-related bloodstream infections along with the vastly different sample size and extremely small PICC population size has, predictably, yielded inconsistent findings. Our current understanding is still limited; the studies we have identified do point us towards some tentative understanding that the CVC/PICC performance remains inconclusive.

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Abstract. The Vulnerability of Underwater Cultural Heritages in Karang Bui Site, Northern Coast of West Java. Underwater remains which found in Karang Bui site, Karawang-Subang waters are originated from the colonial period of Vereenigde Oostindische Compagnie (VOC) and occupation period of the Kingdom of the Netherlands in Indonesia. Research on the vulnerability of the Karang Bui site has been conducted by the Ministry of Marine Affairs and Fisheries in 2017-2018. Research methods including observation of sea area; diving activities for site documentation, seabed profiles mapping, and the use of Side Scan Sonar. Besides looting activities that occurred in the past, the threats toward Karang Bui site preservation nowadays are from human and natural factors. Karang Bui site is located in shallow water with a depth of 5-12 m, so during the maximum elevation, the waves height and current velocity which forms at that location is increasing. Sedimentation level in Karang Bui site is also high caused by many rivers estuary around the site. The site is located within the area of P.T. Pertamina petroleum refineries which is likely the spill oil will threaten the archaeological remains. Furthermore, Karang Bui site is located near Patimban, Subang port development area which also the shipping line. Planning and protection measurement needs to be carried out immediately by related institutions and local governments. Thus, due those various vulnerability factors, the lifting of Karang Bui underwater artifacts is important to be done.   Abstrak. Tinggalan bawah air yang ditemukan di Karang Bui, perairan Karawang-Subang, berasal dari masa Vereenigde Oostindische Compagnie (VOC) dan masa penjajahan Kerajaan Belanda di Indonesia. Penelitian terhadap kerentanan Situs Karang Bui telah dilakukan oleh Kementerian Kelautan dan Perikanan (KKP) pada tahun 2017-2018. Metode penelitian meliputi observasi kawasan laut, penyelaman bawah air untuk dokumentasi situs, pemetaan profil dasar laut, penggunaan side scan sonar. Selain aktivitas penjarahan pada masa lalu, ancaman terhadap kelestarian Situs Karang Bui saat ini berasal dari alam dan ulah manusia. Situs Karang Bui berada di perairan dangkal dengan kedalaman 5-12 m sehingga saat elevasi maksimal, tinggi gelombang dan kecepatan arus yang terbentuk di lokasi tersebut semakin meningkat. Tingkat sedimentasi di Situs Karang Bui juga tinggi karena banyak muara sungai di sekitar situs. Lokasi situs berada di area kilang-kilang pengeboran minyak bumi milik P.T. Pertamina, yang kemungkinan  tumpahan minyak akan mengancam tinggalan arkeologis. Selain itu, lokasi situs berada di dekat area pembangunan Pelabuhan Patimban, Subang, juga merupakan alur pelayaran. Perencanaan dan tindakan pelindungan Situs Karang Bui perlu segera dilakukan oleh institusi terkait dan pemerintah daerah. Oleh karena berbagai faktor kerentanan tersebut, pengangkatan artefak bawah air Karang Bui sangat penting untuk dilakukan.

Introduction: Percutaneous endoscopic gastrostomy (PEG) tube insertion is a widely utilized enteral access technique offering long-term nutritional support for patients unable to tolerate oral intake. While the PEG tube provides numerous advantages, adherence to evidence-based guidelines is crucial to minimize complications. This study aims to evaluate adherence to PEG tube insertion guidelines and analyze associated complication rates in a tertiary care setting.Methods: A retrospective clinical audit was conducted at Quaid-e-Azam International Hospital, Islamabad. Data were collected over three years from patients undergoing PEG tube insertion by a single consultant gastrointestinal surgeon. Adherence to guidelines was evaluated using a 10-item checklist developed based on European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Complication rates and patient characteristics were analyzed.Results: The study included 70 participants (mean age = 72.21 ± 13.17). The PEG tube insertion rate was 100%. The mean checklist score was 8.34 ± 1.2. Laboratory investigations were performed for 98.6% of patients. 91.4% of patients had a life expectancy exceeding 30 days. 60% of patients received an anticoagulation hold. Prophylactic antibiotics were administered to 90% of patients. Psychological counseling and dietician consultation were offered to 38.6% and 64.2% of patients, respectively. Caregivers received specialized training in 98.5% of cases. 12.8% of patients experienced early complications postprocedure, and 14.2% experienced late complications. PEG tube removal occurred in 27% of patients, with only one patient experiencing complications after removal.Conclusion: Adherence to PEG tube insertion guidelines was observed in various aspects of patient care, resulting in a low incidence of complications. Comprehensive auditing and guideline adherence are essential to ensure optimal patient safety and procedural outcomes.