Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

SARS-CoV-2 as a potential trigger for microscopic colitis in a young adult: A case report

This case highlights the potential role of SARS-CoV-2 in triggering lymphocytic colitis, emphasizing the need for further research and vigilance in identifying potential post-COVID-19 GI complications. We describe a case of a young adult who experienced chronic diarrhea and abdominal pain for 10 months after a SARS-CoV-2 infection. Extensive laboratory and imaging investigations yielded no significant findings. Despite a preliminary diagnosis of irritable bowel syndrome and symptomatic treatment, symptoms persisted. Colonoscopy with biopsies revealed unremarkable colonic mucosa but confirmed moderate lymphocytic infiltration consistent with lymphocytic colitis. Treatment with budesonide achieved complete symptom resolution. The findings underscore the importance for clinicians to consider triggered microscopic colitis in patients presenting with persistent diarrhea following SARS-CoV-2 infection

Supplementary Material for: Endoscopic Vacuum Therapy for Treating an Esophago-Pulmonary Fistula after Esophagectomy: A Case Report and Review of the Literature

An acquired esophago-respiratory fistula represents an abnormal connection between the esophagus and the respiratory system. It is usually caused by malignancy and infection, or it occurs as a complication after surgery or radiation therapy. It can be divided according to its anatomical level into esophago-tracheal fistula, esophago-bronchial fistula, and in the rarest case, esophago-pulmonary fistula (EPF). We present a case of EPF aggravating an anastomotic leak (AL) after the Ivor-Lewis operation for esophageal cancer. The leak was treated with endoscopic vacuum therapy (EVT) using the Eso-Sponge® system (B. Braun Melsungen AG, Melsungen, Germany). In the further course of treatment, an EPF was suspected by a new onset of severe cough after oral fluid intake. The suspicion was confirmed by injecting methylene blue dye into the paraesophageal-extraluminal cavity during endoscopy and attesting to its presence in the respiratory tract by simultaneous bronchoscopy. Furthermore, an oral contrast computed tomography scan showed the presence of contrast in the right lower lobe of the lung. This complication was treated conservatively with EVT and antibiotics. Nutrition was administered through the existing jejunostomy. Both fistulas and the paraesophageal cavity were fully healed, oral intake was maintained, and the patient was discharged. This rare life-threatening complication can be treated conservatively. Its management is challenging, controversial, and lacks a general consensus

Evolving perspectives in dental marketing: A study of Jordanian dentists' attitudes towards advertising and practice promotion

Advertising for dental services in Jordan is subject to regulation. Dental professionals must obtain approval from their respective councils before initiating any advertising campaigns to ensure compliance with ethical and professional standards. Although the dental advertising landscape in Jordan has made considerable progress, research on dentists' perspectives regarding advertising in the country remains limited. This preliminary research specifically evaluates four factors: dentists' perspectives on advertising, the correlation between dentists' demographics and their viewpoints, their preferred advertising channels, and the prevalence of dental advertising. Additionally, it aims to address the rationale behind certain restrictions on dental advertising. A comprehensive online survey was conducted among a simple random sample of 206 Jordanian dentists, focusing on their attitudes toward various aspects of dental advertising. The attitude of dentists toward advertising has become increasingly favourable compared to the past. The study revealed a general acceptance of dental advertising, with 79.1 % of dentists considering it appropriate. Proponents of advertising argue that it benefits the community by enhancing the quality of dental services (51.9 %), lowering prices through competition (26.7 %), providing educational information (74.3 %), and assisting the community in making informed choices (59.7 %). Conversely, critics contend that advertising undermines the public's perception of the profession (33.9 %) and diminishes the trustworthiness of dentists (24.7 %). Male dentists, senior practitioners, specialists, middle-income professionals, and those with over 10 years of clinical experience were more likely to support advertising practices. Additionally, digital marketing platforms were favoured over traditional advertising channels. The attitudes of Jordanian dentists toward advertising and practice promotion are evolving, with a growing acceptance of marketing as an essential tool for practice growth. However, ethical considerations and regulatory compliance remain paramount, especially in digital marketing

Biological activity and characterization of leaf and seed lectins from Terminalia brownii: Insights into their analgesic and antiulcer properties

Terminalia brownii Fresen, an African medicinal plant, is known for its analgesic, antiulcer, and antimicrobial properties, with its leaves, bark, and fruits deeply ingrained in indigenous healing practices. Two lectins, TerBLL (from leaves) and TerBSL (from seeds) of Terminalia brownii Fresen, were purified using salting-out and affinity chromatography on a fetuin-agarose column. The purified lectins were then assessed for protein yield, hemagglutination activity, and physicochemical properties. Both TerBLL and TerBSL have subunits with molecular weights of 57.3 and 65.7 kDa, respectively. TerBLL remains stable at 60–80 °C and is activated by Mn+2, while TerBSL is activated by Zn+2. These lectins maintain consistent activity under acidic conditions, with TerBLL demonstrating heightened activity at extreme alkaline pH. TerBLL retained 50 % of its activity in 2–8M urea, in contrast to the 13 % of TerBSL. Investigation of the properties of TerBLL revealed that it had antinociceptive effects, reducing abdominal pain and prolonging latency time in the hotplate assay, potentially through μ-opioid receptor blockade akin to that of morphine. TerBLL exhibits antiulcer activity at doses of 0.25 and 1 mg/kg, reducing ulcer formation by up to 33 %, comparable to that of pantoprazole (80 mg/kg). The physiochemical attributes of TerBLL, in addition to its pain-relieving and gastroprotective effects, underscore its therapeutic promise, which is consistent with its traditional use

Public Awareness and Barriers to Seeking Medical Advice for Colorectal Cancer in the Gaza Strip: A Cross-Sectional Study

PURPOSE Raising awareness of colorectal cancer (CRC) symptoms for early recognition, reduction of modifiable risk factors, and removing barriers to seeking medical help could lower its mortality. This study aimed to assess the level of public awareness of CRC in the Gaza Strip. MATERIALS AND METHODS This was a cross-sectional study conducted at three hospitals and 10 high schools between September and October 2017. The Arabic version of the validated Bowel Cancer Awareness Measure (BoCAM) questionnaire was used to evaluate awareness of CRC symptoms and risk factors, and barriers to seeking medical help. Adults (age ≥ 18 years) in three major hospitals and adolescents (ages 15 to 17 years) in 10 schools were recruited for face-to-face interviews to complete the BoCAM. RESULTS Of 3,172 potential participants, 3,080 completed the BoCAM (response rate, 97.1%). Among these, 1,578 (51.2%) were adults and 1,614 (52.4%) were females. Persistent abdominal pain was the most commonly recognized CRC symptom (n = 1,899; 61.7%), whereas anorectal pain was the least common (n = 1,056; 34.3%). In total, 2,177 (70.7%) were not confident in recognizing CRC symptoms or signs. Having a bowel disease was the most frequently recognized CRC risk factor (n = 1,456; 47.3%) and diabetes the least recognized (n = 591; 19.2%). The overall mean scores ± standard deviations for recalling and recognizing CRC symptoms were 1.2 ± 1.3 and 4.3 ± 2.3, respectively (out of 9 points). The overall mean scores ± standard deviations for recalling and recognizing CRC risk factors were 0.7 ± 0.8 and 8.0 ± 3.1, respectively (out of 16 points). Emotional barriers were the most commonly reported barriers to seeking medical help, with feeling worried about what a doctor might find as the most common barrier (n = 1,522; 49.4%). CONCLUSION Public awareness of CRC is suboptimal in Gaza. Improving CRC awareness with educational interventions is needed, including in local schools. </jats:sec

Access to and quality of elective care: a prospective cohort study using hernia surgery as a tracer condition in 83 countries

Background Timely and safe elective health care facilitates return to normal activities for patients and prevents emergency admissions. Surgery is a cornerstone of elective care and relies on complex pathways. This study aimed to take a whole-system approach to evaluating access to and quality of elective health care globally, using inguinal hernia as a tracer condition.Methods This was a prospective, international, cohort study conducted between Jan 30 and May 21, 2023, in which any hospital performing inguinal hernia repairs was eligible to take part. Consecutive patients of any age undergoing primary inguinal hernia repair were included. A measurement set mapped to the attributes of WHO's Health System Building Blocks was defined to evaluate access (emergency surgery rates, bowel resection rates, and waiting times) and quality (mesh use, day-case rates, and postoperative complications). These were compared across World Bank income groups (high-income, upper-middle-income, lower-middle-income, and low-income countries), adjusted for hospital and country. Factors associated with postoperative complications were explored with a three-level multilevel logistic regression model.Findings 18 058 patients from 640 hospitals in 83 countries were included, of whom 1287 (7 center dot 1%) underwent emergency surgery. Emergency surgery rates increased from high-income to low-income countries (6 center dot 8%, 9 center dot 7%, 11 center dot 4%, 14 center dot 2%), accompanied by an increase in bowel resection rates (1 center dot 2%, 1 center dot 4%, 2 center dot 3%, 4 center dot 2%). Overall waiting times for elective surgery were similar around the world (median 8 center dot 0 months from symptoms to surgery), largely because of delays between symptom onset and diagnosis rather than waiting for treatment. In 14 768 elective operations in adults, mesh use decreased from high-income to low-income countries (97 center dot 6%, 94 center dot 3%, 80 center dot 6%, 61 center dot 0%). In patients eligible for day-case surgery (n=12 658), day-case rates were low and variable (50 center dot 0%, 38 center dot 0%, 42 center dot 1%, 44 center dot 5%). Complications occurred in 2415 (13 center dot 4%) of 18 018 patients and were more common after emergency surgery (adjusted odds ratio 2 center dot 06, 95% CI 1 center dot 72-2 center dot 46) and bowel resection (1 center dot 85, 1 center dot 31-2 center dot 63), and less common after day-case surgery (0 center dot 39, 0 center dot 34-0 center dot 44).Interpretation This study demonstrates that elective health care is essential to preventing over-reliance on emergency systems. We identified actionable targets for system strengthening: clear referral pathways and increasing mesh repair in lower-income settings, and boosting day-case surgery in all income settings. These measures might strengthen non-surgical pathways too, reducing the burden on society and health services. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license