Techniques for Peritoneal Dialysis Catheter Placement

This chapter describes the peritoneal dialysis (PD) catheter implantation techniques. It will also discuss the merits and demerits of each technique, catheter types as well as the PD catheter-related complications. Several techniques and modifications have been described for the insertion of the catheter into the abdominal cavity. We will describe the currently available catheter designs which come in a variety of shapes (straight, pigtail-curled, swan-neck), length and number of Dacron cuffs for optimal ingrowth and fixation and insertion techniques with its early and late complications. These techniques include open surgical, laparoscopic and percutaneous techniques. The strategy for an optimal catheter implantation together with the preventive and therapeutic means for complicated treatment will be discussed

Incarceration and the restriction in the enjoyment of the rights of prisoners

Human rights are universal standards that protect and safeguard all persons from severe mistreatments and abuses. The notion of human rights is grounded on the recognition that “all human beings are born free and equal in dignity and rights” and everyone is therefore “entitled to all rights and freedoms” contained in the human rights law. All the rights and freedoms guaranteed by the law can however, be subjected to a restriction according to other laws of the land. The respect and protection for the human rights of a person depend upon his status, whether he is an adult or a child; a prisoner or freeman; male or female. It was argued that prisoners are entitled to all their personal rights as well as personal dignity that are not temporarily taken away by the law or necessarily inconsistent with the circumstances in which they have been placed. The question to ask is do the laws expressly stated the rights that are not forfeited as a result of incarceration? If the answer is in the negative, what is the litmus test to employ in order to determine the rights that are not lost as a result of incarceration? This study examines relevant laws, published and unpublished reports in order to answer the above posed questions

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical 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. Methods: This 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. Findings: Between 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). Interpretation: Countries 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