Agricultural importance of algae

Algae are a large and diverse group of microorganisms that can carry out photosynthesis since they capture energy from sunlight. Algae play an important role in agriculture where they are used as biofertilizer and soil stabilizers. Algae, particularly the seaweeds, are used as fertilizers, resulting in less nitrogen and  phosphorous runoff than the one from the use of livestock manure. This in turn, increases the quality of water flowing into rivers and oceans. These organisms are cultivated around the world and used as human food  supplements. They can produce a clean and carbon-neutral food also and can be grown on abandoned lands and arid desert lands with minimal demands for fresh water. Seaweeds are an important source of iodine. Iodine levels in milk depend on what the cow producing the milk has been fed with. Feeding milk cattle with seaweeds can increase the quantity of iodine in milk, according to Fuzhou Wonderful Biological Technology. Egg-laying rate in hen is also increased by algae feed additives. In this article, we discussed the most important aspects of algae and its agricultural uses to those who work in this area.Key words: Algae, seaweeds, agriculture, biofertilizer, soil stabilizers

Childhood pneumonia at the University of Ilorin Teaching Hospital, Ilorin Nigeria

Background/Objectives: Pneumonia is a leading cause of morbidity and mortality in children and thus this study was designed to document the sociodemographic, clinical features as well as the bacterial agents  responsible for pneumonia in children seen at University of Ilorin Teaching Hospital.Methodology: A descriptive cross -sectional study of children aged one month to 14 years with features of pneumonia admitted between July 1st 2010 and June 31st, 2011 was carried out. Sociodemograpic data, clinical features, complications and outcome were obtained. Chest radiographs and blood samples for culture of bacterial organism and full bloodcounts were obtained in all children.Results: Pneumonia accounted for 13.3% (167 out of 1254) of the all admissions during this period. The male: female ratio was 1.5:1, and 101(60.5%) of the children were infants. Bronchopneumonia was identified in 147(88%) children, lobar pneumonia in 15 (9%) while 5(3%) had a combination of both. Cough, fever, difficulty in breathing, tachypnoea andchest wall recessions were recognised as clinical features in the study population. Bacteraemia was present in 46(27%)children and Staphylococcus aureus was the most common organism cultured from the blood of children with pneumonia present in 11 (23.9%) out of the 46 (100.0%) isolates. Heart failure was associated complication present in 52 of the 60 children with one or more complications accounting for over 30% of all patients. Eleven out of the 15 children with lobar pneumonia hadpneumonia-related complications which was significantly higher compared to 46 of 157 children with bronchopneumonia, p=0.003. The case fatality was 6.6%. Eight (72.7%) of the children that died were infants while the remaining three (27.3%) were aged between 12 and 60 months. The mean duration of hospitalization among those who survived of 6.5 ±5.0 days was significantly lower than the corresponding value of 10.2 ±12.3 days in those that died, p= 0.042. Conclusion: Pneumonia-related mortality and morbidity is high in under-five children, with the infant age group most affected. Bronchopneumonia is the most prevalent ALRI diagnosis but lobar pneumonia is associated with a higher mortality

Serum zinc levels as a predictor of clinical features and outcome of paediatric acute lower respiratory infections in Nigeria

Background: Malnutrition, especially macronutrient deficiency, has been shown to be interrelated with ALRI-related morbidity and mortality. However the import of zinc deficiency has only recently become the focus of research attention.Objective: The current study was carried out in Ilorin, Kwara State, Nigeria to determine the relationship between serum zinc levels, clinical features and outcome in hospitalized children with acute lower respiratory infections(ALRI).Method: A descriptive crosssectional hospital-based study involving 120 children aged two months to five years with ALRI. Socio-demographic, clinical and laboratory data were obtained. The serum zinc was analyzed with a Jenway™ spectrophotometer after initial preparation with theQuantiChrom™ zinc assay kit.Results: Children with tachypnoea and crepitations had significantly lower mean serum zinc levels compared to the corresponding values in those without these features (each p<0.05). Significantly higher mean serum zinc level was recorded in children with grunting respiration compared with thosewithout grunting (p=0.028). Agerelated tachypnoea, grunting, and crepitations remained significant (each p<0.05) following a linear  regression analysis. The mean serum zinc level in children with multiple complications was significantly lower than the corresponding level recorded in children who had one complication, p=0.020. No significant differencewas found between the mean serum zinc level of the children who were discharged compared with the corresponding level recorded in those that died, p=0.589.Conclusion: The presence of crepitations had the strongest clinical association with a low serum zinc level. Children managed for ALRI would benefit from post-treatment zinc supplements and appropriate zinc-rich sources of food at discharge.Keywords: Children zinc respiratory infection

Effectiveness of a pharmacist-led educational intervention to reduce the use of high-risk abbreviations in an acute care setting in Saudi Arabia: A quasi-experimental study

Objectives: To evaluate the effectiveness of a pharmacist-led educational intervention to reduce the use of high-risk abbreviations (HRAs) by healthcare professionals. Design: Quasi-experimental study consisting of a single group before-and-after study design. Setting: A public emergency hospital in Mecca, Saudi Arabia. Participants: 660 (preintervention) and then 498 (postintervention) handwritten physician orders, medication administration records (MRAs) and pharmacy dispensing sheets of 482 and 388 patients, respectively, from emergency wards, inpatient settings and the pharmacy department were reviewed. Intervention: The intervention consisted of a series of interactive lectures delivered by an experienced clinical pharmacist to all hospital staff members and dissemination of educational tools (flash cards, printed list of HRAs, awareness posters) designed in line with the recommendations of the Institute for Safe Medical Practices and the US Food and Drug Administration. The duration of intervention was from April to May 2011. Main outcome: Reduction in the incidence of HRAs use from the preintervention to postintervention study period. Findings: The five most common abbreviations recorded prior to the interventions were 'IJ for injection' (28.6%), 'SC for subcutaneous' (17.4%), drug name and dose running together (9.7%), 'OD for once daily' (5.8%) and 'D/C for discharge' (4.3%). The incidence of the use of HRAs was highest in discharge prescriptions and dispensing records (72.7%) followed by prescriptions from in-patient wards (47.3%). After the intervention, the overall incidence of HRA was significantly reduced by 52% (ie, 53.6% vs 25.5%; p=0.001). In addition, there was a statistically significant reduction in the incidence of HRAs across all three settings: the pharmacy department (72.7% vs 39.3%), inpatient settings (47.3% vs 23.3%) and emergency wards (40.9% vs 10.7%). Conclusions: Pharmacist-led educational interventions can significantly reduce the use of HRAs by healthcare providers. Future research should investigate the long-term effectiveness of such educational interventions through a randomised controlled trial

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

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

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone