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

Microbiological quality and safety of cooking butter in Beni-Suef governorate-Egypt

Background: Cooking butter is one of the most popular types of fat consumed in Egyptian houses. It is produced in villages by rural women that are usually using their traditional knowledge during manufacturing. Objective: To study the rate of contamination and hygienic quality of cooking butter Methods: A total of 60 random samples of cooking butter, were collected from different farmers′ houses in different villages, Beni-Suef Governorate, Egypt. Cooking butter samples were examined for psychrotrophic bacteria, total coliforms, faecal coliforms and molds and yeasts counts. Additionally examination for the presence of pathogenic bacteria like E.coli, S.aureus and Ps.aeruginosa were also performed. Results: The microbiological examination revealed that 100, 100, 36.7, 31.7, 31.7 and 23.3 % of the examined samples were contaminated by psychrotrophic bacteria, molds and yeasts, coliforms, faecal coliforms, E.coli and S.aureus, respectively. None of the examined cooking butter samples contained Ps.aeruginosa. The means values of sodium chloride and titratable acidity were 0.57 ± 0.05 % and 0.20 ± 0.013%, respectively. Conclusion: The present study showed that cooking butter is produced under unhygienic condition and without good manufacturing practice. The Public health significance and suggestive control measures are discussed