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

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

Extended distribution patterns of the Arabian burnet moth Reissita simonyi (Lepidoptera: Zygaenidae; Rebel, 1899) and the Arabian wall brown Lasiommata felix (Lepidoptera: Nymphalidae: Satyrinae; Warnecke, 1929) in Southern Arabia.

Die aktuelle Verbreitung zweier im Jemen vorkommender Schmetterlingsarten, Lasiommata felix (Warnecke, 1929) und Reissita simonyi (Rebel, 1899) werden vorgestellt. Beide Arten sind endemisch in der Arabischen Halbinsel, und ihre Verbreitung war bisher nur lückenhaft bekannt. Einerseits fasst der Artikel die Resultate zahlreicher Feldaufenthalte nach Südarabien in den Jahren 2001/2002 zusammen, andererseits werden zusätzliche bereits publizierte Arbeiten einer aufmerksamen Aufarbeitung hinsichtlich der Verbreitung unterzogen. Zahlreiche neue Fundorte für beide Schmetterlingsarten im Jemen werden veröffentlicht. Gegenwärtig ist Reissita simonyi von Al Hada, vic. Ta´if, Asir in Saudi-Arabien bis zur Province Dhofar, Jabal Samhan, N von Juffa im Oman bekannt. Lasiommata felix ist von Ta´if in Saudi-Arabien bis zur Region Jaffah, östlich von Taiz/Jemen in Südarabien verbreitet. L. felix scheint auf den westlichen Gebirgszug entlang des Roten Meeres beschränkt zu sein, während R. simonyi eine Teilung in zwei Subspezies zeigt: R. simonyi yemenicola, welche ebenfalls entlang des Roten Meeres zu finden ist und R. simonyi simonyi, welche entlang des Indischen Ozeans bis in den Oman verbreitet ist. Des Weiteren ist in diesem Zusammenhang eine kurze Beschreibung der morphologischen Merkmale und phylogenetischen Verwandtschaftsbeziehungen dieser Arten gegeben.Stichwörter Reissita simonyi, Lasiommata felix, distribution pattern, endemism, Southern Arabia, Yemen.The extended distribution patterns of two faunal elements of Yemen, Lasiommata felix (Warnecke, 1929) and Reissita simonyi (Rebel, 1899) are presented. Both species are endemic to the Arabian Peninsula and information about distribution patterns has been rather fragmentary so far. The paper summarizes the results of several field trips to Southern Arabia in 2001/2002 and reviews additional published evidence on the distribution patterns. Numerous new localities for both studied species from Yemen are offered. Currently, Reissita simonyi is known from Al Hada, vic. Ta´if, Asir in Saudi Arabia to Province Dhofar, Jabal Samhan, N of Juffa in Oman. Lasiommata felix is distributed from Ta´if, Saudi Arabia to the Jaffah area, E of Taiz/Yemen in Southern Arabia. L. felix seems to be limited to the western escarpment along the Red Sea, whereas R. simonyi shows a division into two subspecies: R. simonyi yemenicola, which also occurs along the mountainous areas along the Red Sea and R. simonyi simonyi, which is distributed along the Indian Ocean. Furthermore, a brief description of morphological characteristics and phylogenetic relationships of these species is given in this context.Keywords Reissita simonyi, Lasiommata felix, distribution pattern, endemism, Southern Arabia, Yemen

Multilocus phylogeny and taxonomic revision of the Hemidactylus robustus species group (Reptilia, Gekkonidae) with descriptions of three new species from Yemen and Ethiopia

The gecko genus Hemidactylus, with its 132 currently recognized species, ranks among the most species-rich reptile genera. Recent phylogenetic studies disclosed unexpectedly high genetic variability and complex biogeographic history within its arid clade distributed in the Mediterranean, Northeast Africa, Middle East and the Indian subcontinent. Particularly, the species from the Arabian Peninsula have been lately the subject of many taxonomic revisions that have resulted in the descriptions of 16 new taxa. Yet not all detected cryptic lineages have been treated taxonomically and thoroughly investigated morphologically. Based on phylogenetic analyses of two mtDNA (12S, cytb) and four nDNA (cmos, mc1r, rag1, rag2) gene fragments of a total length of 4015 bp in combination with analysis of morphological characters, we reinvestigate the systematics of the H. robustus species group consisting of the widespread H. robustus and three undescribed species, two of which occur in Southwest Yemen and one in central Ethiopia. By comparing two phylogenetic inference methods, concatenated gene trees and species-tree estimation, we reconstruct the phylogeny of the H. robustus species group. The coalescent-based species-tree estimation resulted in different tree topology than the concatenation approach, being probably a result of incomplete lineage sorting of ancestral polymorphism, suggesting that the H. robustus species group is in a stage of incipient speciation. The degree of differentiation of the characters examined within the H. robustus species group allowed us to provide a redescription of H. robustus and formally describe three new species of Hemidactylus – H. adensis sp. nov. and H. mandebensis sp. nov. from Yemen and H. awashensis sp. nov. from Ethiopia.Peer reviewe

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 percent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P &lt; 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P &lt; 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 &lt; 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P &lt; 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 &lt; 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