Management of Complicated Colonic Diverticulosis

Prevalence of diverticular disease has been increasing worldwide in concert with the development of industrial era and the alteration of diet pattern to low dietary fiber. Mean age of patients is 60 years; peak incidence at age more than 50 years, 20% less than 50 years, 2-8% less than 40 years. About 50 - 90% of diverticular disease are left-sided especially sigmoid, while in Asian people are mostly right sided. The usual complaint of patient is abdominal pain. Complications that may occur due to diverticulosis are diverticulitis, abscess, fistula, obstruction and bleeding. The presence of complicated diverticulosis can be evaluated by plain X-rays, CT-scan, barium with contrast, ultrasonography and colonoscopy in addition of laboratory examination. The management of complicated diverticulosis usually consists of combination of medical therapy and surgery. Proper and immediate treatment will influence the prognosis of patients

Drivers of Retail Supply Chain Efficiency: Moderating Effect of Lean Strategy

The retail chain store business is an infant stage of growth and development in Bangladesh and so are the supply chain management practices in this sector. The main objective of this study is to identify the key drivers of retail supply chain efficiency. Moreover this study aims at examining the moderating effect of lean supply chain strategy on the link between supply chain drivers and performance. For the purpose of the study, data were collected with a structured questionnaire from 115 participants consisting of outlet and supply chain managers of some selected retail chain stores in Bangladesh. Collected data were analyzed using partial least squares (PLS) structural equation modeling with the support of the software Smart PLS 2.0 M3. Findings revealed that out of five supply chain drivers, four namely inventory management, use of IT, transportation management and coordination were the most significant determinants of retail supply chain efficiency while suppliers role was found to be negatively correlated. Moderating effect of lean strategy was also noticed on the link between two drivers namely transportation management and coordination with retail supply chain efficiency

Socioeconomic, livelihood and cultural profile of the Meghna River Hilsa Fishing Community in Chandpur, Bangladesh

The goal of the study was to build a comprehensive portrait of the socioeconomic, livelihood, and cultural profile of the Meghna River fishing community in Chandpur, Bangladesh. Shatnol Malopara, an ecologically and economically suitable fishing community under the Matlab Uttor Upazila of Chandpur district, was selected for the in-depth investigation, where 410 fishermen relied solely on fishing for their livelihood. This community is made up of 185 households, supporting close to 1000 people. They are all Hindus, and fishing was their ancestral profession. A well-structured questionnaire was used to collect the data. The research revealed that the majority (35%) of fishermen were in the 18-30 age range. The community preferred nuclear families (98%), and the average family size was 5-8 individuals, which is predominant at 80%. About 60% of households lived in tiny tin shades and 40% in medium tin shades, while 60% did not have their own land. They (80%) rely on solar energy for illumination and for health facilities 50% of fisher households depend on the local pharmacy to take medication. Almost 100% of the residents in this community used potable drinking water, and 50% of fishers have ring slab latrines while the other 50% have pits. According to the survey, 60% of fishermen were very poor, 20% were poor, and 20% were moderately poor. Based on the survey, the majority (70%) of the fishermen earned between the ranges of 3000-5000 BDT (Bangladesh Taka) per month. During the ban period, the majority of fishers (50%) took out loans from various sources. Non-governmental organizations that operate microcredit businesses provided 70% of the loans to fishermen. According to the survey, 32% of fishermen had a boat and gear, while 68% worked as labor or engaged in catch-sharing with Mohajons' boats and gear. A range of crafts (Dingi nouka, Kosa nouka with mechanization) and fishing gear (Kona jal, Gulti jal, Dhon jal, Chap jal, Bada jal, Current jal, Chewa jal, etc.) was observed to be used in the study area. They have a plethora of traditional ecological knowledge as a result of their fishing ancestors. The study revealed that hilsa fishermen had a variety of issues. Extortion by local extortionists was the principal concern; other issues included inadequate credit and alternative income sources during the ban period. To assist the community in raising its standard of living, government agencies, nonprofits, and other relevant groups of organizations should adopt a number of steps. It is imperative to prioritize alternative income-generating options in this context

Statistical investigation on anaerobic sulphate-reducing bacteria growth by turbidity method

In oil and gas industry, corrosion due to activity of microorganism is one of the main factors, which contribute to catastrophic structural failure. Previous study always linked Sulfate-Reducing Bacteria (SRB) upon the mechanism of Microbiologically Influenced Corrosion (MIC), as the major contributors. In this study, mechanisms of SRB genus D. vulgaris in terms of bacterial growth under influence of environmental factors were investigated. The growth of pure strain ATCC 7757 and SRB isolated from the soil in suspected areas in Peninsular Malaysia were investigated by using turbidity measurement. Results from the study were analyzed statistically to show the significant influence due to various environmental factors. The results agreed that variation of each environmental parameter tested gives strong influence upon bacterial growth for SRB strain individually

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

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

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations