Design, synthesis and evaluation of new colourimetric chemosensors containing quinazolinones moiety for some cations detection in an aqueous medium and biological sample

755-766The current project deals with designing and synthesizing of colourimetric chemosensors to detect the cations in the aqueous medium and biological sample. To achieve this goal a new series of quinazolinone derivatives have been synthesized via reaction of the novel 6-nitro-2-propyl-4H-benzo[d][1,3]oxazin-4-one 3 with selected nitrogen nucleophiles, namely, formamide, hydrazine hydrate, hydroxylamine hydrochloride, o-phenylendiamine, o-aminophenol and o-aminothiophenol, urea and/or thiourea. Structures of the new compounds have been investigated depending on their spectral data (IR, 1H and 13C NMR and MS) and elemental analyses. Some of the newly synthesized products exhibit significant response as chemosensors for a few cations detection

Design, synthesis and evaluation of new colourimetric chemosensors containing quinazolinones moiety for some cations detection in an aqueous medium and biological sample

The current project deals with designing and synthesizing of colourimetric chemosensors to detect the cations in the aqueous medium and biological sample. To achieve this goal a new series of quinazolinone derivatives have been synthesized via reaction of the novel 6-nitro-2-propyl-4H-benzo[d][1,3]oxazin-4-one 3 with selected nitrogen nucleophiles, namely, formamide, hydrazine hydrate, hydroxylamine hydrochloride, o-phenylendiamine, o-aminophenol and o-aminothiophenol, urea and/or thiourea. Structures of the new compounds have been investigated depending on their spectral data (IR, 1H and 13C NMR and MS) and elemental analyses. Some of the newly synthesized products exhibit significant response as chemosensors for a few cations detection.

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

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

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

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

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

A 5-year registry of mechanically ventilated patients comprising epidemiology, initial settings, and clinical outcome

Introduction Our primary aim was to document our interactions with patients subjected to mechanical ventilation (MV) in the Critical Care Department focusing on epidemiological characteristics; the initial modes of ventilation used, and initial settings. Our secondary aim was to document final clinical outcomes of MV, including length of stay, weaning, complications, and hospital mortality. Patients and methods Patients’ data were collected retrospectively from January 2010 to December 2014 (5 years) through reviewing an electronic database (Medica Plus). Results We enrolled a total of 1081 patients. The duration of ventilation was 6±10 days, and length of ICU stay was 13±15 days. The predominant indications of ventilation were cardiac diseases followed by respiratory diseases, neurological diseases, sepsis, and septic shock. Volume controlled ventilation was the most common initial mode of ventilation followed by Non Invasive Continuous Positive Airway Pressure – Pressure Support (NICPAP-PS) and pressure controlled ventilation. Noninvasive ventilation was associated with shorter duration on MV and ICU stay. Pressure Support – Continuous Positive Airway Pressure (PS-CPAP) was the most common weaning mode used followed by unplanned extubation, Non Invasive Continuous Positive Airway Pressure (NICPAP), T-piece, and sencronized intermittent mandatory ventilation. Highest rate of successful weaning was in patients with central nervous system diseases followed by respiratory diseases, cardiac diseases, and least in patients with sepsis and septic shock. Mortality rate in mechanically ventilated patients was 64%. Mortality rate was higher in patients with cardiac diseases followed by respiratory diseases, central nervous system diseases, and septic shock. Mortality was higher with higher levels of tidal volumes, higher FiO2 levels, and lower positive end-expiratory pressure levels. Mortality was higher in invasive ventilation than noninvasive ventilation. Patients with failed weaning had higher mortality. Conclusions We have demonstrated the magnitude of MV use in our ICU, the epidemiology and initial ventilation modes used, and their association with complications and in-hospital mortality

Achieving comprehensive remission or low disease activity in rheumatoid patients and its impact on workability &ndash; Saudi Rheumatoid Arthritis Registry

Hani Almoallim,1&ndash;3 Nahid Janoudi,2 Fahdah Alokaily,4 Zeyad Alzahrani,5 Shereen Algohary,3 Hanan Alosaimi,3,6 Suzan Attar3,7 1Department of Medicine, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia; 2Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia; 3Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia; 4Division of Rheumatology, Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 5Department of Medicine, Faculty of King Saud bin Abdulaziz for Health Sciences, Jeddah, Saudi Arabia; 6Department of Medicine, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia; 7Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia Purpose: Ability to work is an important endpoint in rheumatoid arthritis (RA). It is not clear what outcome measures should be used to guide treatment in order to maximize workability. This study addressed the impact of RA on workability in a Saudi population and examined the correlation between objective measures of disease activity and reduced workability. This will allow better understanding of treatment targets that will translate into improved workability. Patients and methods: Data were collected through a digital patient record keeper: The Rheumatoid Arthritis Saudi Database. Male and female patients, &ge;18 years of age, that met the American College for Rheumatology criteria for diagnosis of RA, were recruited, regardless of treatment. Demographic and disease-specific data were collected. Disease Activity Score-28 (DAS-28) was used to define patients as low (DAS-28 &le;3.2) vs high (DAS-28 &gt;3.2) disease activity. Health assessment questionnaire (HAQ) score, visual analog scale (VAS) score, and musculoskeletal ultrasound 7 joint score were documented also. The work productivity and activity impairment (WPAI) score was used to measure absenteeism, presenteeism, overall work impairment, and activity impairment. DAS-28 score was correlated with WPAI score and linear regression used to identify the demographic and measures of treatment response that predict improvement in WPAI score. Results: Higher absenteeism and more activity impairment were seen for patients with persistent DAS-28 &gt;3.2 (non-achievers). HAQ and VAS scores correlated with presenteeism, overall work impairment, and activity impairment. Conclusion: Disease activity, as defined by DAS-28 score, correlates with absenteeism and work impairment in a Saudi population. However, on linear regression analysis, HAQ and VAS scores were the only measures predictive of work impairment. These scores should be used to monitor response to treatment regimens that aim to maximize work potential for Saudi individuals. Keywords: rheumatoid arthritis, work impairment, WPAI score, disease activity, HAQ score, VAS scor

Determining early referral criteria for patients with suspected inflammatory arthritis presenting to primary care physicians: a cross-sectional study

Hani Almoallim,1&ndash;3 Nahid Janoudi,2 Suzan M Attar,4 Mohammed Garout,5 Shereen Algohary,3 Muhammad Irfanullah Siddiqui,5 Hanan Alosaimi,3 Ashraf Ibrahim,3 Amira Badokhon,6 Zaki Algasemi7 1Department of Medicine, Medical College, Umm Alqura University, Makkah, 2Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, 3Alzaidi Chair of Research in Rheumatic Diseases, Medical College, Umm Alqura University, Makkah, 4Department of Medicine, King Abdulaziz University, Jeddah, 5Department of Community Medicine and Public Health, Umm Alqura University, Makkah, 6Administration of Public Health, Ministry of Health, Jeddah, 7Joint Program of Family and Community Medicine, Ministry of Health, Jeddah, Kingdom of Saudi Arabia Objective: Early diagnosis and initiation of treatment for inflammatory arthritis can greatly improve patient outcome. We aimed to provide standardized and validated criteria for use by primary care physicians (PCPs) in the identification of individuals requiring referral to a rheumatologist. Patients and methods: We analyzed the predictive value of a wide variety of demographic variables, patient-reported complaints, physical examination results, and biomarkers in order to identify the most useful factors for indicating a requirement for referral. Patients for this cross-sectional study were enrolled from various centers of the city of Jeddah, Saudi Arabia, if they were &ge;18 years of age and presented to a PCP with small joint pain that had been present for more than 6 weeks. A total of 203 patients were enrolled, as indicated by the sample size calculation. Each patient underwent a standardized physical examination, which was subsequently compared to ultrasound findings. Biomarker analysis and a patient interview were also carried out. Results were then correlated with the final diagnosis made by a rheumatologist. Results: A total of 9 variables were identified as having high specificity and good predictive value: loss of appetite, swelling of metacarpophalangeal joint 2 or 5, swelling of proximal inter-phalangeal joint 2 or 3, wrist swelling, wrist tenderness, a positive test for rheumatoid factor, and a positive test for anti-citrullinated protein antibodies. Conclusion: Nine variables should be the basis of early referral criteria. It should aid PCPs in making appropriate early referrals of patients with suspected inflammatory arthritis, accelerating diagnosis and initiation of treatment. Keywords: inflammatory arthritis, rheumatoid, diagnosis, primary care, early referral criteri