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)

Ecological Synthesis of CuO Nanoparticles Using <i>Punica granatum</i> L. Peel Extract for the Retention of Methyl Green

The aqueous extract from the bark of Punica granatum L. was invested to generate CuO nanoparticles from CuSO4 using a green, economical, ecological, and clean method. The synthesized nanoparticles were characterized and were successfully used as adsorbents for methyl green retention of an absorptive capacity amounting to 28.7 mg g−1. Methyl green equilibrium adsorption data were correlated to the Langmuir model following the pseudo-second order kinetics model. This study clearly corroborates that copper nanoparticles exhibit a high potential for use in wastewater treatment

Ecological Synthesis of CuO Nanoparticles Using Punica granatum L. Peel Extract for the Retention of Methyl Green

The aqueous extract from the bark of Punica granatum L. was invested to generate CuO nanoparticles from CuSO4 using a green, economical, ecological, and clean method. The synthesized nanoparticles were characterized and were successfully used as adsorbents for methyl green retention of an absorptive capacity amounting to 28.7 mg g&minus;1. Methyl green equilibrium adsorption data were correlated to the Langmuir model following the pseudo-second order kinetics model. This study clearly corroborates that copper nanoparticles exhibit a high potential for use in wastewater treatment

Biodegradable composite films based on mucilage from Opuntia ficus-indica (Cactaceae): Microstructural, functional and thermal properties

International audienceThis study evaluated the feasibility of using cactus mucilage (CM) to elaborate biobased composite films blended with styrene-butadiene rubber latex (SBL). The CM was extracted and precipitated with ethanol (CMET) and isopropanol (CMIS). Mucilage-based films were formulated using three levels of mucilage (4, 6, and 8 wt%). The microstructure, thickness, moisture content, density, water contact angle, water vapor permeability, film solubility, thermal stability, and toughness of mucilage films blended with SBL (SBL/CMET and SBL/CMIS) were measured. The properties of mucilage-based films varied systematically, depending on the concentration of mucilage. The addition of SBL to CM film produces compatible, hydrophobic, flexible, and stiffer films with low moisture contents and good barrier properties. The mucilage film incorporated with 6 wt% CMET and CMIS reached the highest Young's modulus of 1512 ± 21 and 1988 ± 55 MPa, respectively. The DSC of produced films reveals that the Tg of SBL/CMIS is lower than that of SBL/CMIS. The synthesized films were structurally stable at high temperatures. The biodegradability of the composite films buried in the ground shows that the produced films are 100 % biodegradable after 40 days. Thus, CM blended with SBL can benefit specific applications, especially food packaging

Optimization of the Preparation of Activated Carbon from Prickly Pear Seed Cake for the Removal of Lead and Cadmium Ions from Aqueous Solution

In this study, we evaluated the use of prickly pear seed cake, a by-product of prickly pear seed oil extraction, as a new precursor for producing activated carbon by phosphoric acid activation, and the obtained carbon’s capacity for heavy metal removal from aqueous solution. Response surface methodology based on the full factorial design at two levels (24) was developed to reduce the number of experiments and reach optimal preparation conditions for the removal of cadmium and lead ions from aqueous solutions. Design Expert 11.1.2.0 Trial software was used for generating the statistical experimental design and analyzing the observed data. Factors influencing the activation process, such as carbonization temperature, activation temperature, activation time, and impregnation ratio, were studied. Responses were studied in depth with an analysis of variance to estimate their significance. Each response was outlined by a first-order regression equation demonstrating satisfactory correspondence between the predicted and experimental results as the adjusted coefficients of correlation. Based on the statistical data, the best conditions for the removal of heavy metals from aqueous solution by the obtained activated carbon were indicated. The maximum iodine number and methylene blue index were 2527.3 mg g−1 and 396.5 mg g−1, respectively, using activated carbon obtained at the following conditions: Tc = 500 °C, Ta = 500 °C, impregnation ratio = 2:1 (g H3PO4: g carbon), and activation time of two hours. The maximum adsorption reached 170.2 mg g−1 and 158.4 mg g−1 for Cd2+ and Pb2+, respectively, using activated carbon obtained at the following conditions: Tc = 600 °C, Ta = 400 °C, impregnation ratio = 2:1 (g H3PO4: g carbon), and activation time of one hour. The activated carbon obtained was characterized by Boehm titration, pH of point of zero charge (pHPZC), Brunauer–Emmett–Teller surface area (SBET), and scanning electron microscopy. Adsorption was performed according to different parameters: pH solution, adsorbent dosage, temperature, contact time, and initial concentration. Regeneration experiments proved that the obtained activated carbon still had a high removal capacity for Cd2+ and Pb2+ after five regeneration cycles

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