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

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)

Site-specific modification of the lactose operator with acetylaminofluorene.

We have synthesized the tetradecamer GAGCXGATAACAAG containing a part of the sequence of the lactose operator. A guanine base in the sequence is replaced by the adduct of the carcinogen 2-acetylaminofluorene with guanine. Under the standard conditions of de-protection, the fluorene moiety is lost, leaving behind a guanine oxidation product. New conditions of de-protection have been developed which allow the isolation of an oligonucleotide containing the adduct of 2-aminofluorene with guanine. The presence of the aminofluorene adduct greatly increases retention on reverse phase chromatography and produces a unique pattern of sequencing bands

2-(ω-Hydroxyalkyl)-3-methylindanO[2,1-c]piperidines

Two isomers of 3-methylindano[2,1-c]piperidine were isolated in the reduction of 3-methyl-2-azafluorene with sodium in alcohol. N-(ω-Hydroxyalkyl) derivatives of this heterocyclic system were obtained © 1974 Consultants Bureau

2-(ω-Hydroxyalkyl)-3-methylindanO[2,1-c]piperidines

Two isomers of 3-methylindano[2,1-c]piperidine were isolated in the reduction of 3-methyl-2-azafluorene with sodium in alcohol. N-(ω-Hydroxyalkyl) derivatives of this heterocyclic system were obtained © 1974 Consultants Bureau

Competencias lingüísticas y su incidencia en la pronunciación de inglés en estudiantes

The main goal of this research is the proposed solution to the problem of the limited Language Skills and its incidence on the Pronunciation of English in the first level students from the Administrative and Financial science faculty of the Management School, south campus of the Salesian Polytechnic University of Quito. The Language skills (Listening, Speaking, Reading and Writing) are the English-learning base because through them, it is possible to take into account the specificity of Oral Language and Written Language. In addition, in order to fulfill a good communication in English, it must be taken into account the Pronunciation of Sounds (Phonemes); and the intonation and fluency which are part of the language. The questions for the research arise in order to propose the alternative of solution to the problem and they consider the analysis of the Language Skills development as a key point to fulfill an optimum level of Pronunciation in English. This research has been performed according to the norms of the critical-proactive research and that is the reason why it is quanti – qualitative. The principal source of primary information is the survey directed to students and docents using the Questionnaire as instrument and the established knowledge in the development of the Conceptual Framework. Its approval was supported by the analysis of experts in both research and the researched topics and area. In this research, it is concluded that the development of the Language Skills is good, but it is not complete and it is limited; and the level of Pronunciation in English the students have is low. Finally, the proposed solution to the problem proves to be very useful because it attempts to guide the Language Skills to be developed considering as the main goal, the significant improvement of the level of Pronunciation in English of the students, allowing them to fulfill a better communication.El objetivo principal de esta investigación es la propuesta de solución al problema de las limitadas Competencias Lingüísticas que inciden en la Pronunciación de inglés en los estudiantes  de los primeros niveles de la Facultad de Ciencias Administrativas y Económicas, Escuela de Administración, Campus Sur de la Universidad Politécnica Salesiana de Quito. Las Competencias Lingüísticas (Escuchar, Hablar, Leer y Escribir) son importantes para el aprendizaje de inglés porque a través de ellas se llega a tener en cuenta la especificidad de la Lengua Oral y la Lengua Escrita. También, para lograr una buena comunicación en inglés se debe prestar atención a la Pronunciación de los sonidos (fonemas) y a la entonación y fluidez. Las interrogantes de investigación que surgen para proponer la alternativa de solución al problema se refieren al análisis del desarrollo de las Competencias Lingüísticas como punto clave para lograr un nivel óptimo de Pronunciación en inglés. Este trabajo de investigación se ha desarrollado de acuerdo a las pautas de la investigación crítico - propositiva y por tanto es de tipo cuanti – cualitativa. La principal fuente de información primaria son las encuestas aplicadas a estudiantes y docentes utilizando el Cuestionario como instrumento y los conocimientos establecidos en el desarrollo del Marco Conceptual. Su verificación estuvo respaldada mediante el análisis de expertos tanto en investigación, como en el área y temas investigados. En el presente trabajo de Investigación se concluye que el desarrollo de las Competencias Lingüísticas es bueno, pero no es completo y es limitado; y que el nivel de Pronunciación en inglés que los estudiantes tienen es bajo. Finalmente la propuesta de solución al problema demuestra ser de gran utilidad porque intenta orientar a que las Competencias Lingüísticas se desarrollen considerando como objetivo que el nivel de Pronunciación de los estudiantes mejore significativamente, permitiéndoles lograr una mejor comunicación. 

Necesidades de formación de los docentes de bachillerato

El presente trabajo tuvo como objetivo general analizar las necesidades de formación de los docentes de bachillerato en el período lectivo 2012-2013, en este caso de los docentes del Colegio Particular Mixto Interandino de la ciudad de Quito. El instrumento que se utilizó para la recolección de datos fue el cuestionario proporcionado por el Departamento de Ciencias de la Educación de la Universidad Técnica Particular de Loja. Luego del análisis de los cuestionarios, se concluye que el principal obstáculo en la capacitación de los docentes de bachillerato del Colegio Interandino es la falta de apoyo de la institución, ya que no motiva a sus docentes a mantenerse capacitados y actualizados en la materia que cada uno tiene a su cargo. También se detectó falencias en el aspecto pedagógico, así como en la incorporación de las nuevas tecnologías al proceso de aprendizaje. Para suplir esas deficiencias de los docentes se diseñó un curso de formación que trata sobre la creación y desarrollo de un entorno virtual de enseñanza-aprendizaje basado en las herramientas de libre uso asociadas a la WEB 2.0., para de esta manera mejorar los procesos de enseñanza-aprendizaje del colegio