Improving aid effectiveness in aid-dependent countries : lessons from Zambia

Zambia was a middle-income country when it achieved independence from Great Britain in 1964. After decades of international aid Zambia has become a low-income country, and its per capita GDP is only now returning to the levels it had reached over forty years ago. While aid is far from the only variable at work in Zambia's development, its impact has been questionable. This paper examines the issue of aid effectiveness in Zambia, especially in terms of how the incentive structure faced by donors may lead to decreased accountability and inadequate concern for long-term outcomes, rendering aid less beneficial. The paper concludes by proposing a revised approach to the provision and use of international aid in Zambia, as well as in other aid-dependent countries in Sub-Saharan Africa.Aid effectiveness, Zambia, donors, projects, aid incentives.

Timing of surgery in acute pancreatitis

Clinica de Chirurgie a Spitalului Clinic de Urgență Floreasca, Universitatea de Medicină și Farmacie "Carol Davila", București, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Pancreatita acuta reprezinta o patologie cu evolutie impredictibila, cu potential letal, fiind insotita de o rata de mortalitate si morbiditate semnificativa. Managementul chirurgical al acestei patologii vizeaza faza tardiva de evolutie a bolii, in care riscul major este reperzentat de infectia necrozei pancreatice si peripancreatice. Literatura actuala arata ca abordul de tip interventional progresiv este asociata cu rezulatate: Corelarea momentului operator cu rata complicatiilor la pacientii cu pancreatita acuta. Materiale și metoda: Studiu retrospectiv, efectuat pe o perioada de 4 ani, in care au fost inclusi pacientii internati in Spitalul Clinic de Urgenta Bucuresti cu diagnosticul de pancreatita acuta, pentru care s-a practicat chirurgie deschisa sau minim invaziva. Rezultate obținute: Au fost inclusi 624 de pacienti diagnosticati cu pancreatita acuta din care in functie de gradul de severitate 44 pacienti (7%) au avut forma severa, 243 pacienti (39%) forma moderat severa si 337 pacienti (54%) forma usoara. In ceea ce priveste corelatia dintre momentul operator si gradul de severitate , pentru pancreatita acuta severa timpul mediu pana la interventia chirurgicala a fost de 26.43 zile, iar pentru pancreatita acuta moderat severa timpul mediu pana la momentul operator a fost de 9.8 zile. Mortalitatea pentru pacientii cu pancreatita acuta forma severa este una semnificativa, in proportie de 42%. Analiza curbelor de supravietuire corelate cu momentul operator au aratat faptul ca pacientii operati tardiv au avut o rata de supravietuire mai buna. Concluzii: Interventia chirurgicala efectuata in primele 28 zile se asociaza cu o rata semnificativa de complicatii si mortalitate. Managementul multidisciplnar al pacientilor cu pancreatita acuta, terapie intenziva asociata cu tehnici minim invazive, pot oferi timp pretios acestor pacienti, pentru a ajunge la momentul optim tratamentului chirugical.Introduction: Acute pancreatitis is a potentially lethal disease with an unpredictable evolution, with a significant morbidity and mortality rate. Surgical management of this disease targets the late evolution phase, when there are major risks from the infection of pancreatic and peripancreatic necrosis. Modern literature reports that progressive interventional approach shows better clinical results. Objective: Correlation of surgery timing with morbidity rate in patients with acute pancreatitis. Material and method: Retrospective study which included patients with acute pancreatitis admitted and operated (open and minimally invasive procedures) in the București Clinical Emergency Hospital during a period of 4 years. Results: 624 patients with acute pancreatitis were included; distribution according to severity: severe form - 44 patients (7%), moderate severe - 243 patients (39%), and mild - 337 patients (54%). Regarding the correlation between the timing of surgery and severity – median time until surgery for severe acute pancreatitis was 26.43 days, and for moderate severe - 9.8 days. Mortality rate for patients with severe acute pancreatitis is significant and reached 42%. Survival curves analysis corelated to the timing of surgery unveiled that the patients with delayed surgery showed a better survival rate. Conclusion: Surgical intervention performed during the first 28 days is associated with a significant rate of morbidity and mortality. Multidisciplinary management of these patients, intensive care combine with minimally invasive techniques may offer precious time to these patients in order to reach the optimal surgery timing

Foreign banks in Central and Eastern Europe : source of vulnerability or stabilization factor?

We study the impact of foreign banks' presence in Central and Eastern Europe's countries on their economic development and on the financial crisis they went through. We show that, despite a certain vulnerability of the domestic banking systems, the consequences of the opening of the banking markets to the foreign banks was globally positive. Thanks to local acquisitions by foreign investors, domestic banks have been recapitalized and transformed into effective and profitable banks with modern methods of risk management. Their access to international financial markets allowed the increase of credit supply and returned this supply less sensitive to domestic shocks. Without this opening the existing financing methods would not have been adequate to the economic development these countries knew the last years. The presence of foreign banks is so identified as a factor of stabilization.Financial crisis; contagion; economic development; regional integration; foreign banks;

Conduct of duodenal traumatic lesions in toraco-abdominal traumatism

Catedra de chirurgie nr. 1 “Nicolae Anestiadi”, Universitatea de Stat de Medicină și Farmacie “Nicolae Testemitanu”, Chișinău, Republica Moldova, Spitalul Clinic de Urgență “Floreasca”, București, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Traumatismul toraco-abdominal se caracterizează prin gravitate aparte și politraumatism de organe a toracelui și abdomenului, urmată de greșeli de diagnostic 25-65% și letalitate înaltă, 20% se datorează leziunilor toracelui. Toracele cu organele adăpostite de importanță vitală pun în valoare gravitatea acestor leziuni în asociere cu abdomenul. Nu este precizat un algoritm diagnostico-curativ datorită polimorfismului, stării grave și caracterului lezional. Scopul: Analiza rezultatelor tratamentului leziunilor traumatice duodenale în cadrul traumatismului toraco-abdominal. Material și metode: Studiul include 21(100%) pacienți cu traumatism toraco-abdominal închis(TTAÎ) 13(62%), deschis(TTAD) 8(38%) cu implicarea duodenului. Bolnavii cu implicarea toracelui n=63 pacienți, restul cazuri implică alte sisteme. Bărbați-16(76,19%), femei-5(23,8%), vârsta 26-72ani. Mecanismul traumei: accident rutier-1(4,76%), catatrauma-3(14,28%), agresiune fizică-8(38,09%), sport-2(9,52%), armă albă-4(19,04%), armă de foc, explozie-3(14.28%); spitalizați<12ore 16(76,19%); ebrietate 8(38,09%), șoc 17(80,95%); examinați 15(71,42%): Rx.abdominală 7(38.33%). Rx.torace 10(47,61%), USG 9(42,85%), CT 1(4,76%), laparocenteză 3(14,28%), laparoscopie 3(14,28%), FEGDS 1(4,76%); operați<12ore15(71,42%); intraoperator: peritonită 6(28,57%), hemoperitoneum14(66.6%), hematom retroperitoneal12(57,14%), flegmon retroperitoneal 2(9,52%); D1-7(33.33%),D2- 15(71,42%),D3-6(25,57%),D4-0, leziuni asociate-4cazuri. Peretele: anterior-5(23,8%), posterior-6(25,57%), asociat-10(47,61%). Gr.I-8(38.9%), gr.II-7(33,33%), gr.III-0, gr.IV-3(14,28%), gr.V-3(14,28%). Torace: fracturi costale-11, unilateral-11, bilateral-1, hemotorace+pneumotorace-9, diafragm-4. Rezultate: Intraoperator s-a stabilit metoda, volumul și succesivitatea rezolvării prin raportul complexității și severității lezionale la starea pacientului și timpul scurs. Conduita a inclus succesivitatea măsurilor de rezolvare urgentă: toracocenteză(n=9), laparotomie(n=21) în ansamblu cu măsurile anti-șoc și restituire volemică. Complicații: 8-abdominale,4-pulmonare. În 9 cazuri (4-cazuri de fistule duodenale,5-fistule externe pancreatice) s-a recurs la operații repetate. Letalitatea generală-12(57,14%), legată de corecțiile duodenale-3(14,28%). Concluzii: Conduita pacienților cu traumatism toraco-abdominal este strict legată de gravitatea și complexitatea lezională și constă în utilizarea de urgență succesiv a măsurilor complexe anti-șoc, prioritar hemostază, toracocenteză, laparotomie.Background: Toraco-abdominal trauma is characterized by particular gravity and organ pluritraumatism of the thorax and abdomen, followed by 25-65% and high lethality rate, 20% due to thoracic lesions. Chest with organs housed with vital importance highlight the severity of these lesions in association with the abdomen. There is no cure diagnostic algorithm due to polymorphism, serious condition and lesional character. Aim of the study: Analysis of the results of the treatment of traumatic duodenal injuries in the thoraco-abdominal trauma. Methods and materials: The study includes 21(100%) patients with closed, 13(62%) open thoraco-abdominal trauma, 8(38%) with duodenal involvement. Patients with chest involvement n = 63, the remaining cases involve other systems. Men16(76.19%), women-5(23.8%), age 26-72 years. Trauma mechanism: Road accident 1(4.76%), catatrauma-3(14.28%), physical aggression-8(38.09%), sport-2(9.52%), knife injury 4(19.04%), firearm, explosion-3 (14.28%); hospitalized <12h 16(76.19%); inebriety 8(38.09%), shock 17(80.95%); examined 15(71.42%): abdominal Rx 7(38.33%), chest Rx 10(47.61%),USG 9(42.85%), CT1(4.76%), laparocentesis3(14.28%), laparoscopy 3(14.28%),gastroscopy 1 (4.76%); operated <12 h 15(71.42%), intraoperative: peritonitis 6(28.57%), hemo-peritoneum 14(66.6%), retroperitoneal hematoma12(57.14%), retroperitoneal-phlegmon 2(9.52%), D1- 7(33.33%),D2-15(71.42%),D3-6(25.57%),D4-0, associated lesions-4 cases. The wall: Previously 5(23.8%), Posterior 6(25.57%), Associate 10(47.61%). First degree 8(38.9%), II dg-7(33.33%), third degree-0 IV dg-3(14.28%),V dg-3(14.28% ). Chest: costal fractures 11, unilateral11, bilateral1, hemopneumothorax 9, diaphragm-4. Results: The method was established intraoperative, which depends on the volume, the complexity and severity of the lesion to the patient's condition and the elapsed time. Conduct included the succession of urgent resolving measures: thoracentesis 9, laparotomy 21 as a whole with anti-shock and volumetric rescue measures.8-abdominal complications,4-lung. In 9 cases (4 duodenal fistulas, 5 external pancreatic fistulas) repeated procedures were performed. Overall lethality 12(57.14%), correlated with duodenal corrections 3(14.28%). Conclusion: The algorithm of patients with thoraco-abdominal trauma is strictly related to lesion seriousness and complexity and consists in the successive use of complex anti-shock measures, in particular haemostasis, thoraco-concentration, laparotomy

Improving aid effectiveness in aid-dependent countries : lessons from Zambia

URL des Documents de travail : http://centredeconomiesorbonne.univ-paris1.fr/bandeau-haut/documents-de-travail/Documents de travail du Centre d'Economie de la Sorbonne 2011.40 - ISSN : 1955-611XZambia was a middle-income country when it achieved independence from Great Britain in 1964. After decades of international aid Zambia has become a low-income country, and its per capita GDP is only now returning to the levels it had reached over forty years ago. While aid is far from the only variable at work in Zambia's development, its impact has been questionable. This paper examines the issue of aid effectiveness in Zambia, especially in terms of how the incentive structure faced by donors may lead to decreased accountability and inadequate concern for long-term outcomes, rendering aid less beneficial. The paper concludes by proposing a revised approach to the provision and use of international aid in Zambia, as well as in other aid-dependent countries in Sub-Saharan Africa.Lorsque la Zambie a obtenu son indépendance du Royaume-Uni en 1964, elle était un pays à revenu intermédiaire. Après plusieurs décennies d'aide, la Zambie est devenue un pays à faible revenu et son PIB par tête commence à peine à revenir au niveau qu'il avait atteint quarante ans auparavant. Bien que l'aide ne soit pas le seul facteur permettant de promouvoir le développement en Zambie, son efficacité est parfois contestable. Ce papier propose une analyse de l'efficacité de l'aide en Zambie, particulièrement sous l'angle des motivations des bailleurs de fonds qui peuvent conduire à une faible responsabilisation et à des préoccupations inappropriées quant au développement à long terme, rendant ainsi l'aide moins efficace. Le papier propose une approche révisée de la manière dont l'aide devrait être mise en oeuvre et utilisée en Zambie, ainsi que dans d'autres pays dépendants de l'aide en Afrique sub-saharienne

The impact of patient-dependent risk factors on morbidity and mortality following gastric surgery for malignancies

Gastric cancer remains a leading cause of mortality worldwide. The treatment for gastric cancer is multimodal, in which gastrectomy remains the only curative approach. However, gastric resection is often associated with increased morbidity and mortality rates, depending on several factors. These factors can be attributed to the patient as comorbidities or effects of the disease upon him and, on the other hand, there are risk factors independent of the patient, such as aspects of the tumor (type, staging, location), experience of the surgical and anesthetic team, logistics of the hospital, yield of adjuvant therapies etc. We recognize the fact that patient-related risk factors are often overlooked and not taken into consideration prior to surgery, thus becoming a source of morbidity and mortality. These factors are more susceptible to modulating in order to better select candidates for gastric resection and thus create a better outcome. Therefore, identifying and modulating patient-related risk factors is paramount in order to decrease the incidence of morbidity and mortality following gastric resections

Are There Myths on Road Impact and Transport in Sub-Saharan Africa?

URL des Documents de travail : http://centredeconomiesorbonne.univ-paris1.fr/bandeau-haut/documents-de-travail/Documents de travail du Centre d'Economie de la Sorbonne 2013.49 - ISSN : 1955-611XAs planned large investments in road infrastructure continue to be high on the agenda of many African countries, only few of these countries have actually ammended their investments strategy. In many cases, there seems to be a preference for a status quo that can easily be explained by political economy factors driving the policies in the sector. This paper first presents data on the state of roads in Sub-Saharan Africa (length, density, condition) as well as on investments in the sector over the last decades. It then demonstrates how most countries' strategies are based on some misperceptions and recommends some changes to improve the developmental impact of roads investments. Better prioritization of investments, better procurement and contract management, better projects implementation and better monitoring are still needed, in spite of the efforts observed in the last 10 years.Alors que les investissements routiers sont toujours en tête des agendas de la plupart des pays Africains, seuls certains d'entre eux ont modifié leur stratégie d'investissement. Il semble en effet existé une préférence pour le status quo, préférence due aux facteurs d'économie politique conduisant les décisions dans le secteur. Cet article présente tout d'abord l'état des routes en Afrique Sub-saharienne (longueur, densité, condition) et sur les investissements dans ce secteur sur les dernières décennies. Il démontre ensuite que la plupart des stratégies des pays concernés sont basées sont des perceptions erronées et recommande des changements pour améliorer les impacts développementaux des investissements routiers. Malgré les efforts observés sur les 10 dernières années, des améliorations restent à faire en termes de hiérarchisation des priorités, de gestion et d'acquisition des contrats, de mise en oeuvre et de suivi des projets

Multivisceral resection for a rare case of malignant left adrenal tumor

Vă prezentăm cazul unei femei în vârstă de 44 de ani cu o tumoră corticosuprarenală voluminoasă care a fost detectată la o examinare de rutină abdominala . Pacientul a fost operat în cadrul Secției de Chirurgie Generală. a Spitalului Clinic de Urgență București. Am efectuat ablația tumorii maligne mari a glandei suprarenale stângi cu nefrectomie stângă, splenectomie, colectomie segmentara de colon transvers și pancreatectomie parțială. Examenul histopatologic a relevat un carcinom corticosuprarenalian difuz. Cazul prezinta interes datorită incidenței scăzute a acestui tip de tumoră malignă și de asemenea datorită dimensiunilor impresionante ale acesteia ,avand diametrul maxim de 19 cm.We present the case of a 44-year-old woman with a bulky adrenocortical tumor that was detected during a routine abdominal examination. The patient was operated in the General Surgery Department of the Emergency Clinical Hospital Bucharest. We performed ablation of a large malignant tumor of the left adrenal gland with left nephrectomy, splenectomy, segmental colectomy of transverse colon and partial pancreatectomy. Histopathological examination revealed diffuse adrenocortical carcinoma. The case is of interest because of the low incidence of this type of malignancy and also because of its impressive size, with a maximum diameter of 19 cm