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

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

Influence of Combined Yeast-derived Zinc, Selenium and Chromium on Performance, Carcass Traits, Immune Response and Histomorphological Changes in Broiler Chickens

This study was carried out to assess the effects of dietary supplementation of yeast-based Zn, Se, and Cr on growth performance, carcass characteristics, immune response, and histomorphological changes in broiler chickens. A total of 1092 one-day-old unsexed broilers of Ross 308 strain were randomly allocated into two equal treatment groups (6 equal replicates/ group). Birds were fed the dietary treatments from day 1 to day 35 of age. The first group was fed a basal diet without yeast-based Zn, Se and Cr supplementation (control). The second group was fed a basal diet supplemented with 1.5 mg, 0.15 mg and 2 µg / kg diet of Zn, Se, and Cr, respectively. The yeast-based Zn, Se and Cr increased (P&lt;0.05) the growth rate, carcass traits and improved feed conversion ratio compared to control. The antibody titer against avian influenza and the relative weight of bursa, thymus and spleen were increased (P &lt; 0.05) in broilers supplemented with yeast-based Zn, Se, and Cr compared with the control. The intestinal villi height and crypt depth and bursa diameters were increased in broilers fed the yeast-based Zn, Se and Cr supplemented diet. In addition, there was an increase in the lymphocytic infiltration in the bursa and a decrease in germinal centers in the submucosal lymph nodules of the ileum of birds supplemented with yeast-based Zn, Se and Cr compared to the control. In conclusion, dietary supplementation of yeast-based Se, Cr, and Zn in combination could improve growth performance, carcass traits, immune responses and histo-morphological parameters in broiler chickens

Effect of Nano-hydroxyapatite as an Alternative to Inorganic Dicalcium Phosphate on Growth Performance, Carcass Traits, and Calcium and Phosphorus Metabolism of Broiler Chickens

The influence of nano-hydroxyapatite (NHA) as a source of calcium (Ca) and phosphorous (P) alternative to inorganic dicalcium phosphate (DCP) on the performance, carcass traits, and the Ca and P contents in serum, bone, and excreta was evaluated in broiler chickens. One-day-old un-sexed Arbor Acres Plus broiler chickens (n.= 160) were randomly assigned to four treatment groups of four replicates with 10 birds in each replicate.

The potential Enhancing Effect of both Phytase and β-xylanase Enzymes on Performance, Bone Mineralization and Nutrient Absorption in Broiler Chicken

The response to dietary fortification of both phytase and β-xylanase enzymes was investigated in broilers (Ross 308, No.=300) that were allocated into 3 different treatments; control (G1) was fed the basal diet only, the second group (G2) was fed the basal diet supplemented with 100 g/ton feed phytase 5000 FTU in combination with 250 g /ton feed β-xylanase, while the third group (G3) was fed the basal diet fortified with 50 g/ton feed phytase 10000 FTU plus 250 g /ton feed β-xylanase. When compared to the control diet, our results exhibited that co-feeding either Phytase 5000 or 10000 FTU with xylanase improved both growth performance and feed utilization. Moreover, tibia Ca and P% were significantly higher (P ≤ 0.05) when diets were supplemented with phytase 5000 and phytase 10000 FTU in comparison to control group indicating that each product could improve bioavailability of these minerals. Serum phosphorus (P) was greater with phytase inclusions in both doses, when compared to the control group (P ≤ 0.05). Microscopical examination revealed a significant increase in the villus height of duodenum and jejunum of phytase and xylanase combination treated groups in a concentration dependent manner, when compared with the control group. Chemical examination of litter disclosed an improvement in litter moisture, reduced total nitrogen (N), and phosphorus percent in groups supplemented with phytase and xylanase enzymes. In conclusion, the use of combined supplementation of xylanase and phytase (5000 or 10000 FTU) could improve growth performance, P metabolism, bone mineralization and the intestinal nutrient absorption of broiler chicken

Response of Broiler Chickens to the Dietary Fortification of Bile Acid

The feeding trial was conducted for 31 days to investigate whether dietary energy modifications using bile acid feed additive (Runeon®) affected broiler performance, carcass characteristics, blood indices, intestinal lipase activity, and broiler's meat quality. A total of 1200 one-day-old Ross-308 broiler chicks (as hatch) were randomly distributed into three groups, each with five replicates (80 chicks/replicate). The first group was a control (T1) which fed a basal diet only. In the second group (T2), birds were fed the basal diet supplemented with bile acid (Runeon®) (on top application) at the rate of 200g/ton. In the third group (T3), birds were fed a basal diet reduced in energy requirements by 30kcal/kg and reformulated with 200g/ton of bile acid (Runeon®). Birds' diets fortified with bile acid in (T2) or (T3) significantly (P≤0.05) improved body weight, body weight gain, feed conversion ratio (FCR), and European Production Efficiency Factor (EPEF) as compared to the control. The dressing%, breast, thigh, and drumstick yields were improved in T2 and T3 than in control. Supplementation of bile acid significantly (P≤0.05) reduced abdominal fat%, as well, blood cholesterol, triacylglycerol, HDL, and LDL concentrations, but increased total protein concentration (P≤0.05). Additionally, intestinal lipase levels significantly (P≤0.05) increased in groups fortified with bile acid (T2 and T3). Besides, chicken meat moisture% and fat% were significantly (P≤0.05) decreased in T3 compared to T1 and T2. Conclusively, dietary fortification of bile acid could improve growth performance, profitability, carcass traits, serum lipids profile, intestinal lipase secretion, and chicken meat quality in broiler chickens

Influence of Bacillus subtilis and Bacillus licheniformis Probiotic Supplementation via the Drinking Water on Performance and Gut Health of Broiler Chickens

The experimental trial was carried out to evaluate the impact of a mixture of Bacillus subtilis and Bacillus licheniformis probiotic supplementation via the drinking water (AVI-GROW®) on growth performance, carcass traits, gut microbiome, intestinal histomorphology, blood biochemical indices, and litter quality of broiler chickens. A total of 480 one-day-old Ross 308 broiler chicks (as hatch) were randomly allocated into two groups, each with three replicates (80 chicks/replicate). The control group (T1) and the supplemented group (T2) were fed a basal diet, however, T2 was supplemented with (AVI-GROW®) via the drinking water at the rate of 1mL/L drinking water every 12 hours for 2 days after every vaccination and change of diet. The experiment lasted 31 days. Supplementation of (AVI-GROW®) via the drinking water in T2 significantly (P≤0.05) improved body weight gain and feed conversion ratio (FCR), as well as villus crypt ratio of the small intestine as compared to the control. The dressing percent, breast, thigh and drumstick yields were improved in T2 than in control. Additionally, blood cholesterol, triacylglycerol, ALT, and AST concentrations were reduced, while total protein concentration was significantly (P≤0.05) increased in T2 as compared to control. Moreover, cecal clostridial counts were significantly (P&lt;0.05) lower in T2 as compared to control. Supplementation of (AVI-GROW®) in (T2) reduced nitrogen content in birds' excreta and litter. Conclusively, the supplementation of (AVI-GROW®) via the drinking water could improve growth performance, carcass characteristics, gut microbiome, intestinal histomorphology, blood biochemical indices, and litter quality in broiler chickens

Impact of dietary-nucleotides and Saccharomyces cerevisiae-derivatives on growth-performance, antioxidant-capacity, immune-response, small-intestine histomorphometry, caecal-Clostridia, and litter-hygiene of broiler-chickens treated with florfenicol

ABSTRACTStress in poultry production is energy-demanding. Nucleotides and yeast cell-wall products are essential nutrients for broiler performance, gut function, and immune response. Antibiotics, like florfenicol, negatively affect the immune system. A total of 600 one-d-old broiler chickens (Cobb-500) were weighed and randomly allotted into four groups with three replicates each. The control group (G1) received the basal diet, G2 received a diet supplemented with a combination of nucleotides and Saccharomyces cerevisiae derivatives (250 g/Ton), G3 received the basal diet and medicated with florfenicol (25 mg/Kg body weight) in drinking water for 5 days, while G4 received a combination of nucleotides and Saccharomyces cerevisiae-derivatives (250 g/Ton) and medicated with florfenicol in drinking water. Growth performance criteria were recorded weekly. Blood, intestinal contents, small-intestine sections, and litter samples were collected to measure birds’ performance, carcass yields, leukocytic counts, antioxidant capacity, antibody titres, phagocytic index, caecal Clostridia, intestinal histomorphometry, and litter hygiene. Nucleotide-supplemented groups (G2 and G4) revealed significant (p ≤ 0.05) improvements in feed conversion, and body weight, but not for carcass yields in comparison to the control. Dietary nucleotides in G2 elevated blood total proteins, leucocytic count, antioxidant capacity, and phagocytic index, while they lowered blood lipids and litter moisture and nitrogen (p ≤ 0.05). Dietary nucleotides in G4 ameliorated the immunosuppressive effect of florfenicol (p ≤ 0.05) indicated in reducing caecal Clostridia, improving duodenal and ileal villi length, and increasing blood albumin and globulin levels, and phagocytosis%. Supplementing diets with nucleotides and yeast products has improved the immune system and provided a healthier gut for broilers

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