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)

THE ECONOMIC REVENUES OF USING BIOGAS TECHNOLOGY IN THE NEW EGYPTIAN RECLAMED AREAS [

Energy sources represent one of the most important inputs of the production process without which the production process can't begin or continue. The process of fossil fuels production has Longley been associated with large amounts of emitted pollutants into the atmosphere starting through the industrial revolution at the beginning of the last century and up to nowadays, causing high levels of pollution that have threatened the human presence on earth. Fossil fuels has three main problems: the first is polluting the environment and the second is that it is steadily depleting and the third is that it has a decreasing supply function, contrary to its increasing demand, which has led to a steady increase in its international prices. It is a must and not a luxury. These made the world to produce the biogas and its secondary product "the biogas compost" which environmentally and economically compatible compared to other alternatives offered in the global market.  In Egypt, the problem of fuel is more acute, especially in the desert provinces, where the challenges of shortage of supply of LPGs combine with increasing demand due to rapid population increase with spatial spacing between production  and distribution areas accompanied by transportation, storage and handling risks, In a short period of time, all of which are a constant pressure on the balance of the local market for fuel, especially gas cylinders (LPG). Increasing carbon emissions from different sectors especially transport and agriculture (with regard to the accumulation and unsustainable handling of agricultural wastes) and the industrial sector pose significant challenges to environmental safety in Egypt. Which makes these factors a pressure pathway for the state to encourage the spread of the use of biogas technology in the agricultural sector, especially as it save the foreign currency through the provision of a complete decomposed, free of parasites, and low cost fertilizer in addition to it doesn't cause environmental pollution compared to other high-cost organic fertilizers and extremely expensive and environmentally pollutant chemical ones. The study found that the size of the most common fermenter in the category of small-size fermenters is 6 m 3 because it has a high economic return.  The research concluded that in biogas production units studied in the newly reclaimed areas of three Governorates (South Sinai, Fayoum, Assiut), net profit reached the end of life of the project, estimated at about 15 years, is about 42642 LE. The average annual profit per unit (4240 LE), IRR (15%), and the total cost recovery period of the unit are estimated at (7 years).   A sensitivity analysis of 10% found that    First    Increase costs by 10%    Net profit of LE 40454. The average annual profit is LE 3424. Internal rate of return (IRR) 15% The total cost recovery period for the unit is 7 years.    Second    Revenues decrease by 10%    Net profit of LE 3622. The average annual profit is LE 3075. Internal rate of return (IRR) 15%  The total cost recovery period for the unit is 7 years   Third    Increase costs by 10% and decrease revenue by 10% together    Net profit of LE 34014. The average annual profit is 3000 pounds. Internal rate of return (IRR) 15% The total cost recovery period for the unit is 7 years    The study recommends the use of 6 m3 biogas fermenters in the agriculture sector for heating, lighting and cooking purposes especially in newly reclaimed lands to provide energy and organic fertilizers to ensure the sustainability of the environmental resources in these virgin areas and the success of production processes economically

Chickpea (Cicer arietinum) steep liquor as a leavening agent: Effect on dough rheology and sensory properties of bread

Dough fermentation is one of the oldest process in food technologies. It has been recently intensively studied for its impact on the sensory, structural, nutritional and shelf life properties of leavened baked products. The goals of this work were to investigate chickpea steep liquor (CSL) as a dough-leavening agent and to study the effect of CSL on the dough rheology and sensory properties of leavened bread. CSL was prepared by submerging chickpea seeds in boiled distilled water (1:2, w/v) for 24 h at 37оC, and then obtained liquor was filtered and freeze-dried to obtain CSL. The addition of CSL to wheat flour (WF) brought changes in the dough mixing behavior as measured by the farinograph. An increase in the farinograph water absorption of WF dough was observed when 4.5% CSL and 1.5% yeast was added, while arrival time was not affected. Addition of CSL to the dough at a content of 4.5, 9.0 and 13.5 g CSL/300 g WF caused an increase in dough stability. The CSL addition also increased mechanical tolerance index, dough weakening and mixing time. Dough development time for all blends was higher than the control (1.2-1.5 min), while between the CSL samples no significant difference was observed. The loaf weight slightly increased from 146.2 g for control to 152.2 g for CSL fermented bread, whereas the loaf volume and specific volume of CSL-fermented bread were lower than the control. The combination of yeast and CSL increased the acceptability of bread with the increasing level of both leavening agents’. The results show that CSL could be used as an alternative to yeast for syngas fermentation. On the other hand, CLS is rich in nutrients and lower in cost compared to yeast

Spectrophotometric analysis of two eye preparations, vial and drops, containing ketorolac tromethamine and phenylephrine hydrochloride binary mixture and their ternary mixture with chlorphenirmaine maleate

Ketorolac tromethamine, KTC and phenylephrine hydrochloride, PHE binary mixture is co-formulated as eye vial, while their ternary mixture with chlorpheniramine maleate is co-formulated as eye drops. The existing work utilizes different spectrophotometric methods which are considered to be simple and rapid for the determination of both mixtures. These methods include: zero-order (D0), first derivative (D1), derivative (DR) or difference ratio (R.D), delta absorbance (ΔA) and finally convolution of derivative data using discrete Fourier functions (FFD). In the binary mixture, KTC is assayed using D0, D1 and ΔA methods with no interference from PHE, while PHE needed some spectroscopic treatments for its analysis due to the spectral overlap of KTC with its maximum wavelength (λmax) at 273 nm. Such treatments involve D1 R.D, D2R, FFD2 and ΔA methods. In the ternary mixture, KTC is assayed using D0 and D1 with no interference from both PHE and CPM, while R.D, D1R and FFD2 are used to assay both PHE and CPM to resolve the overlap in their spectra. Linear regression lines were obtained over the concentration ranges 1–18 and 6–48 μg.mL−1 for KTC and PHE (binary mixture), respectively and 2–9, 1–18 and 2–9 μg.mL−1 for CPM, KTC and PHE (ternary mixture), respectively yielding high correlation coefficients values (higher than 0.999). The lowest LOQ value for KTC (0.46 μg.mL−1) was obtained upon using the D1 method in the binary mixture while the R.D method yielded the lowest LOQ values for both PHE (0.34 μg.mL−1) and CPM (0.97 μg.mL−1) in the ternary mixture

Paraumbilical hernia repair during cesarean delivery

<b>Background and Objectives: </b> Pregnant women with paraumbilical hernia usually postpone hernia repair until after delivery, but some patients request that it be done during cesarean delivery. Therefore, we evaluated the outcome of combined cesarean delivery and paraumbilical hernia repair in a prospective study at a tertiary referral university hospital. <b> Patients and Methods: </b> In a prospective study, we compared the outcome of 48 patients undergoing cesarean delivery combined with paraumbilical hernia repair versus 100 low-risk patients undergoing cesarean delivery alone. The main outcome measures were operation time, blood loss, severity of pain, peripartum com--plications, , hospital stay, hernia recurrence, and patient satisfaction. <b> Results: </b> The combined procedure took significantly longer than cesarean delivery alone (75.2 minutes versus 60.5 minutes, P&#60; .001)). There were no major complications. Wound infection occurred in 6 patients (4.1&#x0025;). Hospital stay did not differ significantly from those of controls. Pain at the hernia site repair occurred in two pa--tients, and one hernia recurred in the hernia repair group during a mean follow-up period of 22 months (range, 6-36 months). All hernia patients reported that they preferred the combined operation. <b> Conclusions: </b> Combined cesarean delivery and paraumbilical hernia repair had the advantage of a single in--cision, single anesthesia, and a single hospital stay while avoiding re-hospitalization for a separate hernia repair. Our results indicate that the combination approach is safe, effective, and well accepted