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

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)

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

Microtensile bond strength and scanning electron microscopic evaluation of zirconia bonded to dentin using two self-adhesive resin cements; effect of airborne abrasion and aging

Aim of the study: This in vitro study was conducted to evaluate the microtensile bond strength (mTBS) of surface treated zirconia bonded to dentin specimens using two aged contemporary dual cured selfadhesive resin cements. Materials and methods: Sixty cuboidal-shaped zirconia ceramic specimens were obtained using CAD/ CAM system. Specimens were divided into two equal main groups; 30 specimens each, gp A in which specimens did not receive any further surface treatment & gp B in which only one surface of each specimen was airborne abraded. Each group was then divided into two equal groups; 15 each, according to the type of adhesive resin cement used for bonding zirconia specimens to ground flat dentine surfaces; RelyX™ U200 (cement I) and Multilink® Speed (cement II). The assemblies were further subdivided into 3 equal subgroups; 5 assemblies each, according to aging protocol. The aging protocols were storage in distilled water for 1 day, for 7 days without thermocycling and for 7dayes followed by thermocycling; subgroups 1, 2 and 3 respectively. After aging, the assemblies were sectioned into beams approximately 1 mm2 in cross section resulting in 25 beams for each subgroup; 20 of them were selected for mTBS (n ¼ 20) and 5 were kept for SEM examination. Results: Group B showed statistically significantly higher mean micro tensile bond strength value than group A. The type of cement had statistically insignificant effect on mean micro tensile bond strength. Thermocycling significantly reduced mTBS of both cements bonded to untreated zirconia ceramic; IA3 and IIA3 subgroups. For SEM, cement I showed gaps at its interface with zirconia groups A and B regardless of aging protocol. Cement II showed only gaps at its interface with zirconia ceramic group A only but good adaptation appeared at its interface with zirconia ceramic group B for aged for 1 day (subgroup IIB1) and 7 days without thermocycling (subgroup IIB2). However, cement II bonding air abraded zirconia ceramic followed by thermocycling (subgroup IIB3) showed both gap free as well as gap containing areas at high magnification only. Conclusions: Airborne abrasion-surface treatment of zirconia significantly enhanced the mTBS of both cements adhered to dentin while aging had an adverse effect. MS showed higher insignificant mTBS

Retraction notice to “A novel technique of multi-track percutaneous balloon mitral commissurotomy (PBMC)” [Egypt. J. Chest Dis. Tuberc. 61/3 (2013) 223–228]

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This paper has been retracted upon mutual agreement between the publisher and the Editor-in-Chief of EJCDT when it was discovered that this article had also been submitted and published in the International Heart Journal http://dx.doi.org/10.1536/ihj.54.196. The authors did not give clarification for the action; therefore the paper was retracted following international publishing practices

RETRACTED: A novel technique of multi-track percutaneous balloon mitral commissurotomy (PBMC)

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This paper has been retracted upon mutual agreement between the publisher and the Editor-in-Chief of EJCDT when it was discovered that this article had also been submitted and published in the International Heart Journal http://dx.doi.org/10.1536/ihj.54.196. The authors did not give clarification for the action, therefore the paper was retracted following international publishing practices

Qualitative and Quantitative Coronary Angiography in patients with Acute Coronary Syndrome (ACS)

Background and Aim: Acute Coronary Syndrome (ACS) encompasses several diseases, previously thought to be separate and defined disease states. In this syndrome, Unstable Angina (UA), Non-ST Elevation Myocardial Infarction (NSTEMI), and ST-Elevation Myocardial Infarctions (STEMI) are all part of this category. The pathogenesis begins with plaque rupture which activates the platelets and coagulation cascade leading to thrombus formation. The thrombus leads to partial or complete coronary artery occlusion leading to various clinical manifestations of ACS. The aim of the present study is to assess the extent of coronary artery disease and characterizes plaque morphology and lesion severity in patients with ACS in comparison with patients with chronic stable ischemic heart disease. Subjects and Methods: To achieve this aim, we studied 100 patients with symptomatic coronary artery disease admitted to Mansoura medical Hospital, where they were subjected to full clinical evaluation; 12 lead electrocardiogram, full laboratory investigations and Coronary angiography was done to every patient, then we analyses the results both qualitative (eye ball description of angiographic lesions) and quantitative (computer-based). Those patients were classified into two main groups, the first group of patients were those with ACS (50 patients) as a test group while the second one included patients chronic stable ischemic heart disease (50 patients) as a control group. Results: Both groups were comparable and no significant difference was present as regard age, sex, diabetes mellitus, hypertension, smoking, left ventricular function, prior PTCA, prior CHF and angina class while, prior MI more frequent among test group. One hundred, forty-seven lesions (66 in test group and 81 in control group) were available for detailed qualitative angiographic analysis. Out of seven criteria analyzed only presence of lumen irregularity and thrombus were more frequent among patient who presented with ACS (17 (26%) vs. 2 (2.5%) p < 0.05; 9 (13.6%) vs. 0 (0%) p < 0.05) respectively), and this represents the main finding in the current study. No significant difference was present in Quantitative Coronary angiographic characteristics in both groups. Conclusion: The qualitative angiographic assessment represents an essential tool in the evaluation and risk stratification of patients with ACS, through the demonstration of the presence of thrombus and lumen irregularity that correlated more with ACS than the other studded criteria. In addition, QCA although added accurate assessment of the degree of luminal narrowing, thus helping in assessment of the severity of the disease

EVALUATION OF NANOLEAKAGE OF TWO DUAL CURE SELF-ADHESIVE RESIN CEMENTS

Aim of the study: This in vitro study was conducted to evaluate nanoleakage of two contemporary dual cured self-adhesive resin cements bonding high strength ceramic to dentin. Materials and Methods: sixteen rectangular-shaped zirconia blocks (ICE Zirkon Translucent ZirkonZhan, Italy) were fabricated and divide into two group according to cements used for cementation of zirconia blocks to freshly prepared flat dentin surfaces to form assemblies. (Group1- RelyXU200 (RXU200), (3M ESPE Germany) and group2- Multilink® Speed (MS), (Ivoclar Vivadent, Liechtenstein)). Each group were divided to three subgroups ten assemblies in each according to storage periods 1day, 7 days without thermocycling and 7 days with thermocycling for 500 cycles at temperature between 5 and 55 period the assemblies were sectioned into1 mm thick slaps. Two slaps from each assembly were selected, stained with 50wt% ammoniacal silver nitrate and tested for nanoleakage using Electron Dispersive Analytical X-ray (EDAX). Results: Group 2 showed the higher insignificant mean of nanoleakage (15.55±4.47 AgL in wt%) than group 1 (13.83±5.36 AgL in wt%). One day follow-up period showed the highest significant mean of nanoleakage (18.35±4.18 AgL in wt%) followed by seven days without thermocycling (13.10±4.44 AgL in wt%) and 7 days with thermocycling (11.87±4.13 AgL in wt%). Conclusions: RXU200 cement had lower mean of nanoleakage than MS and Storage time had influences on nanoleackage but thermocycling had not