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

Pattern sensitivity: a missed part of the diagnosis

Hanan M El Shakankiry,1 Ann A Abdel Kader21Department of Pediatrics, King Fahd University Hospital&amp;ndash;Al Dammam University, Al Khobar, Kingdom of Saudi Arabia; 2Department of Clinical Neurophysiology, Kasr Aini Hospitals&amp;ndash;Cairo University, Cairo, EgyptRationale: Pattern sensitivity can be diagnosed by presenting a series of visual patterns to the subject in the electroencephalography (EEG) laboratory; however, testing for pattern sensitivity is not routinely done during EEG recording. This work aimed to highlight the incidence of pattern sensitivity among patients referred for routine EEG recording during a 1-year period, identifying the cause of referral, diagnosis, and the characteristics of pattern-sensitive patients.Methods: All patients aged 4 years and older who were referred for routine EEG during a 12-month period and had no motor or visual impairment were enrolled in the study. Intermittent photic stimulation and pattern sensitivity were tested for each case. Pattern sensitivity was tested by scanning three different rhythmically moving patterns at reading distance with the patient seated in an illuminated room. A pattern evoking a paroxysmal response was reintroduced after exposure to a blank white card to confirm the findings.Results: Two hundred twenty-eight patients were studied; twelve patients (5.26%) had pattern sensitivity and their ages ranged from 5 to 12 years. Eight of these patients (66.7%) were referred for seizure disorders, two were referred with the diagnosis of migraine, one with headache and poor scholastic performance and one with recurrent attacks of dizziness for investigation. Seven of the twelve patients (58.3%) had a previous EEG done without testing for pattern sensitivity. Five patients (41.6%) had positive family history for epilepsy, three (25%) for migraine, and two (16.6%) for migraine and epilepsy. Two patients (16.6%) had pattern sensitivity without photosensitivity. Pattern stimulation provoked epileptiform discharges in eight patients (66.6%), focal discharges in one, and unilateral build-up of posterior discharge in three.Conclusion: Diagnosis of pattern sensitivity is often missed as it is not routinely tested for during EEG recording. The result of the study challenges the concept of a consistent association between photosensitivity and pattern sensitivity; it also raises questions about the incidence of pattern sensitivity among children who do not suffer from epilepsy and in particular those with migraine, headache and scholastic difficulties. Further studies are therefore needed to clarify the phenotypic spectrum of this EEG trait.Keywords: reflex epilepsy, pattern sensitivity, migraine, headach

Influence of the magnetic field on microorganisms in the oral cavity

Since the beginning of their lives, all living organisms are exposed to the influence of geomagnetic fields. Objectives : With respect to the positive effects that magnetic fields have on human tissues, especially the bactericidal effect, this investigation aimed to assess their influence on the reduction of oral microorganisms. Material and Methods : In order to obtain adequate specimens of dental plaque deposit, microbes such as Streptococcus parasanguinis, Staphylococcus epidermidis, Rhodococcus equi and Candida albicans were isolated from the human mouth. To establish the intensity of microbial growth on the basis of the modified optical density (OD) of agar turbidimetry assay, microbial count and spectrophotometry were applied. The study was carried out with two microbial concentrations (1 and 10 CFU/ml) after periods of incubation of 24 and 48 h and using micromagnets. Results : A positive effect of the magnetic field, resulting in the reduction of dental plaque microbes in vitro, was found. In the first 24 hours of exposure to the magnetic field, the number of all isolated microbes was significantly reduced. The most potent influence of magnets and the most intensified reduction after 24 hours were evident in Candida albicans colonies. The decrease in the influence of magnets on microbes in vitro was also detected. Conclusions : Magnets reduce the number of microbes and might be recommended as a supplement in therapy for reduced periodontal tissues. This is important because periodontal tissues that are in good conditions provide prolonged support to the oral tissues under partial and supradental denture