A review on Bacillus coagulans as a Spore-Forming Probiotic

Background and objective: Growth of beneficial probiotics is attributed to their tolerance to stress factors while most probiotics have a relatively short and unstable shelf life. Bacillus coagulans, an economically important spore-forming species, is becoming increasingly remarkable in field of probiotics for the decrease of harmful effects of processing and environment conditions on the survival of bacterial cells and to assure their functionality in the human body. The aim of this review was to explore scientific research on therapeutic, functional and biosafety properties of Bacillus coagulans as a novel probiotic.Results and conclusion: Many scientific literatures have been published on the use of health promoting Bacillus spores in foods. Bacillus coagulans mostly includes several health benefits of non-spore forming probiotics and is able to tolerate heat and stressful requirements of food processing as well as gastrointestinal tract conditions. Considering specific characteristics of spore-forming probiotics, Bacillus coagulans demonstrates a promising potential in production of probiotic foods.Conflict of interest: The authors declare no conflict of interest

Electrolyte Imbalance Pattern in Hospitalized Unconscious Patients

Objective: To determine the pattern of electrolyte imbalance and associated etiological factors among the unconscious patients hospitalized at Pak Emirates Military Hospital. Study Design: Cross-sectional study Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan from Sep 2019 to Feb 2020 Methodology: A total of 240 cases were included in this study in liaison with other departments where the admitted patients became unconscious. Patients with a Glasgow coma scale score <10 were included in the study. Serum electrolytes, including Sodium, Potassium, Magnesium and Chloride, were measured in the study participants. Results: Mean age of study participants was 49.10±7.55 years. One hundred and sixty-two (67.5%) patients were from Medicine -Allied Wards while 78(32.5%) patients were from Surgical-Allied Wards. Thirty-eight patients were from the Critical Care Unit. Mean serum sodium was 139.10±11.52 meq/L, while potassium was 4.60±1.06 meq/L. Mean chloride was 809.4±53.55 meq/L, and Magnesium was 1.40±1.05) meq/L. Our analysis revealed that advanced age, underlying medical illness and duration of hospitalization were strongly linked with electrolyte imbalance among the unconscious patients. Conclusion: Electrolyte imbalance emerged as a common finding in the unconscious patients hospitalized in our tertiary care unit. Patients with advancing age, medical illnesses and long hospitalization should be screened for electrolyte wasting a priority to prevent them from going unconscious

Effect of raster angle and infill pattern on the in-plane and edgewise flexural properties of fused filament fabricated acrylonitrile–butadiene–styrene

Fused Filament Fabrication (FFF) is a popular additive manufacturing process to produce printed polymer components, whereby their strength is highly dependent on the process parameters. The raster angle and infill pattern are two key process parameters and their effects on flexural properties need further research. Therefore, the present study aimed to print test specimens with varying raster angles and infill patterns to learn their influence on the in-plane and edgewise flexural properties of acrylonitrile–butadiene–styrene (ABS) material. The results revealed that the highest in-plane and edgewise flexural moduli were obtained when printing was performed at 0 ° raster angle. In comparison, the lowest values were obtained when the printing was executed with a 90 ° raster angle. Regarding the infill pattern, the tri-hexagon pattern showed the largest in-plane modulus, and the quarter-cubic pattern exhibited the greatest edgewise flexural modulus. However, considering both the modulus and load carrying capacity, the quarter-cubic pattern showed satisfactory performance in both planes. Furthermore, scanning electron microscopy was used to investigate the failure modes, i.e., raster rupture, delamination of successive layers and void formation. The failure occurred either due to one or a combination of these modes

A Sociological Study about the Adoption of Contraception Methods and Their Effects on the Married Females’ Health in Rural Areas of Tehsil Dera Ghazi Khan-Pakistan

Population is growing rapidly &amp; adoption of FP has been neglected by Govt. of Pakistan due to lack of services, awareness and education, traditional believes, employment &amp; misconception. Mostly people think that the use of contraception methods is against the nature and Islam and is also harmful for health. So present study was designed in rural areas of Tehsil Dera Ghazi Khan in 2013 to investigate the knowledge level, adoption of contraception as well as to perceived positive and negative effects of contraception methods on the health of married females in rural community. 160 rural married females were interviewed to find out their demographic features; utilization of contraception and its side effects on their health in tehsil Dera Ghazi Khan. The data was analyzed by using Uni-variate (frequency distribution and percentage) and Bi-variate analysis (Chi square and Gamma Statistics) was carried out. Predominating age categories were &lt;15 and 16-20 years, 45.6% were illiterate, and 55.6% had good mutual understandings. More than one fifth (26.2%) had 1-2 pregnancies, 59.4% had sometimes heard about contraceptive methods while 84.4% had favorable attitude towards adoption of contraception methods. Whereas 58.1% had sometimes used contraceptive methods, 31.9% got information about contraceptive methods from relatives. In adoption of different contraception methods during the life span, respondents reported both types i.e. modern injections (60.6%), spermicides (50.6%), and in traditional methods i.e. withdrawal (6.2%); adoption of herbs (5.7%) and 44.4% had faced positive effects while 19.4% faced negative effects whereas 36.2% of the respondents had both type of effects (positive/ negative) on their health after the adoption of FP methods during reproductive span. Bi-variate analysis showed positive relationship between desired of family size and utilization of contraception, Freedom of decision making vs utilization of contraception methods and mutual understanding of spouse vs adoption of contraception method. There was a need to bring positive change in societal attitude for the utilization of family planning. Keywords: FP Methods, Contraception adoption, effects, Religious opinion, Decision making, Rural Females, Socio-economic statu

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

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 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

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)

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries