Ethanol-Induced Hepatic and Renal Histopathological Changes in BALB/c mice

This study was to investigate the histopathologic changes of different concentrations of ethanol on the mice liver and kidney. Forty albino mice of the Mus musculus species, BALB/c strain mice underwent this study and were divided into four groups; control, %20, %40 and %60 of ethanol administration groups. The mice of each group (%20, %40 and %60 of ethanol) were orally administered with 1ml of ethanol 4days/week for 3 weeks. Hematoxylin and eosin staining indicated development of mild to severe lesions in kidney and liver which included; In %20 of ethanol administration group there was mild lesion development; hydropic swelling in liver and swelling of kidney parenchyma while in %40 of ethanol administration group developed moderate changes; hydropic swelling of hepatocytes and kidney tubules with hyaline degeneration and in %60 of ethanol administration group produced severe lesion; focal macro and micro abscess in liver parenchyma and focal neutrophil infiltration within renal parenchyma and hyaline cast within renal tubules. Based on our study, it can be concluded that ethanol intoxication leads to a various disorders of the liver and kidney which arrange from mild to severe injury which was depended on the concentration of ethanol. Keywords: Ethanol, Mice, Kidney, Liver, H&E stain

Anatomical and histological studies of esophagus of one-humped camel (Camelus dromedarius)

This study was designed to describe the anatomical and histological features of the normal esophagus in one- humped dromedary camel (Camelus dromedarius). Twelve adult male camels were used for this study. Anatomical features were described and samples were collected from 8 animals. Samples were kept in 10% neutral buffered formalin and processed with routine histological procedures. The present study revealed that the length of the esophagus of camel was 148±2.3 cm. The esophageal outer diameter began in the cervical portion at 2.6 ±0.5 cm and gradually enlarged to 4±0.2 cm in thoracic inlet. In the cranial part the esophagus of camel lied dorsally to the cricoids cartilage of the larynx and trachea. However, the cervical region deviates to the left of the trachea and maintains this relation until it reaches to the end of cervical region, where it again slopes to the dorsal region of the trachea. Later on, the esophagus continues caudally in thoracic cavity and passes through the esophageal hiatus of the diaphragm and after a short abdominal part it joins to the cardiac region of the stomach. The histological study showed that the esophagus of camel composed from many layers. It is arranged from internal to external in order: the mucosal layer consist of keratinized stratified squamous epithelium, the lamina propria (contain a relatively dense connective tissue with amount of elastic fibers), the Muscularis (consist from two layer of smooth muscle bundles that are relatively large). The sub mucosal glands abundant throughout the esophagus (this gland were less numerous towards the caudal end of the esophagus), while the number of lobules of sub-mucosal glands found in each region of the esophagus ranged from 42 in the cranial cervical region to 31 in the middle thoracic region. The tunica muscularis of the esophagus are stratified muscle and it is occurred in two general layers inner circular muscularis layer and outer longitudinal muscularis layer

Morphological, Histological and Histochemical Study of trachea of One Hump Camel (Camelus dromedaries) In South of Iraq

The objective of this study was to describe the morphological, histological and histochemical structural features of the trachea of the camel (Camelus. dromedaries) Tracheas from 10 adult male camels aged between 3-5 years were collected from slaughter house in Al- samawa and Al- zubair distract. This study were performed at college of veterinary medicine / university of Basra. Clinically, all camels were appeared normal and healthy. The length, and the number of tracheal cartilage rings were measured and processed for histological study. The morphological study revealed that the mean length of the trachea was 95 ± 0.77 cm, while the mean number of the cartilage rings was 75.6 ± 0.74. The histological results revealed that the wall of trachea consist of mucosa, submucosa, hyaline cartilage and adventitia. The mucosa was lined by respiratory epithelium (pseudostratified ciliated columnar epithelium) with numerous goblet and basal cells, while the lamina propria was consisted of loose connective tissue. Muscularis mucosa was very thin layer, while the submucosa appeared as a layer of loose connective tissue and contained tubulo - acinar submucosal glands, which were very few in number and small in size. The hyaline cartilage layer was surrounded by perichondriun with the dense fibroblastic tissue presented between the cartilaginous rings. The adventitia was consisted of connective tissue with numerous elastic fibers. On the other hand the Periodic acid–Schiff stain (PAS) showed a positive reaction of gobblet cells and submucosl gland

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

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

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