Prevalence of somatisation and psychologisation among patients visiting primary health care centres in the State of Qatar

Background: Medically unexplained somatic complaints are among the most common clinical presentations in primary care in developing countries and they are considerable burden for patients and health care system. Objectives: The aim of this study was to determine the prevalence of somatisation in comparison to psychologisation among a sample of Qatari patients who were visiting primary health care (PHC) centres and to investigate the clinical and socio-demographic characteristics of somatisers (STs) and psychologisers (PGs). Method: The survey was conducted among PHC Qatari patients during the period from January to July 2007. About 2,320 patients were approached, of whom 1,689 agreed to participate and responded to the questionnaire. Among the studied Qatari patients, 404 patients were identified for clinical interview. The first stage of the study was conducted with the help of general practitioners, using the 12-item General Health Questionnaire. The second stage was carried out by a consultant using the Clinical Interview Schedule. A specific operational criterion was used to identify STs and PGs. Results: The prevalence rate of STs among the total studied sample was 12.4%, while the PGs were 11.5%. Among the identified psychiatric cases, the proportion of STs (52%) was higher than PGs (48%). Most of the diagnostic categories were more prevalent among PGs. The dissatisfaction at work and stressful life events within 12 months before the onset of the presenting symptoms were the three postulated determinants which were significantly more among STs than PGs. Conclusion: The prevalence of somatised mental disorder was little higher than the psychologised mental disorder. The prevalence of somatisation and psychologisation is comparable with other reported studies from the Middle-East and Western countries. Dissatisfaction at work and stressful life events were significantly higher among STs than PGs.Keywords: somatisers; psychologisers; primary health care; determinants; Arab cultur

Enhancing the fuel properties of beverage wastes as non-edible feedstock for biofuel production

A few industries, such as the beverage industry, have experienced some growth in sales during the COVID-19 pandemic. Globally, beverage companies alone generate over 200 million tonnes of biomass annually, which largely ends up as animal feed or in landfills. With the UK government’s commitment to reduce its carbon footprint by at least 68% in 2030, many companies, especially small and medium enterprises (SMEs), are exploring options to reduce carbon emissions and develop roadmaps to become carbon neutral. It has thus become imperative for beverage companies to find value in or repurpose their waste. This paper unlocks the potential for improving the fuel properties of beverage waste through a blending process and explores the determination of optimal fractions for the blends via characterization. With an initial moisture content of 82 and 58 wt.% brewery spent grain (BSG) and spent coffee grounds (SCG), respectively, the pre-treatment process reduced moisture content by approximately 10–15 wt.%. The study concludes that biomass blending improved the fuel properties of the biomass, providing a competitive comparison with coal for energy applications

Temporal and spatial distribution of polycyclic aromatic hydrocarbons (PAHs) in the Danube River in Hungary

The Danube is a significant transboundary river on a global scale, with several tributaries. The effluents from industrial operations and wastewater treatment plants have an impact on the river's aquatic ecosystem. These discharges provide a significant threat to aquatic life by deteriorating the quality of water and sediment. Hence, a total of 16 Polycyclic Aromatic Hydrocarbons (PAHs) compounds were analyzed at six locations along the river, covering a period of 12 months. The objective was to explore the temporal and spatial fluctuations of these chemicals in both water and sediment. The study revealed a significant fluctuation in the concentration of PAHs in water throughout the year, with levels ranging from 224.8 ng/L during the summer to 365.8 ng/L during the winter. Similarly, the concentration of PAHs in sediment samples varied from 316.7 ng/g in dry weight during the summer to 422.9 ng/g in dry weight during the winter. According to the Europe Drinking Water Directive, the levels of PAHs exceeded the permitted limit of 100 ng/L, resulting in a 124.8% rise in summer and a 265.8% increase in winter. The results suggest that the potential human-caused sources of PAHs were mostly derived from pyrolytic and pyrogenic processes, with pyrogenic sources being more dominant. Assessment of sediment quality standards (SQGs) showed that the levels of PAHs in sediments were below the Effect Range Low (ERL), except for acenaphthylene (Acy) and fluorene (Fl) concentrations. This suggests that there could be occasional biological consequences. The cumulative Individual Lifetime Cancer Risk (ILCR) exceeds 1/104 for both adults and children in all sites

Removal of Pharmaceuticals from Water Using Laccase Immobilized on Orange Peels Waste-Derived Activated Carbon

The ongoing discharge of containments into the environment has raised concerns about the potential harm they pose to various organisms. In the framework of eliminating pharmaceutical chemicals from aqueous solutions, enzymatic degradation by laccase is an environmentally friendly option. In this investigation, laccase immobilized on biochar derived from agricultural waste (orange peels, OPs) was used for the first time to remove carbamazepine and diclofenac from aqueous media. Different characterizations, such as Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy and energy dispersive X-ray spectroscopy (SEM-EDS), X-Ray diffraction (XRD), specific surface area (SBET), Boehm titration, proximate and ultimate analysis, as well as the point of zero-charge (pHPZC) analysis, were used in this study. The immobilization of laccase results in enhanced stability with respect to storage, temperature, and pH compared to laccase in its free form. The findings showed that the ideal conditions for immobilization were a pH of 4, a temperature of 30 °C, and a laccase concentration of 4.5 mg/mL. These parameters led to an immobilization yield of 63.40%. The stability of laccase immobilized on biochar derived from orange peels (LMOPs) was assessed over a period of 60 days, during which they preserved 60.2% and 47.3% of their initial activities when stored at temperatures of 25 °C and 4 °C, respectively. In contrast, free laccase exhibited lower stability, with only 33.6% and 15.4% of their initial activities maintained under the same storage conditions. Finally, the use of immobilized laccase proved to be effective in eliminating these pollutants in up to five cycles. Upon comparing the two systems, namely LMOPs and modified orange peels (MOPs), it becomes apparent that LMOPs exhibit an estimated 20% improvement in removal efficiency. These results affirmed the viability of activated carbon derived from OPs as a cost-effective option for immobilizing laccase. This approach could potentially be further scaled up to effectively eliminate organic pollutants from water sources

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

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