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 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

Statistical Analysis Of Reconnaissance Geochemical Data From Orle District, Southwestern Nigeria

The results of concentrations of 22 trace elements, namely, Au, Ag, As, Pb, Zn, Cu, Co, Mo, Hg, Sb, Tl, Sc, Cr, Ni, La, W, V, U, Th, Bi, Sr and Ga in 56 stream sediment samples collected from Orle drainage system were subjected to univariate and multivariate statistical analyses. The univariate methods used include frequency distribution and cumulative probability plots, while the multivariate methods used are correlation and factor analyses. Frequency distribution plots showed that the elements are either log-normally or near log-normally distributed at 95 % confidence level. Cumulative probability plots of the elements show that the concentrations of Cu, Pb, Zn, Co, Sc, Ni, Cr and Ga consisted of one population, whereas those of Au, Hg, Mo, As, La, W, U, Th, Bi, Sr, Tl and V were made up of two populations. Pearson correlation coefficients show that strong correlations exist among Cu-Pb-Zn-Mo-As-Sc-Ni-Bi-V, Au-Hg-Ni-Co-Cu-V, Co-Ni-Cr-Sr-Au, W-As-Mo-Bi, La-Cu-Pb-Zn-Sc-Bi-Ga-Tl, U-Th-La, Co-Tl-V-Ga-Cu-Zn-As-Sc-Ni-Cr, Mo-Ga-V and Hg-Cu-ZnNi-V-Mo-Co. Five factors, whose structures were similar to the subjective groupings derived from the correlation matrix, were derived from R-mode factor analysis and have been interpreted in terms of underlying rock lithology, potential mineralization, and physico-chemical conditions in the environment. A high possibility of occurrence of mineralization of different metals exists in some of the Precambrian basement complex rocks that underlie the study area. The possible mineral potential of the area include base metals (Pb, Zn, Cu, Mo, etc.), Au-Sb-Hg and U-Th-La mineralization. Some elemental associations reflect basement geology and the likelihood of occurrence of the possible mineralization with specific rocks types. Gold and base metal mineralization is likely to occur within the mafic-ultramafic rocks, most probably amphibolite, and U-Th-La mineralization is likely to occur within the felsic rocks, most probably pegmatite in this area. Keywords: Reconnaissance, stream sediment, trace elements, statistical analysis, mineralization.Global Journal of Geological Sciences Vol. 6 (1) 2008: pp. 63-7

Demographic Predictors Of Burnout Among Hiv/Aids Counsellors

Counsellors have been identified as an at-risk group for burnout, especially when the setting is HIV/AIDS counselling center. Considering the nature of the illness, the multifaceted needs of the client, the relative paucity of available counsellors/counselling centers and various psychosocial issues connected with HIV/AIDS, the potential for burnout is particularly high among HIV/AIDS counsellors. Despite these problems, little or nothing is being done by way of rigorous research and ameliorative activities on this important issue. This study represented an attempt at empirically investigating the experience of emotional exhaustion among HIV/AIDS counsellors in Lagos State, Nigeria. Two hundred conveniently selected counsellors participated in this cross-sectional survey. Participants were 170 females and 70 males with an average age of 34.19 years and a standard deviation of 6.82. Results indicated that respondents were very high on emotional exhaustion and depersonalisation but very low on personal accomplishment. Additionally, age, education and work experience significantly predicted emotional exhaustion{R=.50; F=26.01;

Pregnancy Duration and Choice of Ante-natal and Delivery Care in Selected Rural and Mixed Urban Areas of Ijebu, South Western Nigeria

Pregnancy duration and choice of care for maternal health are crucial primary health issues that the World Health Organization (WHO) keeps constant in the campaign for all round healthcare delivery for mother and child. To be sure, there is consensus on the need for optimal care for the mother and baby; this is believed to enhance the mother and child social development and biological growth and to reduce maternal and infant mortality and morbidity which are prevalent in Nigeria and other Sub-Saharan Africa countries. The study thus, investigates challenges being faced by the mothers, which are sometime inconsistent to their socio-economic pursuits, growth and maternal well being. Other objectives include understanding of inhibitions and determinants to pregnant healthcare consumptions contribution in terms of culture, income, occupation etc. Methodologically, sample size of 152 respondents was selected for interview through purposeful random sampling among the pregnant and nursing mothers between the age of 15 to 49 years in Ijebu- Yoruba south western Nigeria involving mixed urban (i.e. informal and informal sectors) and the rural societies. The methods of data collection were survey method and in-depth (IDI) interviews. 10 in-depth interviews for mothers, fathers, health givers and opinions leaders were conducted. The data were analyzed through simple statistical method and content analysis for IDI. Data revealed strong significant but inverse relationship between the socio-cultural factors and choice of health care also incongruous relationship between the pregnant woman and nursing mother&#8216;s residence and healthcare consumption. The results amongst other things saw culture of patriarch , income ,occupation and where one reside acting as determinants for when commences care and the choice of healthcare centre. The ethnographic result also confirmed this much that men are the key to their wives choice of care during pregnancy this is because majority of them still pay the medical bill. It is therefore suggested that government, international agencies and concerned nongovernmental organization (NGOs) should intensify effort to open up rural and mixed urban settlements to Human Development Amenities (HDA) and bring about a strong intervention to bring about adequate maternal healthcare delivery

Mineralogy and ceramic properties of lateritic clays derived from basement complex rocks in Ibadan area, southwestern Nigeria

No Abstract.Global Journal of Pure and Applied Sciences Vol. 13 (3) 2007: pp.421-42