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

Alleviation of Abiotic and Biotic Stresses in Plants by Azospirillum

International audienc

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Not AvailableSymbiotic (Rhizobia, Frankia, and VAM) or free-living (Azotobacter, and Clostridium) association of plant growth-promoting rhizobacteria (PGPR) and fungi (PGPF) is essential for plant and soil health. Nitrogen (N), phosphorus (P) and potassium (K) as major and iron (Fe) and zinc (Zn) as the minor elements are key to plant health. They are important constituents of plant genetic material (N, P) and chlorophyll content (N, Fe) and important for enzymatic activities (Fe, Zn) and are involved in many biochemical and physiological activities. The ‘microbiome’ around the rhizosphere is specific to plant type and involved in nutrient cycling through various processes such as fixation (N), solubilization, mineralization (P, K) and uptake, with the help of various organic acids (gluconic acid, oxalic acid, and tartaric acid), siderophore activity (Fe uptake) and enzymatic actions (nitrogenase, phytases, and acid phosphatases). Phytohormones essential to plant growth and development are produced by microbes themselves or induce their production via other hormones or communication chemicals, viz., volatile organic compounds (VOCs) like 2-pentylfuran, 2,3-butanediol and acetonin. PGPR (Pseudomonas, Trichoderma and Streptomyces) helps the host plant to fight against various abiotic and biotic stresses by the release of bactericidal and fungicidal enzymes, metabolite accumulation and induced systemic resistance (ISR), systemic acquired resistance (SAR) by phytohormones (jasmonic acid, salicylic acid, and ethylene) and VOCs. Attributing to so many benefits, microbes are increasingly becoming part of sustainable agriculture where PGPR (Rhizobium and Pseudomonas) and fungi (Aspergillus, Trichoderma and VAM) are being used as biofertilizers either single strained or in consortia approach, where the latter is found to be more beneficial for plant and soil health.Not Availabl