Physical disability and psychosocial impact due to chronic filarial lymphoedema in Sri Lanka

BACKGROUND: Information on the physical and psychosocial disability of lymphatic filariasis in Sri Lanka is scarce. Therefore this study was carried out to describe the physical disability and psychosocial impact associated with chronic lymphoedema in patients attending filariasis clinics in the Colombo district, Sri Lanka. METHODS: Four hundred and thirteen patients with lymphoedema of limbs attending filariasis clinics in Werahera and Dehiwala in the Colombo district were enrolled in the study after obtaining informed written consent. Data were collected using a pre-tested, interviewer-administered questionnaire and analyzed using SPSS. RESULTS: Majority (95%) of patients had lower limbs affected and there was a significant association with difficulty in walking (p = 0.023). The swollen limb affected the work of 87 (52 %) of employed patients and 26 persons reported loss of job. Approximately 25 % and 6 % reported having problems interacting with the community and family, respectively and 8.7 % felt that they were rejected by society. The swollen limb was perceived as a major problem by 36.8 % of patients. Of the married persons, 5.7 % and 6.2 % reported sexual and marital problems respectively, due to their swollen limb/s. Of those who had marital problems, 77.3% reported sexual problems as well (p < 0.001). CONCLUSION: Lymphoedema significantly affects physical, psychological and social functioning in affected individuals. Morbidity control, in addition to control of physical disability, should target the psychosocial consequences

Beliefs and practices regarding herbal plants used in self care among persons in Raththanapitiya area and the university community

Objective: To list the herbal plants used in self care and describe the perception of beneficial effects experienced by the study population. Method: Six focus group discussions were held. Each group comprised of eight members of similar age, both sexes and similar backgrounds. Four were university student groups from different parts of the country, one from staff members and another from Family Practice Centre patients. Ethical clearance was obtained from faculty committee. Results: The participants frequently use herbal remedies for diabetes mellitus, urinary problems, skin diseases, coughs, eye conditions and abdominal conditions. Following were used often and by the majority. Names as given in Sinhala are; wal koththamalli, kothalahimbutu, madatiya, sepalika, kowakka, thebu, ginithilla, karawila and nidikumba as remedies for diabetes mellitus; akkapana, polpala, neeramulliya, rabu and ranawara for urinary problems; kohomba, nidikumba, lunuwila and nelli for skin diseases; koththamalli, yaki naran, ambul dodan, batu and adathoda for coughs and delum, pichcha and sepalika for eye conditions; beli, kohila eramudu and dehi for abdominal conditions. All parts of a plant (leaves, fruits, roots, flowers and bark) are used. Methods of preparation have a wide variation and unique to the condition. Boiling with water, crushing, preparing ‘melluma’ or consuming the raw product are some of the methods often used. Nearly all remedies were perceived as effective. Side effects were attributed to use in large quantities. Conclusion: Herbal plants are used widely by the study population irrespective of social or educational background. Participants perceived beneficial effects when herbs were used in moderation.

Beliefs and practices regarding herbal plants used in self care among persons in Raththanapitiya area and the university community

Objective: To list the herbal plants used in self care and describe the perception of beneficial effects experienced by the study population. Method: Six focus group discussions were held. Each group comprised of eight members of similar age, both sexes and similar backgrounds. Four were university student groups from different parts of the country, one from staff members and another from Family Practice Centre patients. Ethical clearance was obtained from faculty committee. Results: The participants frequently use herbal remedies for diabetes mellitus, urinary problems, skin diseases, coughs, eye conditions and abdominal conditions. Following were used often and by the majority. Names as given in Sinhala are; wal koththamalli, kothalahimbutu, madatiya, sepalika, kowakka, thebu, ginithilla, karawila and nidikumba as remedies for diabetes mellitus; akkapana, polpala, neeramulliya, rabu and ranawara for urinary problems; kohomba, nidikumba, lunuwila and nelli for skin diseases; koththamalli, yaki naran, ambul dodan, batu and adathoda for coughs and delum, pichcha and sepalika for eye conditions; beli, kohila eramudu and dehi for abdominal conditions. All parts of a plant (leaves, fruits, roots, flowers and bark) are used. Methods of preparation have a wide variation and unique to the condition. Boiling with water, crushing, preparing ‘melluma’ or consuming the raw product are some of the methods often used. Nearly all remedies were perceived as effective. Side effects were attributed to use in large quantities. Conclusion: Herbal plants are used widely by the study population irrespective of social or educational background. Participants perceived beneficial effects when herbs were used in moderation.

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

Effect of Coal Rank on Various Fluid Saturations Creating Mechanical Property Alterations Using Australian Coals

During CO2 sequestration in deep coal seams, the coal mass may be subjected to various fluid (CO2, N2, etc.) saturations. Therefore, in order to maintain the long-term integrity of the process, it is necessary to identify the mechanical responses of preferable coal seams for various fluid saturations. To date, many studies have focused on the CO2 saturation effect on coal mass strength and less consideration has been given to the influence of other saturation mediums. Hence, this study aims to investigate coal’s mechanical responses to water and N2 saturations compared to CO2 saturation and to determine the effect of coal-rank. A series of unconfined compressive strength (UCS) tests was conducted on Australian brown and black coal samples saturated with water and N2 at various saturation pressures. An advanced acoustic emission (AE) system was utilized to identify the changes in crack propagation behaviors under each condition. According to the results, both CO2 and water act similarly with coal by enhancing the ductile properties of the coal mass and this mechanical weakening is greater for high-rank coal. Conversely, N2 saturation slightly enhances coal strength and delays crack propagation in coal and this strength enhancement can be improved by increasing the N2 saturation pressure

Experimental investigation of geochemical and mineralogical effects of CO2 sequestration on flow characteristics of reservoir rock in deep saline aquifers

Interactions between injected CO2, brine, and rock during CO2 sequestration in deep saline aquifers alter their natural hydro-mechanical properties, affecting the safety, and efficiency of the sequestration process. This study aims to identify such interaction-induced mineralogical changes in aquifers, and in particular their impact on the reservoir rock's flow characteristics. Sandstone samples were first exposed for 1.5 years to a mixture of brine and super-critical CO2 (scCO2), then tested to determine their altered geochemical and mineralogical properties. Changes caused uniquely by CO2 were identified by comparison with samples exposed over a similar period to either plain brine or brine saturated with N2. The results show that long-term reaction with CO2 causes a significant pH drop in the saline pore fluid, clearly due to carbonic acid (as dissolved CO2) in the brine. Free H(+) ions released into the pore fluid alter the mineralogical structure of the rock formation, through the dissolution of minerals such as calcite, siderite, barite, and quartz. Long-term CO2 injection also creates a significant CO2 drying-out effect and crystals of salt (NaCl) precipitate in the system, further changing the pore structure. Such mineralogical alterations significantly affect the saline aquifer's permeability, with important practical consequences for the sequestration process

Effective usage of poker vibrator for compacting quarry dust: an application to ground improvement in shallow foundation design

Appropriate ground improvement is required to stabilize soil under shallow foundations when there is a high groundwater table or weak soil. In such situations, a granular material like sand or quarry dust is widely used in the construction industry as a filling material to achieve higher bearing strength and to minimize settlement underneath foundations. Quarry dust, which is a waste product of the crushing process, is more economical and environmentally friendly. According to existing studies, quarry dust can be easily compacted by providing a vibration effect and a poker vibrator is a practical approach that can be used to achieve high degrees of compaction in quarry dust. However, as this technique is still quite novel to the industry, the expected results, in terms of degree of compaction, cannot be guaranteed. This is basically due to inappropriate practice and lack of guidance in the application of poker vibration. It is therefore essential to eliminate inappropriate practice by carrying out laboratory experiments on optimum poker vibration application techniques. The aim of this study was to optimize the effectiveness of poker vibrator in shallow foundation design by studying various factors affecting it, including time of application, shape of the foundation, preferable layer thicknesses and patterns of application of poker vibrators. This was done by conducting a series of poker vibration compaction experiments in circular and square containers and then by assessing the variation of degree of compaction in each trial. According to the test results, the most effective period of compaction for poker vibration comes at around 30 s after the compaction commences and lasts up to around 10 s. Degrees of compaction (DOC) in both circular and square containers increase with increasing application points, because the higher the number of vibration points, the more the compaction process is enhanced. The application of vibrator at the middle gives a relatively higher DOC than application at corners, because the vibration of middle area affects a greater area in the quarry dust fill compared to vibrating from a corner. DOC reduces with increasing initial layer thickness, regardless of pattern, because reduction of the layer thickness causes the vibration applying dust thickness to be reduced, which causes more vibration to the dust in the entire layer. The best poker vibration application pattern was also investigated