Microneedles: A New Frontier in Nanomedicine Delivery

This review aims to concisely chart the development of two individual research fields, namely nanomedicines, with specific emphasis on nanoparticles (NP) and microparticles (MP), and microneedle (MN) technologies, which have, in the recent past, been exploited in combinatorial approaches for the efficient delivery of a variety of medicinal agents across the skin. This is an emerging and exciting area of pharmaceutical sciences research within the remit of transdermal drug delivery and as such will undoubtedly continue to grow with the emergence of new formulation and fabrication methodologies for particles and MN. Firstly, the fundamental aspects of skin architecture and structure are outlined, with particular reference to their influence on NP and MP penetration. Following on from this, a variety of different particles are described, as are the diverse range of MN modalities currently under development. The review concludes by highlighting some of the novel delivery systems which have been described in the literature exploiting these two approaches and directs the reader towards emerging uses for nanomedicines in combination with MN

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

‘Secrecy, Trust, Safety’: A multi-stakeholder situation assessment of gendered and contextual vulnerabilities and service level responsiveness to the needs of women who use drugs in Egypt

Background: Women account for one in every three people who use drugs worldwide and tend to progress to drug-use disorders in a shorter time than men. There is limited understanding of the situation of women who use drugs in the Middle East and North Africa. Methods: A multi-stakeholder rapid situation assessment (RSA) was conducted which aimed to investigate gendered and contextual vulnerabilities and service level responsiveness to the needs of women who use drugs (WWUD) in Egypt. An updated profile of female service user characteristics was sought via mapping of addiction and harm reduction services in the National Drug Observatory system. In-depth interviews were conducted with a purposive sample of representatives of UN agencies and health professionals providing treatment/harm reduction (government, private, community) (n=21). Focus groups were facilitated with a convenience sample of women in treatment, accessing HIV services, and community harm reduction ates (n=75). Thematic analysis and triangulation across data sources occurred. Results: Eight themes emerged; Profile of women who use drugs; Access to drugs and settings for female drug use; Dimensions of stigma; Trauma and drivers of female drug use; Networks and intimate partner relationships; High risk behaviours and harms; Barriers to help-seeking and accessing services; and Enhancing gender responsive and transformative evidence based services. Conclusion: This RSA yields a contemporary insight into the vulnerabilities, traumas, discrimination and stigma-related challenges experienced by WWUD in Egypt. Recommendations are made to enhance harm reduction awareness and uptake, and to integrate gender responsive care within existing maternal, addiction and harm reduction service structures

Notch sensitivity of short and 2D plain woven glass fibres reinforced with different polymer matrix composites

This research article investigated the notch sensitivity of two different glass fibre architectures, namely short and 2D plain-woven glass fibres reinforced with unsaturated polyester and epoxy matrix composites fabricated by the hand lay-up technique. This was carried out through open hole tension tests at different ratios of the specimen hole diameter to the specimen with three different values (0.1, 0.2, 0.5) compared to the unnotched specimen. The notch sensitivity of these composites was evaluated using the residual tensile strength by the application of Whitney-Nuismer Mathematical Model. The results showed that by using polyester matrix, the notch sensitivity of composites reinforced with plain-woven glass fibre is higher than that of short glass fibre at different D/W ratios. On the other hand, on testing epoxy matrixes, the notch sensitivity of composites reinforced with plain-woven glass fibre is lower than that of short glass fibre at different D/W ratios