Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019

Background The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively. Funding The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38)

Superior removal of humic acid from aqueous stream using novel calf bones charcoal nanoadsorbent in a reversible process

While the potable water disinfection regimen has significantly reduced waterborne diseases, development of disinfection byproducts (DBP) during this process has brought a global threat to the environment and human health. The most notorious water pollutant, humic acid (HA), transforms into carcinogenic byproducts during the disinfection process (chlorination) of water treatment. HA removal methods are neither economic nor widely available. This study addresses the most urgent global issue of HA removal by developing an innovative and self-regenerative process based on a low-cost and self-regenerative calf bone char (CBC) that removed 92.1–100% of HA. CBC-based HA removal has not been described yet. The developed CBC, as a super adsorbent of HA, was initially characterized by a scanning electron microscope. Various parameters of adsorption/desorption and self-regeneration of CBC adsorbent were experimentally determined. Results show that prepared CBC with a 112 m2/g surface area exhibited adsorption of 38.08 mg/g (HA = 20 mg/L, pH = 4.0) which is several folds higher than the typical amount of HA present in water. The 30 m reaction time was enough to remove HA which is the shorter HA time in comparison to other similar studies. The increase of HA from 0.5 to 5 g/L, raises % HA removal (36.7–99.8%) while a pH decrease (10–4) increases adsorption (12.3–98.3%). The adsorption data fitted well with the pseudo-second-order model and the Langmuir isotherm which demonstrate that adsorption takes place by a monolayer formation. Thermodynamic constants supported the endothermic, spontaneous and reversible nature of adsorption which can attain 100% HA removal. 100% regeneration of exhausted CBC by NaOH further supports the sustainability of the process. CBC as a new adsorbent material thus provides an economical and sustainable water pre-treatment procedure. The present study provides technical guidance for building a cost-effective and scalable process capable of providing clean water

Pregnant Women’s Experiences with Midwifery-Led Antenatal Care Services in Peri-Urban Communities in Karachi, Pakistan

Nida Salman Yazdani,1 Kaniz Amna Haider,2 Amna Khan,2 Syed Ali Jaffar Zaidi,2 Akbar Rajani,1 Imran Nisar,2 Fyezah Jehan,2 Zahra Hoodbhoy2 1Research and Programs, VITAL Pakistan Trust, Karachi, Pakistan; 2Department of Paediatrics and Child Health, the Aga Khan University, Karachi, PakistanCorrespondence: Zahra Hoodbhoy, Aga Khan University, Stadium Road PO Box 3500, Karachi, 74800, Pakistan, Tel +92-3343481179, Email [email protected]: To understand pregnant women’s experience with midwifery-led antenatal care services using the Respectful Maternity Care charter in primary health centers in Karachi, Pakistan.Methods: This cross-sectional study was at Rehri Goth and Ibrahim Hyderi, two peri-urban communities in Karachi, Pakistan, where women receive antenatal care services. All pregnant women in their third trimester who consented during the study period were included. The participants were asked about access to care, antenatal care experience, person-centered approach, and general satisfaction with the facility using a pre-designed questionnaire. These themes were mapped onto the universal Respectful Maternity Care charter. Descriptive statistics were used to summarize the findings in each of these themes. Multivariable logistic regression techniques to determine the relationship between the dependent and independent variables.Results: There were 904 women who agreed to participate in this study during January to December 2021. Majority of the women (94%, n=854) were satisfied with the operating hours and cleanliness. More than 90% of the women reported positive experiences regarding privacy, respectful treatment by midwives, and non-discriminatory care. However, 40% (n=362) of the women reported not receiving adequate information and informed consent before a medical procedure, while 65% (n=587) reported poor counseling for birth preparedness. Maternal age, women’s occupation, women’s education, and parity were found to be significantly associated with respect provided, satisfaction with counseling and the consent process.Conclusion: This study reported satisfaction of pregnant women with the facility’s ambiance, respect, and care; however, poor communication skills regarding consent and antenatal counseling were reported. The findings suggest the need for more efficient strategies, such as regular respectful maternity care and technical training to strengthen midwife-patient interactions and enhance overall satisfaction, thus improving maternal and newborn outcomes.Keywords: antenatal care, patient satisfaction, Respectful Maternity Care, Pakista

Genetic gains with genomic versus phenotypic selection for drought and waterlogging tolerance in tropical maize (Zea mays L.)

Not AvailableAbstract Erratic rainfall often results in intermittent drought and/or waterlogging and limits maize (Zea mays L.) productivity in many parts of the Asian tropics. Developing climate-resilient maize germplasm possessing tolerance to these key abiotic stresses without a yield penalty under optimal growing conditions is a challenge for breeders working in stress-vulnerable agro-ecologies in the region. Breeding stress-resilient maize for rainfed stress-prone ecologies is identified as one of the priority areas for CIMMYT-Asia maize program. We applied rapid cycle genomic selection (RCGS) on two multiparent yellow synthetic populations (MYS-1 and MYS-2) to improve grain yield simultaneously under drought and waterlogging conditions using genomic-estimated breeding values (GEBVs). Also, the populations were simultaneously advanced using recurrent phenotypic selection (PS) by exposing them to managed drought and waterlogging and intermating tolerant plants from the two selection environments. Selection cycles per se (C1, C2, and C3) of the two populations developed using RCGS and PS approach and their test-cross progenies were evaluated separately in multilocation trials under managed drought, waterlogging, and optimal moisture conditions. Significant genetic gains were observed with both GS and PS, except with PS in MYS-2 under drought and with GS in MYS-1 under waterlogging. Realized genetic gains from GS were relatively higher under drought conditions (110 and 135 kg ha−1 year−1) compared to waterlogging (38 and 113 kg ha−1 year−1) in both MYS-1 and MYS-2, respectively. However, under waterlogging stress PS showed at par or better than GS as gain per year with PS was 80 and 90 kg ha−1, whereas with GS it was 90 and 43 kg ha−1 for MYS-1 and MYS-2, respectively. Our findings suggested that careful constitution of a multiparent population by involving trait donors for targeted stresses, along with elite high-yielding parents from diverse genetic background, and its improvement using RCGS is an effective breeding approach to build multiple stress tolerance without compromising yield when tested under optimal conditionsNot Availabl