Catalogues of Efficient Minimal Weakly Balanced RMDs in Circular Periods of Three Different Sizes

In this article, efficient minimal circular weakly balanced RMDs are constructed for the situations where these designs cannot be constructed through generators. Catalogues of these efficient designs are compiled in periods of three different sizes. In the proposed designs, v/2 ordered pairs of distinct treatments do not appear as their preceded value while the remaining ones appear once, where v is number of treatments to be compared

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

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

Glycyrrhizin, Curcumin and Cinnamon Prevent From Concanavalin-A and Acetaminophen-Induced Liver Injury and Oxidative Stress in Mouse Model

Daily exposure to a number of xenobiotics is the major contributing factor to liver injury. The present study investigated the mechanism of hepatoprotection by glycyrrhizin, curcumin and cinnamon in two distinct models of hepatotoxicity i.e., by using Concanavalin-A (ConA) and Acetaminophen (APAP). For this evaluation, balb/c mice were pretreated with glycyrrhizin (200 mg/kg i.g.), curcumin (100 mg/kg i.g.) and cinnamon (200 mg/kg i.g.) extracts for 14 days followed by administration of ConA (15 mg/kg i.v.) and APAP (200 mg/kg i.p.) for 8 hours. At the end of the experiment, mice were dissected and blood and liver samples were collected for biochemical and histopathological analysis. Statistical analysis by using one-way ANOVA followed by DMR test was performed for the significance of results. The results showed that pre-treatment of glycyrrhizin, curcumin and cinnamon ameliorated the damaging effects of ConA and APAP on the liver as indicated by the serum transaminase enzymes and total protein levels. In addition, ConA and APAP exerted severe damage on liver tissues as confirmed from the histopathological analysis. However, glycyrrhizin, curcumin and cinnamon prevented liver injury, possibly through antioxidant mechanism. In conclusion, glycyrrhizin, curcumin and cinnamon possessed antioxidant properties with therapeutic potential in liver injury related to oxidative stress

Some Generalized Classes of Efficient Circular Repeated Measurements Designs Which are Strongly Balanced

Repeated measurement designs (RMDs) are frequently used in the fields of psychology, animal sciences, medicine and pharmacology, etc. Minimal strongly balanced RMDs are important to estimate the residual and direct effects independently and economically. Minimal strongly balanced generalized RMDs are preferred where minimal strongly balanced RMDs are impossible. Here, some new generators are developed for minimal strongly balanced generalized RMDs in periods of (i) two, (ii) three, and (iii) four different sizes. Proposed designs possess the high efficiency of Separability

Correction to: Anthropometric and metabolic indices in assessment of type and severity of dyslipidemia

Abstract After the publication of this work [1] an error was noticed in one of the formulas

Additional file 1: Figure S1. of Anthropometric and metabolic indices in assessment of type and severity of dyslipidemia

Enrolment flowchart of the study population. Two hundred seventy-five participants visited the free health camps. Thirty-seven participants were excluded because of HCV diagnosis (n=5), Postprandial state (n=30) and diabetes (n=2). The final group sample consisted of 238 participants. Figure S2: Venn-Diagram displays overlaps between prevalence of TG, high-LDL, and low-HDL levels in the dyslipidemic population. Figure S3: Receiver operating characteristic (ROC) curve analysis to determine the predictive capability of different anthropometric/metabolic parameters for identification of (a) overall dyslipidemia (irregularity in the plasma levels of HDL, LDL, or triglycerides, (b) low-HDL levels, (c) high-LDL, and (d) high-TG. (PPT 370 kb