Who is pirating medical literature? A bibliometric review of 28 million Sci-Hub downloads.

We aimed to define the proportion of downloads on Sci-Hub that are medical in nature and to consider these data at the national level, evaluating the relation between density of medical literature downloads and scientific output, national income classifications, and indicators of internet penetrance

Assessing the Brazilian surgical system with six surgical indicators: a descriptive and modelling study

Background: Brazil boasts a health scheme that aspires to provide universal coverage, but its surgical system has rarely been analyzed. In an effort to strengthen surgical systems worldwide, the Lancet Commission on Global Surgery proposed collection of six standardized indicators: two-hour access to surgery, surgical workforce density, surgical volume, perioperative mortality rate (POMR), and protection against impoverishing and catastrophic expenditure. This study aims to characterize the Brazilian surgical health system with these newly devised indicators while gaining understanding on the complexity of the indicators themselves. Methods: Using Brazil’s national healthcare database, commonly reported healthcare variables were used to calculate or simulate the six surgical indicators. Access to surgery was calculated using hospital locations, surgical workforce density was calculated using locations of surgeons, anesthesiologists and obstetricians (SAO), and surgical volume and POMR were identified with surgical procedure codes. The rates of protection against impoverishing and catastrophic expenditure were modelled using cost of inpatient hospitalization and a gamma distribution of incomes based on GINI and GDP/capita. Findings: In 2014, SAO density is 34·7/100,000 population, surgical volume is 4,433 procedures/100,000 people and POMR is 1·71%. 79·4% of surgical patients are protected against impoverishing expenditure and 84·6% were protected against catastrophic expenditure due to surgery each year. Two-hour access to surgery was not able to be calculated from national health data, but a proxy measure suggested that 97·2% of the population has two-hour access to a hospital that may be able to provide surgery. Geographic disparities were seen in all indicators. Interpretation: Brazil‘s public surgical system meets several key benchmarks. Geographic disparities, however, are substantial and raise concerns of equity. Policies should focus on stimulating appropriate geographic allocation of the surgical workforce. In some cases, where benchmarks for each indicator are met, supplemental analysis can further inform our understanding of health systems. This measured and systematic evaluation of surgical systems should be encouraged for all nations seeking to better understand their surgical systems. Funding: There was no funding for this study

Surgical care in the public health agenda

The current article examines surgical care as a public health issue and a challenge for health systems organization. When surgery fails to take place in timely fashion, treatable clinical conditions can evolve to disability and death. The Lancet Commission on Global Surgery defined indicators for monitoring sustainable universal access to surgical care. Applied to Brazil, the global indicators are satisfactory, but the supply of surgeries in the country is marked by regional and socioeconomic inequalities, as well as between the public and private healthcare sectors

Association of serum ferritin and glycated haemoglobin in patients of type 2 diabetes mellitus and its correlation with components of metabolic syndrome

Background: Ferritin is a universal intracellular protein that stores iron and releases it in a controlled fashion, and reflects iron stores of the body. Recent studies indicate that increased body iron stores are associated with development of type 2 diabetes mellitus (DM) hence affecting the level of glycated haemoglobin. The aim and objectives of this study were to determine the relationship between serum ferritin and glycated haemoglobin in type 2 diabetes patients and to find out correlation between serum ferritin level and components of metabolic syndrome.Methods: This study included 100 cases of type 2 DM compared with age and sex-matched 100 non-diabetic controls. Serum ferritin, fasting blood sugar, lipid parameters and waist circumference were estimated, and glycated haemoglobin was calculated by HPLC method.Results: The mean serum ferritin in cases was 178.59±84.17 µg/l and in controls was 107.17±13.83 µg/l (p=0.0001). The mean age was 53.32±10.14 years in cases and 51.8±10.54 years in controls. Mean HbA1C level in cases was higher (8.40±1.22) as compared to controls (5.4±0.34) and it was statistically significant (p<0.0001). There was a positive linear correlation between HbA1C level and serum ferritin irrespective to gender in case group (r=0.342) and it was statistically significant (p<0.0001). Serum ferritin was significantly higher in hypertensive type 2 DM patients than hypertensive non-diabetic patients (p<0.0239).Conclusions: The findings of this study suggest that increased level of serum ferritin is positively related to glycaemic control

The impact of physician migration on mortality in low and middle-income countries : An economic modelling study

Background The WHO estimates a global shortage of 2.8 million physicians, with severe deficiencies especially in low and middle-income countries (LMIC). The unequitable distribution of physicians worldwide is further exacerbated by the migration of physicians from LMICs to high-income countries (HIC). This large-scale migration has numerous economic consequences which include increased mortality associated with inadequate physician supply in LMICs. Methods We estimate the economic cost for LMICs due to excess mortality associated with physician migration. To do so, we use the concept of a value of statistical life and marginal mortality benefit provided by physicians. Uncertainty of our estimates is evaluated with Monte Carlo analysis. Results We estimate that LMICs lose US$15.86 billion (95$3.4 to $38.2) annually due to physician migration to HICs. The greatest total costs are incurred by India, Nigeria, Pakistan and South Africa. When these costs are considered as a per cent of gross national income, the cost is greatest in the WHO African region and in low-income countries. Conclusion The movement of physicians from lower to higher income settings has substantial economic consequences. These are not simply the result of the movement of human capital, but also due to excess mortality associated with loss of physicians. Valuing these costs can inform international and domestic policy discussions that are meant to address this issue

Congenital Absence of the Common Bile Duct - A Rare Anomaly with an Evolving Association with Esophageal Atresia

Congenital absence of the common bile duct (CBD), also known as âcholecystohepatic ductâ or âinterposition of the gallbladderâ is a rare extrahepatic biliary anomaly characterized by the hepatic ducts entering the gallbladder directly and the cystic duct draining the entire biliary tree into the duodenum. There have been only been four reports of children with congenital absence of the CBD, with three of these also carrying a diagnosis of esophageal atresia, suggesting an association between the two entities. We report an additional case of a child with a history of tracheoesophageal fistula and congenital absence of the CBD as well a review of the literature. Keywords: Gallbladder interposition, Biliary tract anomaly, Pediatric cholecystitis, Acalculous cholecystitis, Roux-en-y hepaticojejunostom

A Nationwide Cohort Study of Outcome after Pediatric Appendicitis

Introduction Children with appendicitis often present with complicated disease. The aim of this study was to describe the clinical management of pediatric appendicitis, and to report how disease severity and operative modality are associated with short- and long-term risks of adverse outcome. Materials and Methods A nationwide retrospective cohort study of all Swedish children (<18 years) diagnosed with appendicitis, 2001 to 2014 (n = 38,939). Primary and secondary outcomes were length of stay, surgical site infections, readmissions, 30-day mortality, and long-term risk of surgery for small bowel obstruction (SBO). Implications of complicated disease and operative modality were assessed with adjustment for age, gender, and trends over time. Results Complicated appendicitis was associated with longer hospital stay (4 vs. 2 days, p < 0.001), increased risk of surgical site infection (5.9 vs. 2.3%, adjusted odds ratio [aOR]: 2.64 [95% confidence interval, CI: 2.18-3.18], p < 0.001), readmission (5.5 vs. 1.2, aOR: 4.74 [95% CI: 4.08-5.53], p < 0.001), as well as long-term risk of surgery for SBO (0.7 vs. 0.2%, adjusted hazard ratio [aHR]: 3.89 [95% CI: 2.61-5.78], p < 0.001). Intended laparoscopic approach was associated with reduced risk of surgical site infections (2.3 vs. 3.1%, aOR: 0.74 [95% CI: 0.62-0.89], p = 0.001), but no overall reduction in risk for SBO; however, successful laparoscopic appendectomy was associated with less SBO during follow-up compared with open appendectomy (aHR: 0.27 [95% CI: 0.11-0.63], p = 0.002). Conclusion Children treated for complicated appendicitis are at risk of substantial short- and long-term morbidities. Fewer surgical site infections were seen after intended laparoscopic appendectomy, compared with open appendectomy, also when converted procedures were accounted for

Access to safe blood in low-income and middle-income countries: lessons from India

Timely, affordable access to screened blood is essential to the provision of safe surgical care, and depends on three key aspects: adequate volume of blood supply, safe protocols for blood donation and transfusion, and appropriate regulation to ensure safe, equitable, and sustainable distribution. Many low- and middle-income countries experience a deficit in these categories, particularly in rural areas. We draw on the experience of rural surgical practitioners in India and summarize the existing literature to evaluate India’s blood banking system and discuss its major barriers to the safe and equitable provision of blood. Many low- and middle-income countries struggle with accruing a sufficient voluntary, unpaid blood donation base to meet the need. Efforts to increase blood supply through mandatory family replacement donations can lead to dangerous delays in care provision. Additionally, prohibition of unbanked, directed blood transfusion restricts the options of health practitioners, particularly in rural areas. Blood safety is also a significant concern, and efforts must be taken to decrease the risk of transfusion-transmitted infections and inform and treat donors who test positive. Lastly, blood banking systems need a centralized governing body to ensure fair prices for blood, promote comprehensive transfusion reporting, and increase system-wide transparency and accountability