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

Automatic Classification for Fruits’ Types and Identification of Rotten Ones Using k-NN and SVM

Having a system that classifies different types of fruits and identifies the quality of fruits will be of a value in various areas especially in an area of mass production of fruits’ products. This paper presents a novel system that differentiates between four fruits types and identifies the decayed ones from the fresh. The algorithms used are based on the colour and the texture features of the fruits’ images. The algorithms extract the RGB values and the first statistical order and second statistical of the Gray Level Co-occurrence Matrix (GLCM) values. To segregate between the fruits’ types, Fine, Medium, Coarse, Cosine, Cubic, and Weighted K-Nearest Neighbors algorithms are applied. The accuracy percentages of each are 96.3%, 93.8%, 25%, 83.8%, 90%, and 95% respectively.  These steps are tested with 46 pictures taken from a mobile phone of seasonal fruits at the time i.e., banana, apple, and strawberry. All types were accurately identifying.  To tell apart the decayed fruits from the fresh, the linear and quadratic Support Vector Machine (SVM) algorithms differentiated between them based on the colour segmentation and the texture feature algorithms values of each fruit image. The accuracy of the linear SVM is 96% and quadratic SVM 98%

Automatic Classification for Fruits’ Types and Identification of Rotten Ones Using k-NN and SVM

Having a system that classifies different types of fruits and identifies the quality of fruits will be of a value in various areas especially in an area of mass production of fruits’ products. This paper presents a novel system that differentiates between four fruits types and identifies the decayed ones from the fresh. The algorithms used are based on the colour and the texture features of the fruits’ images. The algorithms extract the RGB values and the first statistical order and second statistical of the Gray Level Co-occurrence Matrix (GLCM) values. To segregate between the fruits’ types, Fine, Medium, Coarse, Cosine, Cubic, and Weighted K-Nearest Neighbors algorithms are applied. The accuracy percentages of each are 96.3%, 93.8%, 25%, 83.8%, 90%, and 95% respectively.  These steps are tested with 46 pictures taken from a mobile phone of seasonal fruits at the time i.e., banana, apple, and strawberry. All types were accurately identifying.  To tell apart the decayed fruits from the fresh, the linear and quadratic Support Vector Machine (SVM) algorithms differentiated between them based on the colour segmentation and the texture feature algorithms values of each fruit image. The accuracy of the linear SVM is 96% and quadratic SVM 98%

In vitro activity of some natural honeys against Entamoeba histolytica and Giardia lamblia trophozoites

Considering the potentiality of honey in combating diseases, the present study was carried out aiming to assess the in vitro antiprotozoal activity of several honeys (Ziziphus spina-christi, Acacia nilotica, Acacia seyal, and Cucurbita maxima) against Entamoeba histolytica and Giardia lamblia by employing the sub-culture method. All the tested honeys inhibited the growth of trophozoites, and the level of inhibition varied according to the assayed concentrations and incubation times. Acacia seyal honey had completely stopped motility of E. histolytica trophozoites at a concentration ≤ 50 µg/ml after incubation for 72 h. Ziziphus spina-christi, Acacia seyal, and Acacia nilotica honeys had completely inhibited the growth of Giardia lamblia trophozoites at concentration ≤ 200 µg/ml after 72 h. These inhibitory activities were similar to that of Metronidazole™ which showed IC50 = 0.27. The mammalian cytotoxicity of these honeys against normal Vero cell line which determined by applying MTT method verified the nontoxicity of the examined honeys. Also the proximate composition of the samples indicated compliance with the natural honey standards. The findings of the study indicate the need for in vivo studies and further investigations to identify active principles with antiprotozoal activities from natural honeys. Keywords: Natural honey, Antiprotozoal, Cytotoxicity, Metronidazole

Nectar secretion dynamics and honey production potentials of some major honey plants in Saudi Arabia

The contribution of a bee plant species to honey production depends on the plant’s nectar secretion quality and quantity, which is mainly governed by biotic and abiotic factors. The aim of the current study, was to investigate the nectar secretion dynamics and honey production potential of 14 major bee plant species of the target area. We examined the quantity and dynamics of nectar sugar per flower five times a day using a nectar sugar washing technique and direct measuring of nectar with calibrated capillary tubes. The average nectar sugar amount of the species varied from 0.41 mg/flower to 7.7 mg/flower (P < 0.0001). The honey sugar per flower was used to extrapolate the honey production potential per plant and per hectare of land. Accordingly the honey production potential of the species observed to vary from 14 kg/hectare in Otostegia fruticosa to 829 kg/hectare in Ziziphus spina-christi. The nectar secretion dynamics of the species generally showed an increasing trend early in the morning, peaking toward midday, followed by a decline but different species observed to have different peak nectar secretion times. Generally, the tree species secreted more nectar sugar/flower than the herbs. The nectar secretion amount of the species was positively correlated with the ambient temperature, indicating the adaptation of the species to hot climatic conditions. However, different species were observed to have a different optimum temperature for peak nectar secretion. Despite the limited rainfall and high temperature of the area, many plants were found to have good potential for honey production. The monetary value of honey per hectare of the studied honeybee plant species can be of equal or greater than the per-hectare monetary value of some cultivated crops that require numerous inputs. In addition, the information generated is believed to be useful in apiary site selection and to estimate the honey bee colony carrying capacity of an area

New cytotoxic isoprenoid derivatives from the Red Sea soft coral<i> Sarcophyton glaucum</i>

<div><p>Chemical investigation of the soft coral <i>Sarcophyton glaucum</i> collected from the Red Sea led to isolation of 11 isoprenoidal metabolites (<b>1</b>–<b>11</b>). A new sesquiterpenoid, 6-oxo-germacra-4(15),8,11-triene (<b>1</b>), a new natural cembranoid, sarcophinediol, along with two known sesquiterpenoids (<b>2</b> and <b>3</b>) and seven known cembranoids (<b>5</b>–<b>11</b>) was obtained. The structures of the compounds were established based on their NMR, MS, IR and UV spectral data. All compounds were evaluated for their cytotoxicity employing three cancer cell lines (HepG2, MCF-7 and HCT116). Compounds <b>4</b> and <b>6</b> showed significant cytotoxicity towards HepG2 with IC₅₀ values of 18.8 ± 0.07 and 19.9 ± 0.02 μM; respectively. Compounds <b>5</b>–<b>7</b> exhibited potent cytotoxicity against MCF-7 cells with IC₅₀ values of 9.9 ± 0.03, 2.4 ± 0.04 and 3.2 ± 0.02 μM, respectively. Compounds <b>1</b>, <b>4</b> and <b>5</b> showed significant activities towards HCT116 cells with IC₅₀ values of 29.4 ± 0.03, 19.4 ± 0.02 and 25.8 ± 0.03 μM, respectively.</p></div