Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

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

Study of the Configuration and Performance of Air-Air Ejectors based onCFD Simulation

International audienc

“Pyramid solar distillers: A comprehensive review of recent techniques”

The most interesting themes worldwide are those relating to sustainable water and energy supplies. They have a significant impact on any society's economic wellbeing. Desalination of brackish water has proven to be a good solution to the freshwater issue that many regions of the world face. Solar stills (SSs) are a simple distillation technique for freshwater purification. From the conventional SSs to the modified SSs, several studies have been carried out to improve the effectiveness of this technique. Pyramid solar stills are effective and efficient, according to researches that have been done to develop several types of solar stills for increased distillate production. In this review, we aim to provide an extensive review of recent advancements in pyramid solar distillation techniques, including new technologies, methods, and best practices. Consequently, this paper helps researchers choose the optimal technique to get the best-optimized productivity from a pyramid solar still. This review highlights the efforts of researchers to improve the efficiency of solar distillation systems by exploring recent techniques and innovations in pyramid solar distillers up to 2023. Various results have demonstrated the significance of modifications or improvements to pyramid SSs, such as utilizing storage materials, which can significantly increase productivity by approximately 35%. Additionally, a v-corrugated absorber with PCM can enhance the yield by about 87.4%. Furthermore, the use of wick materials can increase freshwater production by up to 122%, with jute wick outperforming cotton wick. Integrating evacuated tubes and carbon black nanofluid into a pyramid solar still can also improve freshwater production by approximately 57.1%. Combining nano and wick materials can further boost pyramid distiller productivity by up to 176% and increase thermal efficiency to 60.44%. Moreover, using pyramid distillers with revolving cylinders and electrical heaters can result in a daily output increase of 214%, producing up to 9100 ml/m2/day

Parameters affecting the efficiency of solar stills—Recent review

Although water is the second most important fluid, after air, found on the Earth, there is a vital problem in the availability of water for many organisms, and this problem faces the whole world. As a result, scientists have developed many methods of purifying the saline/brackish water to be suitable for different uses in addition to the purpose of drinking. Fortunately, solar distillation is very rewarding in terms of operating costs and costs for a liter of freshwater distillated with using clean and environmentally friendly energy. Solar distiller is one of the solar distillation systems devices, which is simple in construction, cheap, and easy to use but it has the drawback of low productivity. This article aims to provide a summary of the different ideas and works on solar stills through different variables that affect the performance of distillers. In contrast to the review papers dealing with this topic, this paper contains comprehensive and complete details and careful reviews of all the variables that affect the performance of distillers. Therefore, it is like a ladder in front of the authors until they reach the recent of what has been studied on the distillers in a simplified way to save time and effort, which will help them to come up with different ideas that were not easily studied. Thus, this paper introduces an overview on the detailed parameters affecting the performance of solar stills. These parameters are climatic, design, and operating factors. Climatic factors consist of solar radiation, ambient temperature, air speed, and dusty and cloudy weather. While the design factors include the evaporative and exposure surface areas, glazing cover material, inclination, and thickness, distiller material, and of insulating material and thickness. Whist, the operating parameters consist of the water temperature, feed water temperature, applying vacuum, temperature difference between water and glass cover, and hybrid systems. From the extensive literature, it is concluded that the climatic, design, and operating factors significantly affect the performance of the solar still. Finally, some points are proposed for further investigation