Leishmanicidal Activity of Films Containing Paromomycin and Gentamicin Sulfate both In Vitro and In Vivo

Background: Based on the efficacy of paromomycin ointment and recent ongoing clinical trials of combination of paromomycin and gentamicin, a new physical form of films of the paromomy­cin and gentamicin was prepared and anti-Leishmania activities of the prepared films were as­sessed in vitro and in vivo.Methods: Paromomycin 15% and gentamicin 0.5% was incorporated in a film using ethyl cellu­lose and HPMC (Hydroxyl Propyl Methyl Cellulose). In order to assess the drug release and anti-Leishmania activities of the preparation, a clone L. major parasite was established using a set of modified NNN medium without overlay liquid layer. Therapeutic effects of the films were evalu­ated using Balb/c mice model. The mice were inoculated with 2×106 L. major promastigotes (MRHO/IR/75/ER) and then when the lesions developed the mice were randomly divided in 3 groups, 10 mice per group, and treated with either perpetrated films or placebo for 28 days or left untreated.Results: Growth inhibition of cloned promastigotes showed that the films have enough releasing capacity and in vivo system, the films containing paromomycin and gentamicin was able to re­duce the lesion size and induced complete cure in 80% of the mice but relapse was seen in 60% of the cured mice and overall 50% cure rate was seen during 20 weeks period of the study.Conclusion: It seems that the prepared films might be further used in human clinical trials

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

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 &lt; 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P &lt; 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P &lt; 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P &lt; 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P &lt; 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

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

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

The Effect of Using Patency File on Apical Transportation in Canals Prepared with Passive Step Back Technique

Background: The purpose of this study was to assess the effect of patency file on apical transportation in curved canals prepared with passive step back (P.S.B) technique. Methods: This is an interceptive experimental, Invitro, study. Human extracted first permanent molars with 19-23mm length and curvature of 15-35 degrees (Schneider method) were considered for use in this study. Simple sampling was done and 35 teeth for each group was selected. In experimental group A canal preparation was done with P.S.B technique and usage of a # 10 file (as Patency file) between successive files. In experimental group B preparation was done in the same way except for usage of patency file. Pre and post operative radiographs were taken with similar condition. Radiographs were scanned and changes in canal curvature was determined using four different methods [Schneider, Weine, Long – Axis techniques (L. A.T), and Digital image overlay technique (overlay. T)] , using Idrisi for windows and AutoCAD softwares. Results: The mean of canal transportation angle in experimental group A with Schneider, Weine , LAT, and Over Lay techniques was: 7.006 ± 3.478, 12. 285 ± 6.032, 4.376 ± 3.516, 3.147 ± 2.744 respectively. Mean of canal transportation angle in experimental group B with the same methods was also determined: 8.009 ± 4.178, 13.55 ± 7.602, 9.464 ± 5.384, and 9.641 ± 5.382 respectively. T- test statistical analysis shows that there are no significant differences between the mean of canal transportation angles in two groups as measured by Schneider and Weine method (P&gt;0.05). Mann- Whitney test shows that there are statistically significant differences between two groups as measured by LAT and Over Lay techniques (P&lt;0.001). Conclusions: Results of this study shows that patency file in conjunction with P.S.B techniques causes significant reduction in apical transportation angle. Shortcomings of Schneider method in determination of canal curvature and specially assessment of apical transportation after instrumentation is mentioned in several studies. Our study shows that both Schneider and Weine techniques are not reliable methods for transportation assessment when compared with Image Over Lay technique. The result of LAT Shows close proximity with Over Lay technique and can be used for evaluation of apical transportation as a simple and reliable technique. Keywords: Apical transportation, Passive step back, Apical patency, Schneider technique, Weine technique, Long axis technique, OverLay technique

The effects of a multimedia education on self-efficacy and self-esteem among patients with acute coronary syndrome: A clinical randomized trial

Background: Acute Coronary Syndrome (ACS) is the first leading cause of death in the industrial world. It is associated with low self-esteem and self-efficacy. Given that patient education is a key role of nurses, this study sought to evaluate the effects of multimedia education on self-efficacy and self-esteem among patients with ACS. Materials and Methods: This randomized clinical trial was conducted in 2017 on 60 patients recruited from the two coronary care units of Hajar and Kashani hospitals, Shahrekord, Iran. Participants were randomly allocated to an intervention and a control group. The study intervention was a multimedia educational program. Data were collected before and 1 and 2 months after the intervention onset using a demographic questionnaire, the Cardiac Self-Efficacy Scale, and Coopersmith Self-Esteem Inventory. Data analyses were performed using repeated measures analysis of variance, t-test, Chi-square test, and Fisher's exact test. Results: The mean score of self-efficacy in the intervention group (F-2 = 119.26, p < 0.001) and in the control group (F-2 = 74.21, p < 0.001) significantly increased across the three measurement time points. The mean score of self-esteem in the intervention group significantly increased across the three measurement time points (F-2 = 101.19, p < 0.001), while it remained significantly unchanged in the control group (F-2 = 2.56, p = 0.086). Conclusions: Multimedia education is effective in significantly improving self-efficacy and self-esteem among patients with ACS. Therefore, nurses can use this strategy to improve these patients' self-efficacy and self-esteem

Comparison of the accuracy of apex locator, digital radiography, and cone-beam computed tomography in root canal working length determination in teeth with external root resorption: An in vitro study

BACKGROUND: The aim of this study was to compare the accuracy of apex locator, digital periapical radiography, and cone-beam computed tomography (CBCT) for determining the root canal working length (WL) in teeth with external root resorption (ERR). MATERIALS AND METHODS: In this in vitro study, the sample consisted of 54 extracted permanent single-rooted human teeth. ERRs were performed at the 3 mm apical root using 65 of nitric acid for 24 h. After determining the actual WL by K-file #10 (gold standard) with the visualization method, the teeth were mounted in alginate and the WL of each tooth was determined using the electronic apex locator (EAL) equipped with a K-file #15. The teeth were mounted with wax in the teeth sockets of a dry human mandible, and the images were obtained by digital phosphor plate receptors and CBCT scans. The mean registered WL of each method was statistically compared with the gold standard WL using one-way ANOVA with P < 0.001. RESULTS: The mean +/- standard deviation (SD) of actual WL was 16.00 +/- 2.24. The mean +/- SD of WLs determined by CBCT, EAL, and digital radiography were 15.38 +/- 2.19, 15.52 +/- 2.32, and 16.83 +/- 2.20, respectively. This study showed that the mean measured WL with ERR in all methods was significantly different from the actual WL (P < 0.001). CONCLUSION: This study showed that there was a significant difference between the actual mean WL and the EAL, digital periapical radiography, and CBCT mean WL. Thus, the combination of EAL and CBCT could be a reliable method for determining WL in the presence of ERR