In order to meet the immense demand for surgical care in Bangladesh, public hospitals must address critical shortages in skilled human resources, inadequate physical infrastructure, and low availability of equipment and essential medications. This study identified numerous areas in which the international community can play a vital role in increasing surgical and anesthesia capacity in Bangladesh and ensuring safe surgery for all in the country.
Abstract:ObjectiveTo assess the consistent availability of basic surgical resources at selected facilities in seven countries.MethodsIn 2010–2014, we used a situational analysis tool to collect data at district and regional hospitals in Bangladesh (n = 14), the Plurinational State of Bolivia (n = 18), Ethiopia (n = 19), Guatemala (n = 20), the Lao People's Democratic Republic (n = 12), Liberia (n = 12) and Rwanda (n = 25). Hospital sites were selected by pragmatic sampling. Data were geocoded and then analysed using an online data visualization platform. Each hospital’s catchment population was defined as the people who could reach the hospital via a vehicle trip of no more than two hours. A hospital was only considered to show consistent availability of basic surgical resources if clean water, electricity, essential medications including intravenous fluids and at least one anaesthetic, analgesic and antibiotic, a functional pulse oximeter, a functional sterilizer, oxygen and providers accredited to perform surgery and anaesthesia were always available.FindingsOnly 41 (34.2%) of the 120 study hospitals met the criteria for the provision of consistent basic surgical services. The combined catchments of the study hospitals in each study country varied between 3.3 million people in Liberia and 151.3 million people in Bangladesh. However, the combined catchments of the study hospitals in each study country that met the criteria for the provision of consistent basic surgical services were substantially smaller and varied between 1.3 million in Liberia and 79.2 million in Bangladesh.ConclusionMany study facilities were deficient in the basic infrastructure necessary for providing basic surgical care on a consistent basis.
Introduction: During the course of systemic inflammation, most of the immune cell types get activated to a certain degree as part of, or contributing to, the cascade of physiopathological events. Whether for some cells, classically phagocytes of the innate immune system, it is clear that direct sensing of pathogen-associated molecular patterns leads to activation initiating systemic inflammation, the picture is not so clear for natural killer (NK) cells. While NK cells have been shown to express toll-like receptors (TLR), the role of these receptors on NKs during systemic inflammation has not been directly addressed. Methods: To directly assess the role of TLR expression on NK cells we used an adoptive transfer model in which NKs purified from the spleens of WT, TLR4KO and TLR2/4DKO mice were transferred intravenously to RAG2 -/-γc -/-(devoid of T, B and NK cells). Five days after reconstitution the mice were challenged intraperitoneally with conventional or TLR-grade lipopolysaccharide (LPS). Immune cell activation and production of IFNγ by NK cells was determined after 6 hours by FACS analysis. Results: We observed no differences in reconstitution of the recipient mice with NK cells from different backgrounds suggesting no difference in trafficking and survival of the transferred cells. At 6 hours after LPS challenge, WT, TLR4KO or TLR2/4DKO NK cells recovered from the spleen and lungs of RAG2 -/-γc -/-mice showed comparable levels of CD69 activation marker expression. Intracellular labeling for IFNγ in NK cells also revealed no significant differences. Conclusion: Whether there is a role for direct TLR signaling on NK cells remains the objective of further investigations; however, our data show that in the course of a systemic inflammatory process, like endotoxinemia, the expression of TLR2 and TLR4 by NK cells makes no difference in terms of their activation and secretion of IFNγ P2 Role of 6-hour, 12-hour, and 24-hour lactate clearance in mortality of severe sepsis and septic shock patients. Introduction: Lactate is one of biomarkers used for risk stratification, resuscitation target, and death prediction in sepsis [1,2]. Interpretation of lactate clearance was proven more superior than single measurement to evaluate resuscitation adequacy and to determine prognosis [3,4]. This study aimed to find out whether mean differences of 6-hour, 12-hour, and 24-hour lactate clearance were observed between nonsurvivors and survivors of acute phase mortality in severe sepsis and septic shock patients. Methods: The study design was prospective cohort. Subjects were collected by consecutive sampling from the emergency department, hospital ward, and ICU at Cipto Mangunkusumo Hospital, Jakarta. Lactate levels were measured at 6, 12, and 24 hours, and subjects were subsequently followed to evaluate 3-day mortality. To determine their association with mortality, we used mean difference analysis of those three lactate clearance periods between nonsurvivors and survivors. In addition, to determine the cutoff value, we used re...
SummaryP 300 event-related potentials were recorded in 12 patients with chronic low back pain following epidural methylprednisolone administration. The values of absolute peak latencies and amplitudes of P 300 were recorded before (baseline) and on the 5th and 10th days following epidural injection. Intensity of pain was also recorded using a 10-cm visual analogue scale score. The absolute peak latency of P 300 significantly decreased on the 5th and 10th days following epidural methylprednisolone (p < 0.001) when compared with baseline value. Visual analogue scores also decreased significantly (p < 0.001) after the 5th and 10th days of epidural methylprednisolone. These observations suggest that following epidural methylprednisolone administration in chronic low back pain patients, significant improvement in cognitive functions and pain relief go hand in hand.
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