Measurements of Impoverishing and Catastrophic Surgical Health Expenditures in Low- and Middle-Income Countries and Reduction Interventions in the Last 30 years, a Systematic Review.

INTRODUCTION: Approximately 33 million people suffer catastrophic health expenditure (CHE) from surgery and/or anesthesia costs. The aim of this systematic review is to evaluate catastrophic and impoverishing expenditure associated with surgery and anesthesia in low- and middle-income countries (LMICs). METHODS: We performed a systematic review of all studies from 1990 to 2021 that reported CHE in LMICs for treatment of a condition requiring surgical intervention, including cesarean section, trauma care, and other surgery. RESULTS: 77 studies met inclusion criteria. Tertiary facilities (23.4%) were the most frequently studied facility type. Only 11.7% of studies were conducted in exclusively rural health-care settings. Almost 60% of studies were retrospective in nature. The cost of procedures ranged widely, from $26 USD for a cesarean section in Mauritania in 2020 to $74,420 for a pancreaticoduodenectomy in India in 2018. GDP per capita had a narrower range from $315 USD in Malawi in 2019 to $9955 USD in Malaysia in 2015 (Median = $1605.50, interquartile range = $1208.74). 35 studies discussed interventions to reduce cost and catastrophic expenditure. Four of those studies stated that their intervention was not successful, 18 had an unknown or equivocal effect on cost and CHE, and 13 concluded that their intervention did help reduce cost and CHE. CONCLUSIONS: CHE from surgery is a worldwide problem that most acutely affects vulnerable patients in LMICs. Existing efforts are insufficient to meet the true need for affordable surgical care unless assistance for ancillary costs is given to patients and families most at risk from CHE.

MicroRNAs Targeting Critical Molecular Pathways in Diabetic Cardiomyopathy Emerging Valuable for Therapy.

MicroRNAs have emerged as an important regulator of post-transcriptional gene expression studied extensively in many cancers, fetal development, and cardiovascular diseases. Their endogenous nature and easy manipulation have made them potential diagnostic and therapeutic molecules. Diseases with complex pathophysiology such as Diabetic Cardiomyopathy display symptoms at a late stage when the risk of heart failure has become very high. Therefore, the utilization of microRNAs as a tool to study pathophysiology and device-sustainable treatments for DCM could be considered. The present review focuses on the mechanistic insights of diabetic cardiomyopathy and the potential role of microRNAs.

Global Neurosurgery: Progress and Resolutions at the 75th World Health Assembly.

Neurosurgical advocates for global surgery/neurosurgery at the 75th World Health Assembly gathered in person for the first time after the COVID-19 pandemic in Geneva, Switzerland, in May 2022. This article reviews the significant progress in the global health landscape targeting neglected neurosurgical patients, emphasizing high-level policy advocacy and international efforts to support a new World Health Assembly resolution in mandatory folic acid fortification to prevent neural tube defects. The process of developing global resolutions through the World Health Organization and its member states is summarized. Two new global initiatives focused on the surgical patients among the most vulnerable member states are discussed, the Global Surgery Foundation and the Global Action Plan on Epilepsy and other Neurological Disorders. Progress toward a neurosurgery-inspired resolution on mandatory folic acid fortification to prevent spina bifida-folate is described. In addition, priorities for moving the global health agenda forward for the neurosurgical patient as it relates to the global burden of neurological disease are reviewed after the COVID-19 pandemic.

Patient and Surgeon Perceptions Regarding Microdiscectomy Surgery: A Cross-Sectional Analysis of Social Media Posts.

BACKGROUND: Social media offers a powerful and expanding platform for sharing the patient experience with a large audience through an unsolicited perspective. The content may influence future perceptions around surgical care. OBJECTIVE: To analyze publicly available content on a major social media outlet related to microdiscectomy surgery based on perspective, location, timing, content, tone, and patient satisfaction. METHODS: A query of content was performed for the study period 1 January 2019 to 1 January 2021. Relevant content was identified by hashtag "#microdiscectomy." The initial query returned 10,050 publicly available posts, and the 1500 most "liked" posts were included for evaluation. Content was subsequently classified, characterized, and analyzed. RESULTS: Patients created 72.9% of microdiscectomy-related content, and spine surgeons created 23.5%. Regarding region, 77.0% of posts originated in the United States. The majority portrayed the patient experience in the postoperative phase of care (86.0%), with the primary reference to activities of daily living (56.9%). Only 1.7% of posts depicted the surgical incision site. The connotation of posts was deemed positive in 78.5% of cases. Of the posts referencing satisfaction, 98.3% depicted patient satisfaction with the surgical outcome. Patient posts in the postoperative phase of care (>1 week after surgery) were more than 2 times as likely to express positive tone (OR = 2.07, P ≤ 0.013) with their clinical course compared with patient posts outside the postoperative period. CONCLUSIONS AND CLINICAL RELEVANCE: Overall, social media posts are written in a positive tone, express satisfaction with surgical outcome, typically occur in the postoperative period of care, and depict activities of daily living. These popular mechanisms of communication, such as Instagram, offer spine surgeons unique insights into the true patient experience and may provide an opportunity for surgeons to assess patient feedback, influence patient perceptions, and enhance delivery of lumbar spine care.

Monitoring hospital effluents through physico-chemical characterization and genotoxic testing.

Inefficient monitoring of the water resource recovery facility at various health care establishments may lead to detrimental effects on human population, especially when such water get mixed with potable municipal water supply. To ensure the efficiency and proper functioning of the water resource recovery facility and quality of water, before it being disposed of, the present study was conducted with the assessment of physico-chemical parameters of water and its genotoxic and cytogenetic effects in mice. The sample water was given ad libitum to animals for three different time durations, that is, 7, 15, and 30 days. Bone marrow chromosomal aberration and bone marrow micronucleus (MN) assay were performed to get the extent of genotoxicity and cytogenicity. The results showed presence of chromosomal aberrations like fragments breaks and ring formation in different groups. Besides this, a significant (p < 0.05*, p < 0.01**, p < 0.001***) decrease in the mitotic index was noted in the group which was given 100% concentrated sample water for 30 days. A significant (p < 0.05*, p < 0.01**, p < 0.001***) increase in MN induction and decreased ratio of polychromatic to normochromatic erythrocytes were observed in groups which were given samples at 10% and 100% concentrations for longer durations. The findings suggest that even the recovered sample water reflects a positive in vivo genotoxic potential when given for a longer duration of 30 days, indicating some lacuna in the treatment process.

Synthesis of Novel Bis-imino and Bis-amino Curcuminoids for Evaluation of Their Anticancer and Antibacterial Activity.

A new set of curcumin analogues with a Schiff base moiety were synthesized from a bis-aldehyde derivative of hydroxybenzylidene cyclohexanone and various alicyclic and aromatic amines. The single crystals of compound 2 (bis-aldehyde), compound 3b (bis-cyclohexylimino derivative), and compound 3c (bis-1-imino piperidyl derivative) were developed. The said bis-imino and bis-amino curcuminoids were tested for anticancer activity against MCF-7 utilizing the conventional MTT assay. These Schiff bases had significantly higher anticancer efficacy than curcumin and methotrexate against MCF-7 cell lines. Compounds 3k, 3b, and 3l have the highest efficacy among all synthesized curcuminoids. The MTT results are in accordance with the binding affinities found by docking the said molecules with HER2 Tyrosine Kinase (HER2-TK). Compound 3b is identified as a promising HER2-TK inhibitor and also shows effective inhibition against Gram-positive bacteria Staphylococcus aureus.

Assessment of genotoxic potential of the treated hospital wastewater using cytogenetic assays.

The cytogenetic study using hospital effluent was carried out engaging three cytogenetic end points-chromosomal aberration (CA) assay, mitotic indices (MIs), and micronucleus (MN) Analysis. These bioassays were performed in hematopoietic bone marrow cells of Mus musculus. The experiment commenced with the collection of hospital effluent from the final outlet when wastewater gets collected after undergoing treatment by a multistep process. The pure treated sample water was collected at different times between March 2019 to January 2020 and was given ad libitum to mice at its low (90% dilution) and high (pure form), i.e. 100% concentration for 3 different durations i.e. 7, 15, and 30 days, respectively. The results indicated a significant (P < 0.01) decrease in the MI in all the groups but was more pronounced in the group which was given 100% concentrated sample water collected in the month of March 2019. Besides this, the major finding was presence of CAs like breaks, fragments, rings, and pulverization in bone marrow cells in different groups; however, the frequency of these aberrations varied from group to group. A significant (P < 0.01) increase in MN Induction and decreased ratio (P < 0.01) of polychromatic to normonochromatic erythrocytes were observed in samples collected in month of March both at 10% and 100% concentrations. However, decrease in the ratio was observed in the samples of September and January at low-concentration sample water. The results thus indicated that there was some lacuna in the treatment process earlier in the month of March, which was rectified to some extent in the subsequent months. Hence, the treated wastewater collected in the month of January next year was more suitable for its use than other samples. Summary: These findings thus draw attention toward ensuring efficiency of the treatment plant and quality of water by the hospital management before it being disposed off into the municipal supply; a step that can help society to live a healthy life. With these findings, it is conveyed that all the hospitals, diagnostic labs, and other health care establishments must pay utmost attention at liquid waste disposal mechanism to make environment pollution-free.

Microbial Mutagenicity Assay: Ames Test.

The Microbial mutagenicity Ames test is a bacterial bioassay accomplished in vitro to evaluate the mutagenicity of various environmental carcinogens and toxins. While Ames test is used to identify the revert mutations which are present in strains, it can also be used to detect the mutagenicity of environmental samples such as drugs, dyes, reagents, cosmetics, waste water, pesticides and other substances which are easily solubilized in a liquid suspension. We present the protocol for conducting Ames test in the laboratory.