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

Drake, T.M.; Camilleri-Brennan, J.; Tabiri, S.; Fergusson, S.J.; Spence, R.; Fitzgerald, J.E.F.; Bhangu, A.; Harrison, E.M.; Ademuyiwa, A.O.; Fergusson, S.; Glasbey, J.C.; Khatri, C.; Mohan, M.; Nepogodiev, D.; Søreide, K.; Gobin, N.; Freitas, A.V.; Hall, N.; Kim, S.; Negida, A.; Jaffry, Z.; Chapman, S.J.; Arnaud, A.P.; Recinos, G.; Manipal, C.E.; Amandito, R.; Shawki, M.; Hanrahan, M.; Pata, F.; Zilinskas, J.; Roslani, A.C.; Goh, C.C.; Irwin, G.; Shu, S.; Luque, L.; Shiwani, H.; Altamimi, A.; Alsaggaf, M.U.; Rayne, S.; Jeyakumar, J.; Cengiz, Y.; Raptis, D.A.; Fermani, C.; Balmaceda, R.; Modolo, M.M.; Macdermid, E.; Chenn, R.; Yong, C.O.; Edye, M.; Jarmin, M.; D’Amours, S.K.; Iyer, D.; Youssef, D.; Phillips, N.; Brown, J.; George, R.; Koh, C.; Warren, O.; Hanley, I.; Dickfos, M.; Nawara, C.; Öfner, D.; Primavesi, F.; Mitul, A.R.; Mahmud, K.; Hussain, M.; Hakim, H.; Kumar, T.; Oosterkamp, A.; Assouto, P.A.; Lawani, I.; Souaibou, Y.I.; Tun, A.K.; Chong, C.L.; Devadasar, G.H.; Qadir, M.R.M.; Aung, K.P.; Yeo, L.S.; Castillo, V.D.P.; Munhoz, M.M.; Moreira, G.; De Castro Segundo, L.C.B.; Ferreira, S.A.K.; Careta, M.C.; Kim, S.B.; De Sousa, A.V.; Cury, A.D.L.; Miguel, G.P.S.; De Freitas, A.V.C.; Silvestre, B.P.; Vianna, J.G.P.; Felipe, C.O.; Laufer, L.A.V.; Altoe, F.; Da Silva, L.A.; Pimenta, M.L.; Giuriato, T.F.; Morais, P.A.B.; Luiz, J.S.; Araujo, R.; Menegussi, J.; Leal, M.; de Lima, C.V.B.; Tatagiba, L.S.; Leal, A.; dos Santos, D.V.; Fraga, G.P.; Simoes, R.L.; Stock, S.; Nigo, S.; Kabba, J.; Ngwa, T.E.; Brown, J.; King, S.; Zani, A.; Azzie, G.; Firdouse, M.; Kushwaha, S.; Agarwal, A.; Bailey, K.; Cameron, B.; Livingston, M.; Horobjowsky, A.; Deckelbaum, D.L.; Razek, T.; Marinkovic, B.; Grasset, E.; D’Aguzan, N.; Jimenez, J.; Macchiavello, R.; Zhang, Z.; Guo, W.; Junyeong, O.; Zheng, F.; Montes, I.; Sierra, S.; Mendez, M.; Villegas, M.I.; Arango, M.C.M.; Mendoza, I.; Aristizã¡bal, F.A.N.; Botero, J.A.M.; Riaza, V.M.Q.; Restrepo, J.; Morales, C.; Cruz, H.; Munera, A.; Karlo, R.; 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Warda, M.; Deen, K.N.E.; Elnemr, A.E.; Salah, O.; Abbas, M.; Rashad, M.; Elzayyat, I.; Hemeda, D.; Tawfik, G.; Salama, M.; Khaled, H.; Seisa, M.; Elshaer, K.; Hussein, A.; Elkhadrawi, M.; Afifi, A.M.; Ebrahim, O.S.; Metwally, M.M.; Elmelegy, R.; Elsawahly, D.M.E.; Safa, H.; Nofal, E.; Elbermawy, M.; Ghazy, A.A.; Samih, H.; Abdelgelil, A.; Abdelghany, S.; Kholy, A.E.; Aboraya, M.; Elkady, F.; Salma, M.; Samy, S.; Fakher, R.; Aboarab, A.; Samir, A.; Sakr, A.; Haroun, A.; Al-Aarag, A.A.; Elkholy, A.; Elshanwany, S.; Ghanem, E.; Tammam, A.; Hammad, A.M.; Shoura, Y.E.; Ashal, G.E.; Khairy, H.; Antar, S.; Mehrez, S.; Abdelshafy, M.; Hamad, M.G.M.; Hosh, M.; Abdallah, E.; Magdy, B.; Alzayat, T.; Gamaly, E.; Elfeki, H.; Abouzahra, A.; Elsheikh, S.; Elgendy, F.I.; El-Salam, F.A.; Seifelnasr, O.; Ammar, M.; Eysa, A.; Sadek, A.; Toeema, A.G.; Nasr, A.; Abuseif, M.; Zidan, H.; Barakat, S.A.E.; Elsayed, N.; Elrasoul, Y.A.; Elkelany, A.; Ammar, M.S.; Mustafa, M.; Hegazy, Y.; Etman, M.; Saad, S.; Alrahawy, M.; Raslan, A.; Morsi, M.; Rslan, A.; Sabry, A.; Elwakil, H.; Shaker, H.; Abd-Elrasoul, Y.; El-Kashef, H.; Shaalan, M.; Tarek, A.; Elwan, A.; Nayel, A.R.; Seif, M.; Emadeldin, D.; Ghonaim, M.A.; Almallah, A.; Fouad, A.; Sayma, E.A.; Elbatahgy, A.; El-Ma’doul, A.S.; Mosad, A.; Tolba, H.; Elsorogy, D.E.A.A.; Mostafa, H.A.; Omar, A.A.; Hameed, O.S.A.E.; Lasheen, A.; Salam, Y.A.E.; Morsi, A.; Ismail, M.; El-badawy, H.A.; Amer, M.A.; El-Hamouly, A.S.; Attallah, N.A.; Mosalum, O.; Afandy, A.; Mokhtar, A.; Abouelnasr, A.; Ayad, S.; Shaker, R.; Sakr, R.; Shaker, R.; Amreia, M.; Elsobky, S.; Mustafa, M.; Magd, A.A.E.; Marey, A.; Hafez, A.T.; Zalabia, M.F.; Mohamed, M.M.; Fadel, A.; Ahmed, E.A.; Ali, A.; Alwafai, M.G.; Dwydar, A.; Kharsa, S.; Mamdouh, E.; El-Sheemy, H.; Alyoussef, I.; Aly, A.K.; Aldalaq, A.; Alnawam, E.; Alkhabbaz, D.; Saad, M.; Hussein, S.; Elazayem, A.A.; Meshref, A.; Elashmawy, M.; Mousa, M.; Nashaat, A.; Ghanem, S.; Elsayed, Z.M.; Elwaey, A.; Elkadsh, I.; Darweesh, M.; Mohameden, A.; 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doi:10.1007/s00464-018-6064-9

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.

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: A multicenter, prospective, cohort study / T.M. Drake, J. Camilleri-Brennan, S. Tabiri, S.J. Fergusson, R. Spence, J.E.F. Fitzgerald, A. Bhangu, E.M. Harrison, A.O. Ademuyiwa, S. Fergusson, J.C. Glasbey, C. Khatri, M. Mohan, D. Nepogodiev, K. Søreide, N. Gobin, A.V. Freitas, N. Hall, S. Kim, A. Negida, Z. Jaffry, S.J. Chapman, A.P. Arnaud, G. Recinos, C.E. Manipal, R. Amandito, M. Shawki, M. Hanrahan, F. Pata, J. Zilinskas, A.C. Roslani, C.C. Goh, G. Irwin, S. Shu, L. Luque, H. Shiwani, A. Altamimi, M.U. Alsaggaf, S. Rayne, J. Jeyakumar, Y. Cengiz, D.A. Raptis, C. Fermani, R. Balmaceda, M.M. Modolo, E. Macdermid, R. Chenn, C.O. Yong, M. Edye, M. Jarmin, S.K. D’Amours, D. Iyer, D. Youssef, N. Phillips, J. Brown, R. George, C. Koh, O. Warren, I. Hanley, M. Dickfos, C. Nawara, D. Öfner, F. Primavesi, A.R. Mitul, K. Mahmud, M. Hussain, H. Hakim, T. Kumar, A. Oosterkamp, P.A. Assouto, I. Lawani, Y.I. 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Sund, L. Andersson, U. Gunnarsson, Y. Cengiz, S. Ahlqvist, I. Björklund, H. Royson, P. Weber, H. Pahlsson, E. Borin, M. Hjertberg, R. Schmid, D. Schivo, V. Despotidis, S. Breitenstein, R.F. Staerkle, E. Schadde, F. Deichsel, A. Gerosa, A. Nocito, D.A. Raptis, B. Mijuskovic, M. Zuber, L. Eisner, S. Kruspi, K.B. Reinisch, C. Schoewe, A. Novak, A.F. Palma, G. Teufelberger, M. Kimaro, R. King, A.Z.A. Balkan, M. Gumar, M.A. Yavuz, U. Karabacak, G. Lap, B.B. Ozkan, M. Karakahya, R. Adams, R. Morton, L. Henderson, R. Gratton, K.D. Clement, K.Y. Chang, D. Mcnish, R. Mcintosh, W. Milligan, B. Skelly, H. Anderson-Knight, R. Lawther, J. Onimowo, V. Shatkar, S. Tharmalingam, E. Woin, T. Fautz, O. Ziff, S. Dindyal, S. Arman, S. Talukder, V. Gadhvi, L.S. Chew, J. Heath, N. Blencowe, S. Hallam, K. Gash, G.S. Mannu, D. Zachariades, A.C. Snaith, T.S. Hettiarachchi, A. Nesaratnam, J. Wheeler, D. Mccullagh, J.M. Clements, A. Khan, F. Koumpa, C. Neophytou, J. Roth, W.C. Soon, M. Deputy, A. Ahmed, A. Ashton, J. Vincent, J. Almy, T. Khan, J.L.Y. Allen, C.J. Mcintyre, D.C. Marshall, M. Sykes, N. Behar, H. Jordan, Y. Rajjoub, T. Sherman, T. White, A. Watts, R. Ardley, T. Arulampalam, A. Shah, D. Brown, E. Blower, P. Sutton, K. Gasteratos, D. Vimalachandran, C. Magee, A. Mcguigan, S. Mcaleer, C. Morgan, S. Braungart, K. Lafferty, P. Labib, A. Tanase, C. Mangan, L. Reza, H. Woodward, C. Gouldthorpe, M. Turner, J.R.L. Wild, T.A.M. Malik, V.K. Proctor, K. Hewage, J. Davies, A. Dubois, S. Sarwary, A. Zardab, A. Grant, R. Mcintyre, Y.P. Mogan, W. Ho, B.F.H.K. Chong, S. Tewari, G. Humm, E. Farinella, N.J. Hall, N.J. Wright, C.P. Major, T. Xerri, J. Amin, M. Farhad, J.F. Camilleri-Brennan, A.G.N. Robertson, J. Swann, J. Richards, A. Jabbar, P. De Bono, M. Attard, H. Burns, E. Macdonald, M. Baldacchino, J. Skehan, T.F. Hall, M. Gimzewska, G. Mclachlan, J. Shah, J.G.S. Chiu, B. Weber, S.M.Y. Chiu, S. Highcock, M. Hassan, W. Beasley, A. Vlachogiorgos, S. Dias, G. Maharaj, R. Mcdonald, A. Macdonald, P. Witherspoon, A. Baird, P. Sarmah, N. Green, H. Youssef, K. Cross, C.M. Rees, B. Van Duren, E. Upchurch, K. Khan, H. Abudeeb, A. Hammad, S. Karandikar, D. Bowley, A. Karim, W. Chachulski, L. Richardson, G. Dawnay, B. Thompson, A. Mistry, M. Ghetia, S. Roy, O. Al-Obaedi, K. Das, A. Prabhudesai, D.M. Cocker, J.J. Tan, R. Tyler, F. Di Franco, S. Ayyar, S. Vivekanantham, S. Gokani, M. Gillespie, K. Gudlaugsdottir, T. Pezas, C. Currow, M.Y. Kim, A. Birring, J. Edwards, A. Ali, S. Das, M. Jha, K. Atkinson, J. Luck, T. Fozard, M. Puttick, Y. Salama, R. Shah, A.A. Ibrahem, H. Ebdewi, G. Gravante, S. El-Rabaa, H. Nnajiuba, R. Allott, A. Bhargava, Z. Chan, Z. Hassan, M. Makinde, D. Hemingway, R. Dean, A. Boddy, A. Aber, V. Patel, J. Parakh, S. Parthiban, H.K. Ubhi, S. Hosein, S. Ward, K. Malik, L. Jennings, T. Newton, M. Alkhouri, M.K. Kang, C. Houlden, J. Barry, I. Raza, A. Farquharson, S. Bhattacharya, K. Chang, M.S.J. Wilson, Y.N. Neo, I. Ibrahim, E. Chan, F.S. Peck, P.J. 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Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: A multicenter, prospective, cohort study

Drake, Thomas M.;Camilleri-Brennan, Julian;Tabiri, Stephen;Fergusson, Stuart J.;Spence, Richard;Fitzgerald, J. Edward F.;Bhangu, Aneel;Harrison, Ewen M.;Ademuyiwa, Adesoji O.;Fergusson, Stuart;Glasbey, James C.;Khatri, Chetan;Mohan, Midhun;Nepogodiev, Dmitri;Søreide, Kjetil;Gobin, Neel;Freitas, Ana Vega;Hall, Nigel;Kim, Sung-Hee;Negida, Ahmed;Jaffry, Zahra;Chapman, Stephen J.;Arnaud, Alexis P.;Recinos, Gustavo;Manipal, Cutting Edge;Amandito, Radhian;Shawki, Marwan;Hanrahan, Michael;Pata, Francesco;Zilinskas, Justas;Roslani, April Camilla;Goh, Cheng Chun;Irwin, Gareth;Shu, Sebastian;Luque, Laura;Shiwani, Hunain;Altamimi, Afnan;Alsaggaf, Mohammed Ubaid;Rayne, Sarah;Jeyakumar, Jenifa;Cengiz, Yucel;Raptis, Dmitri A.;Fermani, Claudio;Balmaceda, Ruben;Modolo, Maria Marta;Macdermid, Ewan;Chenn, Roxanne;Yong, Cheryl Ou;Edye, Michael;Jarmin, Martin;D’amours, Scott K.;Iyer, Dushyant;Youssef, Daniel;Phillips, Nicholas;Brown, Jason;George, Robert;Koh, Cherry;Warren, Oliver;Hanley, Isaac;Dickfos, Marilla;Nawara, Clemens;Öfner, Dietmar;Primavesi, Florian;Mitul, Ashrarur Rahman;Mahmud, Khalid;Hussain, Margub;Hakim, Hafiz;Kumar, Tapan;Oosterkamp, Antje;Assouto, Pamphile A.;Lawani, Ismail;Souaibou, Yacoubou Imorou;Tun, Aung Kyaw;Chong, Chean Leung;Devadasar, Giridhar H.;Qadir, Muhammad Rashid Minhas;Aung, Kyaw Phyo;Yeo, Lee Shi;Castillo, Vanessa Dina Palomino;Munhoz, Monique Moron;Moreira, Gisele;De Castro Segundo, Luiz Carlos Barros;Ferreira, Salim Anderson Khouri;Careta, Maíra Cassa;Kim, Stella Binna;De Sousa, Alexandre Venancio;Cury, Alyne Daltri Lazzarini;Miguel, Gustavo Peixoto Soares;De Freitas, Ana Vega Carreiro;Silvestre, Barbara Pereira;Vianna, Julia Guasti Pinto;Felipe, Carolina Oliveira;Laufer, Luis Alberto Valente;Altoe, Fernanda;Da Silva, Luana Ayres;Pimenta, Marina Luiza;Giuriato, Thiago Fernandes;Morais, Paulo Alves Bezerra;Luiz, Jessica Souza;Araujo, Rafael;Menegussi, Juliana;Leal, Marisa;de Lima, Caio Vinícius Barroso;Tatagiba, Luiza Sarmento;Leal, Antônio;dos Santos, Diogo Vinicius;Fraga, Gustavo Pereira;Simoes, Romeo Lages;Stock, Simon;Nigo, Samuel;Kabba, Juana;Ngwa, Tagang Ebogo;Brown, James;King, Sebastian;Zani, Augusto;Azzie, Georges;Firdouse, Mohammed;Kushwaha, Sameer;Agarwal, Arnav;Bailey, Karen;Cameron, Brian;Livingston, Michael;Horobjowsky, Alexandre;Deckelbaum, Dan L.;Razek, Tarek;Marinkovic, Boris;Grasset, Eugenio;D’aguzan, Nicole;Jimenez, Julio;Macchiavello, Roberto;Zhang, Zhongtao;Guo, Wei;Oh, Junyeong;Zheng, Fei;Montes, Irene;Sierra, Sebastian;Mendez, Manuela;Villegas, Maria Isabel;Arango, Maria Clara Mendoza;Mendoza, Ivan;Aristizã¡bal, Fred Alexander Naranjo;Botero, Jaime Andres Montoya;Riaza, Victor Manuel Quintero;Restrepo, Jakeline;Morales, Carlos;Cruz, Herman;Munera, Alejandro;Karlo, Robert;Domini, Edgar;Mihanovic, Jakov;Radic, Mihael;Zamarin, Kresimir;Pezelj, Nikica;Hache-Marliere, Manuel;Lemaire, Sylvia Batista;Rivas, Ruben;Khyrallh, Ahmed;Hassan, Ahamed;Shimy, Gamal;Baky Fahmy, Mohamed A.;Nabawi, Ayman;Elfil, Mohamed;Ghoneem, Mohamed;Asal, Mohamed;Abdelkader, Mostafa;Gomah, Mahmoud;Rashwan, Hayssam;Karkeet, Mohamed;Gomaa, Ahmed;Hasan, Amr;Elgebaly, Ahmed;Saleh, Omar;Fattah, Ahmad Abdel;Gouda, Abdullah;Elshafay, Abd Elrahman;Gharib, Abdalla;Menshawy, Ahmed;Hanafy, Mohammed;Al-Mallah, Abdullah;Abdulgawad, Mahmoud;Baheeg, Mohamad;Alhendy, Mohammed;AbdelFattah, Ibrahim;Kenibar, Abdalla;Osman, Omar;Gemeah, Mostafa;Mohammed, Ahmed;Adel, Abdalrahman;Mohammed, Abdelrahman;Sayed, Abdelrahman;Abozaid, Mohamed;Kotb, Ahmed Hafez El-Badri;Ata, Ali Amin Ahmed;Nasr, Mohammed;Alkammash, Abdelrahman;Saeed, Mohammed;Hamid, Nader Abd El;Attia, Attia Mohamed;Galeel, Ahmed Abd El;Elbanby, Eslam;El-Dien, Khalid Salah;Hantour, Usama;Alahmady, Omar;Mansour, Billal;Elkorashy, Amr Muhammad;Taha, Emad Mohamed Saeed;Lasheen, Kholod Tarek;Elkolaly, Salma Said;Abdel-Wahab, Nehal Yosri Elsayed;Abozyed, Mahmoud Ahmed Fathi;Adel, Ahmed;Saeed, Ahmed Moustafa;Sayed, Gehad Samir El;Youssif, Jehad Hassan;Ahmed, Soliman Magdy;El-Shahat, Nermeen Soubhy;Khedr, Abd El-Rahman Hegazy;Elsebaaye, Abdelrhman Osama;Elzayat, Mohamed;Abdelraheim, Mohamed;Elzayat, Ibrahim;Warda, Mahmoud;Deen, Khaled Naser El;Elnemr, Abdelrhman Essam;Salah, Omar;Abbas, Mohamed;Rashad, Mona;Elzayyat, Ibrahim;Hemeda, Dalia;Tawfik, Gehad;Salama, Mai;Khaled, Hazem;Seisa, Mohamed;Elshaer, Kareem;Hussein, Abdelfatah;Elkhadrawi, Mahmoud;Afifi, Ahmed Mohamed;Ebrahim, Osama Saadeldeen;Metwally, Mahmoud Mohamed;Elmelegy, Rowida;Elsawahly, Diaa Moustafa Elbendary;Safa, Hisham;Nofal, Eman;Elbermawy, Mohamed;Ghazy, Ahmed Abdelmotaleb;Samih, Hisham;Abdelgelil, Asmaa;Abdelghany, Sarah;Kholy, Ahmed El;Aboraya, Metwally;Elkady, Fatma;Salma, Mahmoud;Samy, Sarah;Fakher, Reem;Aboarab, Aya;Samir, Ahmed;Sakr, Ahmed;Haroun, Abdelrahman;Al-Aarag, Asmaa Abdel-Rahman;Elkholy, Ahmed;Elshanwany, Sally;Ghanem, Esraa;Tammam, Ahmed;Hammad, Ali Mohamed;Shoura, Yousra El;Ashal, Gehad El;Khairy, Hosni;Antar, Sarah;Mehrez, Sara;Abdelshafy, Mahmoud;Hamad, Maha Gamal Mohamad;Hosh, Mona;Abdallah, Emad;Magdy, Basma;Alzayat, Thuraya;Gamaly, Elsayed;Elfeki, Hossam;Abouzahra, Amany;Elsheikh, Shereen;Elgendy, Fatimah I.;El-Salam, Fathia Abd;Seifelnasr, Osama;Ammar, Mohamed;Eysa, Athar;Sadek, Aliaa;Toeema, Aliaa Gamal;Nasr, Aly;Abuseif, Mohamed;Zidan, Hagar;Barakat, Sara Abd Elmageed;Elsayed, Nadin;Elrasoul, Yasmin Abd;Elkelany, Ahmed;Ammar, Mohamed Sabry;Mustafa, Mennat-Allah;Hegazy, Yasmin;Etman, Mohamed;Saad, Samar;Alrahawy, Mahmoud;Raslan, Ahmed;Morsi, Mahmoud;Rslan, Ahmed;Sabry, Ahmed;Elwakil, Hager;Shaker, Heba;Abd-Elrasoul, Yasmin;El-Kashef, Hussein;Shaalan, Mohamed;Tarek, Areej;Elwan, Ayman;Nayel, Ahmed Ragab;Seif, Mostafa;Emadeldin, Doaa;Ghonaim, Mohamed Ali;Almallah, Ahmad;Fouad, Ahmed;Sayma, Eman Adel;Elbatahgy, Ahmad;El-Ma’doul, Angham Solaiman;Mosad, Ahmed;Tolba, Hager;Elsorogy, Diaa Eldin Abdelazeem Amin;Mostafa, Hassan Ali;Omar, Amira Atef;Hameed, Ola Sherief Abd El;Lasheen, Ahmed;Salam, Yasser Abd El;Morsi, Ashraf;Ismail, Mohammed;El-badawy, Hager Ahmed;Amer, Mohamed A.;El-Hamouly, Ahmed Sabry;Attallah, Noura A.;Mosalum, Omnia;Afandy, Ahmed;Mokhtar, Ahmed;Abouelnasr, Alaa;Ayad, Sara;Shaker, Ramdan;Sakr, Rokia;Shaker, Ramadan;Amreia, Mahmoud;Elsobky, Soaad;Mustafa, Mohamed;Magd, Ahmed Abo El;Marey, Abeer;Hafez, Amr Tarek;Zalabia, Mohamed F.;Mohamed, Mohamed Moamen;Fadel, Amr;Ahmed, Emad Ali;Ali, Ahmad;Alwafai, Mohammad Ghassan;Dwydar, Abdullah;Kharsa, Sara;Mamdouh, Ehab;El-Sheemy, Hatem;AlYoussef, Ibrahim;Aly, Abouelatta Khairy;Aldalaq, Ahmad;Alnawam, Ehab;Alkhabbaz, Dalia;Saad, Mahmoud;Hussein, Shady;Elazayem, Ahmed Abo;Meshref, Ahmed;Elashmawy, Marwa;Mousa, Mohammed;Nashaat, Ahmad;Ghanem, Sara;Elsayed, Zaynab M.;Elwaey, Aya;Elkadsh, Iman;Darweesh, Mariam;Mohameden, Ahmed;Hafez, Mennaallah;Badr, Ahmed;Badwy, Assmaa;Slam, Mohamed Abd El;Elazoul, Mohamed;Al-Nahrawi, Safwat;Eldamaty, Lotfy;Nada, Fathee;Ameen, Mohamed;Hagar, Aya;Elsehimy, Mohamed;Aboraya, Mohammad;Dawoud, Hossam;Mesery, Shorouk El;Gendy, Abeer El;Abdelkareem, Ahmed;Marey, Ahmed Safwan;Allam, Mostafa;Shehata, Sherif;Abozeid, Khaled;Elshobary, Marwa;Fahiem, Ahmed;Sarsik, Sameh;Hashish, Amel;Zidan, Mohamed;Hashish, Mohamed;Aql, Shaimaa;Elhendawy, Abdelaziz Osman Abdelaziz;Husseini, Mohamed;Kasem, Esraa;Gheith, Ahmed;Elfouly, Yasmin;Soliman, Ahmed Ragab;Ibrahim, Yasmein;Elfouly, Nesma;Fawzy, Ahmed;Hassan, Ahmed;Rashid, Mohammad;Elsherbiny, Abdallah Salah;Sieda, Basem;Badwi, Nermin M.;Mohammed, Mohammed Mustafa Hassan;Mohamed, Osama;Habeeb, Mohammad Abdulkhalek;Worku, Mengistu;Starr, Nichole;Desta, Semay;Wondimu, Sahlu;Abebe, Nebyou Seyoum;Thomas, Efeson;Asele, Frehun Ayele;Dabessa, Daniel;Abebe, Nebiyou Seyoum;Zerihun, Abebe Bekele;Mentula, Panu;Leppäniemi, Ari;Sallinen, Ville;Scalabre, Aurelien;Frade, Fernanda;Irtan, Sabine;Graffeille, Vivien;Gaignard, Elodie;Alimi, Quentin;Graffieille, Vivien;Abbo, Olivier;Mouttalib, Sofia;Bouali, Ourdia;Hervieux, Erik;Aigrain, Yves;Botto, Nathalie;Faure, Alice;Fievet, Lucile;Panait, Nicoleta;Eyssartier, Emilie;Schmitt, Francoise;Podevin, Guillaume;Parent, Valentine;Martin, Amandine;Arnaud, Alexis Pierre;Muller, Cecile;Bonnard, Arnaud;Peycelon, Matthieu;Abantanga, Francis;Boakye-Yiadom, Kwaku;Bukari, Mohammed;Owusu, Frank;Awuku-Asabre, Joseph;Bray, Lemuel Davies;Lytras, Dimitrios;Psarianos, Kyriakos;Bamicha, Anastasia;Kefalidi, Eirini;Gemenetzis, Georgios;Dervenis, Christos;Gouvas, Nikolaos;Agalianos, Christos;Kontos, Michail;Kouraklis, Gregory;Karousos, Dimitrios;Germanos, Stylianos;Marinos, Constantinos;Anthoulakis, Christos;Nikoloudis, Nikolaos;Mitroudis, Nikolaos;Estupinian, Sergio;Forno, Walter;Azmitia, José René Arévalo;Cabrera, Carla Cecilia Ramã-rez;Guevara, Romeo;Aguilera, Maria;Mendez, Napoleon;Mendizabal, Cesar Augusto Azmitia;Ramazzini, Pablo;Urquizu, Mario Contreras;Tale, Fernando;Soley, Rafael;Barrios, Emanuel;Barrios, Emmanuel;Rodríguez, Daniel Estuardo Marroquín;Velásquez, Carlos Iván Pérez;Mérida, Sara María Contreras;Regalado, Francisco;Lopez, Mario;Siguantay, Miguel;Lam, Fong Yee;Szeto, Kylie Joan-yi;Szeto, Charing Cheuk Ling;Li, Wing Sum;Li, Kieran Ka Kei;Leung, Man Fung;Mak, Tony;Ng, Simon;Prasad, S. S.;Kirishnan, Anand;Gyanchandani, Nidhi;Kumar, Bylapudi Seshu;Rangarajan, Muthukumaran;Bhat, Sriram;Sreedharan, Anjana;Kinnera, S. V.;Reddy, Yella;Venugopal, Caranj;Kumar, Sunil;Mittal, Abhishek;Nadkarni, Shravan;Lakshmi, Harish Neelamraju;Malik, Puneet;Limaye, Neel;Pai, Srinivas;Jain, Pratik;Khajanchi, Monty;Satoskar, Savni;Satoskar, Rajeev;Mahamood, Abid Bin;Sutanto, Eldaa Prisca Refianti;Soeselo, Daniel Ardian;Tedjaatmadja, Chintya;Rahmawati, Fitriana Nur;Mayasari, Maria;Al-Hameedi, Hasan Ismael Ibraheem;Ibraheem, Hasan Ismael;Al-Azraqi, Israa Abdullah Aziz;Sabeeh, Lubna;Kamil, Rahma;Telfah, Muwaffaq Mezeil;Rasendran, Amoudtha;Sheehan, Jacqueline;Kerley, Robert;Normile, Caoimhe;Gilbert, Richard William;Song, Jiheon;Dablouk, Mohamed;Mauro, Linnea;Dablouk, Mohammed Osman;Kielty, Paul;Marks, Eleanor;Gosling, Simon;Mccarthy, Michelle;Mirghani, Diya;Naqvi, Syed Altaf;Wong, Chee Siong;Chung, Siyi;D’cruz, Reuban;Cahill, Ronan;Gosling, Simon George;Fahy, Ciara;Cadogan, Diana Duarte;Powell, Anna;Gilbert, Richard;Clifford, Caroline;Driscoll, Aoife;Paul, Stassen;Lee, Chris;Bowe, Ross;Hutch, William;Mohan, Helen;O’neill, Maeve;Mealy, Kenneth;P. Danelli;A. Bondurri;A. Maffioli;Pasini, Mario;Pata, Giacomo;Roncali, Stefano;Silvani, Paolo;Carlucci, Michele;Faccincani, Roberto;L. Bonavina;Macchitella, Yuri;Ceriani, Chiara;Tugnoli, Gregorio;Di Saverio, Salomone;Khattab, Khaled;Paludi, Miguel Angel;Pata, Domenica;Cloro, Luigi Maria;Allegri, Andrea;Ansaloni, Luca;Coccolini, Federico;Veronese, Ezio;Bortolasi, Luca;Hasheminia, Alireza;Nastri, Giacomo;Canto, Massimiliano Dal;Cucumazzo, Stefano;Benevento, Angelo;Tessera, Gaetano;Grandinetti, Pier Paolo;Maniscalco, Alessio;Lamanna, Giovanni Luca;Turati, Luca;Sgroi, Giovanni;Rausa, Emanuele;Villa, Roberta;Monteleone, Michela;Merlini, David;Grassi, Veronica;Cirocchi, Roberto;Cacurri, Alban;Waleed, Hamza;Diab, Ahmed;Elzowawi, Fathi;Jokubauskas, Mantas;Varkalys, Karolis;Venskutonis, Donatas;Pranevicius, Robertas;Ambrozeviciute, Viktorija;Juciute, Simona;Skardžiukaitė, Austė;Bradulskis, Saulius;Urbanavicius, Linas;Austraite, Aiste;Riauka, Romualdas;Dambrauskas, Zilvinas;Karumnas, Paulius;Urniezius, Zigmantas;Zilinskiene, Reda;Rudzenskaite, Anele;Usaityte, Ausrine;Montrimaite, Margarita;Kaselis, Nerijus;Strazdas, Andrius;Jokubonis, Kristijonas;Maceviciute, Kornelija;Beisa, Virgilijus;Poskus, Tomas;Strupas, Kestutis;Laugzemys, Erikas;Kolosov, Andrej;Jotautas, Valdemaras;Rakita, Ignas;Mikalauskas, Saulius;Kazanavicius, Darius;Rackauskas, Rokas;Rakauskas, Ritauras;Preckailaite, Egle;Coomber, Ross;Johnson, Kenneth;Nowers, Jennifer;Periasammy, Dineshwary;Salleh, Afizah;Das, Andre;Tze, Reuben Goh Ern;Kumar, Milaksh Nirumal;Abdullah, Nik Azim Nik;Kosai, Nik Ritza;Taher, Mustafa;Rajan, Reynu;Chong, Hoong Yin;Agius, Marija;Borg, Elaine;Bezzina, Maureen;Bugeja, Roberta;Vella-Baldacchino, Martinique;Spina, Andrew;Psaila, Josephine;Francois-Coridon, Helene;Tolg, Cecilia;Colombani, Jean-Francois;Diaz-Zorrilla, Carmina;La Medina, Antonio Ramos-De;Gonzalez, Samantha Corro-Diaz;Jacobe, Mário;Mapasse, Domingos;Snyder, Elizabeth;Oumer, Ramadan;Osman, Mohammed;Mohammad, Aminu;Anyanwu, Lofty-John;Sheshe, Abdulrahman;Adesina, Alaba;Faturoti, Olubukola;Taiwo, Ogechukwu;Ibrahim, Muhammad Habib;Nasir, Abdulrasheed A.;Suleiman, Siyaka Itopa;Adeniyi, Adewale;Adesanya, Opeoluwa;Adebanjo, Ademola;Osuoji, Roland;Atobatele, Kazeem;Ogunyemi, Ayokunle;Williams, Omolara;Oludara, Mobolaji;Oshodi, Olabode;Ademuyiwa, Adesoji;Lawal, AbdulRazzaq Oluwagbemiga;Alakaloko, Felix;Elebute, Olumide;Osinowo, Adedapo;Bode, Christopher;Adesuyi, Abidemi;Tade, Adesoji;Adekoya, Adeleke;Nwokoro, Collins;Ayandipo, Omobolaji O.;Lawal, Taiwo Akeem;Ajao, Akinlabi E.;Ali, Samuel Sani;Odeyemi, Babatunde;Olori, Samson;Popoola, Ademola;Adeyeye, Ademola;Adeniran, James;Lossius, William J.;Havemann, Ingemar;Thorsen, Kenneth;Narvestad, Jon Kristian;Soreide, Kjetil;Wold, Trude Beate;Nymo, Linn;Elsiddig, Mohammed;Dar, Manzoor;Bhopal, Kamran Faisal;Iftikhar, Zainab;Furqan, Muhammad Mohsin;Nighat, Bakhtiar;Jawaid, Masood;Khalique, Abdul;Zil-E-Ali, Ahsan;Rashid, Anam;Dharamshi, Hasnain Abbas;Naqvi, Tahira;Faraz, Ahmad;Anwar, Abdul Wahid;Yaseen, Tahir Muhammad;Shamsi, Ghina Shamim;Shamsi, Ghina;Yaseen, Tahir;Anwer, Wahid;Decoud, Horacio Paredes;Aguilera, Omar;Alvarez, Ismael Isaac Zelada;Delgado, Juan Marcelo;Vega, Gustavo Miguel Machain;Lohse, Helmut Alfredo Segovia;Aguilar, Wendy Leslie Messa;Chiong, Jose Antonio Cabala;Bautista, Ana Cecilia Manchego;Huaman, Eduardo;Zegarra, Sergio;Camacho, Rony;Celis, Jose María Vergara;Pozo, Diego Alonso Romani;Hamasaki, José;Temoche, Edilberto;Herrera-Matta, Jaime;Torres, Carla Pierina García;Barreda, Luis Miguel Alvarez;Ojeda, Ronald Renato Barrionuevo;Garaycochea, Octavio;Mollo, Melanie Castro;Fujii, Francisco;Durand, Susana Yrma Aranzabal;Basto, Carlos Alejandro Arroyo;Rojas, Nelson Manuel Urbina;Yip, Sebastian Bernardo Shu;Vergara, Ana Lucia Contreras;Moran, Andrea Echevarria Rosas;Luque, Giuliano Borda;Castro, Manuel Rodriguez;Jaramillo, Ramon Alvarado;Sila, George Manrique;Lopez, Crislee Elizabeth;De Leon, Mardelangel Zapata Ponze;Machaca, Massiell;Huaraya, Ronald Coasaca;Arenas, Andy;López, Crislee;Puma, Clara Milagros Herrera;Pino, Wilfredo;Hinojosa, Christian;De Leon, Melanie Zapata Ponze;Limache, Susan;Sila, George Manrrique;Rodriguez, Layza-Alejandra Mercado;Melo, Renato;Costa-Maia, Jose;Muralha, Nuno;Sauvat, Frederique;Dan, Ionasc;Hogea, Mircea;Eduard, Pandi;Bratu, Razvan-Matei;Beuran, Mircea;Diaconescu, Ionut-Bogdan;Martian, Bogdan-Valeriu;Iordache, Florin-Mihail;Vartic, Mihaela;Vida, Lucian Corneliu;Muntean, Liviu Iuliu;Mironescu, Aurel Sandu;Nsengimana, Vizir Jean Paul;Niragire, Alice;De La Croix Allen Ingabire, Jean;Niyirera, Eugene;Zanini, Nicola;Jovine, Elio;Landolfo, Giovanni;Alomar, Ibrahim N.;Alnuqaydan, Saleh A.;Altwigry, Abdulrahman M.;Othman, Moayad;Osman, Nohad;Alqahtani, Enas;Alzahrani, Mohammed;Alyami, Rifan;Aljohani, Emad;Alhabli, Ibrahim;Mikwar, Zaher;Almuallem, Sultan;Nawawi, Abrar;Bakhaidar, Mohamad;Maghrabi, Ashraf A.;Alsaggaf, Mohammed;Aljiffry, Murad;Altaf, Abdulmalik;Khoja, Ahmad;Habeebullah, Alaa;Akeel, Nouf;Ghandora, Nashat;Almoflihi, Abdullah;Huwait, Abdulmalik;Al-shammari, Abeer;Al-Mousa, Mashael;Alghamdi, Masood;Adham, Walid;Albeladi, Bandar;Alfarsi, Muayad Ahmed;Mahdi, Atif;Awwad, Saad Al;Nouh, Thamer;Hassanain, Mazen;Aldhafeeri, Salman;Sadig, Nawal;Algohary, Osama;Aledrisy, Mohannad;Gudal, Ahmad;Alrifaie, Ahmad;AlRowais, Mohammed;Althwainy, Amani;Shabkah, Alaa;Alamoudi, Uthman;Alrajraji, Mawaddah;Alghamdi, Basim;Aljohani, Saud;Daqeeq, Abdullah;Al-Faifi, Jubran J.;Jennings, Vicky;Ngayu, Nyawira;Moore, Rachel;Kong, Victor;Kretzmann, Hayden;Connor, Katie;Nel, Daniel;Sampson, Colleen;Panieri, Eugenio;Sishuba, Nosisa;Tun, Myint;Mphatsoe, Albert Mohale;Carreira, Jo-Anne;Teasdale, Ella;Wagener, Mark;Botes, Stefan;Du Plessis, Danelo;Fernandez-Bueno, Fernando;Aguilar-Jimenez, Jose;Garcia-Marin, Jose Andres;García, Lorena Solar;Florez, Luis Joaquín García;Pacheco, Rubén Darío Arias;Pagnozzi, Janet;Quezada, Jimy Harold Jara;Rodicio, Jose Luis;Minguez, German;Rodríguez-Uría, Raquel;Ugalde, Paul;Lopez-Arevalo, Camilo;Barneo, Luis;Stuva, Jessica Patricia Gonzales;Ortega-Vazquez, Irene;Rodriguez, Lorena;Herrera, Norberto;Arachchi, Prasad Pitigala;Sivaganesh, Sivasuriya;Samaraweera, Dulan Irusha;Thanusan, Vimalakanthan;Musa, Ahmed Elgaili Khalid;Balila, Reem Mohammed Hassan;Mohamed, Mohamed Awad Elkarim Hamad;Ali, Hussein;Elabdin, Hagir Zain;Hassan, Alaa;Mahdi, Sefeldin;Ahmed, Hala;Idris, Sahar Abdoun Ishag;Elsayed, Makki;Elsayed, Mohammed;Mahmoud, Mohamed;Boijsen, Magnus;Lundgren, Per-Olof;Gustafsson, Ulf;Kiasat, Ali;Wogensen, Fredrik;Jurdell, Emma;Thorell, Anders;Thorarinsdottir, Hildur;Utter, Maria;Sundstrom, Sami Martin;Wredberg, Cecilia;Kjellin, Ann;Nyberg, Johanna;Frisk, Bjorn;Sund, Malin;Andersson, Linda;Gunnarsson, Ulf;Cengiz, Yücel;Ahlqvist, Sandra;Björklund, Ida;Royson, Hanna;Weber, Per;Pahlsson, Hans-Ivar;Borin, Eva;Hjertberg, Maria;Schmid, Roger;Schivo, Debora;Despotidis, Vasileios;Breitenstein, Stefan;Staerkle, Ralph F.;Schadde, Erik;Deichsel, Fabian;Gerosa, Alexandra;Nocito, Antonio;Raptis, Dimitri Aristotle;Mijuskovic, Barbara;Zuber, Markus;Eisner, Lukas;Kruspi, Swantje;Reinisch, Katharina Beate;Schoewe, Christin;Novak, Allan;Palma, Adrian F.;Teufelberger, Gerfried;Kimaro, Msafiri;King, Rachel;Balkan, Ali Zeynel Abidin;Gumar, Mehmet;Yavuz, Mehmet Ali;Karabacak, Ufuk;Lap, Gokhan;Ozkan, Bahar Busra;Karakahya, Murat;Adams, Ryan;Morton, Robert;Henderson, Liam;Gratton, Ruth;Clement, Keiran David;Chang, Kate Yu-Ching;Mcnish, David;Mcintosh, Ryan;Milligan, William;Skelly, Brendan;Anderson-Knight, Hannah;Lawther, Roger;Onimowo, Jemina;Shatkar, Veereanna;Tharmalingam, Shivanee;Woin, Evelina;Fautz, Tessa;Ziff, Oliver;Dindyal, Shiva;Arman, Sam;Talukder, Shagorika;Gadhvi, Vijay;Chew, Luen Shaun;Heath, Jonathan;Blencowe, Natalie;Hallam, Sally;Gash, Katherine;Mannu, Gurdeep Singh;Zachariades, Dimitris-Christos;Snaith, Ailsa Claire;Hettiarachchi, Thusitha Sampath;Nesaratnam, Arjun;Wheeler, James;McCullagh, Darragh;Clements, Joshua Michael;Khan, Ata;Koumpa, Foteini;Neophytou, Christina;Roth, Jessica;Soon, Wai Cheong;Deputy, Mohammed;Ahmed, Ahmed;Ashton, Annelisse;Vincent, Joe;Almy, Jack;Khan, Taufiq;Allen, John Lee Y.;Mcintyre, Charlotte Jane;Marshall, Dominic Charles;Sykes, Mark;Behar, Nebil;Jordan, Harriet;Rajjoub, Yaseen;Sherman, Thomas;White, Timothy;Watts, Anna;Ardley, Rohan;Arulampalam, Tan;Shah, Apar;Brown, Damien;Blower, Emma;Sutton, Paul;Gasteratos, Konstantinos;Vimalachandran, Dale;Magee, Cathy;Mcguigan, Andrew;Mcaleer, Stephen;Morgan, Clare;Braungart, Sarah;Lafferty, Kirsten;Labib, Peter;Tanase, Andrei;Mangan, Clodagh;Reza, Lillian;Woodward, Helen;Gouldthorpe, Craig;Turner, Megan;Wild, Jonathan R. L.;Malik, Tom A. M.;Proctor, Victoria K.;Hewage, Kalon;Davies, James;Dubois, Andre;Sarwary, Sayed;Zardab, Ali;Grant, Alan;Mcintyre, Robert;Mogan, Yogendra Praveen;Ho, Weiguang;Chong, Bryon Frankie Hon Khi;Tewari, Shirish;Humm, Gemma;Farinella, Eriberto;Hall, Nigel J.;Wright, Naomi J.;Major, Christina P.;Xerri, Thelma;Amin, Jasim;Farhad, Mustafa;Camilleri-Brennan, John F.;Robertson, Andrew G. N.;Swann, Joanna;Richards, James;Jabbar, Aijaz;De Bono, Phoebe;Attard, Myranda;Burns, Hannah;Macdonald, Euan;Baldacchino, Matthew;Skehan, Jennifer;Hall, Tom Falconer;Gimzewska, Madelaine;Mclachlan, Greta;Shah, Jamie;Chiu, James Giles Selina;Weber, Beatrix;Chiu, Selina Man Yeng;Highcock, Saskia;Hassan, Maleeha;Beasley, William;Vlachogiorgos, Apostolos;Dias, Stephen;Maharaj, Geta;Mcdonald, Rosie;Macdonald, Alisdair;Witherspoon, Paul;Baird, Alan;Sarmah, Panchali;Green, Nikki;Youssef, Haney;Cross, Kate;Rees, Clare M.;Van Duren, Bernard;Upchurch, Emma;Khan, Khurram;Abudeeb, Haytham;Hammad, Ahmed;Karandikar, Sharad;Bowley, Doug;Karim, Ahmed;Chachulski, Witold;Richardson, Liam;Dawnay, Giles;Thompson, Ben;Mistry, Ajayesh;Ghetia, Millika;Roy, Sudipta;Al-Obaedi, Ossama;Das, Kaustuv;Prabhudesai, Ash;Cocker, D. M.;Tan, Jessica Juliana;Tyler, Robert;Di Franco, Filippo;Ayyar, Shruti;Vivekanantham, Sayinthen;Gokani, Shyam;Gillespie, Michael;Gudlaugsdottir, Katrin;Pezas, Theodore;Currow, Chelise;Kim, Matthew Young-Han;Birring, Amerdip;Edwards, Joanne;Ali, Ased;Das, Suparna;Jha, Madan;Atkinson, Kieran;Luck, Joshua;Fozard, Thomas;Puttick, Michael;Salama, Yahya;Shah, Rohi;Ibrahem, Ahmad Aboelkassem;Ebdewi, Hamdi;Gravante, Gianpiero;El-Rabaa, Saleem;Nnajiuba, Henry;Allott, Rebecca;Bhargava, Aman;Chan, Zoe;Hassan, Zaffar;Makinde, Misty;Hemingway, David;Dean, Ramzana;Boddy, Alexander;Aber, Ahmed;Patel, Vijay;Parakh, Jehangirshaw;Parthiban, Sunil;Ubhi, Harmony Kaur;Hosein, Simon-Peter;Ward, Simon;Malik, Kamran;Jennings, Leifa;Newton, Tom;Alkhouri, Mirna;Kang, Min Kyu;Houlden, Christopher;Barry, Jonathan;Raza, Imtanan;Farquharson, Alistair;Bhattacharya, Sanjeet;Chang, Kate;Wilson, Michael S. J.;Neo, Yan Ning;Ibrahim, Ibrahim;Chan, Emily;Peck, Fraser S.;Lim, Pei J.;North, Alexander S.;Blundell, Rebecca;Williamson, Adam;Fouad, Dina;Minocha, Ashish;Mccarthy, Kathryn;Court, Emma;Chambers, Alice;Yee, Jenna;Tham, Ji Chung;Beaton, Ceri;Walsh, Una;Lockey, Joseph;Bokhari, Salman;Howells, Lara;Griffiths, Megan;Yallop, Laura;Singh, Shailinder;Nasher, Omar;Jackson, Paul;Shariffuddin, Abdul Muiz;Ho, Weng Chee;Wilson, Michael Sj;Pabla, Gurpreet;Ramzi, Saed;Zeidan, Shady;Doughty, Jennifer;Sinha, Sidhartha;Davenport, Ross;Lewis, Jason;Duffy, Leo;Mcaleer, Elizabeth;Williams, Eleanor;Som, Robin;Javed, Omar;Boal, Matthew;Harrison, Nicola;Tafazal, Habib;Brogden, Tom;Griffiths, Ewen;Obute, Rhalumi Daniel;Glover, Thomas E.;Clark, David J.;Boshnaq, Mohamed;Akhtar, Mansoor;Capleton, Pascale;Doughan, Samer;Rabie, Mohamed;Mohamed, Ismail;Samuel, Duncan;Dickson, Lauren;Kennedy, Matthew;Dempster, Eleanor;Brown, Emma;Maple, Natalie;Monaghan, Eimear;Wolf, Bernhard;Garland, Alicia;Mcphee, Arthur;Anderson, David;Anderson, Robert;Hassan, Sarah;Smith, Dave;Lund, Jonathan;Boereboom, Catherine;Murphy, Jennifer;Tierney, Gillian;Tou, Samson;Zimmermann, Eleanor Franziska;Smart, Neil James;Warwick, Andrea Marie;Stasinou, Theodora;Daniels, Ian;Findlay-Cooper, Kim;Mitrasinovic, Stefan;Ray, Swayamjyoti;Varcada, Massimo;D’Souza, Rovan;Omara, Sharif;Spurr, Matthew;Parkinson, Lucienne;Hanks, Anthony;Ma, Jennifer;Abington, Emily;Ramcharn, Meera;Williams, Gethin;Winstanley, Joseph;Kennedy, Ewan D.;Yeung, Emily N. W.;Jones, Catrin;O’neill, Stephen;Lim, Shujing Jane;Liew, Ignatius;Nair, Hari;Fairfield, Cameron;Oh, Julia;Koh, Samantha;Wilson, Andrew;Fairfield, Catherine;Anandkumar, Delran;Kirupagaran, Ashok;Jones, Timothy F.;Torrance, Hew Dt;Fowler, Alexander J.;Chandrakumar, Charmilie;Patel, Priyank;Ashraf, Syed Faaz;Lakhani, Sonam M.;Mclean, Aaron Lawson;Basson, Sonia;Batt, Jeremy;Bowman, Catriona;Stoddart, Michael;Benons, Natasha;Mason, Clare;Harrison, Rebecca;Quayle, John;Barker, Tom;Summerour, Virginia;Harper, Edward;Smith, Caroline;Hampton, Matthew;Pitt, Sophie K.;Ward, Alex E.;O’Connor, Timothy;Heywood, Emily G.;Chowdhury, Abeed;Hossaini, Sina;Watson, Nicholas Fs;Mckechnie, Doug;Farah, Ayaan;Chun, Anita;Koh, Hoey;Lim, Grace;Sunderland, Graham;Gould, Laura;Munipalle, P. C.;Rooney, H.;Browning, D. R. L.;Pereira, Bernadette;Nemeth, Kristof;Decker, Emily;Giuliani, Stefano;Shalaby, Aly;Shaikh, Shafaque;Tan, Chern Yan;Palkhi, Ebrahim Y. A.;Szczap, Aleksandra;Chidambaram, Swathikan;Chen, Chee Yang;Kulasabanathan, Kavian;Chhabra, Srishti;Kostov, Elisabeth;Harbord, Philippe;Barnacle, James;Palliyil, Madan Mohan;Zikry, Mina;Porter, Johnathan;Raslan, Charef;Hafiz, Shazia;Soltani, Niksa;Baillie, Katie;Singh, Priyanka;Sheth, Shailee;Patel, Kishen;Khalili, Mahry;Choi, Jeesoo;Benger, Matthew;Marples, Lucy;Macfarlane, Alastair;Thurairaja, Ramesh;Boyce, Tamsin;Whewell, Harriet;Jones, Elin;Th’ng, Francesca;Robertson, Nichola;Mirza, Ahmad;Saeed, Haroon;Galloway, Simon;Elena, Gia;Afzal, Mohammad;Zakir, Mohamed;Sodde, Peter;Hand, Charles;Sriram, Aiesha;Clark, Tamsyn;Holton, Patrick;Livesey, Amy;Sinha, Yashashwi;Iqbal, Fahad Mujtaba;Bharj, Indervir Singh;Rotundo, Adriana;Jenvey, Cara;Slade, Robert;Golding, David;Haines, Samuel;Abdullah, Ali Adel Ne’ma;Tilston, Thomas W.;Loughran, Dafydd;Donoghue, Danielle;Giacci, Lorenzo;Sherif, Mohamed Ashur;Harrison, Peter;Tang, Alethea;Kotecha, Deevia;Elshaer, Mohamed;Urbonas, Tomas;Riaz, Amjid;Chapman, Annie;Acharya, Parisha;Shalhoub, Joseph;Grossart, Cathleen;McMorran, David;Mlotshwa, Makhosini;Hawkins, William;Loizides, Sofronis;Krishna, Kandaswamy;Orchard, Melanie;Ho, Chik Wai;Thomson, Peter;Khan, Shahab;Taylor, Fiona;Shukla, Jalak;Howie, Emma Elizabeth;Macdonald, Linda;Komolafe, Olusegun;Mcintyre, Neil;Cragg, James;Parker, Jody;Stewart, Duncan;Lintin, Luke;Tracy, Julia;Farooq, Tahir;Molina, George;Kaafarani, Haytham;Beyene, Robel;Sava, Jack;Scott, Mark;Swaroop, Mamta;Kennedy, Raelene;Azodo, Ijeoma A.;Heffernan, Daithi;Chun, Tristen;Stephen, Andrew;Sion, Melanie;Weinstein, Michael S.;Punja, Viren;Bugaev, Nikolay;Goodstein, Monica;Razmdjou, Shadi;Etchill, Eric;Puyana, Juan Carlos;Kesinger, Matthew;Napolitano, Lena;To, Kathleen;Hemmila, Mark;Todd, Oliver;Jenner, Edward;Hoogakker, Ellen;Chen, Jacky Hong Chieh;Ismail, Lawani;Roi, Dylan;Escobar, Eugenio Grasset

2018

Abstract

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.

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	Parole chiave
	
			Appendectomy; Appendicitis; Global surgery; Laparoscopic; Operative standards; Postoperative care; Postoperative complications; Surgical site infection; Surgery
		
	Settori scientifico-disciplinari dell'articolo
	
			Settore MED/18 - Chirurgia Generale
		
	Data di pubblicazione
	
			ago-2018
		
	Rivista in ANCE
	
			SURGICAL ENDOSCOPY
		
	DOI
	
			https://dx.doi.org/10.1007/s00464-018-6064-9
		
	Tipologia
	
			Article (author)
		
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			01 - Articolo su periodico

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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/625691

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