There was no statistical difference in overall long-term success (POEM 72.7%, HM 65.1% p = 0.417, although higher rates of success were seen in Type III Achalasia in POEM vs Heller (53.3% vs 44.4%, p  less then  0.05). Type III Achalasia was the only variable associated with failure on a univariate COX analysis and no covariants were identified on a multivariate Cox regression. There was no statistical difference in GERD symptoms, esophagitis, or major procedural complications. CONCLUSION POEM and HM have similar long-term (4-year) efficacy with similar adverse event and reflux rates. POEM was associated with greater efficacy in Type III Achalasia.BACKGROUND Surgery and anesthesia are indivisible parts of health care, but safe and timely care requires more than operating rooms and skilled providers. One vital component of a functional surgical system is reliable blood transfusion. While almost half of all blood is donated in high-income countries (HICs), over eighty percent of the global population lives outside of these countries. High-income countries have on average 30 donations per 1000 people, and the average age of transfusion recipient is over 65. Most low-income countries (LICs) have fewer than five donations per 1000 people, where maternal hemorrhage and childhood anemia are the most common indications for transfusion. https://www.selleckchem.com/products/E7080.html In LICs, greater than 50% of blood is administered to children under 5 years of age. This study aims to snapshot, by survey, available resources for transfusion and then discusses the infrastructure and cultural barriers to optimal transfusion practice. METHODS In January 2019, a 10-question survey was sent electronically to phye rural patients presenting late. Inadequate triaging and supervision jeopardize patients to shock. Inadequate blood storage leads to waste. Modeling systems from HICs fail to overcome hurdles faced by clinicians working with distinctive belief systems and unique patient populations.BACKGROUND In sub-Saharan Africa, trauma is a leading cause of mortality in people less than 45 years. Injury mechanism and cause of death are difficult to characterize in the absence of pre-hospital care and a trauma surveillance database. Pre-hospital deaths (PHD) and in-hospital deaths (IHD) of trauma patient were compared to elucidate comprehensive injury characteristics associated with mortality. METHODS A retrospective, descriptive analysis of adults (≥ 13 years) presenting to Kamuzu Central Hospital in Lilongwe, Malawi, from February 2008 to May 2018 was performed. Utilizing an emergency department-based trauma surveillance database, univariate and bivariate analysis was performed to compare patient and injury characteristics of pre-hospital and in-hospital deaths. A Poisson multivariate regression was performed, predicting the relative risk of PHD. RESULTS Between February 2008 and May 2018, 131,020 adult trauma patients presented to KCH, with 2007 fatalities. Of those patients, 1130 (56.3%) and 877 (D in Malawi. The majority of patients are transported via police if PHD. Of IHD patients, the majority are transported by ambulance, most often from outside hospitals. Both are consistent with the absence of a pre-hospital system in Malawi. Improving pre-hospital care, with a particular focus on head injury and strategies for vehicular injury prevention within a trauma system, will reduce adult trauma mortality in Malawi.BACKGROUND Adequate surgical training is paramount to produce competent surgeons to address the global burden of surgical disease. The Pan-African Academy of Christian Surgeons (PAACS) has general surgery training programs in eight countries. Operative case volumes have been positively associated with improved trainee performance and patient outcomes. For certification in the USA, 850 total operations are required from defined case categories. Yet, little is known about the operative experience of surgical trainees throughout Africa. METHODS Operative procedures were reviewed, categorized, and validated from a cohort of PAACS graduates and compared to graduates from Accreditation Council for Graduate Medical Education (ACGME) programs. The primary and secondary outcomes were total case volumes and cases within ACGME-defined categories. Regional variations were explored. RESULTS Twenty PAACS trainees, from five programs in four countries, performed 38,267 unique procedures. ACGME reports on 1211 residents from 251 programs. PAACS graduates logged more major cases (median 1448) than ACGME graduates (median 993) (p value = 0·0001). PAACS graduates performed more gynecology and obstetrics, orthopedics, head and neck, urology, endocrine, operative trauma, pediatric surgery, plastic surgery, and skin and soft tissue cases. US graduates performed more cases in abdomen, alimentary tract, breast, thoracic, and vascular categories. Comparison between regions demonstrated volume and category variations between Kenya and Gabon, Ethiopia, and Cameroon. CONCLUSION PAACS trainees perform more operations than ACGME trainees with differences in distribution. This experience can serve as a model for regional educational programs seeking to address the broad and largely unmet burden of surgical disease.BACKGROUND Two types of repair techniques, FasT-Fix modified Mason-Allen (F-MMA) and two simple stitches (TSS), for the treatment of a medial meniscus posterior root tear (MMPRT) were previously reported. However, whether these techniques could prevent postoperative medial meniscus extrusion (MME) progression is unknown. This study investigated and compared postoperative MME of the two repair techniques. METHODS Forty-seven knees that had undergone pullout repair for MMPRT were retrospectively reviewed. These knees were divided into two groups as follows In 26 knees, MMPRT was treated using the F-MMA technique and fixed with the knee flexed at 45° and 20 N of tension [F-MMA (45°-20 N) group], and in 21 knees, MMPRT was treated using the TSS technique and fixed with the knee flexed at 20° and 30 N of tension [TSS (20°-30 N) group]. The medial meniscus body width (MMBW), absolute MME (aMME), and relative MME (rMME = absolute MME/MMBW) were measured and compared using magnetic resonance imaging 3 months postoperatively.