Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

New method of abdominoplasty for morbidly obese patients.

We report two cases of morbidly obese patients with huge infected abdominal aprons who underwent apronectomies at Alice Springs Hospital, Northern Territory, Australia. We describe a novel technique which to date has not been described in the available literature. Patients afflicted by morbid obesity with large aprons can be incapacitated by immobility as well as suffer from recurrent infections. Apronectomy in this situation can be difficult because of the heavy weight of the apron. This technique involves the use of a small crane and large orthopaedic K-nails. Two K-nails were inserted into the apron and attached to a small crane. This facilitated the elevation and manipulation of the apron during surgical dissection. The abdominal tissue removed from the female and male weighed 30 kg and 64 kg, respectively. The wounds were closed primarily and drained by three large bore suction drains. The female patient had a largely uneventful postoperative course with a minor wound infection that resolved with conservative treatment. The other patient required a more protracted course of antibiotics for his more severe infection. Mobility was markedly improved in both individuals. This novel technique can be used successfully for severely morbidly obese individuals and can significantly reduce the surgeon's and assistants' difficulty in manipulating and handling a heavy apron during dissection

Prevalence of dyslipidaemia among type 2 diabetes mellitus patients in the Western Cape, South Africa

Dyslipidaemia, an irregular aggregate of lipids in the blood is common in diabetes and cardiovascular disease sufferers. A cross-sectional study on the prevalence of dyslipidaemia was performed among type 2 diabetes mellitus (T2DM) patients in the Western Cape, South Africa. Patients (n = 100) that participated in the study were within the age range of 19–68 years, of whom 89% were observed to have serum lipid abnormalities. Out of the 100 patients, 56%, 64%, 61%, and 65% were recorded to have high total cholesterol (TC), hypertriglycemia, increased low-density lipoproteins cholesterol (LDL-C), and reduced high-density lipoproteins cholesterol (HDL-C), respectively. In male diabetic patients, a marked prevalence of (94%) dyslipidemia was noted, of which 52% were affected by high TC (5.3–7.9 mmol/L), with 70% having a high level of triglyceride (TG) [1.72–7.34 mmol/L], while 60% had a high LDL-C (3.1–5.5 mmol/L), including 78% with low HDL-C (0.7–1.1 mmol/L). In comparison, 84% of diabetic females had dyslipidemia, with high TC (5.1–8.1 mmol/L), hypertriglycemia (1.73–8.63 mmol/L), high LDL-C (3.1–5.6 mmol/L), and low levels of HDL-C (0.8–1.1 mmol/L) affecting 60%, 58%, 62%, and 52% of the patients, respectively. This study showed the importance of screening and the regular surveillance of dyslipidaemia in T2DM patients as there is a paucity of data on it in Afric

Prevalence of Dyslipidaemia among Type 2 Diabetes Mellitus Patients in the Western Cape, South Africa

Dyslipidaemia, an irregular aggregate of lipids in the blood is common in diabetes and cardiovascular disease sufferers. A cross-sectional study on the prevalence of dyslipidaemia was performed among type 2 diabetes mellitus (T2DM) patients in the Western Cape, South Africa. Patients (n = 100) that participated in the study were within the age range of 19–68 years, of whom 89% were observed to have serum lipid abnormalities. Out of the 100 patients, 56%, 64%, 61%, and 65% were recorded to have high total cholesterol (TC), hypertriglycemia, increased low-density lipoproteins cholesterol (LDL-C), and reduced high-density lipoproteins cholesterol (HDL-C), respectively. In male diabetic patients, a marked prevalence of (94%) dyslipidemia was noted, of which 52% were affected by high TC (5.3–7.9 mmol/L), with 70% having a high level of triglyceride (TG) [1.72–7.34 mmol/L], while 60% had a high LDL-C (3.1–5.5 mmol/L), including 78% with low HDL-C (0.7–1.1 mmol/L). In comparison, 84% of diabetic females had dyslipidemia, with high TC (5.1–8.1 mmol/L), hypertriglycemia (1.73–8.63 mmol/L), high LDL-C (3.1–5.6 mmol/L), and low levels of HDL-C (0.8–1.1 mmol/L) affecting 60%, 58%, 62%, and 52% of the patients, respectively. This study showed the importance of screening and the regular surveillance of dyslipidaemia in T2DM patients as there is a paucity of data on it in Africa.</jats:p

Trends in the Occurrence of Compound Extremes of Temperature and Precipitation in C&ocirc;te d&rsquo;Ivoire

The aim of this study is to characterize the compound extremes of rainfall and temperature in C&ocirc;te d&rsquo;Ivoire. For this purpose, we analyzed the outputs of fourteen (14) climate models from the CORDEX-Africa project. Results show an increase (approximately 4.3 &deg;C) in the surface temperature and a decrease (5.90%) of the mean rainfall in the near (2036&ndash;2065) and far futures (2071&ndash;2100) over C&ocirc;te d&rsquo;Ivoire during the January&ndash;February&ndash;March (JFM) period. The analysis of the compound extremes of the wet/warm type highlights an increase in the frequency of this climatic hazard in the northern and central parts of the country during the January&ndash;March (JFM) season in the near and far futures. The dry/warm mode will increase in the central and southern parts of the country in the near future and in the whole country in the far future. These increases in compound extremes could lead to an increase in droughts and natural disasters across the country and could have a negative impact on socio-economic activities, such as transportation and agricultural production. This work could provide decision support for political decision-makers in formulating future public policies for managing agricultural production, food security, and natural disasters

Effects of Population Knowledge, Perceptions, Attitudes, and Practices on COVID-19 Infection Prevention and Control in NUST

The global COVID-19 pandemic has had a major impact on the education sector of most countries. One of the basic CDC prevention guidelines is the implementation of non-pharmaceutical interventions (NPIs) to protect the health of students and staff members to curve the spread of COVID-19. The current study aimed to examine the knowledge, perceptions, attitudes, and practices of students at the Namibia University of Technology toward the COVID-19 pandemic. A cross-sectional descriptive survey was conducted using a closed-ended questionnaire. Data were collected from full-time students who were on campus during the COVID-19 pandemic between 29 January to 14 February 2021. The average knowledge about the modes of transmission, protective measures, and clinical symptoms ranged from 78% to 96%. About 31% of student respondents believed the virus was created in a laboratory, and 47% believed the vaccine has negative side effects and therefore, refused to take it. The three main sources of information about COVID-19 were social media (75%), television (63%), and friends and family (50%). The students had an overall positive attitude towards the implementation of NPIs. However, the importance of vaccine safety must be emphasized. Lockdowns should be lifted gradually to reduce the amount of time students are spending on online content. Reopening of classrooms for face-to-face study will bring unquestionable benefits to students and the wider economy

Analysis of Reference Ranges of Total Serum Protein in Namibia: Clinical Implications

A reference range is an essential part of clinical laboratory test interpretation and patient care. The levels of total serum protein (TSP) are measured in sera to assess nutritional, liver, and kidney disorders. This study determined the TSP reference range with respect to gender, age, and region in Namibia. A retrospective cross-sectional study was conducted to determine the TSP reference range among 78,477 healthy participants within the ages of less than one year to more than 65 yrs in 14 regions of Namibia. The reference range of TSP was 51–91 g/L for females and 51–92 g/L for males. A reduced TSP range of 48.00–85.55 g/L (2.5–97.5 percentiles) was established at &lt;1–5 years and increased towards adolescence. An uttermost range of 54–93 g/L was observed from 36–65 years of age. At the age &gt;65 years; a steady decline in the reference range (51.00–89 g/L) was recorded. An upper TSP range of 53–92 g/L (2.5–97.5 percentiles) was detected in Erongo, Zambezi, Hardap, Kavango East, and a comparable trend was also seen in Omusati with a 54–91 g/L range. Meanwhile; a reduced TSP range of 50–89 g/L was identified in Ohangwena. This study showed that gender, age, and geographical location can impact TSP levels with a significant clinical difference (p &lt; 0.05) between each category.</jats:p