Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Theoretical and experimental inhibitive properties of mild steel in HCl by ethanolic extract of Boscia senegalensis

The experimental aspect of the corrosion inhibition potentials of Boscia senegalensis was carried out using gravimetric and linear polarization techniques as well as scanning electron microscopy and Fourier transform infrared spectroscopy (FTIR), whereas the theoretical aspect was studied using the density functional theory calculations to be performed and modeling the electronic structures of some extract constituents, including physiosorptive interactions with the Fe surface. The analyses of the experimental results showed that the inhibition efficiency increased with increase in concentration of the inhibitor and decreased with increase in temperature. The efficiency of the extract in HCl was 70%. Thermodynamic parameters revealed that the adsorption of extract onto the metal surface was spontaneous, exothermic, and supported the physical adsorption process. FTIR results showed that the inhibition mechanism was an absorption process through the functional groups present in the extract and that of the inhibited. Surface morphology also revealed that corrosion product confirmed the protection offered by the extract on the surface of the metal immersed in the acid media. The data obtained were fitted into various adsorption isotherms, though the Freundlich isotherm was found to be the best fit

Prognostically significant fusion oncogenes in Pakistani patients with adult acute lymphoblastic leukemia and their association with disease biology and outcome

Background and objectives: Chromosomal abnormalities play an important role in genesis of acute lymphoblastic leukemia (ALL) and have prognostic implications. Five major risk stratifying fusion genes in ALL are BCR-ABL, MLL-AF4, ETV6-RUNX11, E2A-PBX1 and SIL-TAL1. This work aimed to detect common chromosomal translocations and associated fusion oncogenes in adult ALL patients and study their relationship with clinical features and treatment outcome. Methods: We studied fusion oncogenes in 104 adult ALL patients using RT-PCR and interphase-FISH at diagnosis and their association with clinical characteristics and treatment outcome. Results: Five most common fusion genes i.e. BCR-ABL (t 9; 22), TCF3-PBX1 (t 1; 19), ETV6-RUNX1 (t 12; 21), MLL-AF4 (t 4; 11) and SIL-TAL1 (Del 1p32) were found in 82/104 (79%) patients. TCF3-PBX1 fusion gene was associated with lymphadenopathy, SIL-TAL1 positive patients had frequent organomegaly and usually presented with a platelets count of less than . Survival of patients with fusion gene ETV6-RUNX1 was better when compared to patients harboring other genes. MLL-AF4 and BCR-ABL positivity characterized a subset of adult ALL patients with aggressive clinical behaviour and a poor outcome. Conclusions: This is the first study from Pakistan which investigated the frequency of5 fusion oncogenes in adult ALL patients, and their association with clinical features, treatment response and outcome. Frequencies of some of the oncogenes were different from those reported elsewhere and they appear to be associated with distinct clinical characteristics and treatment outcome. This information will help in the prognostic stratification and risk adapted management of adult ALL patients.Noreen Sabir, Zafar Iqbal, Aamer Aleem, Tashfeen Awan, Tahir Naeem, Sultan Asad, Ammara H Tahir, Muhammad Absar, Rana MW Hasanato, Sulman Basit, Muhammad Azhar Chishti, Muhammad Faiyaz Ul-Haque, Ahmad Muktar Khalid, Muhammad Farooq Sabar, Mahmood Rasool, Sajjad Karim, Mahwish Khan, Baila Samreen, Muhammad Hassan Siddiqi, Saba Shahzadi, Sana Shahbaz, Agha Shabbir Ali, Amer Mahmood, Muhammad Akram, Tariq Saeed, Arsalan Saleem, Danish Mohsin, Ijaz Hussain Shah, Muhammad Khalid, Muhammad Asif, Mudassar Iqbal, Tanveer Akhta