Plasma Disposition of Ampicillin following Thiopentone Sodium Anaesthesia in Rabbits (Oryctolagus cuniculi)

Nigerian Veterinary Journal, Vol. 32(2): 2011; 97 - 10

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

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 middle-income 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 low-income 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 low-income, 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

Five insights from the Global Burden of Disease Study 2019

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3.5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.Peer reviewe

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Prevalence of pneumonia among slaughtered cattle, goats and sheep in Maiduguri abattoir, Maiduguri, Nigeria

Retrospective study on bovine, ovine and caprine pneumonia was conducted over a five-year period (2000-2004). Data were collected from the Maiduguri metropolitan abattoir and a total of 173,824 cattle, 270,339 goats and 12,587 sheep were examined at post-mortem for pneumonic lesions. Of these, 54%, 52% and 53% were males while 46%, 48% and 47% were females for the species respectively. Differences were not observed in the slaughter figures among species (p>0.05). A total of 361 cattle, 253 goats and 149 sheep had pneumonia with overall prevalence rates of 0.21%, 0.09% and 0.12% respectively. The data revealed that cattle had the highest number of cases (133) in 2004 while goats had the least (7 cases) in the same year. Over the years, the incidence of pneumonia amongst species was relatively unstable but not significant statistically (p>0.05). The low prevalence recorded in this study may be due to subclinical disease, activities of the butchers such as hiding the affected lungs from meat inspectors, slaughtering of animals outside the abattoir particularly during festive seasons and the use of antibiotics in feeds by farmers to curtail bacterial infections. Keywords:Pneumonia, cattle, goats, sheep, abattoir, Maiduguri, NigeriaSahel Journal of Veterinary Science Vol. 6 (1) 2007: pp. 5-

Prevalence and Biotyping of Pasteurella Haemolytica Isolates from Sahel Sheep and Goats at Maiduguri, Nigeria

P. haemolytica isolated from Sahel sheep and goat in Maiduguri was characterized phenotypically. A total of 92 P. haemolytica isolates were obtained from the nasopharyngeal swabs while a total of 15 isolates came from pneumonic lung samples. The results showed that 37(20.22%) P. haemolytica isolates were obtained from goats while 55(25.23%) came from sheep. The overall isolation rate was 22.94%. Sheep had the highest (25.23%) number of the isolates but the difference was not statistically significant (P&gt;0.05). Prevalence rate of P. haemolytica was higher in female sheep and in sheep between 18-24 months of age but not significant statistically (P&gt;0.05), likewise species and sex difference did not play any significant role. However, the prevalence rate was higher in diseased animals compared with the apparently normal healthy ones (P&lt;0.05).&nbsp; In all, biotype A was 60.75%, biotype T 22.43% and untypable isolates were 16.82%. Overall, biotype A occurred more significantly than biotype T (P&lt;0.05) and appeared to be the predominant biotype in the area.&nbsp; Gross pathological appearance of pneumonic lungs was characterized by pulmonary oedema, congestion and multifocal to coalescing haemorrhages with deposition of fibrin. Histopathologically, there was severe pulmonary congestion and oedema with heavy infiltration of mononuclear and leucocytic cells into the interalveolar septae with collapse of alveoli and formation of bullae. These pathological changes are similar to lesions seen in experimental pasteurellosis

Antimicrobial susceptibility of Pasteurella haemolytica isolates from sheep and goats in Maiduguri, Nigeria

No Abstract.Animal Production Research Advances Vol. 4 (1) 2008: pp. 73-7

Update on Paediatric Urolithiasis in North-Eastern Nigeria

Background: Among the Childhood urolithiasis, bladder stones appear to predominate. We reviewed our experience in the management of urolithiasis in children, highlighting recent changes observed in our practice. Patients and Methods: In the period between January, 2004 and December, 2009, 56 children with urinary stones were retrospectively reviewed. Results: Over the last 6 years, 56 children were managed for childhood urinary stones in our center. Their ages ranged from 9 months to 15 years (mean age: 6.7 years). There were 46 boys and 10 girls (M:F= 4.6:1). Eighteen (32.1%) children were below 5 years of age, 28(50.0%) were between 5-10 years and 10(17.9%) were 10-15 years of age. Majority 39(69.4%) of the stones were located in the upper urinary tract (UUT), 16 (28.6%) were in the lower urinary tract (LUT) and 1(1.8%) were in both UUT and LUT. In 2 cases, (3.6%) of bilateral ureteric stones were due to concomitant schistosomal fibrosis of the distal ureters, otherwise no other aetiological factors were identified. One patient passed the stone spontaneously, while the remaining had open surgical removal with no mortality. Postoperative morbidity occurred in 5 patients, (8.9%) wound infection in 4patients and vesicocutaneous fistula in one patient.Conclusion : Paedatric urolithiasis is a common occurrence in our setting, affecting predominantly the upper urinary tract.Keywords: Paediatric,Urolithiasis,North-Eastern Nigeri