54 research outputs found

    Are children with SARS-CoV-2 infection at high risk for thrombosis? Viscoelastic testing and coagulation profiles in a case series of pediatric patients

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    © 2020 Wiley Periodicals LLC The coagulopathy of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is well documented in adults, with increases in D-dimer and prothrombin time found to be strong predictors of mortality, and anticoagulation shown to decrease this mortality. Viscoelastic parameters such as elevations in maximum clot firmness (MCF) on rotational thromboelastometry (ROTEM) have correlated with a hypercoagulable state in adults with SARS-CoV-2. We report our experience in children infected with SARS-CoV-2, with noted elevations in D-dimer and MCF on ROTEM (indicating hypercoagulability). Exploration of viscoelastic testing to provide additional laboratory-based evidence for pediatric-specific risk assessment for thromboprophylaxis in SARS-CoV-2 is warranted

    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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    Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

    The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

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    INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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    Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

    Ocena projektu, budowy i działania systemu chłodzenia ewaporacyjnego w przechowywaniu pomidorów

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    An evaporative cooling system was designed and constructed to increase the shelf life of stored vegetables. The evaporative cooler was tested and evaluated using freshly harvested roma tomatoes. The equipment operates on the principle of evaporative cooling which increased the relative humidity and decreased temperature in the preservation chamber. The storage system was made up of wood of 25.4 mm thickness. A side of the system is made of jute sack, which was moistened with water flowing through a series of perforated pipes from a reservoir located at the top of the storage system. The water flowed under gravity. The relative humidity and temperature of the tomatoes were analyzed using tinytag humidity, temperature data logger. The weight loss of the tomatoes was also analyzed using a dial gauge scale. The results revealed that there was significant difference in using the evaporative cooling system for storing tomatoes as compared to ambient conditions. The average cooling efficiency was found to be 81%. The average temperature achieved in the cooling system dropped to an average of 23°C when compared to the average ambient temperature of 33°C, and the relative humidity also increased up to 99% when compared to the average ambient of 59%. The analysis of the evaporative cooling system showed that tomatoes can be stored for more than 6 days with negligible changes in weight, colour and firmness as compared to those under ambient condition, which deteriorated after day 3. The evaporative cooling system was found to be effective and hence can be used by farmers, households, and tomato processing factories for short term storage of fresh tomatoes.System chłodzenia ewaporacyjnego został zaprojektowany i skonstruowany w celu przedłużenia terminu przydatności do spożycia warzyw. Chłodziarka ewaporacyjna została zbadana i oceniona przy zastosowaniu świeżo zebranych pomidorów odmiany Roma. Sprzęt działa na zasadzie chłodzenia ewaporacyjnego, które zwiększa wilgotność względną i zmniejsza temperaturę w komorze przechowalniczej. System przechowywania został zbudowany z drewna o grubości 25,4 mm. Bok systemu składa się z worka jutowego zwilżonego wodą płynącą przez perforowane rurki ze zbiornika umieszczonego na szczycie systemu przechowywania. Woda płynęła pod wpływem siły ciężkości. Wilgotność względna i temperatura pomidorów mierzone były za pomocą rejestratora danych. Utrata wagi pomidorów analizowana była za pomocą czujnika zegarowego. Wyniki pokazały istotne różnice w przechowywaniu pomidorów w systemie chłodzenia ewaporacyjnego w porównaniu do warunków otoczenia. Średnia wydajność chłodzenia wynosiła 81%. Średnia temperatura osiągnięta w systemie chłodzenia spadła średnio do 23°C w porównaniu do średniej temperatury otoczenia wynoszącej 33°C, a wilgotność względna również zwiększyła się do 99% w porównaniu do średniej z otoczenia wynoszącej 59%. Analiza systemu chłodzenia ewaporacyjnego wykazała, że pomidory mogą być przechowywane przez więcej niż 6 dni z nieistotnymi zmianami w wadze, kolorze i jędrności w porównaniu do pomidorów przechowywanych w warunkach otoczenia, które uległy pogorszeniu się po 3 dniach. Stwierdzono skuteczność system chłodzenia i możliwość zastosowania go przez rolników, gospodarstwa domowe i przedsiębiorstwa przetwarzające pomidory w krótkoterminowym przechowywaniu świeżych pomidorów

    Management of vaso-occlusive episodes in the day hospital decreases admissions in children with sickle cell disease

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    © 2019 British Society for Haematology and John Wiley & Sons Ltd Acute vaso-occlusive episodes (VOE) are the most common reason for presentation to the Emergency Department (ED) and inpatient admission in people living with sickle cell disease (SCD). The goal of this study was to compare the hospital admission rate for VOE from our centre’s day hospital (Pediatric Ambulatory Chemotherapy and Transfusion Unit; PACT) versus the ED, and to determine which factors influence admission rate. The study included a total of 370 visits involving 140 children with SCD with a mean age of 10·9 ± 5·5 years. The timing from triage to the first analgesic was significantly different between the PACT and the ED (median, 32 vs. 70 min, P \u3c 0·0001). The initial choice of opioid dosage adhered to our centre’s guidelines 84% of the time in the PACT v. 45% in the ED for morphine (P = 0·0003) and 100% in the PACT vs. 43% (P = 0·002) for hydromorphone. The admission rate from the ED (57%) was significantly higher than that of the PACT (29%) even when accounting for differences in baseline variables (P = 0·0001). In conclusion, the odds of being admitted were 3·8 times higher if the patient was treated in the ED. Timely administration and appropriate dosing of intravenous opioids may change this outcome in the future
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