Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

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

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

3(2<em>H</em>)-Furanones promising candidates for synthesis of new fluorescent organic probes

567-575Several novel 3-arylidene-5-(4-methoxy-3-nitrophenyl)-2(3H)-furanones (2a-d) have been successfully prepared and used as precursors for building up of other new heterocyclic architectures such as pyrrolones (4a-c), (5) and unsaturated aroyl-hydrazides (7a-d). These aroyl-hydrazides have been subsequently converted into pyridazinone derivatives (8a-d) by refluxing in HCl/AcOH mixture. Eventually, benzoylation of the hydrazides (7a-c) with benzoyl chloride affords the corresponding N-benzoyl-3(2H)-pyridazinones (9a-c). The structures of all synthesized compounds have been established using elemental analysis and spectral methods. The photophysical (fluorescence and electronic absorption spectra) properties of newly synthesized compounds have also been investigated

Hybrid CLAHE-CNN Deep Neural Networks for Classifying Lung Diseases from X-ray Acquisitions

Chest and lung diseases are among the most serious chronic diseases in the world, and they occur as a result of factors such as smoking, air pollution, or bacterial infection, which would expose the respiratory system and chest to serious disorders. Chest diseases lead to a natural weakness in the respiratory system, which requires the patient to take care and attention to alleviate this problem. Countries are interested in encouraging medical research and monitoring the spread of communicable diseases. Therefore, they advised researchers to perform studies to curb the diseases’ spread and urged researchers to devise methods for swiftly and readily detecting and distinguishing lung diseases. In this paper, we propose a hybrid architecture of contrast-limited adaptive histogram equalization (CLAHE) and deep convolutional network for the classification of lung diseases. We used X-ray images to create a convolutional neural network (CNN) for early identification and categorization of lung diseases. Initially, the proposed method implemented the support vector machine to classify the images with and without using CLAHE equalizer. The obtained results were compared with the CNN networks. Later, two different experiments were implemented with hybrid architecture of deep CNN networks and CLAHE as a preprocessing for image enhancement. The experimental results indicate that the suggested hybrid architecture outperforms traditional methods by roughly 20% in terms of accuracy

Integrative Seed and Leaf Treatment with Ascorbic Acid Extends the Planting Period by Improving Tolerance to Late Sowing Influences in Parsley

Abnormal production of reactive oxygen species (ROS) is an undesirable event which occurs in plants due to stress. To meet this event, plants synthesize ROS-neutralizing compounds, including the non-enzymatic oxidant scavenger known as vitamin C: ascorbic acid (AsA). In addition to scavenging ROS, AsA modulates many vital functions in stressed or non-stressed plants. Thus, two-season (2018/2019 and 2019/2020) trials were conducted to study the effect of integrative treatment (seed soaking + foliar spray) using 1.0 or 2.0 mM AsA vs. distilled water (control) on the growth, seed yield, and oil yield of parsley plants under three sowing dates (SDs; November, December, and January, which represent adverse conditions of late sowing) vs. October as the optimal SD (control). The ion balance, osmotic-modifying compounds, and different antioxidants were also studied. The experimental layout was a split plot in a completely randomized block design. Late sowing (December and January) noticeably reduced growth traits, seed and oil yield components, and chlorophyll and nutrient contents. However, soluble sugar, proline, and AsA contents were significantly increased along with the activities of catalase (CAT) and superoxide dismutase (SOD). Under late sowing conditions, the use of AsA significantly increased growth, different yields, essential oil fractions, CAT and SOD activities, and contents of chlorophylls, nutrients, soluble sugars, free proline, and AsA. The interaction treatments of SDs and AsA concentrations indicated that AsA at a concentration of 2 mM was more efficient in conferring greater tolerance to adverse conditions of late sowing in parsley plants. Therefore, this study recommends 2.0 mM AsA for integrative (seed soaking + foliar spraying) treatment to prolong the sowing period of parsley seeds (from October up to December) and avoid damage caused by adverse conditions of late sowing

Integrative Seed and Leaf Treatment with Ascorbic Acid Extends the Planting Period by Improving Tolerance to Late Sowing Influences in Parsley

Abnormal production of reactive oxygen species (ROS) is an undesirable event which occurs in plants due to stress. To meet this event, plants synthesize ROS-neutralizing compounds, including the non-enzymatic oxidant scavenger known as vitamin C: ascorbic acid (AsA). In addition to scavenging ROS, AsA modulates many vital functions in stressed or non-stressed plants. Thus, two-season (2018/2019 and 2019/2020) trials were conducted to study the effect of integrative treatment (seed soaking + foliar spray) using 1.0 or 2.0 mM AsA vs. distilled water (control) on the growth, seed yield, and oil yield of parsley plants under three sowing dates (SDs; November, December, and January, which represent adverse conditions of late sowing) vs. October as the optimal SD (control). The ion balance, osmotic-modifying compounds, and different antioxidants were also studied. The experimental layout was a split plot in a completely randomized block design. Late sowing (December and January) noticeably reduced growth traits, seed and oil yield components, and chlorophyll and nutrient contents. However, soluble sugar, proline, and AsA contents were significantly increased along with the activities of catalase (CAT) and superoxide dismutase (SOD). Under late sowing conditions, the use of AsA significantly increased growth, different yields, essential oil fractions, CAT and SOD activities, and contents of chlorophylls, nutrients, soluble sugars, free proline, and AsA. The interaction treatments of SDs and AsA concentrations indicated that AsA at a concentration of 2 mM was more efficient in conferring greater tolerance to adverse conditions of late sowing in parsley plants. Therefore, this study recommends 2.0 mM AsA for integrative (seed soaking + foliar spraying) treatment to prolong the sowing period of parsley seeds (from October up to December) and avoid damage caused by adverse conditions of late sowing