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

Microbial contaminants of retail beef in open market stalls and meat shops within Makurdi metropolis, Nigeria

No Abstract.Animal Production Research Advances Vol. 4 (1) 2008: pp. 47-5

Computer game assisted instruction and students’ achievement in social studies

This paper examines the effects of computer game assisted instructional method, student’s achievement in social studies in Nigerian schools. An overview of the position of social studies subject in schools today is undertaken showing social studies teaching needs more attention, this is done by applying or integrating computer game assisted instructional method. Two research questions and hypotheses were formulated to direct the study. Social studies achievement test (SSAT) was used to collect data from 176 junior secondary school students (JSSII). The results showed that there is a significant difference in the achievement of students in favour of CGAIM, but there is no significant difference in the mean achievement level of boys and girls. It is recommended that in-service training seminars and workshops should be regularly organized for practicing teaching to acquaint them with new innovations and ideas in the methods of teaching the subject.Keywords: Computer game, instruction, achievement, Social studie

Relationship between Corneal Biomechanical Properties among Pregnant Women in a Tertiary Hospital in Nigeria

Objective: In Nigeria, many pregnant women as well as health‑care providers are unaware of the effect of pregnancy on the eye. The present study investigated the changes in central corneal thickness (CCT), corneal sensitivity (CS), and intraocular pressure (IOP) among pregnant women in a tertiary hospital in Nigeria and the relationship between them. Materials and Methods: A prospective longitudinal study was used. One hundred and thirty‑four pregnant women attending the Obstetric Clinic of the University of Nigeria Teaching Hospital, Enugu, were consecutively recruited in their second trimester for the study. Changes in CCT, CS, and IOP were monitored at the second and third trimesters and 6‑week postpartum. Data obtained were analyzed using Statistical Package for the Social Sciences version 20. The effect of duration of pregnancy on these variables was determined using simple linear regression and further analysis was done using Bonferroni’s post hoc test. Results: The women were aged 18–48 years, with a mean age of 30.81(±5.49) years and majority of them (61.2%) were multigravida. The duration of pregnancy varied inversely and significantly with CS (P < 0.05) and IOP (P < 0.000) with the least values recorded in the third trimester, while it varied directly and also significantly with CCT (P < 0.000) with the highest value obtained in the third trimester. A negative correlation that was significant only in third trimester was found between CCT and IOP (P < 0.02) and CS (P < 0.03). Conclusion: There was a progressive increase in CCT with a corresponding decrease in CS and IOP across the trimesters of pregnancy, but these changes reversed 6‑week postpartum.Keywords: Central corneal thickness, cornea sensitivity, intraocular pressure, pregnanc

ASA classification and in-hospital deaths in surgery

Background: ASA (American Society of Anesthesiologists’) classification appears to have a direct relationship to in-hospital mortality in surgery,provided other factors that can equally affect mortality are favorable.Aims and objectives: To study the relationship between ASA classification and in-hospital mortality within the surgical service in our center.Design: Retrospective study.Setting: Nnamdi Azikiwe University Teaching Hospital, a tertiary institution serving rural, semi-urban and urban communities.Patients and methods: Searching through the records, all the in-hospital deaths that occurred in our center between 1st August 1999 and 31st July2006, a 7-year period, were studied with a view to seeing what the ASA classification of the patients were at the time they were admitted, nature ofsurgical intervention, type of anesthesia, time of death after admission/surgery, and cause of death.Results: A total of 251 in-hospital deaths occurred in the surgical service during the period under review. However, only 106 of the patients(42.2%) had records of ASA classification before death. These were recruited into this study. Ten of the patients (9.4%) were in ASA classification V; 57 (53.8%) were in ASA IV; 32 (30.2%) in ASA III and only seven (6.6%) were in ASA II. None of the patients was in ASA I or ASA VI.Seventy-six patients (71.7%) presented as emergencies.Conclusion: There appears to be a direct relationship between ASA classification and the rate of in-hospital mortality within the surgical service:higher ASA classification being associated with higher in-hospital deaths

Regulation of the T-box transcription factor Tbx3 by the tumour suppressor microRNA-206 in breast cancer

BACKGROUND: The Tbx3 transcription factor is over-expressed in breast cancer, where it has been implicated in proliferation, migration and regulation of the cancer stem cell population. The mechanisms that regulate Tbx3 expression in cancer have not been fully explored. In this study, we demonstrate that Tbx3 is repressed by the tumour suppressor miR-206 in breast cancer cells. METHODS: Bioinformatics prediction programmes and luciferase reporter assays were used to demonstrate that miR-206 negatively regulates Tbx3. We examined the impact of miR-206 on Tbx3 expression in breast cancer cells using miR-206 mimic and inhibitor. Gene/protein expression was examined by quantitative reverse-transcription–PCR and immunoblotting. The effects of miR-206 and Tbx3 on apoptosis, proliferation, invasion and cancer stem cell population was investigated by cell-death detection, colony formation, 3D-Matrigel and tumorsphere assays. RESULTS: In this study, we examined the regulation of Tbx3 by miR-206. We demonstrate that Tbx3 is directly repressed by miR-206, and that this repression of Tbx3 is necessary for miR-206 to inhibit breast tumour cell proliferation and invasion, and decrease the cancer stem cell population. Moreover, Tbx3 and miR-206 expression are inversely correlated in human breast cancer. Kaplan–Meier analysis indicates that patients exhibiting a combination of high Tbx3 and low miR-206 expression have a lower probability of survival when compared with patients with low Tbx3 and high miR-206 expression. These studies uncover a novel mechanism of Tbx3 regulation and identify a new target of the tumour suppressor miR-206. CONCLUSIONS: The present study identified Tbx3 as a novel target of tumour suppressor miR-206 and characterised the miR-206/Tbx3 signalling pathway, which is involved in proliferation, invasion and maintenance of the cancer stem cell population in breast cancer cells. Our results suggest that restoration of miR-206 in Tbx3-positive breast cancer could be exploited for therapeutic benefit