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

PLANTAS HOSPEDEIRAS DE Thyrinteina arnobia (LEPIDOPTERA: GEOMETRIDAE) AFETAM O DESENVOLVIMENTO DO PARASITOIDE Palmistichus elaeisis (HYMENOPTERA: EULOPHIDAE)1

O objetivo deste trabalho foi avaliar a eficiência do parasitismo e a biologia da prole do parasitoide Palmistichus elaeisis Delvare e La Salle (Hymenoptera: Eulophidae) em pupas de Thyrinteina arnobia Stoll (Lepidoptera: Geometridae) quando criadas em plantas de Psidium guajava ou Eucalyptus cloeziana. Ovos de T. arnobia foram coletados e colocados em sacos de tecido tipo organza envolvendo galhos de plantas de P. guajava (T1) e E. cloeziana (T2) até as lagartas alcançarem a fase de pupa. Trinta pupas de cada tratamento foram individualizadas em tubos de vidro e expostas ao parasitismo por quatro fêmeas de P. elaeisis por 24 h. Avaliaram-se a emergência da progênie do parasitoide por pupa; a porcentagem de parasitismo, pupas mortas e de adultos de T. arnobia emergidos; a duração do ciclo de vida (ovo-adulto);a longevidade; a razão sexual; e o tamanho da cápsula cefálica e do corpo do parasitoide. A porcentagem de parasitismo, a emergência de P. elaeisis por pupa, a longevidade das fêmeas e o tamanho da cápsula cefálica e do corpo dos machos do parasitoide foram menores quando seu hospedeiro foi criado em plantas de eucalipto. Isso pode ter ocorrido devido à grande quantidade de compostos do metabolismo secundário presentes nesta planta, que podem ser acumulados no corpo do herbívoro ao se alimentar, afetando negativamente o inimigo natural. Palmistichus elaeisis mostrou-se mais adaptado à mirtácea nativa da América P. guajava

Polyarteritis nodosa related to hepatitis B virus infection

peer reviewedA 66-year-old man was hospitalized for asthenia, weight loss, fever and chills. A polyarteritis nodosa associated with hepatitis B virus infection in a replicative phase was diagnosed. Etiology, physiopathology, and clinical characteristics of hepatitis B virus-related polyarteritis nodosa will be reviewed, as well as the effectiveness of therapy combining corticosteroids, interferon alpha and plasma exchanges

Clinical case of the month. Adult onset Still's disease: a rare cause of acute febrile hepatitis

peer reviewedA 63-year-old woman was hospitalized for the third time in one year for asthenia, fever and chills, jaundice, cytolysis and cholestasis. An adult onset Still's disease was diagnosed. Hepatic manifestations, diagnostic criteria and efficient therapy of AOSD will be reviewed

Gastric antral vascular ectasia syndrome : clinical and endoscopic presentation and endoscopic treatment

Nous rapportons une série de dix patients chez lesquels un «syndrome d'Ectasies Vasculaires Antrales » a été découvert lors d'un bilan endoscopique. Sept patients présentaient une anémie ferriprive chronique et ont bénéficié d'un traitement endoscopique. Les aspects clinique, physiopathologique, histologique et endoscopique sont discutés à la lumière de la littérature