48 research outputs found

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

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    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

    Road Traffic Accident Research in India: A Scientometric Study from 1977 to 2020

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    This study carried out the scientometric analysis of road traffic accident research in India from 1977 to 2020. It aimed to examine type of publications with their citations and usage, the year wise publication and citation growth, most preferred journals, authors’ preference of keywords used, collaboration of Indian authors, authorship pattern and most prolific authors, and top contributing organizations. During 44 years of study, 1,132 research items were published and indexed in Web of Science (WoS) bibliographic database. Analysis discovered that number of publications increased from one (0.08%) in 1977 to 182 (16.07%) in 2018 and observed good progress in scholarly literature. Majority of scholarly publications were published in the form of article (740, 65.37%). From 2006 to 2018, number of publications increased rapidly from 11 (0.97%) to 182 (16.07%) publications, which was the most productive year for the researchers. On an average 25.73 documents were published per year and received 392.95 citations per year. Journal of Evaluation of Medical and Dental Sciences published majority of the publications (108, 30.50%). The word “Trauma” was the most frequently used keyword. Majority of publications (83.38%) on road traffic accidents (RTA) were written by the Indian authors individually or with local collaboration. Majority of the publications (1,081, 95.49%) were written by multiple authors while 51 publications (4.51%) were from single author. Most prolific authors were Tiwari, G. and Mohan, D. with 18 publications each. The Indian Institute of Technology was highly contributing organization, which published 120 documents (10.60%)

    مولود شریف(قلمی): غوث محمد شاہ

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mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} The enclosed script has been acquired from Ishfaq Ahmad Qureshi, the grand maternal son of Ghous Muhammad Shah, who is a teacher in the Govt. boy's high school No. 1 in Bakhar. This script (Makhtuta) contains Maulood Sharief which is incomplete and is quite mutilated. It denotes that it was composed between 19th and 20th century A.D. because Ghous Muhammad Shah's year of birth is 1886 and he died in 1933. Its study shows that it is in the form of Moulood Sharief, and important form of poetry critical survey of Naat, and Maulood includes the definition tradition and style of this form. Along with critical appreciation of this form and its traditions it includes an index and explanatory notes and references which are helpful to understand and evaluate this piece of literature.</p
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