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

Growth responses of mutants of spring barley to fumigation with SO2 and NO2in combination.

This study was undertaken to evaluate the range of variation in growth responses of sodium azide-induced M2mutants (stocks SI and S2) of spring barley, Hordeum vulgare. L. cv. Maris Mink, in relation to air pollution tolerance or sensitivity. The preliminary screening experiment with 150 nl l−1concentrations of SO2 and NO2 in combination for 10 d, yielded well-defined sensitive and tolerant lines in both the stocks. However, the percentage frequency distribution of plants in different injury classes varied and stock S2 showed a better segregation of different lines. In a subsequent experiment, treatment with a mixture of each gas at 100 nl l−lconcentration for 22 d caused a variable degree of growth reduction. As a result of air pollution treatment, most of the growth parameters were significantly (P < 0.001) reduced in the sensitive lines of both the stocks, whereas the tolerant lines showed a marked resistance to the growth inhibitory effect of the pollutants. The magnitude of the difference between the sensitivities of different lines was usually double or more, and the effects were, more pronounced in stock S2 than in stock SI. Root dry weight was more adversely affected than shoot dry weight in sensitive lines of both the stocks. The results indicated that inter-line differences in growth responses of these mutants were wide ranging, distinct and consistent. In conclusion, this study clearly demonstrates that artificial mutations may cause a markedly broad base of variation in air pollution sensitivity of crop plants which may be used in future plant breeding programmes of pollution tolerant cultivars

Mycoparasitism of Alternaria alternata by an Additional Eight Fungi Indicating the Existence of Further Unknown Candidates for Biological Control

In studies using light and scanning electron microscopy it was clearly demonstrated that Nectria inventa, Gliocladium roseum, G. ca.tenula.tum, Clonostacbys sp., Sesquidllium sp., Verticillium nigrescens, Dicyma olivacea, Stachybotrys elegans, Myrothecium carmichaelii, M. cinctum, M. roridum, M. tongaense, M. verrucaria and Coniothyrium sporulosum are able to parasitize Alternaria alternata. With the exception of N. inventa and the five Myrothecium spp., none of the other fungi has been previously reported to be mycoparasitic on Alternaria. Moreover, there is no current information about the mycoparasitic and antibiotic activity of the genera Clonostacbys and Sesquici-lium. The mode of parasitism was nearly the same in all of the mycoparasites. In many cases, penetration was achieved directly by the hyphal tips without the formation of appressorium like structures (ALS) and there was no evidence that the formation of ALS was a prerequisite for penetration. Dependant on the severity of infection, a gradual shrinkage, distortion and an eventual collapse of the parasitized conidia were observed. A bursting and total collapse of the spores without any penetration was detected by the antibiotic producing mycoparasites such as G. roseum, G. CAtenulatum, Clonostacbys sp., Sesquicillium sp., D. olivacea and the five Myrothecium species. In consideration of their activity, all of the tested antagonists would appear to be candidates for in vivo investigations to check their suitability as biocontrol agents. Copyright © 1993, Wiley Blackwell. All rights reserve