Narrowing the gap for hematopoietic stem cell transplantation in the East-Mediterranean/African region: comparison with global HSCT indications and trends.

Hematopoietic Stem Cell Transplantation (HSCT) activity was evaluated in the African (AFR)/EMRO region and compared to the global activity for the years 2006-2013. Data were obtained from 1570 teams in the 6 WHO continental regions. Of these, 29 (1.85%) of all teams were active in 12 of the 68 AFR/EMRO countries. They reported 2.331 (3.3%) of the worldwide 71.036 HSCT, and a transplant rate of 32.8 (TR; HSCT/10 million inhabitants; worldwide 128.5). This reflects still the lowest regional TR despite an increase of 90% since 2006. HSCT activity in AFR/EMRO countries was characterized by a higher use of allogeneic compared to autologous HSCT, an almost exclusive use of family donors, including haploidentical family donors. These findings contrast with the prevalence of autologous over allogeneic HSCT, and a higher frequency of unrelated HSCT in other parts of the world. Of note, the increase by 200% in HSCT for hemoglobinopathies from 2006 to 2013 (72 per year) in the AFR/EMRO region. This reflects the specific role of HSCT for these disease categories with high prevalence and incidence in the AFR/EMRO region. This report provides information for the competent authorities to foster adequate infrastructure. It urges transplant organization to optimize their cooperation

113 Invasive fungal infections among pediatric patients with hematologic malignancies at KFSH&RC/KFCCC&R

Objectives: To define the magnitude of the problem, study factors associated with increased risk of invasive fungal, infections (IFI) and outcome.Methods: From June 1998 to March 2003, all, radiological, studies of patients with hematologic/ oncologic disorders were evaluated for inclusion. AII, cases of invasive fungal, infection were reviewed. The criteria for inclusion were obvious lesion suggestive of fungal, infection shown on radiological, studies, and fungal, infections were classified as proven , probable\u27, possible or insufficient evidence according to a prior definitions.Results: A total, of 1615 patient charts were reviewed. The underlying diagnoses include ALL 410, SCT 293, AML 133, non-malignant hematology 288, NHL/solid tumors 491. 152 (9%) had evidence of fungal, infection (55 [36%] \u27definite = proven/probable\u27, 97 [64%] \u27possible\u27). Biopsy was performed in 94 cases and the findings included budding yeast in 10 patients, septated hyphae in 19, and hyphae with no specifications in 12 patients. Delays in performing diagnostic procedures possibly resulted in the lower incidence of \u27definite\u27 IFI (36% vs 64% \u27possible ). The overall, incidence of fungal, infection was 9%, being highest for AML (39%), followed by ALL (17%). The majority of IFI developed during or immediately after induction (42% of IFI in AML and 53% of IFI in ALL), which can be a target for intervention. The infections included disseminated fungal, infection (36%), CDC (11%), pulmonary fungal, infection (43%) and aspergillosis (9.5%) including pulmonary, Para nasal, sinuses, skin and disseminated. IFI was radiologically diagnosed during neutropenia in 123 patients (81%). Ten patients died due to fungal, infection (7%), 75 (49%) were cured, 26 (17%) were alive with fungal, infection, and 39 patients (26%) died due to primary disease seemingly unrelated to fungal, infection. Mortality due to IFI in this study is less than what is reported in the literature and could be a result of our practice of early intervention. The average LOS for IFI was 56 days compared with the usual. 12 days, which can add to the increased cost.Conclusions: Invasive fungal, infection is becoming a serious problem. Furthermore, acute invasive fungal, infection is associated with a much higher mortality. Early diagnosis with prompt antifungal, therapy, or even with surgical, intervention, might be warranted to save patients\u27 lives

BJS commission on surgery and perioperative care post-COVID-19

Background: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues experiences and published evidence. Methods: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. Results: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. Conclusion: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era

BJS commission on surgery and perioperative care post-COVID-19

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues' experiences and published evidence