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

Determination of BTEX by GCMS in air of offset printing plants: comparison between conventional and ecological inks

The use of inks containing organic solvents by the offset printing process implies in the release of volatile organic compounds to the work environment. Many of these compounds such as benzene, toluene, ethylbenzene, and the xylene isomers (well known by the acronym BTEX) are extremely toxic. In this study, the BTEX concentrations were determined in two different printing plants that use distinct types of inks: the conventional and the so-called ecological, which is manufactured based on vegetal oil. Concentration ranges were 43-84, 15-3,480, 2-133, 5-459, and 2-236 μg m-3 for benzene, toluene, ethylbenzene, m + p-xylene, and o-xylene, respectively, for the conventional printing plant. At the ecological printing plant, concentration ranges were below limit of detection (<LD)-31, <LD-618, <LD-1,690, <LD-10,500, <LD-3,360 μg m-3 for benzene, toluene, ethylbenzene, m + p-xylene, and o-xylene, respectively. BTEX concentrations are lower at the ecological printing environment than in the conventional, where mineral oil-based inks are used. However, the worker who cleans the printing matrices is exposed to high concentrations of ethylbenzene and xylenes, due probably to the cleaning product's composition (containing high amounts of BTEX). Although the BTEX concentrations found in both printing work environments were below the limits considered by the Brazilian Law for Activities and Unhealthy Operations (NR-15), the exposure to such vapors characterizes risk to the workers' health for some of the evaluated samples, mainly the personal ones. © Springer Science+Business Media B.V. 2009

Assessment of immune function after short-term administration of recombinant human growth hormone in healthy young males

Growth hormone (GH) is a commonly used drug aimed at improving sport performance. The aim of this study is to evaluate the immunomodulatory effects of short-term administration of recombinant GH (rhGH) in healthy young males. NK cell number, activity and phenotype, T cell number, CD4(+) (Th1/Th2) cytokine production of IL2, IL4, IL6, IL10, TNF-alpha and IFN-gamma and CD4(+)/CD8(+) ratio with particular attention to the possible correlation to IGF-I production were investigated. 30 males (27 +/- A 9 years) were randomly assigned to placebo (n = 15) or drug (rhGH) 1 mg/day groups (n = 15) with daily injection for 7 days. IGF-I plasma concentration and flow cytometry data were generated at baseline and days 8, 15, 22 and 29 post injection. Data analysis used General Linear Model with repeated measures, Bonferroni correction factor and significance at p a parts per thousand currency sign 0.05. Serum IGF-I levels (ng/mL) increased significantly (p a parts per thousand currency sign 0.01) on day 8 (0.48 +/- A 0.78) after injections compared to baseline (0.31 +/- A 0.07) and days 15 (0.33 +/- A 0.06), 22 (0.29 +/- A 0.05) and 29 (0.29 +/- A 0.06). A significant time effect was noted in IL10 secretion (pg/mL) from day 15 (P = 35.14 +/- A 19.93, rhGH = 26.63 +/- A 16.39) to days 22 (P = 61.32 +/- A 20.41, rhGH = 74.99 +/- A 46.91) and 29 (P = 101.98 +/- A 67.25, rhGH = 107.74; +/- A 122.58). There was no correlation between IGF-I and NK activity, phenotype or number along with T lymphocyte number, CD4(+)/CD8(+) ratio or Th1 and Th2 cytokine production. In conclusion, cytokine secretion spectrum was not affected by short-term rhGH administration in young males

Recombinant human erythropoietin in sports: a review

Erythropoietin is an endogenous hormone of glicoproteic nature secreted by the kidneys and is the main regulator of the erythropoiesis. An alteration in its production generates a disturbance in the plasmatic concentration giving rise to several types of pathologies related to the hematopoietic system. The recombinant forms of erythropoietin have indiscriminately been used by athletes, mainly in endurance sports, by increasing the erythrocytes concentration, generating a better delivery of oxygen to the muscle tissue. The administration of recombinant erythropoietin was prohibited by the International Olympic Committee and its use considered as doping. This review has the intention to describe the physical, biological and pharmacokinetic properties of the endogenous erythropoietin, as well as its recombinant form, describing also its use in sports and the process of searching methodologies for its detection in doping control