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

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Origem do conhecimento sobre HIV/AIDS: entre o pessoal e o acadêmico

Knowledge on HIV/AIDS has accumulated after two decades of the epidemic; however, studies show the need for changes in teaching so as to transform future professionals’ attitudes. In this scenario, the present study aimed at identifying the HIV/AIDS knowledge of students in the fifth year of a medicine undergraduate program. A positive self-evaluation concerning HIV/AIDS knowledge was found in association with undergraduate education as regards to biosafety for professional practice. Nevertheless, concerning sexual behavior, academic education did not have the same impact, since students reported previous knowledge, which was acquired from the media, secondary education and family and social relations, as determinant in their sexual practice. The results presented showed that teaching establishments must be responsible for critical awareness, which can develop prevention as the best form to control the disease. But this type of knowledge must make sense to students as future health care professionals, and particularly as citizens who are exposed to risks.Há um conhecimento acumulado sobre HIV/AIDS após duas décadas de epidemia, no entanto, estudos mostram a necessidade de mudanças na abordagem do ensino para transformação das posturas dos futuros profissionais. Neste contexto, objetivou-se identificar o conhecimento sobre HIV/AIDS entre alunos do 5º ano de um curso de medicina. Encontrou-se uma auto-avaliação positiva sobre o conhecimento em relação ao HIV/AIDS atrelado à formação durante a graduação, principalmente no que diz respeito à biossegurança para o exercício profissional. Já em relação ao comportamento sexual, a formação acadêmica não teve o mesmo impacto, pois os estudantes indicam como determinante no exercício da sexualidade o conhecimento prévio, adquirido através da mídia, ensino médio, relações familiares e sociais. Os resultados apresentados mostraram que a instituição formadora deve ser responsável pela consciência crítica capaz de desenvolver a prevenção como a melhor forma de controlar a doença. Mas, este tipo de ensinamento tem que fazer sentido para o aluno enquanto futuro profissional da saúde e principalmente enquanto cidadão exposto a riscos.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Origem do conhecimento sobre HIV/Aids: entre o pessoal e o acadêmico

Há um conhecimento acumulado sobre HIV/AIDS após duas décadas de epidemia, no entanto, estudos mostram a necessidade de mudanças na abordagem do ensino para transformação das posturas dos futuros profissionais. Neste contexto, objetivou-se identificar o conhecimento sobre HIV/AIDS entre alunos do 5º ano de um curso de medicina. Encontrou-se uma auto-avaliação positiva sobre o conhecimento em relação ao HIV/AIDS atrelado à formação durante a graduação, principalmente no que diz respeito à biossegurança para o exercício profissional. Já em relação ao comportamento sexual, a formação acadêmica não teve o mesmo impacto, pois os estudantes indicam como determinante no exercício da sexualidade o conhecimento prévio, adquirido através da mídia, ensino médio, relações familiares e sociais. Os resultados apresentados mostraram que a instituição formadora deve ser responsável pela consciência crítica capaz de desenvolver a prevenção como a melhor forma de controlar a doença. Mas, este tipo de ensinamento tem que fazer sentido para o aluno enquanto futuro profissional da saúde e principalmente enquanto cidadão exposto a riscos

Qualidade da recuperação de pacientes submetidos à hernioplastia inguinal sob anestesia local associada à anestesia geral via máscara laríngea ou raquianestesia. Ensaio clínico randomizado.

INTRODUÇÃO E OBJETIVOS: A hernioplastia inguinal pode ser realizado sob anestesia local, regional ou geral. O objetivo do presente estudo foi utilizar o questionário QoR-40 para comparar a anestesia local associada à anestesia geral sob máscara laríngea com a raquianestesia; MÉTODOLOGIA: 60 pacientes entre 18 e 65 anos, ASA I e II, submetidos à hernioplastia inguinal unilateral foram distribuídos de forma aleatória nos grupos: R – raquianestesia (15 mg de bupivacaína pesada 0,5%) ou L - anestesia geral sob máscara laríngea associada à infiltração regional (alfentanil e propofol seguido da inserção de máscara laríngea. Bloqueio de campo com 50 mL de ropivacaína a 0,5% e manutenção da anestesia com propofol). O questionário foi obtido na manhã seguinte; RESULTADOS: Não houve diferença significativa entre grupos quanto à qualidade da recuperação segundo o QoR-40, assim como não houve diferenças em relação às complicações. O tempo de permanência na SRPA foi menor no grupo L (p<0,05); CONCLUSÃO: Não há diferença na qualidade da recuperação após realização de hernioplastia sob bloqueio de campo associado à anestesia geral com máscara laríngea ou raquianestesia

Comparison among homemade repellents made with cloves, picaridin, andiroba, and soybean oil against Aedes aegypti bites

Submitted by Guilherme Lemeszenski ([email protected]) on 2013-08-22T19:07:08Z No. of bitstreams: 1 S0037-86822011000600030.pdf: 598602 bytes, checksum: bfb64a9cf3451d5ff334a299aaef72a2 (MD5)Made available in DSpace on 2013-08-22T19:07:08Z (GMT). No. of bitstreams: 1 S0037-86822011000600030.pdf: 598602 bytes, checksum: bfb64a9cf3451d5ff334a299aaef72a2 (MD5) Previous issue date: 2011-12-01Made available in DSpace on 2013-09-30T18:18:56Z (GMT). No. of bitstreams: 2 S0037-86822011000600030.pdf: 598602 bytes, checksum: bfb64a9cf3451d5ff334a299aaef72a2 (MD5) S0037-86822011000600030.pdf.txt: 7367 bytes, checksum: 13d9a97219544751edbd8b19c94fadaf (MD5) Previous issue date: 2011-12-01Submitted by Vitor Silverio Rodrigues ([email protected]) on 2014-05-20T13:34:18Z No. of bitstreams: 2 S0037-86822011000600030.pdf: 598602 bytes, checksum: bfb64a9cf3451d5ff334a299aaef72a2 (MD5) S0037-86822011000600030.pdf.txt: 7367 bytes, checksum: 13d9a97219544751edbd8b19c94fadaf (MD5)Made available in DSpace on 2014-05-20T13:34:18Z (GMT). No. of bitstreams: 2 S0037-86822011000600030.pdf: 598602 bytes, checksum: bfb64a9cf3451d5ff334a299aaef72a2 (MD5) S0037-86822011000600030.pdf.txt: 7367 bytes, checksum: 13d9a97219544751edbd8b19c94fadaf (MD5) Previous issue date: 2011-12-01Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Dermatologia e RadioterapiaUniversidade Estadual Paulista Instituto de Biociências Departamento de ParasitologiaUniversidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Dermatologia e RadioterapiaUniversidade Estadual Paulista Instituto de Biociências Departamento de Parasitologi

Diagnostic imaging of injuries caused by venomous and traumatogenic catfish

Abstract: Injuries caused by fish are common in marine and freshwater environments. Catfish of the Ariidae and Pimelodidae families cause about 80% of those injuries. One of the complications of injuries caused by fish is the retention of fragments of the stinger in the wounds. Here we report five cases (of a total of 127 injuries caused by catfish in the Brazilian coast) in which the retained fragments were detected by radiological examination. Retained fragments should be considered in patients stung by catfish. A simple X-ray is sufficient to detect fragments of stingers in the wounds

Trauma and envenoming caused by stingrays and other fish in a fishing community in Pontal do Paranapanema, state of São Paulo, Brazil: epidemiology, clinical aspects, and therapeutic and preventive measures

INTRODUÇÃO: Os acidentes causados por peixes são comuns em comunidades de pescadores fluviais no Brasil, sendo acidentes ocupacionais na maioria das vezes. Estas populações não têm informações dos mecanismos de trauma e envenenamento. MÉTODOS: Através de um questionário aplicado aos pescadores, foram obtidos dados clínicos e epidemiológicos sobre acidentes em Rosana, Pontal do Paranapanema, Estado de São Paulo, Brasil. Estes dados foram analisados e convertidos em um programa de prevenção e tratamento de acidentes através de um folheto de fácil assimilação RESULTADOS: Trinta e nove pescadores responderam o questionário. Todos os pacientes apresentaram ferimentos causados por algum peixe. Dos peixes mencionados, mandijubas (Pimelodus maculatus) foram os mais associados aos ferimentos, mas outros também causaram traumas. em relação às arraias, seis pescadores tinham sido envenenados. Dor intensa e úlceras foram os principais sintomas. Aproximadamente metade dos acidentados usou apenas medidas de tratamentos populares. CONCLUSÕES: Os pescadores apresentaram acidentes múltiplos por mandis, que são peçonhentos e causam dor intensa, assim como traumas por outros peixes, como surubins, traíras, corvinas de água doce e piranhas. Cerca de 16% dos entrevistados apresentaram envenenamento por arraias. Nossos dados e experiência prévia permitiram a criação de um folheto de fácil assimilação pelas populações locais que pode ajudar os pescadores de forma efetiva, em uma área extremamente carente de serviços de saúde e prevenção de doenças. Esta iniciativa é aplicável a toda a bacia do Rio da Prata, área extensa e de fauna similar.INTRODUCTION: Accidents caused by fish are common in inland fishing communities in Brazil, being work-related injuries in the majority of cases. These populations have no information on the mechanisms of trauma or envenoming. METHODS: Through a questionnaire administered to fishermen, we obtained clinical and epidemiological data on accidents in Rosana, Pontal do Paranapanema, State of São Paulo, Brazil. These data were analyzed and converted into an easily understood prevention and treatment program for the colony. RESULTS: Thirty-nine fishermen replied to the survey. All of the patients had been hurt by fish. of those mentioned, the yellow catfish (Pimelodus maculatus) was the main fish species associated with injuries, but others also caused trauma to the fishermen. Six fishermen had been envenomed by stingrays. Pain and ulcers were the main symptoms and were described as intolerable. Approximately half of those injured were treated using traditional folk remedies. CONCLUSIONS: The fishermen suffered multiple accidents with catfish, which are venomous and cause intense pain, as well as trauma due to other fish, such as surubins, traíras, freshwater croakers, and piranhas. Approximately 16% of those interviewed presented with envenomation from stingrays. Our data and previous experience in the area led to the creation of a pamphlet with clear language that can effectively help fishermen in the region, an area in need of health services and disease prevention. This initiative also applies to the whole La Plata River basin, which has similar fauna