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

Women from the Middle East and North Africa in Europe: Understanding their marriage and family dynamics

The aim of this article is to assist the understanding of social workers in Europe of marriage and family dynamics among women from Middle East and North African countries who have moved to Europe. The focus of this article is on husband selection processes and family dynamics after marriage in Egypt, which is used as a case study reflecting culture and norms surrounding marriage in this region. This article reports on the findings of doctoral studies which examined marriage patterns and family dynamics in North Africa and in particular in Egypt where more in-depth data were available. The authors reflect issues surrounding values and process of marriage not only in terms of the implications for practice with social work clients or service users, but also in relation to the potential of women from this region who may join the social care workforce

Organic matter interactions with natural manganese oxide and synthetic birnessite

© 2017 Elsevier B.V.Redox reactions of inorganic and organic contaminants on manganese oxides have been widely studied. However, these reactions are strongly affected by the presence of natural organic matter (NOM) at the surface of the manganese oxide. Interestingly, the mechanism behind NOM adsorption onto manganese oxides remains unclear. Therefore, in this study, the adsorption kinetics and equilibrium of different NOM isolates to synthetic manganese oxide (birnessite) and natural manganese oxide (Mn sand) were investigated. Natural manganese oxide is composed of both amorphous and well-crystallised Mn phases (i.e., lithiophorite, birnessite, and cryptomelane). NOM adsorption on both manganese oxides increased with decreasing pH (from pH. 7 to 5), in agreement with surface complexation and ligand exchange mechanisms. The presence of calcium enhanced the rate of NOM adsorption by decreasing the electrostatic repulsion between NOM and Mn sand. Also, the adsorption was limited by the diffusion of NOM macromolecules through the Mn sand pores. At equilibrium, a preferential adsorption of high molecular weight molecules enriched in aromatic moieties was observed for both the synthetic and natural manganese oxide. Hydrophobic interactions may explain the adsorption of organic matter on manganese oxides. The formation of low molecular weight UV absorbing molecules was detected with the synthetic birnessite, suggesting oxidation and reduction processes occurring during NOM adsorption. This study provides a deep insight for both environmental and engineered systems to better understand the impact of NOM adsorption on the biogeochemical cycle of manganese

Cancers cutanés de la face : avis comparés de réunions de concertation pluridisciplinaire françaises

National audienceBackground - The aim of our study was to evaluate the diversity, or homogeneity, of recommendations made in multidisciplinary team meetings (MTM) concerning the management of facial skin cancers in France, and to analyze the determinants thereof. Patients and methods - We contacted a panel of dermatology and ENT multidisciplinary teams (MDT) and collected their recommendations made at meetings regarding 3 clinical cases: squamous cell carcinoma in a renal transplant patient with an incomplete excision margin (case 1), locally advanced basal cell carcinoma (case 2), and lentigo maligna (case 3). The responses were analyzed globally and then based on 2 subgroups defined by the presence or absence of a dermatologist in the MTM. The effect of the makeup of the MTM (based on the presence of a dermatologist, a plastic surgeon, an oncologist and an ENT specialist) was evaluated for the main therapeutic proposals. Results - The opinions of the 45 MDMs that responded to the survey were mixed for the three cases as regards important elements such as the indication of surgical revision for case 1, the proposal of an alternative treatment to surgery for case 2, and monitoring arrangements for case 3. Certain proposals were associated with the presence of a dermatologist in the MTM, such as discussion of adaptation of immunosuppressive treatment and details of the surgical margins to be applied for case 1, as well as simple monitoring and details of monitoring arrangements in case 3. Conclusion - It is important to maintain dermatologists in MTMs on account of their expertise in all therapeutic areas concerning skin cancers

Euphorbia dendroides Latex as Source of Jatrophane Esters: Their Isolation, Structural Analysis, Conformational Study and Anti-CHIKV Activity

International audienceAn efficient process was used to isolate six new jatrophane esters, euphodendroidins J (3), K (5), L (6), M, (8), N (10), and O (11), along with seven known diterpenoid esters, namely, euphodendroidins A (4), B (9), E (1), and F (2), jatrophane ester (7), and 3α-hydroxyterracinolides G and B (12 and 13), and terracinolides J and C (14 and 15) from the latex of Euphorbia dendroides. Their 2D structures and relative configurations were established by extensive NMR spectroscopic analysis. The absolute configurations of compounds 1, 11, and 15 were determined by X-ray diffraction analysis. Euphodendroidin F (2) was obtained in 18% yield from the diterpenoid ester-enriched extract after two consecutive flash chromatography steps, making it an interesting starting material for chemical synthesis. Euphodendroidins K and L (5 and 6) showed an unprecedented NMR spectroscopic behavior, which was investigated by variable-temperature NMR experiments and molecular modeling. The structure–conformation relationships study of compounds 1, 5, and 6, using DFT-NMR calculations, indicated the prominent role of the acylation pattern in governing the conformational behavior of these jatrophane esters. The antiviral activity of compounds 1–15 was evaluated against Chikungunya virus (CHIKV) replication