Impact of Nyiragongo volcanic eruptions on the resilience to the COVID-19 and Ebola in the Democratic Republic of the Congo

For decades, the Democratic Republic of the Congo (DRC) has been vulnerable to disasters. The most dangerous Nyiragongo volcanic eruption posed a threat to the country, particularly the city of Goma. The explosions on 22 May 2021 caused unfathomable damages, with loss of lives, properties, and the destruction of homes, displacing thousands of people, with thousands of children being left vulnerable as a result. Furthermore, it charred health and school infrastructures and decimated crops, an issue in the population where the COVID-19 has exacerbated the existing fragile health system. Importantly, these eruptions posed a challenge when DRC struggled to end COVID-19 and Ebola through surveillance, preventive measures, and vaccination. It is doubtless that priorities of the emergency have interrupted the surveillance system, thus increasing exposure to the COVID-19 and Ebola transmission. It is critical to provide basic needs to victims of the Nyiragongo volcanic eruptions in the aftermath of such a disaster. Local and global humanitarian organizations are needed to assist residents in relocating. Furthermore, appropriate and adjusted mitigation strategies will significantly prevent Ebola, COVID-19, and other infectious diseases. In this paper, we discuss the impacts of the volcanic eruption on population health and Ebola preparedness and response in the context of the global COVID-19 outbreak in the Democratic Republic of the Congo

Kajian potensi ekstrak bilberi sebagai penunjuk pH untuk memantau kesegaran makanan secara kromametri

Penunjuk pH sebagai suatu pendekatan untuk memantau kualiti atau kesegaran makanan semasa telah mendapat perhatian industri pembungkusan makanan. Penggunaan sumber semula jadi pigmen tumbuhan terutamanya daripada buah-buahan dan sayur-sayuran menjadi pilihan para pengguna untuk menggantikan pewarna sintetik dalam memastikan keselamatan makanan yang diambil setiap hari. Dalam kajian ini, ekstrak daripada bilberi telah digunakan sebagai pewarna sensitif pH. Perubahan warna sampel dikaji secara terperinci melalui kaedah kromametri dan juga kaedah spektrofotometri ultra-lembayung nampak. Warna merah terang terhasil dalam pH berasid, merah pudar pada neutral dan magenta ke kuning dalam pH beralkali. Keputusan kajian kromametri menunjukkan bahawa ekstrak bilberi berupaya mempamerkan perubahan warna yang jelas terhadap perubahan pH, iaitu terdapat perubahan nilai warna a* yang menyumbang kepada perubahan yang bererti dalam perbezaan warna keseluruhan (ΔE*). Nilai ΔE* juga ditentukan wujud hubungan linear dan kuantitatif terhadap julat pH tertentu. Oleh yang demikian, ekstrak bilberi didapati berpotensi sebagai bahan sensor untuk pH dalam membangunkan satu sensor pH bagi memantau kesegaran makanan terutamanya hasilan laut berbungkus memandangkan tahap kerosakan produk tersebut berkait rapat dengan perubahan pH ke arah alkali

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

Resilience and Empowerment through Higher Education in Kakuma Refugee Camp: A Conversation

Resilience and empowerment are concepts that recently have become popularised in the world of forced displacement management policy and practice. Often undervalued and dismissed as being buzzwords, these concepts have become bound up in the burgeoning study of higher education in refugee contexts. This article explores these themes in the frame of a real-world experience of studying a blended learning medical studies course in Kakuma refugee camp and the impact it has had on an individual’s life and that of his community. Building on the academic discourse, we present a case study of the individual’s experience of studying an online and face-to-face course in Kakuma refugee camp and subsequently undertaking an internship with a local health care organisation. Through a discursive conversation, the subject of the case study reveals the positive impact this educational experience has fostered in his life by instilling resilience and empowering him to become a force for positive change in his community

Endothelin-1 Is Increased in Cerebrospinal Fluid and Associated with Unfavorable Outcomes in Children after Severe Traumatic Brain Injury

Severe pediatric traumatic brain injury (TBI) is associated with unfavorable outcomes secondary to injury from activation of the inflammatory cascade, the release of excitotoxic neurotransmitters, and changes in the reactivity of cerebral vessels, causing ischemia. Hypoperfusion of injured brain tissues after TBI is also associated with unfavorable outcomes. Therapeutic hypothermia is an investigational treatment strategy for use in patients with severe TBI that has shown differential effects on various cerebrospinal fluid (CSF) mediators in pediatric patients. Endothelin-1 (ET-1) is a powerful vasoconstrictor that exerts its effects on the cerebrovascular endothelium for sustained periods after TBI. The purpose of this study was to determine if CSF concentrations of ET-1 are increased after severe TBI in children, and if they are associated with demographics and outcomes that are affected by therapeutic hypothermia. This was an ancillary study to a prospective, randomized-controlled trial of early hypothermia in a tertiary care pediatric intensive care unit. Children (n = 34, age 3 months–15 years) suffering from severe TBI were randomized to hypothermia (n = 19) and normothermia (n = 15) as part of the efficacy study. Children undergoing diagnostic lumbar puncture (n = 11) to rule out infection were used as controls. Patients received either mild to moderate hypothermia (32–33°C) or normothermia as part of their treatment protocol. CSF was serially collected during the first 5 days after TBI. ET-1 concentrations were quantitated in patient and control CSF samples by a validated ELISA in duplicate with a limit of quantification of 0.195 pg/mL. CSF ET-1 concentrations were increased by two- to threefold in children after TBI compared to controls, and the increase was sustained for up to 5 days post-TBI. This relationship was not affected by hypothermia, and there were no differences in ET-1 response between children with inflicted and accidental TBI. Group-based trajectory analysis revealed two distinct groups with similar ET-1 levels over time. Univariate analysis showed a significant association between ET-1 levels and Glasgow Outcome Scale (GOS) scores, for which higher ET-1 levels over time were associated with unfavorable outcomes. ET-1 is increased in children with severe TBI and is associated with unfavorable outcomes. This increase in ET-1 may mediate the hypoperfusion or cerebrovascular dysfunction accompanying severe TBI in children. Importantly, hypothermia does not affect the brain's ET-1 response as measured in the CSF

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)