Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Sarcoidosis in Lagos Revisited. A Retrospective Analysis of 15 cases, Seen at the Pulmonology Unit of an Urban Tertiary Centre in Lagos, South West, Nigeria.

Sarcoidosis amongst Nigerians remains a condition with limited information in literature despite the high prevalence of Sarcoidosis amongst Afro- Americans. This study was conceived to describe the presentation of the cases seen in an urban tertiary centre in Nigeria. A three year retrospective study of Sarcoidosis was carried out at a tertiary hospital in Lagos Nigeria. Fifteen cases were identified with confirmed Sarcoidosis with F: M ratio of 4:1. The mean age of the patientswas55±12.89years. Weight loss was the most predominant symptom which occurred in 12(80%) of the patients while only 2(13.3%) were assymptomatic. All the patients had pulmonary involvement, and the most frequent site for extrapulmonary sarcoidosis was the skin which occurred in 04(26.7%) of the patients. Splenomegaly was present in 2(13.3) while 03 (20%) had hepatomegaly. One(6.7%) patient had ocular manifestations including dry eye and dry mouth due to salivary gland involvement. Tissue biopsy was done in 09(60%) of the patients which showed non caseating granuloma. CXR was abnormal in all cases. HRCT was done in 14 cases. The mean serum ACE was elevated in 12(80%) of the patients. Most of the patients were treated with oral steroid and in some cases topical hydroxyl chloroquine. There is female preponderance of sarcoidosis amongst Nigerians. Pulmonary involvement is common while the skin is the most common site for extrathoracic involvement. Erythema nodosum was not seen in any of the patients. There is need to increase the surveillance for sarcoidosis and carry out more studies to describe its possible peculiarities amongst Nigerian.Key words: Sarcoidosis, pulmonary, extrapulmonary

Evaluation of the indications and arrhythmic patterns of 24 hour Holter electrocardiography among hypertensive and diabetic patients seen at OAUTHC, Ile-Ife Nigeria

Rasaaq A Adebayo,1 Amanze N Ikwu,1 Michael O Balogun,1 Anthony O Akintomide,1 Tuoyo O Mene-Afejuku,1 Victor O Adeyeye,1 Olaniyi J Bamikole,1 Luqman A Bisiriyu,2 Olufemi E Ajayi,1 Suraj A Ogunyemi,1 Omolola A Oketona1 1Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, 2Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria Background: There are very limited published studies in Nigeria on the use of 24 hour Holter electrocardiogram (Holter ECG) in the arrhythmic evaluation of hypertensive and diabetic patients. Objective: To evaluate indications, arrhythmic pattern of Holter ECG, and heart rate variability (HRV) among patients with hypertensive heart disease (HHD) with or without heart failure and type 2 diabetes mellitus (T2DM) seen in our cardiac care unit. Methods: Seventy-nine patients (32 males and 47 females) were studied consecutively over a year using Schiller type (MT-101) Holter ECG machine. Results: Out of the 79 patients, 17 (21.5%) had HHD without heart failure, 33 (41.8%) had HHD with hypertensive heart failure (HHF), while 29 (36.7%) were T2DM patients. The mean (standard deviation) ages of HHD without heart failure, HHF and T2DM patients were 59.65 (&plusmn;14.38), 65.15 (&plusmn;14.30), and 54.66 (&plusmn;8.88) respectively. The commonest indication for Holter ECG was palpitation (38%), followed by syncope (20.3%). Premature ventricular contraction was the commonest arrhythmic pattern among the 79 patients, especially among HHF patients. The HRV, using standard deviation of all normal-normal intervals was significantly reduced in T2DM patients (81.03&plusmn;26.33, confidence interval [CI] =71.02&ndash;91.05) compared to the HHD without heart failure (119.65&plusmn;29.86, CI =104.30&ndash;135.00) and HHF (107.03&plusmn;62.50, CI =84.00&ndash;129.19). There was a negative correlation between the duration of T2DM and HRV (r=&minus;0.613). Conclusion: Palpitation was the commonest Holter ECG indication and premature ventricular contractions were the commonest arrhythmic pattern among our patients. HRV was reduced in T2DM patients compared with hypertensive patients. Keywords: Holter electrocardiography, arrhythmias, hypertension, diabetes mellitus, Nigerian

Heart rate variability and arrhythmic patterns of 24-hour Holter electrocardiography among Nigerians with cardiovascular diseases

Rasaaq Ayodele Adebayo, Amanze Nkemjika Ikwu, Michael Olabode Balogun, Anthony Olubunmi Akintomide, Olufemi Eyitayo Ajayi, Victor Oladeji Adeyeye, Tuoyo Omasan Mene-Afejuku, Olaniyi James Bamikole, Suraj Adefabi Ogunyemi, Adeola Olubunmi Ajibare, Omolola Abiodun OketonaCardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State, NigeriaBackground: Facilities for Holter electrocardiography (ECG) monitoring in many Nigerian hospitals are limited. There are few published works in Nigeria on the use of 24-hour Holter ECG in cardiac arrhythmic evaluation of patients with cardiovascular diseases.Objective: To study the clinical indications, arrhythmic pattern, and heart rate variability (HRV) among subjects referred for 24-hour Holter ECG at our Cardiac Care Unit.Methods: Three-hundred and ten patients (134 males and 176 females) were studied consecutively over a 48-month period using Schiller type (MT-101) Holter ECG machine.Results: Out of the 310 patients reviewed, 134 were males (43.2%) and 176 were females (56.8%). The commonest indication for Holter ECG was palpitation followed by syncope in 71 (23%) and 49 (15.8%) of subjects, respectively. Premature ventricular complex and premature atrial complex were the commonest types of arrhythmia in 51.5% and 15% subjects, respectively. Ventricular arrhythmia was more prevalent in dilated cardiomyopathy patients (85.7%). The HRV of subjects with palpitation, stroke, and diabetes mellitus with autonomic neuropathy, using standard deviation of normal to normal intervals average (milliseconds), were 107.32&plusmn;49.61, 79.15&plusmn;49.15, and 66.50&plusmn;15.54, respectively. The HRV, using standard deviation of averages of normal to normal intervals average (milliseconds), of patients with palpitation, stroke, and diabetes mellitus with autonomic neuropathy were 77.39&plusmn;62.34, 57.82&plusmn;37.05, and 55.50&plusmn;12.71, respectively.Conclusion: Palpitation and syncope were the commonest indications for Holter ECG among our subjects. The commonest arrhythmic patterns were premature ventricular complex and premature atrial complex, with ventricular arrhythmia being more prevalent in dilated cardiomyopathy. There was a reduction in HRV in patients with stroke and diabetic autonomic neuropathy.Keywords: heart rate, arrhythmia, Holter electrocardiography, cardiovascular diseases, Nigerian