53 research outputs found
Action to protect the independence and integrity of global health research
Storeng KT, Abimbola S, Balabanova D, et al. Action to protect the independence and integrity of global health research. BMJ GLOBAL HEALTH. 2019;4(3): e001746
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
Pharmacodynamic and pharmacokinetic study of chronic low-dose metronomic cyclophosphamide therapy in mice
Prolonged, frequently administered low-dose metronomic
chemotherapy (LDM) is being explored (pre)clinically as a
promising antiangiogenic antitumor strategy. Although
appealing because of a favorable side effect profile and
mostly oral dosing, LDM involves new challenges different
from conventional maximum tolerated dose chemotherapy.
These include possible altered pharmacokinetic
characteristics due to long-term drug exposure potentially
resulting in acquired resistance and increased risk of
unfavorable drug interactions. We therefore compared the
antitumor and antivascular effects of LDM cyclophosphamide
(CPA) given to mice that had been pretreated
with either LDM CPA or normal saline, obtained blood
4-hydroxy-CPA (activated CPA) concentrations using
either gas chromatography/mass spectrometry or liquid
chromatography/tandem mass spectrometry in mice
treated with LDM CPA, and measured hepatic and intratumoral
activity of enzymes involved in the biotransformation
of CPA and many other drugs [i.e., cytochrome
P450 3A4 (CYP3A4) and aldehyde dehydrogenase].
Exposure of mice to LDM CPA for z8 weeks did not
compromise subsequent activity of LDM CPA therapy, and
biologically active 4-hydroxy-CPA levels were maintained
during long-term LDM CPA administration. Whereas the
effects on CYP3A4 were complex, aldehyde dehydrogenase
activity was not affected. In summary, our findings
suggest that acquired resistance to LDM CPA is unlikely
accounted for by altered CPA biotransformation. In the
absence of reliable pharmacodynamic surrogate markers,
pharmacokinetic parameters might become helpful to
individualize/optimize LDM CPA therapy. LDM CPA-associated
changes of CYP3A4 activity point to a potential risk
of unfavorable drug interactions when compounds that are
metabolized by CYP3A4 are coadministered with LDM
CPA
- …