14 research outputs found
Mortality of emergency abdominal surgery in high-, middle- and low-income countries
Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI).
Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression.
Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1â
6 per cent at 24 h (high 1â
1 per cent, middle 1â
9 per cent, low 3â
4 per cent; P < 0â
001), increasing to 5â
4 per cent by 30 days (high 4â
5 per cent, middle 6â
0 per cent, low 8â
6 per cent; P < 0â
001). Of the 578 patients who died, 404 (69â
9 per cent) did so between 24 h and 30 days following surgery (high 74â
2 per cent, middle 68â
8 per cent, low 60â
5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2â
78, 95 per cent c.i. 1â
84 to 4â
20) and low-income (OR 2â
97, 1â
84 to 4â
81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days.
Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)
A Study on Stakeholder Trust in Sri Lankaâs Multi-Hazard Early Warning (MHEW) Mechanism
Inflammatory cell infiltrate associated with primary and transplanted tumours in an inbred model of oral carcinogenesis
Immunohistologic Analysis of Epithelial-Cell Populations in Oral Lichen-Planus
Previous studies have demonstrated heterogeneity within lesional lymphocytes in drugârelated oral lichen planus (DâLP) and idiopathic lichen planus (IâLP). This study examined the phenotype of Langerhans cells (LC) and keratinocytes in nonâerosive DâLP and IâLP. In IâLP, keratinocytes expressed HLAâDR antigens whilst LC coâexpressed CDIa, MHC Class II and CD4 antigens. The high levels of expression of MHC Class II antigens by LC were maintained during short term organ culture. In IâLP, the epithelium contained occasional CD25 + dendritic cells (putative activated LC). These cell phenotypes are suggestive of cell activation and likely result from local production of gamma interferon. In DâLP, expression of MHC Class II antigens on LC was reduced and no CD25+ cells were detected. The epithelium contained an increased number of CD45RA+ dendritic cells. While no differences between the production of interleukinâ1 and interleukinâ1 inhibitors by tissue samples could be detected, it is likely that the variations in epithelial cell phenotypes in IâLP and DâLP reflect altered cytokine production