South African Paediatric Surgical Outcomes Study : a 14-day prospective, observational cohort study of paediatric surgical patients

BACKGROUND : Children comprise a large proportion of the population in sub-Saharan Africa. The burden of paediatric surgical disease exceeds available resources in Africa, potentially increasing morbidity and mortality. There are few prospective paediatric perioperative outcomes studies, especially in low- and middle-income countries (LMICs). METHODS : We conducted a 14-day multicentre, prospective, observational cohort study of paediatric patients (aged <16 yrs) undergoing surgery in 43 government-funded hospitals in South Africa. The primary outcome was the incidence of in-hospital postoperative complications. RESULTS : We recruited 2024 patients at 43 hospitals. The overall incidence of postoperative complications was 9.7% [95% confidence interval (CI): 8.4–11.0]. The most common postoperative complications were infective (7.3%; 95% CI: 6.2–8.4%). In-hospital mortality rate was 1.1% (95% CI: 0.6–1.5), of which nine of the deaths (41%) were in ASA physical status 1 and 2 patients. The preoperative risk factors independently associated with postoperative complications were ASA physcial status, urgency of surgery, severity of surgery, and an infective indication for surgery. CONCLUSIONS : The risk factors, frequency, and type of complications after paediatric surgery differ between LMICs and high-income countries. The in-hospital mortality is 10 times greater than in high-income countries. These findings should be used to develop strategies to improve paediatric surgical outcomes in LMICs, and support the need for larger prospective, observational paediatric surgical outcomes research in LMICs. CLINICAL TRIAL REGISTRATION : NCT03367832.Jan Pretorius Research Fund; Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town; Department of Anaesthesia, University of the Witwatersrand; and the Paediatric Anaesthesia Community of South Africa (PACSA).https://bjanaesthesia.org2020-02-01gl2019Anaesthesiolog

Recife: Coastal protection plan

Over the past decades the north-eastern coast of Brazil has been degrading due to erosion. This degradation has both natural- and men-made causes. Brazil has no specific laws and acts which relate to coastal protection and management up to this date. Beaches in the metropolitan area of Recife show variety in beach width according to the seasons. However the local factors play such a significant role in this, that it is not possible to establish a direct link between the seasons and beach width. Since the beginning of the 20th century, men has built structures all along this coast without proper guidelines. Wrong implementation of the structures has ,most probable, made matters worse. Another aspect is that men built structures (1970) on the backshore creating less back buffer which resulted in relative erosion. This paper entails the study of the coast of metropolitan Recife which is 45 km long. The goal of this study is to assess the area: to create solutions for their problems. The paper consist of two parts, part A and part B. Part A consists of a study of the entire coast of metropolitan Recife. Part B focuses on Boa Viagem, an area of 2.78 km within the metropolitan area of Recife. In order to assess the entire area more suffiecient, the area has been split up into 7 parts, from north to south: Janga, Casa Caiada, Bairro Novo, Fortim, Boa Viagem, Piedade and Candeias. All these areas have been studied in order to find the cause of erosion, and possible solution. This has been done by preliminary assessment, where the current structures are observed; a problem assessment, this study emphasizes each area’s problem and probable causes; and finally a solution assessment where possible solutions are represented. The total area of the coast of metropolitan Recife consists of men-made hard structures such as groynes, breakwaters and revetment. But has also natural breakwaters such as reefs. The presence of the latter makes study of this coast highly complex. The area has one major and one minor source of sediment. The major is the sediment that is transported in the littoral drift. The minor source is sediment being discharged by the rivers in the area. The sediment is fine to medium size sand. The current level of “protection” is highly ineffective and has made matters worse in many cases such as Casa Caiada. The level of protection can be classified as poor. Initially, the area was thought be a flood risk, however, closer inspection has revealed that coastal flooding is a non-issue in the metropolitan area of Recife. The amount of erosion cannot be limited but only displaced if hard measures are deployed. If sediment is trapped in one area, another area will be adversely affected. The only solution to sediment deficiency is introducing additional sediment in the area. Part B focusses on Boa Viagem, an area of 2.78 km long with probably the most economic value. The coast of Boa Viagem has healthy beaches but also shows signs of erosion. The area consist mostly of reefs, but also has revetments and a harbor. Different solutions for Boa Viagem have been presented, via a Multi Criteria Analysis one has concluded that a solution of only nourishment will be applied. The nourishment will be dredged by a hopper, 10 km off the coast. The hopper transports the sand with the aid of a pumping system through a 2.5 km piping system to the beach. The nourishment will be spread by a bulldozer and a scraper. In order to maintain the beach, re-nourishment will be done every 5 years. The total amount of initial nourishment is 1.2 million m³ sand. And for re-nourishment 0.5 million m³ sand has been calculated. The whole operation cost R$ 143 mln ( \u80 60 mln ) during a period of 50 years, this includes: initial nourishment, re-nourishments and interest etc.Hydraulic EngineeringCivil Engineering and Geoscience

The association between preoperative anemia and postoperative morbidity in pediatric surgical patients: A secondary analysis of a prospective observational cohort study

BACKGROUND : The prevalence of anemia in the South African pediatric surgical population is unknown. Anemia may be associated with increased postoperative complications. We are unaware of studies documenting these findings in patients in low- and middle-income countries (LMICs). AIM : The primary aim of this study was to describe the association between preoperative anemia and 26 defined postoperative complications, in noncardiac pediatric surgical patients. Secondary aims included describing the prevalence of anemia and risk factors for intraoperative blood transfusion. METHOD : This was a secondary analysis of the South African Paediatric Surgical Outcomes Study, a prospective, observational surgical outcomes study. Inclusion criteria were all consecutive patients aged between 6 months and <16 years, presenting to participating centers during the study period who underwent elective and nonelective noncardiac surgery and had a preoperative hemoglobin recorded. Exclusion criteria were patients aged <6 months, undergoing cardiac surgery, or without a preoperative Hb recorded. To determine whether an independent association existed between preoperative anemia and postoperative complications, a hierarchical stepwise logistic regression was conducted. RESULTS : There were 1094 eligible patients. In children in whom a preoperative Hb was recorded 46.2% had preoperative anemia. Preoperative anemia was independently associated with an increased risk of any postoperative complication (odds ratio 2.0, 95% confidence interval: 1.3-3.1, P = .002). Preoperative anemia (odds ratio 3.6, 95% confidence interval: 1.8-7.1, P < .001) was an independent predictor of intraoperative blood transfusion. CONCLUSION : Preoperative anemia had a high prevalence in a LMIC and was associated with increased postoperative complications. The main limitation of our study is the ability to generalize the results to the wider pediatric surgical population, as these findings only relate to children in whom a preoperative Hb was recorded. Prospective studies are required to determine whether correction of preoperative anemia reduces morbidity and mortality in children undergoing noncardiac surgery.http://wileyonlinelibrary.com/journal/panhj2021Anaesthesiolog