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

Infrared thermography applied to the evaluation of metabolic heat loss of chicks fed with different energy densities

Brazil must comply with international quality standards and animal welfare requirements in order to maintain its position as world's largest exporter of poultry meat. With the scenario of global climate change there is the forecast of occurrence of extreme events with characteristics of both excess cold and heat for several regions of the country. This study aimed to evaluate the effectiveness of using images of infrared thermography to evaluate the loss of sensible heat in young broilers fed different dietary energy levels. Twenty birds were reared in a house with appropriate brooding using infrared lamps. Birds were distributed in a completely randomized experimental into two treatments: T1 (control diet with 2950 kcal ME/kg-1), and T2 (high-energy diet with 3950 kcal ME/kg-1). Infrared thermographic images of the birds were recorded for four consecutive days. One bird was randomly chosen per treatment, and had special images taken and analyzed. Average surface temperature of the body area was calculated using the surface temperature recorded at 100 spots (50 at the front and 50 at the lateral side of the bird's body). Mean surface temperature of the flock was calculated recording 100 spots on the group of birds. Total radiant heat loss was calculated based on the average data of surface temperature. The results indicated that the young broilers fed the high-energy diet presented a metabolic energy loss equivalent to 0.64 kcal h-1, while the birds fed with the control diet lost 2.18 kcal h-1. This finding confirms that oil supplementation to the diet reduces bird heat loss. The infrared camera was able to record young broilers' surface temperature variation when birds were fed diets with different energy contents

Reproductive physiology as a constraint to seed production in cool season food legumes

International audienc

M1 and M3 muscarinic receptors may play a role in the neurotoxicity of anhydroecgonine methyl ester, a cocaine pyrolysis product

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