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

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Apendicite epiplóica: resolução videolaparoscópica

Appendices epiploicae can be the site of torsion and appendagitis. Diagnosis is currently being made by ultrasonography and computerized tomography. Expectant treatment is proposed based on the assumption that epiploic appendicitis is a self limited affection. A case of torsion of a sigmoid epiploic appendage is described. The condition was missed by abdominal ultrasonography. Correct diagnosis and immediate definite treatment were performed by videolaparoscopy

Exigências de lisina digestível para codornas japonesas na fase de postura

Objetivou-se estimar as exigências nutricionais de lisina digestível para codornas japonesas em postura. Foram utilizadas 240 codornas distribuídas em delineamento de blocos casualizados, com cinco tratamentos, cada um com seis repetições de oito aves. Os tratamentos consistiram de uma ração basal deficiente em lisina e suplementada com L-lisina.HCL, de modo a apresentar 0,88; 0,96; 1,04; 1,12 ou 1,20% de lisina digestível. Avaliaram-se o consumo de ração (CR), a produção de ovos (PR), o peso (PO) e a massa (MO) do ovo, a conversão alimentar por massa (CMO) e por dúzia (CDZ) de ovos, os pesos de albúmen (PA), gema (PG) e casca (PC), as porcentagens de albúmen (%A), gema (%G) e casca (%C) e a gravidade específica (GE) dos ovos. O nível de lisina digestível da ração influenciou o consumo de ração, enquanto a produção de ovos respondeu de forma quadrática aos níveis de lisina. As demais variáveis analisadas não foram influenciadas pelo nível de lisina digestível da ração. A exigência de lisina digestível para codornas japonesas em postura foi estimada em 1,03% da ração, que corresponde a um consumo diário de 292 mg de lisina digestível

Níveis de cálcio em dietas para poedeiras semipesadas após o pico de postura Levels of calcium in diets for brown layers post-peak production

Um experimento foi conduzido com o objetivo de estudar os efeitos dos níveis de cálcio nas rações sobre o desempenho e a qualidade de ovos de poedeiras comerciais. Foram utilizadas 216 poedeiras da linhagem Lohmann Brown no período de 39 a 55 semanas de idade. O delineamento utilizado foi inteiramente casualizado, composto de seis níveis de cálcio (3,0; 3,4; 3,8; 4,2; 4,6; 5,0%) e seis repetições de seis aves por parcela. Os níveis de cálcio avaliados não influenciaram os parâmetros produtivos, mas afetaram significativamente as porcentagens de albúmen e casca do ovo. O aumento do cálcio na dieta promove incremento na qualidade da casca do ovo em relação aos demais componentes do ovo. Recomenda-se nível de 4,3% de cálcio em dietas para poedeiras semipesadas após o pico de postura.<br>Two hundred and sixteen layers were raised from 39 to 55 weeks of age to study the effects of levels of calcium in the rations on performance and eggs quality of brown commercial layers. A completely randomized experimental design were used with six levels of calcium (3.0; 3.4; 3.8; 4.2; 4.6 and 5.0%) and six replicates of six layers hens. There was no effect of calcium levels on hen performance, however significantly affected the percentage of albumen and egg shell. The increase of calcium in the diet promoted increment in egg shell quality in relationship to other eggs components. The calcium level of 4.3% is recommended for brown layer hens after production peak

Desempenho e qualidade dos ovos de poedeiras semipesadas alimentadas com dietas contendo óleos de soja e canola Performance and eggs quality in laying hens fed diets with soybean and canola oils

Objetivou-se analisar a influência da adição de níveis crescentes de óleo de soja e canola sobre os índices de desempenho e qualidade interna e externa dos ovos de poedeiras comerciais semipesadas da linhagem Bovans Goldline durante cinco períodos de 28 dias. Foram utilizadas 280 aves com 18 semanas de idade, em um delineamento inteiramente casualizado, com sete tratamentos em um esquema fatorial 2 × 3 + 1 (dois tipos de óleo e três níveis de óleo mais um testemunha adicional) com cinco repetições e oito aves por unidade experimental. Os níveis de óleo de soja e de canola não alteraram o consumo de ração, os pesos dos ovos, de albúmen, de gema e de casca, as porcentagens de albúmen, de gema e de casca e a gravidade específica dos ovos. Houve influência significativa da interação tipo × nível de óleo sobre a produção de ovos e a conversão por massa e por dúzia de ovos. Com o aumento do nível de óleo de soja, os resultados obtidos para estas variáveis melhoraram, entretanto, a conversão por massa de ovo piorou com o aumento dos níveis de óleo de canola. A adição de óleo de soja promoveu desempenho melhor que o obtido com óleo de canola.<br>The objective of this study was to evaluate the influence of soybean and canola oil added in crescent levels on production performance indexes and internal and external egg quality of brown commercial layers of the strain Bovans Goldline during five periods of 28 days. Two hundred and eighty hens with 18 weeks old were distributed in a completely randomized design, with seven diets in a 2 × 3 + 1 factorial arrangement (oil type and oil level, and an additional control), with 5 replicates of 8 hens per experimental unit. The soybean and canola oil levels did not affect the feed consumption; egg, albumen, yolk and shell weights; albumen, yolk and shell percentages, neither the specific gravity. There was an interaction between type and oils levels on egg production and mass conversion and per egg dozen. Better results for those characteristics were obtained as soybean oil increased. However, the egg mass conversion was negatively influenced by increase of canola oil. The addition of soybean oil promoted better performance as compared to canola oil

Nucleocapsid (N) Gene Mutations of SARS-CoV-2 Can Affect Real-Time RT-PCR Diagnostic and Impact False-Negative Results

The current COVID-19 pandemic demands massive testing by Real-time RT-PCR (Reverse Transcription Polymerase Chain Reaction), which is considered the gold standard diagnostic test for the detection of the SARS-CoV-2 virus. However, the virus continues to evolve with mutations that lead to phenotypic alterations as higher transmissibility, pathogenicity or vaccine evasion. Another big issue are mutations in the annealing sites of primers and probes of RT-PCR diagnostic kits leading to false-negative results. Therefore, here we identify mutations in the N (Nucleocapsid) gene that affects the use of the GeneFinder COVID-19 Plus RealAmp Kit. We sequenced SARS-CoV-2 genomes from 17 positive samples with no N gene detection but with RDRP (RNA-dependent RNA polymerase) and E (Envelope) genes detection, and observed a set of three different mutations affecting the N detection: a deletion of 18 nucleotides (Del28877-28894), a substitution of GGG to AAC (28881-28883) and a frameshift mutation caused by deletion (Del28877-28878). The last one cause a deletion of six AAs (amino acids) located in the central intrinsic disorder region at protein level. We also found this mutation in 99 of the 14,346 sequenced samples by the Sao Paulo state Network for Pandemic Alert of Emerging SARS-CoV-2 variants, demonstrating the circulation of the mutation in Sao Paulo, Brazil. Continuous monitoring and characterization of mutations affecting the annealing sites of primers and probes by genomic surveillance programs are necessary to maintain the effectiveness of the diagnosis of COVID-19

Correction: Lesbon et al. Nucleocapsid (N) Gene Mutations of SARS-CoV-2 Can Affect Real-Time RT-PCR Diagnostic and Impact False-Negative Results. <i>Viruses</i> 2021, <i>13</i>, 2474

The authors hereby request the inclusion of two authors (Olivia Teixeira and Maria Cristina Nonato) in the recently published article in Viruses entitled “Nucleocapsid (N) gene mutations of SARS-CoV-2 can affect real-time RT-PCR diagnostic and impact false-negative results” [...