Electrocardiogram changes due to sodium stibogluconate treatment of kala-azar

Background: Kala-azar [visceral leishmaniasis (VL)] is caused by the protozoon Leishmania donovani complex. Without adequate treatment, most patients with clinical VL die due to secondary infections. Pentavalent antimonial compounds are commercially available as sodium stibogluconate and meglumine antimoniate. Sodium stibogluconate remains the mainstay of treatment in most parts of the world. The aim of the study was to evaluate the serious adverse effects of sodium stibogluconate in the treatment of kala-azar (VL).   Methods: The study was carried out in the medicine department of North Bengal Medical College Hospital, Sirajganj during the period of June 2021 to December 2021. It was a descriptive cross-sectional study with a sample size of 30. Complete history taking and physical examination were done and recorded in a case record form. At least 7 electrocardiograms (ECGs) were done (1 before treatment, 5 during treatment weekly intervals, and 1 after completion of treatment). Results: In ECG, the following changes were noted (the rhythm, T wave amplitude, ST segment, and QTc interval). Out of 30 patients, 19 patients (63.33%) developed abnormalities in ECG. Among them, 14 patients (46.67%) developed prolongation of QTc interval, 6 patients developed T wave inversion, and 1 patient developed transient 1st-degree heart block. No patients developed symptomatic arrhythmia. Conclusions: Kala-azar is prevalent among the poor in Bangladesh and can be fatal without treatment. Sodium stibogluconate has been associated with cardiological adverse effects, but it can be used safely with proper monitoring

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society