The role of osteopontin in children with systemic inflammatory response syndrome and sepsis

Introduction: Sepsis is a leading cause of morbidity and mortality in critically ill children despite the use of modern antibiotics and resuscitation therapies. Sepsis must be distinguished from non-infection systemic inflammatory response syndrome (SIRS) induced by agents such as trauma and ischemia causing extensive tissue injury to establish appropriate treatments in critically ill patients. Osteopontin acts as an extracellular matrix component or soluble cytokine in inflamed tissues. Its exact role in immune response and sepsis remains to be elucidated.Objective: This study investigated the level of osteopontin in SIRS and sepsis to assess its involvement in the acute inflammatory diseases and its possible role as a marker differentiating children with SIRS from those with sepsis.Methods: Prospective, observational study at pediatric ICU at the children’s Hospital, Zagazig University, Egypt, from October 2013 to December 2014. Fortyfour patients with SIRS or sepsis and 44 healthy subjects were enrolled. All the children were subjected to detailed medical history, Clinical examination, laboratory estimation for CBC, blood cultures, serum osteopontin and IL-6 determination was performed by sandwich enzyme immunoassay technique.Results: Serum osteopontin levels were significantly higher in patients than in controls and in sepsis than in SIRS, and decreased during the resolution of both the disorders. A receiver operating characteristic curve identified that osteopontin level of 1040 ng/ml has discriminative power between SIRS and sepsis patients with 82.6% sensitivity and 70.4% specificity, area under curve was 0.833. Osteopontin levels directly correlated interleukin-6 levels and clinical severity scores.Conclusion: Osteopontin is strongly up-regulated during SIRS and sepsis and correlate with IL6 and clinical severity scores.Keywords: Sepsis, Inflammation, Osteopontin, IL-6, Cytokine

Parvovirus B19 viremia in children with systemic lupus erythematosus

Background: Parvovirus B19 infection may present with fever, rash, nonerosive arthritis, hepatitis, anemia, thrombocytopenia, leucopenia and positive ANA, B19 infection may be misdiagnosed as new onset systemic lupus erythematosus. At the same time, B19 infection and systemic lupus erythematosus may occur simultaneously in some patients. A casual relationship between B19 infection and classic idiopathic systemic lupus erythematosus has not been demonstrated yet. Objectives: This study was undertaken to investigate the seroprevalence of parvovirus B19 in SLE patients and to search for the different correlates of this viremia with positive results. Methods: This case-control study was conducted on 30 patients with SLE and 30 normal controls. All the children were subjected to detailed medical history, Clinical examination, laboratory estimation as sera from them were examined for parvovirus B19 infection by serological assays using nested polymerase chain reaction and IgG and IgM antiB19 antibodies by ELISA. Results: Parvovirus B19 DNA was detected in 11 of the 30 patients with SLE (33.3 percent) while it was not detected in any of our normal controls. Of the 11 patients with B19 DNA, only two had IgG anti-B19 antibody and one had IgM anti-B19 antibodies, whereas IgG and IgM anti-B19 antibodies were detected in 11(57.8%)and 9 (47.3%)of 19 SLE patients without B19 DNA respectively. B19 DNA was found more commonly in sera from SLE patients without anti-B19 antibodies than in those with anti-B19 antibodies (P < 0.05). Conclusions: parvovirus B19 might induce either idiopathic SLE in a person who is genetically susceptible or it might induce a SLE-like picture. Parvovirus B19 infection in patients with SLE may be due to lack of anti-B19 antibodies because of either the immunocompromised nature of the host or the use of immunosuppressive drugs. There was a higher prevalence of hypocomplementemia in patients with parvovirus B19 viremia than in those without parvovirus. Keywords: Human parvovirus B19, Systemic lupus erythematosus, Nested PCREgypt J Pediatr Allergy Immunol 2011;9(2):71-7

Staphylococcus aureus y susceptibilidad de un hospital Nivel II en Palmira-Colombia

Introducción: Staphylococcus aureus es un coco Gram Positivo, anaerobio facultativo, inmóvil, con actividad de catalasa y coagulasa, convirtiéndolo en un agente agresivo para el huésped1. Es considerado el principal responsable de infecciones leves de la piel y tejidos blandos hasta las invasivas, tanto a nivel comunitario como nasocomial2-4. Desde el inicio de la terapia antibiótica se ha creado estrategias terapéuticas para su tratamiento. Actualmente a nivel comunitario ha surgido el cluster bacteriano que ha cambiado la epidemiologia local con un perfil incierto de susceptibilidad que genera estudios para definir su actual patrón resistencia. Objetivo: Describir la susceptibilidad de S. Aureus en aislamiento microbiológico tomada por cultivo de secreción de piel y hemocultivo en población pediátrica que asiste a un hospital nivel II de la Ciudad de Palmira en el periodo comprendido entre enero 1 del 2019 y noviembre 30 del 2020. Materiales y métodos: Se realizó un estudio descriptivo retrospectivo en pacientes pediátricos con infección clínica y aislamiento microbiológico de S.Aureus. De resultados de hemocultivos y cultivos de secreciones; En el periodo de octubre del 2020 a diciembre del 2020. La prueba de susceptibilidad antimicrobiana se realizó utilizando el método automatizado VITEK-2. Resultados: En el estudio se evidencio que los 115 cultivos de secreción y hemocultivos positivos para S.Aureus, se observó una resistencia de 66,1% para oxacilina y una sensibilidad del 100% para Linezolid, Minoxiclina, Moxifloxacina, Nitrofurantoina, Teicoplanina y Vancomicina. Conclusión: Resistencia antimicrobiana del 66.1% a la Oxacilina y una sensibilidad a Linezolid, Minoxiclina, Moxifloxacina, Nitrofurantoina, Teicoplanina y Vancomicina del 100%

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries