Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study.

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay

Human lumbar nuclear intervertebral disc prosthesis: an experimental study

Low back pain is also a vast socioeconomic issue which costing American taxpayers more than $50 billion yearly. Estimates state that up to 75% of low back pain is caused by lumbar degenerative disc disease. The nucleus seems plays a critical role in pain related to disc degeneration; it is the starting point of the degenerative cascade. All of these factors make it the focus of novel treatment options. The goal of this study is to create idealized models to determine the shape of nuclear implant best suited to resist the standard shear and torsional stresses that are generated in the lumbar spine. Thus, five nuclear intervertebral disc prosthetics (Implant designs 1-5) were designed. Shear testing was conducted using an Instron, and torsion testing was conducted using the LabVIEW in conjunction with a torsional pneumatic cylinder. Implant design 4 was determined to be the implant design best suited to resist shear stresses. Implant design 3 was determined to be the implant design best suited to allow normal torsion of the spine. Therefore, it was determined that a combination of implant design 3 and implant design 4 might be optimal in terms of shear, torsion, wear, and stability

Effects of dietary replacement of maize with malted or unmalted sorghum on the performance of weaner rabbits

No Abstrac

Effects Of Dietary Replacement Of Maize With Malted Or Unmalted Sorghum On The Performance Of Weaner Rabbits

This study was carried out at the teaching and research farm of Bowen University, Iwo Nigeria. It was designed to evaluate the performance of weaner rabbits fed concentrate and plantain leaf at ratio 50:50. Thirty six crossbred weaner rabbits obtained by crossing Newzealand and Chinchilla breeds purchased from Agrited farm Ibadan, Nigeria were used for this study .They were divided into nine groups such that each dietary treatment was replicated thrice. Three dietary treatments were formulated as the concentrates such that T1 which had maize and other ingredients served as the control while T2 and T3 had their maize portion replaced separately with malted and unmalted sorghum. Thirty six weaned eight week old rabbits were fed for a period of forty nine days which was the duration of the experiment. The feed intake, weight gain, digestibility, blood parameters and economics of raising weaner rabbits on the experimental diets were determined. The dry matter intake varied from 86.64 to 37.16g, the feed conversion ratio (FCR) from 4.09-7.71g.Similar feed intake of rabbit on T1 and T2 indicated that malted sorghum could actually replace the maize portion. The nutrient digestibility of dry matter, crude protein and ether extract were similar between dietT1 and T2 but higher in T3. The blood analysis indicated that white blood cells (WBC) were significantly affected by the dietary treatment while red blood cell (RBC), packed cell volume (PCV), glucose, total protein and Albumin were not significantly (P>0.05) affected. Assessment of the carcass characteristics of the weaner rabbit indicated similar carcass weight and dressing percentage for all the dietary treatments. Final liveweight, kidney weight, head and fur were similar for T1 and T2 but were significantly higher in T3.However, the heart and the lungs were similar among the treatments. Mortality rate of 33.33% was, however, recorded in T3 unmalted sorghum in combination with plantain leaf at 50:50. Market weight of 2.5kg/rabbit was attained by 6.46 months for rabbit fed control which was earlier than the other diets which were 8.23 and 9.18 months, respectively

DIAGONAL EARLOBE CREASE: FRANK'S SIGN IN ISCHEMIC HEART DISEASE

The article emphasizes the necessity of meticulous physical examination of the patient in the modern clinical practice. Two clinical examples of diagonal earlobe crease, also known as Frank’s sign, are given. Both cases describe patients with ischemic heart disease, but age of patients and severity of Frank’s sign differ. The literature data about its frequency in different groups of population as well as the clinical significance and possible underlying pathophysiological mechanisms of Frank’s are shown

Effects of Lepidium sativum supplementation on growth and gonadotropins secretion in ovariectomized, estrogen-implanted rabbits

Objective: To test the effects of dietary supplementation of Lepidium sativum (LS) seed powder on growth performance and gonadotropins secretion in ovariectomized, estradiol- implanted rabbits. Methods: Ovariectomized, estradiol-implanted Chinchilla rabbits were assigned into four experimental groups: LS seed powder was included into normal rabbit chow at 0% (control), 5% (low), 7% (mid) and 10% (high) w/w. Experimental feed and water were given ad-libitum for 3 weeks. Weekly body weights and daily feed intake of rabbits were recorded. Twenty-one days post-feeding, blood samples were collected at 15-minute interval for 3 h (Period I) after which 2.5 μg gonadotropin-releasing hormone (GnRH) was injected intravenously and the sampling continued for another hour (Period II). Plasma was harvested and analyzed for luteinizing hormone (LH) and follicle-stimulating hormone (FSH) by radioimmunoassay. Results: Feed intake was significantly (P<0.05) increased in LS-supplemented rabbits. However, the increase in feed intake did not result in significant body weight gain. LS seed supplementation significantly (P<0.001) increased mean plasma LH dose-dependently from the low- to the mid-LS level and then decreased LH at the high-LS level. LS supplementation increased (P<0.001) plasma FSH secretion. Injection of GnRH had no effect on plasma LH, however significantly (P<0.05) decreased overall plasma FSH secretion. Conclusions: LS seed supplementation stimulates feed intake and gonadotropins secretion in rabbits. Gonadotropins effect may be mediated through LS seeds phytosterols through the activation of estrogen receptors thereby producing agonistic effects resulting in LH and FSH secretion. The differential responses of gonadotropins to GnRH in LS-supplemented rabbits suggest differential regulation of the synthesis and secretion of these gonadotropins

A review of the clinicopathologic pattern of head and neck malignant tumours in Ilorin, Nigeria

Background: Head and neck cancers remain a major public health concern with increasing prevalence in Africa. The aim of this study was to highlight the current trends of head and neck cancers and compare with previous studies.Methods: A retrospective study of head and neck cancers seen in University of Ilorin Teaching Hospital over a 6-year period (2013 – 2018) was done. Information was retrieved from the clinic, theatre and cancer registry centre. Sites of tumours, duration of symptoms before presentation, reasons for late presentation and histopathological diagnosis were extracted.Result: There were a total of 143 histologically confirmed head and neck cancers.. The age ranged from 2 – 100 years with a mean age of 52 years. The duration of symptoms at presentation was found to range from 3 months to 78 months. Over 80% presented late. Reasons for late presentation were financial constraints (60.5%), ignorance/wrong beliefs (32.4%), traditional treatment (41.6%) and delayed referral (22.5%). Commonest sites were sinonasal region (13.3%), larynx (11.9%), and the nasopharynx (11.2%). Of these, 58.0% were carcinomas, 25.2%were lymphomas, 7.0% were sarcomas while 9.8% were blastomas.Conclusion: The clinicopathologicalpattern of head and neck cancers revealed no significant change over the past 20 years. However, it is expedient to carry out this kind of study at regular intervals to enable health care professionals update existing records. It will help in the revision of policies that are tailored towards reducing the prevalence of head and neck tumours

Iterative Design of Ionizable Lipids for Intramuscular mRNA Delivery

Lipid nanoparticles (LNPs) are the most clinically advanced delivery vehicles for RNA and have enabled the development of RNA-based drugs such as the mRNA COVID-19 vaccines. Functional delivery of mRNA by an LNP greatly depends on the inclusion of an ionizable lipid, and small changes to these lipid structures can significantly improve delivery. However, the structure–function relationships between ionizable lipids and mRNA delivery are poorly understood, especially for LNPs administered intramuscularly. Here, we show that the iterative design of a novel series of ionizable lipids generates key structure–activity relationships and enables the optimization of chemically distinct lipids with efficacy that is on-par with the current state of the art. We find that the combination of ionizable lipids comprising an ethanolamine core and LNPs with an apparent pKa between 6.6 and 6.9 maximizes intramuscular mRNA delivery. Furthermore, we report a nonlinear relationship between the lipid-to-mRNA mass ratio and protein expression, suggesting that a critical mass ratio exists for LNPs and may depend on ionizable lipid structure. Our findings add to the mechanistic understanding of ionizable lipids and demonstrate that hydrogen bonding, ionization behavior, and lipid-to-mRNA mass ratio are key design parameters affecting intramuscular mRNA delivery. We validate these insights by applying them to the rational design of new ionizable lipids. Overall, our iterative design strategy efficiently generates potent ionizable lipids. This hypothesis-driven method reveals structure–activity relationships that lay the foundation for the optimization of ionizable lipids in future LNP-RNA drugs. We foresee that this design strategy can be extended to other optimization parameters beyond intramuscular expression