Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

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&nbsp;years; 78.2% included were male with a median age of 37&nbsp;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

Imunomodulacijska aktivnost polisaharida iz ljuske slanutka (Cicer arietinum L.) vrste kabuli in vitro i in vivo

Research background. Polysaccharides isolated from plants, fungi and bacteria are associated with immunomodulatory effects. Chickpea hull, which is regarded as food industrial waste, contains considerable amounts of antioxidants and bioactive compounds. Experimental approach. In the present study, we investigated the immunomodulatory activity of polysaccharides from kabuli chickpea (Cicer arietinum L.) hull (CHPS). In vitro study was conducted with RAW264.7 cell line while in vivo study was carried out using specific pathogen-free BALB/c mouse animal model. Results and conclusions. In in vitro test with RAW264.7 murine macrophage cells, the three purified fractions of chickpea hull polysaccharides showed potent immunomodulatory activity. Sample CHPS-3 showed stronger effect on cell viability, promoted the phagocytosis index to a greater extent and had the best effect on acid phosphatase activity. Moreover, it was found that CHPS-3 significantly (p<0.05) enhanced the secretion of nitrogen monoxide and cytokine (interleukins IL-6, IL-1β and tumour necrosis factor-alpha (TNF-α)) levels. In in vivo study, CHPS-3 improved thymus and spleen indices in cyclophosphamide-induced immunodeficient mice. Increased activities of lysozyme, catalase, superoxide dismutase and glutathione peroxidase, serum haemolysin content and total antioxidant capacity were observed, while the amount of malondialdehyde in the liver decreased. Novelty and scientific contribution. The results suggest that chickpea hull polysaccharides enhanced the immune activity and could be developed as the ingredient of functional foods.Pozadina istraživanja. Polisaharidi izolirani iz biljaka, gljivica i bakterija imaju dokazani imunomodulacijski učinak. Ljuska slanutka, koja se smatra otpadom prehrambene industrije, bogata je antioksidansima i bioaktivnim spojevima. Eksperimentalni pristup. U ovom smo radu ispitali imunomodulacijsku aktivnost polisaharida iz ljuske slanutka (Cicer arietinum L.) vrste kabuli. Ispitivanje je provedeno in vitro na staničnoj liniji RAW264,7, a in vivo na BALB/c miševima, uzgojenim u uvjetima bez patogena specifičnih za miševe. Rezultati i zaključci. U ispitivanju in vitro na makrofagu sličnim stanicama RAW264,7, tri pročišćene frakcije polisaharida iz ljuske slanutka imale su izraženu imunomodulacijsku aktivnost. Uzorak iz treće frakcije imao je veći utjecaj na preživljavanje stanica, znatnije je poboljšao fagocitni indeks i u najvećoj mjeri utjecao na aktivnost kisele fosfataze. Osim toga, taj je uzorak bitno (p<0,05) poboljšao oslobađanje dušikovog(II) oksida i povećao razinu citokina (interleukina IL-6, IL-1β i faktora tumorske nekroze alfa (TNF-α)). U ispitivanju in vivo, uzorak iz treće frakcije poboljšao je indekse timusa i slezene u miševima s imunodeficijencijom uzrokovanom ciklofosfamidom. Opažena je povećana aktivnost lizozima, katalaze, superoksid dismutaze i glutation peroksidaze, udjela hemolizina u serumu i ukupnog antioksidacijskog kapaciteta, dok se količina malondialdehida u jetri smanjila. Novina i znanstveni doprinos. Rezultati pokazuju da polisaharidi iz ljuske slanutka poboljšavaju imunološku aktivnost te da se mogu upotrijebiti kao dodatak funkcionalnoj hrani

Application of chitosan‐based chickpea (Cicer arietinum L.) hull polysaccharides edible coating on cherry tomatoes preservation

Abstract Bio‐active food coating having natural antioxidants has attained great attention these days. Polysaccharides extracted from bacteria, fungi, and plants are considered rich in antioxidant biomolecules. Chickpea hull which is a food waste material contains a substantial quantity of antioxidants and bioactive compounds. In this study, chitosan (CS)‐based chickpea hull polysaccharides (CHPS) edible coating of cherry tomatoes was successfully fabricated. Cherry tomatoes were characterized in terms of physico‐chemical characteristics and shelf life. In comparison to the control, it was discovered that the CS‐incorporated CHPS coatings were successful at lowering the respiratory activity, total soluble solids, total polyphenols, firmness, weight loss, lycopene content, and vitamin C as well as improving the fruit's overall acceptability. The dose dependence of each of these effects was noticed. Conclusively, using CS‐incorporated CHPS coatings could preserve the shelf life of cherry tomatoes. A useful and different approach to enhance the postharvest quality of cherry tomatoes is to utilize CS‐CHPS composite coatings

MAPPING LOCAL PATTERNS OF CHILDHOOD OVERWEIGHT AND WASTING IN LOW- AND MIDDLE-INCOME COUNTRIES BETWEEN 2000 AND 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially