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

Reconstruction of the Holocene Paleogeography of Bani Salama, Wadi El‑Natrun, Egypt

International audienceWadi El-Natrun depression lies about 100 km north-west of Cairo, just south of the ‘desert road’ between Cairo and Alexandria. The depression has a longitudinal morphology extending from the southeast to the northwest with average dimensions of about 60 km × 15 km. Bani Salama site lies in the eastern part of the depression, to the east of Fasda Lake, which is located at -27 m below sea level. Based on a geomorphological survey and local archaeology, we found that the site has been occupied by human societies since at least around 4000 years before the present. The site contains ruins of a temple and a castle dating back to the 12th Dynasty of the Pharaonic period (1985-1773 BC). The site also contains workshops of raw glass production dating back to Egypt’s Roman period (31 BC – AD 395). The aim of this study is to investigate the Holocene marsh deposits of Bani Salama, which are located between the Pliocene plateau and Fasda Lake. A sediment core (NAT-11) was taken from the site in June 2015. This core is investigated to understand the Holocene palaeo-geography, palaeoclimates and human impacts.La dépression de Wadi El-Natroun se trouve à environ 100 km au nord-ouest du Caire, juste au sud de la « route du désert » entre Le Caire et Alexandrie. La dépression a une morphologie longitudinale s'étendant du sud-est au nord-ouest avec des dimensions moyennes d'environ 60 km × 15 km. Le site de Bani Salama se situe dans la partie orientale de la dépression, à l'est du lac Fasda, situé à -27 m sous le niveau de la mer. Sur la base d'une étude géomorphologique et de l'archéologie locale, nous avons découvert que le site était occupé par des sociétés humaines depuis au moins environ 4000 ans avant le présent. Le site contient les ruines d'un temple et d'un château datant de la 12e dynastie de la période pharaonique 1985‑1773 av. Le site contient également des ateliers de production de verre brut datant de la période romaine en Egypte 31 avant JC ‑ 395 après JC. Le but de cette étude est d'étudier les dépôts marécageux holocènes de Bani Salama, situés entre le plateau pliocène et le lac Fasda. Une carotte sédimentaire (NAT‑11) a été prélevée sur le site en juin 2015. Cette carotte est étudiée pour comprendre la paléogéographie holocène, les paléoclimats et les impacts humains au cours de l'ancienne occupation humaine du site

The pyramid builders' waterways: Reconstructing the ancient topography of Khufu’s Pharaonic Harbour at Giza, Egypt

International audienceThis article describes the location and sedimentary environments of the Khufu harbour in Giza, Egypt, with the aim of reconstructing its palaeoenvironmental evolution during the Old Kingdom (2686–2160 BCE). We use chronostratigraphy and sedimentology to elucidate the site’s Holocene sedimentary units and compare and contrast the results with previous studies. Our research provides new insights into the palaeogeography of the Giza floodplain during the 4th Dynasty (2613–2494 BCE), including its impacts on the settlement patterns and cultural practices of the ancient Egyptians and their interactions with the natural environment. The findings provide valuable information for understanding the history and archaeology of the Giza area and contribute to ongoing efforts to preserve and interpret the cultural heritage of ancient Egypt

Nile waterscapes facilitated the construction of the Giza pyramids during the 3rd millennium BCE

International audienceThe pyramids of Giza originally overlooked a now defunct arm of the Nile. This fluvial channel, the Khufu branch, enabled navigation to the Pyramid Harbor complex but its precise environmental history is unclear. To fill this knowledge gap, we use pollen-derived vegetation patterns to reconstruct 8,000 y of fluvial variations on the Giza floodplain. After a high-stand level concomitant with the African Humid Period, our results show that Giza’s waterscapes responded to a gradual insolation-driven aridification of East Africa, with the lowest Nile levels recorded at the end of the Dynastic Period. The Khufu branch remained at a high-water level (∼40% of its Holocene maximum) during the reigns of Khufu, Khafre, and Menkaure, facilitating the transportation of construction materials to the Giza Pyramid Complex

First experience of the Egyptian National Cancer Institute using the robot-assisted laparoscopic approach in radical hysterectomies for cervical cancer

Aim of work: Robotics in surgery led to an improvement of visualization, a better handling of tissues and better suturing. This study aimed to document the first experience of the Egyptian National Cancer Institute (NCI) using the robot-assisted laparoscopic approach in radical hysterectomies for cervical cancer and to highlight observed advantages, disadvantages, morbidity and oncological outcomes. Patients and methods: Data of cases that had either early cervical cancer (stage IB-IIA1 with a tumor ≥2 cm) or locally advanced cervical cancer (Stage IIA2-IIB after chemo-radiotherapy) were collected prospectively. Study patients underwent robotic radical hysterectomies for their cervical cancers at the NCI, Cairo University, between January 1, 2015 and December 31, 2016. For each patient, duration of surgery, amount of blood loss, and intra-operative complications were recorded. Similarly, the duration of postoperative hospital-stay, analgesia used and post-operative gastrointestinal recovery were documented. Pathological assessment of safety margins and the lymph nodes number yield were also assessed. Results: Twenty patients underwent robotic radical hysterectomy during the study period. Twelve cases had early cervical cancer while 8 suffered locally advanced disease. The mean procedure time was 319 (range 240–560) minutes; the mean blood loss was 309 (range 150–600) ml. Three cases had bladder injuries during their procedures. The median hospital stay was 6 (range 4–10) days. One case had a positive margin. The median of lymph nodes yield number was 15 (range 10–25). Follow-up ranged 9–31 months, with only one case developing local recurrence. Conclusion: Robotic radical hysterectomy is a feasible approach with a tolerable rate of complications. Keywords: Robotic, Minimally invasive, Cervical cancer, Radical hysterectom

The construction of the Giza pyramids chronicled by human copper contamination

International audienceAlthough the construction of the Giza necropolis necessitated the creation of an extensive array of metal tools, the significance of these early instances of metallurgy, and the contamination they left, has been overlooked in favor of understanding pyramid building techniques. We geochemically analyzed a sediment core from the Khufu harbor, on the Nile floodplain at Giza, Egypt, to track the construction of the necropolis, with a particular focus on copper contamination deriving from metallurgical activities. We found that significant local contamination occurred during the regnal years of Kings Khufu, Khafre, and Menkaure, consistent with metalworking during the preparation and construction of the edifices. While the pyramid complex led to the creation of an outstanding cultural legacy for humanity, it also marked the onset of significant human-caused metal contamination at Giza

The anti-inflammatory effects of atorvastatin upon the outcome of traumatic brain injury patients: A randomized-controlled double-blind clinical trial

ABSTRACTBackground Traumatic brain injury (TBI) is a quite common health problem. A lot of delayed complications are related to inflammatory responses that occurred within the brain itself. Atorvastatin is related to lipid lowering drugs carrying some anti-inflammatory properties and upon this fact this study hypothesis was built.Methods Twenty adult patients with TBI, Glasgow coma scale (GCS) 9–11. Patients were equally and randomly allocated into two groups (group C as control group and group S received atorvastatin 40 mg once daily for 48 h). After 48 h, participants have undergone magnetic resonance imaging brain spectroscopy examination (MRS). The spectral peaks of N-Acetyl aspartate (NAA), Choline, and Creatinine (Cr) were assessed in brain tissue. The primary outcome was presented as ratios of NAA/Cr), Cho/Cr, and NAA/Cho. Other outcomes included GCS and ICU stay.Results There were insignificant variations between groups were found in the MRS results for metabolite alterations (NAA, Cr, and Cho). Contrasted with the control group, the statin group’s Cho/Cr ratio was significantly lower (P = 0.005), and NAA/Cho was significantly greater in the statin group than control group (P = 0.022). Statin group showed higher GCS the 1st day (P = 0.01), and lesser ICU stay (P = 0.04)Conclusion Atorvastatin can be used safely in mild-to-moderate TBI patients with a favourable outcome in the form of decreased Cho/Cr ratio and increased NAA/Cho ratio, higher GCS, and decreased ICU length of stay

Feeding the pyramid builders: Early agriculture at Giza in Egypt

International audienceWhile the exact technical processes employed in the construction of the pyramids are still a subject of ongoing debate, it is widely recognized that the Giza Plateau served as a hub where various trades converged with the common objective of building the necropolis. Of particular importance was the development of a local and sustainable food supply for the thousands of laborers involved in this monumental undertaking. Here, we explore the long-term behavioural mechanisms that led human societies to gradually colonize the Nile swamps at Giza. They developed herding and farming, paving the way for greater human exploitation of the area during the Dynastic Egypt. We show that transhumance tribes, originally from the Eastern Sahara, settled along the Giza Plateau 5200 years ago, primarilyengaging in herding and, more sporadically, agriculture. Giza was transformed into a pastoral landscape, with the development of large swaths of the floodplain, providing societies with permanent access to livestock produce (e.g. proteins, milk, meat and wool). Our palaeoecological data reveal that the initial complex societies at Giza were deeply rooted in transhumance, pastoralism and animal husbandry. These activities played a fundamental role in establishing the foundations of a robust and sustainable food system, while also serving as a crucial logistical support for the subsequent construction of the monumental structures that celebrated the grandeur of pharaonic Egypt