Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Neonatal sepsis and mortality in low-income and middle-income countries from a facility-based birth cohort: an international multisite prospective observational study

Background Neonatal sepsis is a primary cause of neonatal mortality and is an urgent global health concern, especially within low-income and middle-income countries (LMICs), where 99% of global neonatal mortality occurs. The aims of this study were to determine the incidence and associations with neonatal sepsis and all-cause mortality in facility-born neonates in LMICs. Methods The Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS) study recruited mothers and their neonates into a prospective observational cohort study across 12 clinical sites from Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Data for sepsis-associated factors in the four domains of health care, maternal, birth and neonatal, and living environment were collected for all mothers and neonates enrolled. Primary outcomes were clinically suspected sepsis, laboratory-confirmed sepsis, and all-cause mortality in neonates during the first 60 days of life. Incidence proportion of livebirths for clinically suspected sepsis and laboratory-confirmed sepsis and incidence rate per 1000 neonate-days for all-cause mortality were calculated. Modified Poisson regression was used to investigate factors associated with neonatal sepsis and parametric survival models for factors associated with all-cause mortality. Findings Between Nov 12, 2015 and Feb 1, 2018, 29 483 mothers and 30 557 neonates were enrolled. The incidence of clinically suspected sepsis was 166·0 (95% CI 97·69–234·24) per 1000 livebirths, laboratory-confirmed sepsis was 46·9 (19·04–74·79) per 1000 livebirths, and all-cause mortality was 0·83 (0·37–2·00) per 1000 neonate-days. Maternal hypertension, previous maternal hospitalisation within 12 months, average or higher monthly household income, ward size (>11 beds), ward type (neonatal), living in a rural environment, preterm birth, perinatal asphyxia, and multiple births were associated with an increased risk of clinically suspected sepsis, laboratory-confirmed sepsis, and all-cause mortality. The majority (881 [72·5%] of 1215) of laboratory-confirmed sepsis cases occurred within the first 3 days of life. Interpretation Findings from this study highlight the substantial proportion of neonates who develop neonatal sepsis, and the high mortality rates among neonates with sepsis in LMICs. More efficient and effective identification of neonatal sepsis is needed to target interventions to reduce its incidence and subsequent mortality in LMICs. Funding Bill & Melinda Gates Foundation

Morbidity and mortality of childhood illnesses at the emergency pediatric unit of a tertiary hospital, north-eastern Nigeria

Background: Under-five morbidity and mortality from childhood preventable diseases are still very high in most of the developing countries, especially Nigeria. We describe the morbidity and mortality of childhood illnesses at the Emergency Pediatric Unit (EPU) of the Federal Medical Centre, Azare. Materials and Methods: A retrospective study of Emergency Pediatric Unit admissions over a 1-year period. Epi-info statistical software was used for data analysis. Results: A total of 1,161 patients, aged 1 month to 13 years with a mean age (±1 SD) of 9.8 ± 2.6 years were admitted into EPU during the period. There were 576 (49.6%) males and 585 (50.4%) females and 1,034 (89.1%) patients were children under 5 years of age. The major causes of admission were malaria (44.8%). There were 103 (8.9%) discharges, 886 (76.3%) transfers to pediatric wards, 38 (3.3%) referrals to other hospitals, and 11 (0.9%) discharges against medical advice. There were 123 (10.6%) deaths during the period of the study with 107 (87.0%) of the deceased being children ≤5 years of age. Severe malaria 61 (49.6%) was the major cause of deaths in the unit, followed by Protein energy malnutrition (PEM) and pneumonia occurring in each of 10 (8.1%) patients. Conclusion: Malaria, PEM, and pneumonia remained the major causes of morbidity and mortality, especially among the under-five children

Tafsir al-Baydlawi al-Musamma Anwar at-Tanzil Wa Asrar at-Ta wil 2/ Nashir ad-Din Abi Sa id Abdullah Ibn Umar Ibn Muhammmad asy-Syayrazi al-Baydlawi

640 hal.; 25 cm

Anwar at-Tanzil Wa Asrar at-Ta wil 1: al-Ma ruf Bi Tafsir al-Baydlawi/ Nashir ad-Din Abi Sa id Abdullah Ibn Umar Ibn Muhammmad asy-Syayrazi al-Baydlawi/ Nashir ad-Din Abi Sa id Abdullah

330 hal.; 29 cm

Tafsir al-Baydlawi al-Musamma Anwar at-Tanzil Wa Asrar at-Ta wil 1/ Nashir ad-Din Abi Sa id Abdullah Ibn Umar Ibn Muhammmad asy-Syayrazi al-Baydlawi

634 hal.; 25 cm

Anwar at-Tanzil Wa Asrar at-Ta wil 2: al-Ma ruf Bi Tafsir al-Baydlawi/ Nashir ad-Din Abi Sa id Abdullah

204 hal.; 29 cm