Current Opinion and Practice on Peritoneal Carcinomatosis Management: The North African Perspective.

The status of peritoneal surface malignancy (PSM) management in North Africa is undetermined. The aim of this study was to assess and compare current practice and knowledge regarding PSM and examine satisfaction with available treatment options and need for alternative therapies in North Africa. This is a qualitative study involving specialists participating in PSM management in North Africa. The survey analyzed demographic characteristics and current knowledge and opinions regarding PSM management in different institutions. We also looked at goals and priorities, satisfaction with treatment modalities and heated intraperitoneal chemotherapy (HIPEC) usefulness according to specialty, country, years of experience, and activity sector. One-hundred and three participants responded to the survey (response rate of 57%), including oncologists and surgeons. 59.2% of respondents had more than 10 years experience and 45.6% treated 20-50 PSM cases annually. Participants satisfaction with PSM treatment modalities was mild for gastric cancer (3/10 [IQR 2-3]) and moderate for colorectal (5/10 [IQR 3-5]), ovarian (5/10 [IQR 3-5]), and pseudomyxoma peritonei (5/10 [IQR 3-5]) type of malignancies. Good quality of life and symptom relief were rated as main priorities for treatment and the need for new treatment modalities was rated 9/10 [IQR 8-9]. The perceived usefulness of systemic chemotherapy in first intention was described as high by 42.7 and 39.8% of respondents for PSM of colorectal and gastric origins, while HIPEC was described as highly useful for ovarian (49.5%) and PMP (73.8) malignancies. The management of PSM in the North African region has distinct differences in knowledge, treatments availability and priorities. Disparities are also noted according to specialty, country, years of expertise, and activity sector. The creation of referral structures and PSM networks could be a step forward to standardized PSM management in the region

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

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 middle-income 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 low-income 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 low-income, 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

ICAR: endoscopic skull‐base surgery

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Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

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

Просторові розподіли станів 3p54s атомів аргону в плазмі високочастотного магнетронного розпилення з радіаційною моделлю зіткнень

Тонкі плівки використовуються в різних галузях промисловості, а саме у виробництві сонячних елементів, плоских екранів та для поліпшення фізичних властивостей поверхонь матеріалів. У процесах осадження тонких плівок ступінь рівноваги та інші характеристики плазми, такі як природа, густина і температура, повинні бути визначені, щоб зрозуміти появу різних явищ. У роботі основна увага приділяється вивченню просторових розподілів густин збуджених станів Ar* (3p54s (1sx: x = 2-5)), а також відносних внесків таких процесів, як бомбардування електронами, випромінювальне дезбудження, явища дифузії метастабільних станів та іонізація Пеннінга в популяції та депопуляції різних станів атомів аргону. Для цього радіаційну модель зіткнень (CRM), яка включала 41 стан, було застосовано з використанням заданих параметрів у плазмі високочастотного магнетронного розпилення. Ці параметри включають температуру електронів, густини електронів та іонів аргону. Кінетичні рівняння густин станів привели до матричної системи, яка була розв'язана чисельно за допомогою ітераційного методу Гауса-Зейделя. Результати показують, що осьові розподіли різних збуджених станів та станів на катоді трохи більші, ніж на аноді; вони також показують, що обидві густини менші, ніж у центрі реактора. Іонізація Пеннінга важлива для метастабільних станів 3p54s (1s5, 1s3), але не важлива для резонансних станів 3p54s (1s4, 1s2). Різні густини збуджених станів не є симетричними відносно центру реактора через наявність магнітного поля на катоді.Thin films are used in various industrial fields, namely in the manufacture of solar cells, flat screens and in improving the physical properties of material surfaces. In thin film deposition processes, the degree of equilibrium and other plasma characteristics such as the nature, density and temperature must be identified in order to understand the occurrence of various phenomena. In this work, the main focus is on studying the spatial distributions of densities of excited states of Ar* (3p54s (1sx: x = 2-5)), as well as the relative contributions of processes such as the electron impact effect, the radiative de-excitation, the diffusion phenomena of metastable states and the Penning ionization in the population and depopulation of different argon atoms states. For this purpose, a Collisional-Radiative Model (CRM) including 41 states was applied using specified parameters in RF magnetron sputtering plasma. These parameters include electron temperature, electron and ion densities of argon. The rate equations of the state densities led to a matrix system that was solved numerically by iterative Gauss-Seidel Method. The results show that the axial distributions of different excited states and those on the cathode side are slightly larger than those found on the anode side, and they show also that both densities are less than at the reactor center. For metastable states 3p54s (1s5, 1s3), the Penning ionization is important, but it is not important for resonant states 3p54s (1s4, 1s2). Different densities of the excited states are not symmetrical with respect to the center of the reactor due to the existence of a magnetic field at the cathode

Prevalence of Helminthic Infections among Wild Animals in Yankari Game Reserve, Nigeria

The prevalence of helminthic parasites among wild animals in Yankari Game Reserve, Nigeria was assessed for the first time. Out of a total of 397 wild animals belonging to 3 groups and 17 species examined, the infection was significantly (P &lt; 0.05) high among small spotted genet cats (Genetta genetta) 3(33.33%), baboons (Papio anubis) 51(47.66%), red pattas monkeys (Erythrocebus pattas) 3(33.33%), tantalus monkeys (Cercopethicus aethiopes tantalus) 5(100%), waterbucks (Kobus deffasa) 10(96.92%), buffalos (Cyncerus caffer) 6(60%) and Hippopotami (Hippopotami amphibious) 3(100%). This is in comparison to lower prevalence rates encountered among the lions (Panthera leo) 12(27.91%), African civet cats (Viverra civetta) 5(15.15%), serval cats (Felis serval) 14.29%), Temminek&#8217;s golden cats (Felis temminekii) 1(25%) and crocodiles (Crocodylus niloticus) 3(7.89%). Similarly, it was lower among the Proboscidae / Artiodactyla, African elephants (Loxodonta africana) 11(16.42%), bushbucks (Tragelaphus scriptus) 1(18.0%), warthogs (Phacochoerus aethiopes) 5(26.32%) and hartebeests (Alcelaphus buselaphus) 2(22.22%). Among the primates and Artiodactyla/Proboscidae, the males were more infected than their female counterparts (p&lt;0.05). However, among the carnivores/reptiles the females were significantly (p&lt;0.05) more infected than their male counterparts. According to age, the young animals were more infected than their adult counterparts (p&lt;0.05). Mean faecal egg counts revealed that the intensity of infection was generally low to moderate in most animal groups. However, among the lions (Panthera leo) egg counts of 225.0 &#177; 0.41 due to Strongyloides and 237.5 &#177; 0.42 due to Strongyle infections were significantly high (P&lt;0.05). Similarly, the baboons (Papio anubis) and African elephants (Loxodonta africana) had 203.3 &#177; 0.01 due to Ascaris and 450 &#177; 21.21 due to Strongyloides respectively. The warthogs (Phacochoerus aethiopes) and hippopotami (Hippopotami amphibious), counts of 220 &#177; 1.85 and 200 &#177; 14.14 due to Toxoascaris and Dicrocoelum species were encountered respectively. Faecal culture and larval recovery revealed that Strongyloides canis and Ancylostoma caninum larvae were common among the carnivores. For the primates, Stronyloides stercoralis and Ancylostoma duodenale were encountered while, Haemonchus contortus, Stronyloides pappilosus, Trichostrongylus colubrioformis and Oesophagostamum columbianum were encountered among the Artiodactyla/ Proboscidae. In conclusion the wild animals harboured medical and veterinary parasites of various intensities

To assess whether indoor residual spraying can provide additional protection against clinical malaria over current best practice of long-lasting insecticidal mosquito nets in The Gambia: study protocol for a two-armed cluster-randomised study

Background: Recently, there has been mounting interest in scaling-up vector control against malaria in Africa. It needs to be determined if indoor residual spraying (IRS with DDT) will provide significant marginal protection against malaria over current best practice of long-lasting insecticidal nets (LLINs) and prompt treatment in a controlled trial, given that DDT is currently the most persistent insecticide for IRS. Methods: A 2 armed cluster-randomised controlled trial will be conducted to assess whether DDT IRS and LLINs combined provide better protection against clinical malaria in children than LLINs alone in rural Gambia. Each cluster will be a village, or a group of small adjacent villages; all clusters will receive LLINs and half will receive IRS in addition. Study children, aged 6 months to 13 years, will be enrolled from all clusters and followed for clinical malaria using passive case detection to estimate malaria incidence for 2 malaria transmission seasons in 2010 and 2011. This will be the primary endpoint. Exposure to malaria parasites will be assessed using light and exit traps followed by detection of Anopheles gambiae species and sporozoite infection. Study children will be surveyed at the end of each transmission season to estimate the prevalence of Plasmodium falciparum infection and the prevalence of anaemia. Discussion: Practical issues concerning intervention implementation, as well as the potential benefits and risks of the study, are discussed. Trial Registration: ISRCTN01738840 - Spraying And Nets Towards malaria Elimination (SANTE