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

BIOACTIVITY OF TEPA ( Laureliopsis philippiana (Looser) Shodde) POWDER TO Sitophilus zeamais Motschulsky CONTROL IN LABORATORY

The maize weevil ( Sitophilus zeamais Motschulsky) is one of the most widespread pests and causes heavy losses of stored grain throughout the world. Control of this insect is primarily dependent upon continued applications of organophosphorus and pyrethroid insecticides and fumigants as phosphine but the increasing problems with current insecticides drive the need for research and to develop new control methods. The insecticidal effect of leaf powder of tepa, Laureliopsis philippiana (Looser) Shodde, was evaluated against maize weevil under laboratory conditions. The parameters evaluated were adult mortality and emergence, grain weight loss and germination, and residual, repellent and fumigant effect. The highest levels of insect mortality were registered with treatments at 1, 2, and 4%, with values from 94.7 to 100%. Also, it was obtained 0% of adult insect emergence with these concentrations. In all treatments grain weight was less than 5.8 g. Seed germination was not affected. The powder of L. philippiana exhibited repellent effect in all concentrations and did not show fumigant effect. Insecticidal effect of powder remained for 14 d. Finally, we concluded that powder of L. philippiana has great potential for controlling S. zeamais

Control de sitophilus zeamais motschulsky con trece aceites de origen vegetal y mineral

Maize weevil (SitophiluszeamaisMotschulsky) is a primary pest of stored grains Control is usually carried out with synthetic insecticides but problems such as residues in food and development of resistance have made it necessary to search for new control alternatives. Thirteen oils were evaluated in concentrations of 0.5; 1 and 2% (volume / weight) (v / w). The variables evaluated in adult control were mortality and emergence of adult insects, and weight loss and seed germination, while in the control of immature stages the emergence of adult insects (F1) and weight loss of the grain were evaluated. Each treatment had five replicates and the experimental design was completely randomized. The highest mortality was obtained with almond (Prunusamygdalus L), marigold (Helianthusannuus L), walnut (Juglans regia L.) and soybean (Glycinemax L.) at 1 and 2% (v / p) with 100% insects Dead The lowest F1 was observed in treatments with grape seed oil (Vitisvinifera L.), sesame (Sesamumindicum L.) and wonder at 1 and 2% with 0%. In the control of immature states the lowest F1 was recorded with mineral oil at 2% (v / w) with a 14% emergence of adult insects. The oils of European hazelnut (Corylus avellana L.), pumpkin (Cucurbita pepo L.), maize (Zea mays L.), peanut (Arachishypogaea L), marigold, grape seed, castor bean, sesame, Minerals did not significantly affect maize germination. It was concluded that vegetable oils and minerals have potential for the control of S. zeamais.El gorgojo del maíz (SitophiluszeamaisMotschulsky) es una plaga primaria de los granos almacenados El control normalmente se realiza con insecticidas sintéticos pero problemas como residuos en los alimentos y desarrollo de resistencia han hecho necesaria la búsqueda de nuevas alternativas de control. Se evaluaron trece aceites en concentraciones de 0,5; 1 y 2% (volumen/peso) (v/p). Las variables evaluadas en el control de adultos fueron mortalidad y emergencia de insectos adultos, y pérdida de peso y germinación de semillas, mientras que en el control de estados inmaduros se evaluó la emergencia de insectos adultos (F1) y pérdida de peso del grano. Cada tratamiento tuvo cinco repeticiones y el diseño experimental fue completamente al azar. La mayor mortalidad se obtuvo con los aceites de almendra (Prunusamygdalus L), maravilla (Helianthusannuus L), nuez (Juglans regia L.) y soya (Glycinemax L.) al 1 y 2% (v/p) con 100% de insectos muertos. La menor F1 se observó en los tratamientos con aceite de pepita de uva (Vitisvinifera L.), sésamo (Sesamumindicum L.) y maravilla al 1 y 2% con 0%. En el control de estados inmaduros la menor F1 se registró con aceite mineral al 2% (v/p) con un 14% de emergencia de insectos adultos. Los aceites de avellana europea (Corylus avellana L.), calabaza (Cucurbita pepoL.), maíz (Zea mays L.), maní (Arachishypogaea L), maravilla, pepita de uva, ricino (Ricinuscommunis L.), sésamo, soya y mineral no afectaron significativamente la germinación del maíz. Se concluyó que los aceites vegetales y minerales tienen potencial para el control de S. zeamais

Toxicity of Boldo Peumus boldus Molina for Sitophilus zeamais Motschulsky and Tribolium castaneum Herbst

The maize weevil (Sitophilus zeamais Motschulsky) and the red flour beetle (Tribolium castaneum Herbst) are two key pests of stored-grain products worldwide. The insecticidal activity of boldo (Peumus boldus Molina) powder, liquid ethanolic and hexanic extracts against S. zeamais and T. castaneum were evaluated under laboratory conditions. The evaluated variables were mortality, emergence of adult insects (F1), and grain weight loss. The experimental design was completely randomized. The mortality in S. zeamais was 100% even at the lowest powder concentration (0.5% w/w), whereas emergence of F1 adult insects was 0% and grain weight loss was ≤ 0.08%. For T. castaneum, only 8 and 16% w/w powder concentrations reached 100% mortality. The liquid ethanolic and hexanic extracts caused 100% mortality of S. zeamais, whereas only the ethanolic extract reached this value for T. castaneum. Therefore, the powder and the evaluated extracts of P. boldus were toxic for S. zeamais and T. castaneum and are promising against these and other stored-grain pests.El gorgojo del maíz (Sitophilus zeamais Motschulsky) y el escarabajo de la harina roja (Tribolium castaneum Herbst) son dos plagas clave de los productos de grano almacenado en todo el mundo. Se evaluó la actividad insecticida del polvo de boldo (Peumus boldus Molina), extractos etanólicos líquidos y hexánicos contra S. zeamais y T. castaneum en condiciones de laboratorio. Las variables evaluadas fueron la mortalidad, la aparición de insectos adultos (F1) y la pérdida de peso de los granos. El diseño experimental fue completamente al azar. La mortalidad en S. zeamais fue de 100% incluso a la concentración de polvo más baja (0,5% p / p), mientras que la aparición de insectos adultos F1 fue del 0% y la pérdida de peso del grano fue ≤ 0,08%. Para T. castaneum, solo 8 y 16% p / p de concentraciones de polvo alcanzaron una mortalidad del 100%. Los extractos etanólicos y hexánicos líquidos causaron 100% de mortalidad de S. zeamais, mientras que sólo el extracto etanólico alcanzó este valor para T. castaneum. Por lo tanto, el polvo y los extractos evaluados de P. boldus fueron tóxicos para S. zeamais y T. castaneum y son prometedores contra estas y otras plagas de grano almacenado

TOXICITY OF BOLDO Peumus boldus MOLINA FOR Sitophilus zeamais MOTSCHULSKY AND Tribolium castaneum HERBST

The maize weevil ( Sitophilus zeamais Motschulsky) and the red flour beetle ( Tribolium castaneum Herbst) are two key pests of stored-grain products worldwide. The insecticidal activity of boldo ( Peumus boldus Molina) powder, liquid ethanolic and hexanic extracts against S. zeamais and T. castaneum were evaluated under laboratory conditions. The evaluated variables were mortality, emergence of adult insects (F1), and grain weight loss. The experimental design was completely randomized. The mortality in S. zeamais was 100% even at the lowest powder concentration (0.5% w/w), whereas emergence of F1 adult insects was 0% and grain weight loss was = 0.08%. For T. castaneum, only 8 and 16% w/w powder concentrations reached 100% mortality. The liquid ethanolic and hexanic extracts caused 100% mortality of S. zeamais, whereas only the ethanolic extract reached this value for T. castaneum. Therefore, the powder and the evaluated extracts of P. boldus were toxic for S. zeamais and T. castaneum and are promising against these and other stored-grain pests

Actividad insecticida de Melia azedarach L. (Meliaceae) sobre Sitophilus Zeamais Motshulsky (Coleoptera:Curculionidae)

Maize weevil (SitophiluszeamaisMotschulsky) is considered worldwide as a primary pest of stored products, and its control is usually carried out with synthetic insecticides. The insecticidal and repellent properties of woody leaves, fruits and stems of Meliaazedarach L. (Meliaceae) were evaluated in laboratory conditions in concentrations of 0.5; 1.0 and 2.0% (w / w) for the control of S. zeamais. The highest mortality, as contact insecticide, was obtained with leaf dust and fruits at 2% with 91% mortality. No significant fumigant activity was observed, since no treatment exceeded 30% mortality. The powders of the three plant structures showed repellent effect, although the greater activity was observed in leaf dust. Finally, the dust of woody stalks affected the germination of the wheat. The M. azedarach powder presents auspicious prospects for the control of S. zeamais.El gorgojo del maíz (SitophiluszeamaisMotschulsky) es considerado a nivel mundial como plaga primaria de los productos almacenados, y su control normalmente se realiza con insecticidas sintéticos. Se evaluó en condiciones de laboratorio las propiedades insecticidas y repelentes del polvo de hojas, frutos y tallos leñosos de Meliaazedarach L. (Meliaceae) en concentraciones de 0,5; 1,0 y 2,0% (p/p) para el control de S. zeamais. La mayor mortalidad, como insecticida de contacto, se obtuvo con el polvo de hojas y frutos al 2% con 91% de mortalidad. No se observó actividad significativa como fumigante, ya que ningún tratamiento superó el 30% de mortalidad. Los polvos de las tres estructuras vegetales mostraron efecto repelente, aunque la mayor actividad se observó en el polvo de hojas. Finalmente, el polvo de tallos leñosos afectó la germinación del trigo. El polvo de M. azedarach presenta perspectivas auspiciosas para el control de S. zeamais

ACEITE ESENCIAL DE FOLLAJE DE Peumus boldus Molina COLECTADO EN OTOÑO PARA EL CONTROL DE GORGOJO DEL MAÍZ Sitophilus zeamais Motschulsky

Maize weevil (Sitophilus zeamais Motschulsky) is one of the major pests of stored grains worldwide. Contact and fumigant toxicity, as well as repellent effects of essential oil from leaves of Peumus boldus Molina were tested in the laboratory against maize weevil. Leaves of Peumus boldus Molina were collected in autumn. The highest contact toxicity activity was obtained in concentrations of 2.0 and 4.0% (v/w) with 80 and 100% of mortality in the treated surface bioassay, and 81.1 and 100% in treated grain tests, respectively. In the bioassay of fumigant toxicity, the treatments of 30 and 35 µL essential oil 0.15 L-1 air showed 92.5 and 100% of dead insects. In the immature stage control bioassay, adult insect emergence (F1 ) in control was observed from week six, while treatments of 2.0 and 4.0% (v/w) of essential oil inhibited insect emergence in 100%. All the treatments assessed were repellents against adults of S. zeamais and maize germination was not affected when grains were mixed with essential oil. The essential oil of P. boldus has potential to be developed as a natural insecticide to control S. zeamais.El gorgojo del maíz (Sitophilus zeamais Motschulsky) es una de las plagas de los granos almacenados más importantes a nivel mundial. Se evaluó en condiciones de laboratorio la toxicidad como insecticida de contacto, fumigante y repelente del aceite esencial de hojas de Peumus boldus Molina, colectadas en otoño, para el control de S. zeamais. La mayor toxicidad por contacto se obtuvo con las concentraciones de 2,0 y 4,0% (v/p) con 80 y 100% de mortalidad en el bioensayo con una superficie tratada, y 81,1 y 100%, respectivamente, en las pruebas con grano tratado. En el bioensayo de toxicidad por efecto fumigante los tratamientos de 30 y 35 µL aceite esencial 0,15 L-1 aire mostraron 92,5 y 100% de insectos muertos. En el control de estados inmaduros, la emergencia (F1 ) de insectos adultos en el testigo se observó a partir de la semana seis mientras que los tratamientos de 2,0 y 4,0% (v/p) de aceite esencial inhibieron la emergencia en un 100%. Todos los tratamientos evaluados fueron repelentes contra adultos de S. zeamais y la germinación del maíz no se vio afectada al mezclar el grano con el aceite esencial. El aceite esencial de P. boldus tiene potencial para ser desarrollado como insecticida natural para el control de S. zemais

Spray-drying of passion fruit juice using lactose-maltodextrin blends as the support material

The objective of this study was to assess the effectiveness of the blends with different levels of lactose-maltodextrin (8:5, 10:5, and 12:5 % w/v) during the spray-drying of the passion fruit juice. The drying was carried out in a laboratory spray dryer (Pulvis GB 22 model) at two inlet air temperatures (180 and 190 ºC), and two air pressures (0.10 and 0.20 MPa). The moisture content, hygroscopicity and vitamin C retention were evaluated in the powder obtained. Response surface plots (p<0.05) showed that the lowest values of the moisture content and hygroscopicity were reached in the temperature range of 188-190 ºC and at 12:5 % (w/v) concentration of lactose-maltodextrin; the best vitamin C retention level occurred at 180 ºC and 0.2 MPa.<br>O objectivo deste estudo foi a avaliação da efectividade das misturas en diferentes níveis de lactose-maltodextrina (8:5, 10:5, 12:5 % w/v) durante a pulverização do sumo de maracujá. A secagem foi feita em um atomizador de laboratório de pulverização (modelo Pulvis GB 22) com 2 entradas de temperatura de ar (180 e 190 ºC), e 2 compressores de pressão de ar (0.10 e 0.20 MPa). O índice da mistura, higroscopicidade e retenção de vitamina C foram avaliados no pó obtido. As curvas de superfície de resposta (p<0.05) mostram que os valores mais baixos do índice da mistura e higroscopicidade foram alcançados no intervalo de temperatura de 188-190 ºC e com uma concentração de 12:5 % w/v de lactosemaltodextrina; o melhor nível de retenção de vitamina C ocorreu a 180 ºC e 0.2 MPa

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit