Occurrence, population dynamics and habitat characterization of Mytella guyanensis (Lamarck, 1819) (Mollusca, Bivalvia) in the Paraíba do Norte river estuary

A ocorrência de M, guyanensis no estuário do Rio Paraíba do Norte foi mapeada, determinando-se sua presença ao longo dos afluentes e ilhas aí existentes. O estudo da dinâmica da população foi realizado em área protegida da Ilha da Restinga, coletando-se os animais ao longo de 37 transecções. A cada mês foram feitos 60 lançamentos com um delimitador de 0,1 m², sobre uma ou mais transecções. Todo o substrato foi retirado juntamente com os exemplares de M. guyanensis e a fauna associada, até a profundidade de 10 cm. A triagem dos exemplares menores foi feita por peneiramento do substrato. O tipo de substrato foi anotado a cada lançamento. Dois tipos de substrato estão presentes na área: um substrato de tipo consistente, constituido por 89.7% de silte e argila e 10.3% de areia fina e outro de tipo não consistente contendo 74.5% de silte e argila e 25.5% de areia fina. O substrato de tipo não consistente apresenta quantidade de água significativamente maior que o de tipo consistente. Mytella guyanensis vive enterrada no solo numa profundidade máxima de 1,0 cm, sempre envolvida pelos filamentos do bisso. A densidade média anual observada para a espécie foi de 5,2 indivíduos por m²; a distribuição espacial predominante foi do tipo agregado, sofrendo interferência do tipo de substrato presente. Houve preferência de fixação da espécie pelo substrato do tipo consistente. Animais entre 4,5 e 5,5 cm de comprimento ocorrem o ano todo, sendo mais numerosos aqueles com comprimento entre 4,5 e 5,0 cm. A presença de formas jovens foi assinalada em baixa frequência em alguns meses do ano. A salinidade da água estuarina variou de acordo com o regime pluviométrico da região, permanecendo dentro dos níveis de tolerância da espécie. A fauna associada está representada por oito espécies de crustáceos e por uma de molusco bivalve.A survey of Mytellaguyanensis occurrence and population dynamics were performed in the Paraíba do Norte river estuary. The characterization and the influence of temperature, salinity and substrate, as well as the associated fauna and flora on the population were also examined. Mytella guyanensis lives buried in the substrate of the mangrove intertidal zone of the Paraíba do Norte river estuary, from the mouth to 24 km upriver. Average annual density of this bivalve species was 5.2 individuals per m², with a predominantly aggregated distribution. The most frequent size was between 4.5 and 5.5 cm in length. Analysis of the substrate demonstrated the presence of two types of substrates in relation to the percentage of silt and clay and the water content. Besides interfering in the population density, the substrate heterogeneity may be a decisive factor in aggregation. Eight species of crustacean decapods and one bivalve species were identified as associated fauna

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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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. Funding: National Institute for Health and Care Research