Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

Chromatographic analysis of the essential oil and flavonoids in bracts of Ipomoea bracteata Cav. (Convolvulaceae)

The bracts of Ipomoea bracteata Cav, were analyzed to determine the composition of the essential oil and to identify the flavonoids present in this part of the flower. The essential oil composition was determined by gas chromatograph

Essential oil in leaves of Croton pseudoniveus & C suberosus (Euphorbiaceae) species

The essential oil composition of Croton pseudoniveus Lundell and C. suberosus HBK was determined by gas chromatography. C. pseudoniveus is attacked by several insects and the essential oil could have an insecticide or insect repellant activity. There is a direct relationship between leaf feeding damage by the insects and amount of essential oil in the leaves

Terpenes and phototoxic compounds from the inflorescence of Simsia amplexicaulis (Cav.) Pers. (Asteracerae)

From the inflorescence of Simsia amplexicaulis (Cav.) Pers, two triterpenes, two diterpenes, a diacetilene and its acetate were isolated,The chromatographic profiles of the extracts (root, aerial parts and inflorescence) of this species and those of Encelia californica Nutt. were compared Intergeneric differences were observed in the three parts of the plant

Alkaloids in Solanum torvum Sw (Solanaceae)

A comparison was made between plants of Solanum torvum Sw that grow in Chiapas, Mexico, and plants of the same species originating from India. This was effected to establish either similarities or differences between these plants in total alkaloid contents and presence of solasodine, an important alkaloid for the partial synthesis of steroids. The total alkaloid content (0.12%) of the plants coming from Chiapas and India was the same. However, solasodine was found only in the plants of Chiapas. In addition, the total amount of glycoalkaloids (0.038%) and two glycosilated compounds derived from solasodine, solasonine (0.0043%) and solamargine (0.0028%), were determined

flavones in corn silks & resistance to insect attacks

Flavone contents differed in silks of three maize lines with different resistance to larvae of fall amy-worm (FAW), Spodoptera frugiperda Smith, and Southwestern corn borer (SWCB), Diatraea grandiosella Dyar, The main compound in the resistant (CML 67) and in the intermediate (CML 135) lines was apimaysin. In the susceptible line (CML 131) the main compound was 3-methoxymaysin, which was absent from the other two lines. The same distribution pattern was found in the infested plants, The variation in flavone concentration among the 3 lilies and among plants infested with Spodoptera frugiperda and Diatraea grandiosella, suggests a different defense mechanism of the plant against each of the two insects

phenolic acid content in leaves of two strains of maize in three developmental stages

Seeds of two maize strains, one resistant and the other susceptible to Armyworm (Spodoptera frugiperda J. E. Smith) and to Southwestern corn borer (Diatraea grandiosella Dyar), were sown in the field and the plants were artificially infested with neonatal larvae of the two insects. Coumaric and ferulic acid concentration was determined in leaves of the plants at 3 stages. The feeding damage was evaluated. Differences in phenolic acids concentration were found in the two maize lines in all thr ee stages. Leaf damage in the plants infested with Southwestern corn borer was higher in plants infested with Armyworm