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- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 2. |
- Alshahawy, Rasha, et al.
(författare)
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Changes in plasma fatty acids and related biomarkers during transition to an exclusively plant- and fish-based diet in healthy adults
- 2021
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Ingår i: Nutrition (Burbank, Los Angeles County, Calif.). - : Elsevier. - 0899-9007 .- 1873-1244. ; 90
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to examine the time scale of plasma fatty acid changes during transition to an exclusively plant- and fish-based diet in healthy individuals and determine whether there are associated alterations in arachidonic acid (ARA)-derived inflammatory mediators, estimated stearoyl coenzyme A desaturase (SCD) activity, and blood pressure. Methods: In pursuit of a religious fast, 36 adults abstained from eating poultry, meat, dairy products, and eggs, while increasing fish intake for 6 wk. Participants were assessed 1 wk before (W0) and 1 (WI) and 6 (W6) weeks after the diet change. Results: By W6, fasting plasma long-chain omega-3 polyunsaturated fatty acids (omega-3 LC-PUFAs); docosahexaenoic (DHA) and eicosapentaenoic (EPA) had increased (+67% and +73%, respectively; P <= 0.001), with early rise of DHA (+22%), but not EPA at W1.The omega-3 index (sum of DHA and EPA as a percent of total fatty acids) increased from 2.1% to 3.4%. ARA decreased progressively (W1, -9%; W6, -16%; P < 0.001). ARA precursors gamma-linolenic and dihomo-gamma-linolenic acids also decreased, without changes in the ARA-derived mediators prostaglandin-E2 and leukotriene-B4. Myristic acid decreased at W1 (-37%) and W6 (-40%). There was no consistent change in SCD indices. At W6, systolic and diastolic blood pressure had declined by 8 and 5 mm Hg, respectively (P <= 0.013). Conclusions: Shifting to a plant- and fish-based diet produces rapid and sustained increases in omega-3 LC-PUFAs and decreases the omega-6 PUFA ARA and its precursors, consistent with a cardio-protective profile. The rapid response suggests that these biomarkers may be useful for assessment of diet interventions.
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