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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. |
- Ebbestad, Jan Ove R., et al.
(författare)
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Terminal Ordovician stratigraphy of the Siljan district, Sweden
- 2015
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Ingår i: GFF. - : Informa UK Limited. - 1103-5897 .- 2000-0863. ; 137:1, s. 36-56
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Forskningsöversikt (refereegranskat)abstract
- Integration of new isotopic data and earlier biostratigraphic information from eight sections through the terminal Ordovician (Pirgu and Porkuni stages) of the Siljan district, Sweden, allows a more precise correlation of sections in terms of biostratigraphy and carbon isotope dating. Four levels with positive delta C-13 excursions are identified (from bottom) - the Moe, an unnamed excursion, Paroveja and Hirnantian Carbon Isotope Excursion (HICE). The delta C-13 values through the Boda Limestone are 1-2 parts per thousand higher than usual in Baltica, only the values for the HICE remains within what is expected. Background values increase from 1.5 parts per thousand in the bottom of the core of the Boda Limestone up to 3 parts per thousand in the top of it. The HICE is identified in five of eight sections and the main peak falls according to inferred correlation within the Metabolograptus persculptus Biozone, at or close to the Hindella beds in the Upper Boda Member. The late Katian (Pirgu) age of Holorhynchus in the Siljan district is clear and its co-occurrence with the chitinozoan Belonechitina gamachiana in Estonia supports a Katian age for this zone. The base of the Ozarkodina hassi Biozone may occur within units B-C of the Upper Boda Member and in the upper part of the Loka Formation and most likely is correlated with the M. persculptus Biozone. The Hirnantia-Dalmanitina faunas reported from the lowermost part of the Loka Formation and units B-D of the Upper Boda Member seem to range through all the Hirnantian, but detailed morphological studies allow to distinguish an older (=extraordinarius) and a younger (=persculptus) fauna.
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| 3. |
- Guldevall, Karolin, 1981-, et al.
(författare)
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Microchip screening platform for assessment of cytotoxic effector cells
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Here we report a screening platform for assessment of the cytotoxic potential of individual natural killer (NK) or T cells within larger populations. Human primary NK cells or human Epstein-Barr virus (EBV)- specific T cells were distributed across a silicon-glass microchip containing 32 400 individual microwells loaded with target cells. Through fluorescence screening and automated image analysis the numbers of effector and live or dead target cells in each well could be assessed at different time-points after initial mixing. Cytotoxicity was also studied by time-lapse live-cell imaging in microwells quantifying the killing potential of individual NK cells. Although most resting NK cells (≈75%) were non-cytotoxic to the leukemia cell line K562, some NK cells were able to kill several (≥3) target cells within the 12 hours long experiment. We demonstrate that this assay can be used to enumerate and characterize cytotoxic cells, something that could find clinical applications, e.g. in the selection of donors for stem cell transplantation or generation of highly specific and cytotoxic cells for adoptive immunotherapy.
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| 4. |
- Hjalmarsson, Claes, et al.
(författare)
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Orally Administered Trimethoprim-Sulfamethoxazole and Metronidazole as Infection Prophylaxis in Elective Colorectal Surgery
- 2015
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Ingår i: Surgical Infections. - : MARY ANN LIEBERT, INC. - 1096-2964 .- 1557-8674. ; 16:5, s. 604-610
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Tidskriftsartikel (refereegranskat)abstract
- Background: This randomized clinical trial evaluated orally administered trimethoprim-sulfamethoxazole and metronidazole (TSM) in elective colorectal surgery as prophylactic for post-operative surgical site infections (SSI). Methods: Patients undergoing elective colorectal resection were evaluated for inclusion. Randomized subjects received either orally administered TSM or intravenously administered cefuroxime and metronidazole (control group, CXM). The primary endpoint was the rate of SSI. Results: A total of 1073 subjects were randomized to either control (540) or TSM (533). 486 patients in the TSM group and 499 in the control group were followed-up with after 4 weeks. Thirty-seven (3.8%) patients were afflicted by SSI at discharge from hospital and 69 (7.0%) at follow-up four weeks after surgery. After four weeks, the rate of incisional SSI was 7.0% in the TSM group and 3.6% in the control group (p=0.022). For organ/space SSI and the other complications monitored in the study, no differences were observed between the groups. Conclusion: Orally administered TSM as prophylaxis before elective colorectal surgery results in a low rate of organ/space SSI but an increased rate of incisional SSI compared with intravenously administered cefuroxime and metronidazole. Thus, when considering orally administered TSM, because of environmental concerns or for economic reasons, the slightly increased infection rate has to be kept in mind.
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| 6. |
- Oikarinen, Sami, et al.
(författare)
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Characterisation of enterovirus RNA detected in the pancreas and other specimens of live patients with newly diagnosed type 1 diabetes in the DiViD study
- 2021
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Ingår i: Diabetologia. - : Springer Nature. - 0012-186X .- 1432-0428. ; 64:11, s. 2491-2501
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Tidskriftsartikel (refereegranskat)abstract
- Aims/hypothesis The Diabetes Virus Detection (DiViD) study is the first study to laparoscopically collect pancreatic tissue and purified pancreatic islets together with duodenal mucosa, serum, peripheral blood mononuclear cells (PBMCs) and stools from six live adult patients (age 24-35 years) with newly diagnosed type 1 diabetes. The presence of enterovirus (EV) in the pancreatic islets of these patients has previously been reported. Methods In the present study we used reverse transcription quantitative real-time PCR (RT-qPCR) and sequencing to characterise EV genomes present in different tissues to understand the nature of infection in these individuals. Results All six patients were found to be EV-positive by RT-qPCR in at least one of the tested sample types. Four patients were EV-positive in purified islet culture medium, three in PBMCs, one in duodenal biopsy and two in stool, while serum was EVnegative in all individuals. Sequencing the 5' untranslated region of these EVs suggested that all but one belonged to enterovirus B species. One patient was EV-positive in all these sample types except for serum. Sequence analysis revealed that the virus strain present in the isolated islets of this patient was different from the strain found in other sample types. None of the islet-resident viruses could be isolated using EV-permissive cell lines. Conclusions/interpretation EV RNA can be frequently detected in various tissues of patients with type 1 diabetes. At least in some patients, the EV strain in the pancreatic islets may represent a slowly replicating persisting virus.
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