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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. |
- Ljungqvist, Göran, et al.
(författare)
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Lipid composition of particles in exhaled air (PEx) from workers exposed to welding fumes
- 2016
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Ingår i: The European respiratory journal. Vol. 48, Suppl 60. PA385. - 0904-1850.
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Konferensbidrag (refereegranskat)abstract
- More than two million workers are exposed to pneumotoxic welding aerosols and there is a need for biomarkers of effects on the respiratory system. The lipid composition of the respiratory tract lining fluid (RTLF) is such a potential marker. The most abundant pulmonary surfactant phospholipid is dipalmitoylphosphocholine (DPPC). It is specific for the airways, while palmitoyloleoylphosphatidylcholine (POPC) is a common lipid in tissues and body fluids. We hypothesize that the amounts of or ratio between DPPC and DOPC are changed due to short term and/or long term exposure to welding fumes. We have developed a method for the collection of PEx, based on counting of the exhaled particles and subsequent collection by impaction on a teflon membrane. We have also developed a method for analysis of lipids in PEx based on LC/MS. We measured the exposure to iron, manganese, chromium and nickel of 18 stainless steel welders and also analyzed DPPC and DOPC in PEx samples taken at the end of the exposure measurement day. The welders working history was also recoded and summarized as welding years. Spirometry and nitrogen multiple breath wash out were also measured but the results are not yet evaluated. There were no significant correlations between the short term exposure to either iron, manganese, chromium or nickel and the fraction of DPPC in PEx or the ratio DPPC/DOPC. However, there was a tendency of correlation (Spearman correlation coefficient= 0.407 with p-value 0.09) between welding years and the DPPC/DOPC ratio. In this pilot study we could not establish short term effects of welding exposure on the RTFL lipid composition but a tendency of change due the long time exposure.
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