scholarly journals General anaesthesia related mortality in a limited resource settings region: a retrospective study in two teaching hospitals of Butembo

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Furaha Nzanzu Blaise Pascal ◽  
Agnes Malisawa ◽  
Andreas Barratt-Due ◽  
Felix Namboya ◽  
Gregor Pollach
Keyword(s):  
General Anaesthesia ◽  
Limited Resource ◽  
Emergency Operation ◽  
Teaching Hospitals ◽  
High Morbidity ◽  
Perioperative Mortality ◽  
Republic Of The Congo ◽  
Very High ◽  
Risk Practice ◽  
Related Mortality

Abstract Background General anaesthesia (GA) in developing countries is still a high-risk practice, especially in Africa, accompanied with high morbidity and mortality. No study has yet been conducted in Butembo in the Democratic Republic of the Congo to determine the mortality related to GA practice. The main objective of this study was to assess mortality related to GA in Butembo. Methods This was a retrospective descriptive and analytic study of patients who underwent surgery under GA in the 2 main teaching hospitals of Butembo from January 2011 to December 2015. Data were collected from patients files, anaesthesia registries and were analysed with SPSS 26. Results From a total of 921 patients, 539 (58.5%) were male and 382 (41.5%) female patients. A total of 83 (9.0%) patients died representing an overall perioperative mortality rate of 90 per 1000. Out of the 83 deaths, 38 occurred within 24 h representing GA related mortality of 41 per 1000. There was a global drop in mortality from 2011 to 2015. The risk factors of death were: being a neonate or a senior adult, emergency operation, ASA physical status > 2 and a single deranged vital sign preoperatively, presenting any complication during GA, anaesthesia duration > 120 minutes as well as visceral surgeries/laparotomies. Ketamine was the most employed anaesthetic. Conclusion GA related mortality is very high in Butembo. Improved GA services and outcomes can be obtained by training more anaesthesia providers, proper patients monitoring, improved infrastructure, better equipment and drugs procurement and considering regional anaesthesia whenever possible.

scholarly journals General Anaesthesia Related Mortality in a Limited Resource Settings Region: A Retrospective Study in Two Teaching Hospitals of Butembo

2020 ◽  
Author(s):  
Furaha Nzanzu Blaise Pascal ◽  
Agnes Malisawa ◽  
Andreas Barratt-Due ◽  
Felix Namboya ◽  
Gregor Pollach
Keyword(s):  
General Anaesthesia ◽  
Limited Resource ◽  
Emergency Operation ◽  
Teaching Hospitals ◽  
High Morbidity ◽  
Adult Age ◽  
Risk Of Death ◽  
Very High ◽  
Risk Practice ◽  
Related Mortality

Abstract Background: General anaesthesia (GA) in developing countries is still a high-risk practice, especially in Africa, accompanied with high morbidity and mortality. No study has yet been conducted in Butembo to determine the mortality related to GA practice. The main objective of this study was to assess mortality related to GA in Butembo. Methods: This study was a retrospective analytic study of patients who underwent surgery under GA in the 2 main teaching hospitals of Butembo from January 2011 to December 2015. Data were collected from patients file, anaesthesia registries and were analysed with SPSS 26. Results: From a total of 921patients, male and female patients were 539 (58.5%) 382 (41.5%) respectively. A total of 83 (9.0%) patients died. The overall perioperative mortality rate was 90 per 1,000. From the 83 deaths, 38 occurred within 24h representing GA related mortality of 41 per 1,000. There was a global drop in mortality from 2011 to 2015. The risk factors of death were neonate and senior adult age, emergency operation, ASA physical status more than 2 and single deranged vital sign preoperatively. The occurrence of any complication during GA increased the risk of death. Anaesthesia duration more than 120 minutes increased mortality as well as visceral surgeries/laparotomies. Ketamine was the most employed agent. Conclusion: GA related mortality is very high in Butembo. Improved GA services and outcomes can be obtained by training more anaesthesia providers, proper patients monitoring, enhanced the infrastructure, better equipment and drugs procurement.

scholarly journals Correction to: General anaesthesia related mortality in a limited resource settings region: a retrospective study in two teaching hospitals of Butembo

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Furaha Nzanzu Blaise Pascal ◽  
Agnes Malisawa ◽  
Andreas Barratt-Due ◽  
Felix Namboya ◽  
Gregor Pollach
Keyword(s):  
Retrospective Study ◽  
General Anaesthesia ◽  
Limited Resource ◽  
Teaching Hospitals ◽  
Related Mortality

An amendment to this paper has been published and can be accessed via the original article.

scholarly journals Occupational health risk among healthcare workers during COVID-19 pandemic: actions to limit the risk

2021 ◽  
Vol 96 (1) ◽  
Author(s):  
Eman Casper
Keyword(s):  
Occupational Health ◽  
Health Risk ◽  
Healthcare Workers ◽  
World Health ◽  
High Morbidity ◽  
Wuhan City ◽  
Coronavirus Infection ◽  
Health Organization ◽  
Respiratory Droplets ◽  
Very High

AbstractThe World Health Organization declared coronavirus infection 2019 (COVID-19) as a pandemic in March 2020. The infection with coronavirus started in Wuhan city, China, in December 2019. As of October 2020, the disease was reported in 235 countries. The coronavirus infection 2019 (COVID-19) is a disease with high morbidity and mortality. As of February 2021, the number of confirmed cases of COVID-19 globally is 102,942,987 and 2,232,233 deaths according to WHO report. This infection is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which is a ribonucleic acid (RNA) β-coronavirus. The infection is mainly transmitted through respiratory droplets.Healthcare workers (HCWs) play an essential role at the front lines, providing care for patients infected with this highly transmittable disease. They are exposed to very high occupational health risk as they frequently contact the infective persons. In order to limit the number of infected cases and deaths among healthcare workers, it is crucial to have better awareness, optimistic attitude, efficient PPE, and adequate health practices about COVID-19.

scholarly journals Limb fracture during recovery from general anaesthesia : an often tragic complication of equine anaesthesia : clinical communication

2008 ◽  
Vol 79 (3) ◽  
Author(s):  
T.B. Dzikiti ◽  
L. Bester ◽  
I. Cilliers ◽  
A. Carstens ◽  
G.F. Stegmann ◽  
...  
Keyword(s):  
Case Report ◽  
General Anaesthesia ◽  
Arthroscopic Surgery ◽  
Sesamoid Bone ◽  
Clinical Communication ◽  
Limb Fracture ◽  
Metatarsal Bones ◽  
Anaesthetic Procedure ◽  
Related Mortality

A 10-year-old Thoroughbred mare was presented for lameness of the left hindlimb as a result of an apical fracture of the lateral proximal sesamoid bone. The mare was ultimately euthanased after suffering catastrophic fractures of the 3rd and 4th metatarsal bones of the contra-lateral hindlimb during an uncoordinated attempt to rise during recovery from general anaesthesia after undergoing arthroscopic surgery. The case report focuses mostly on horse anaesthesia-related mortality, anaesthetic procedure in the horse, possible causes of fractures in horses during recovery and ways in which rate of occurrence of these fractures can be minimised.

scholarly journals PROBLEM OF ANTIBIOTIC USE AND ANTIMICROBIAL RESISTANCE IN INDONESIA: ARE WE REALLY MAKING PROGRESS?

2013 ◽  
Vol 4 (4) ◽  
pp. 5 ◽  
Author(s):  
Usman Hadi ◽  
Kuntaman Kuntaman ◽  
Mariyatul Qiptiyah ◽  
Hari Paraton
Keyword(s):  
Antimicrobial Resistance ◽  
Antibiotic Use ◽  
Teaching Hospitals ◽  
Resistant Bacteria ◽  
Prevention Study ◽  
Antibiotic Resistant ◽  
Inappropriate Use ◽  
Government Hospitals ◽  
Inappropriate Antibiotics ◽  
Very High

Background: Based on the results Antimicrobial Resistance in Indonesia: prevalence and prevention-study (AMRIN-study), the Ministry of Health of Indonesia in 2005 began a program antibiotic resistance control (PPRA) in some government hospitals, and is currently developing to all government teaching hospitals in Indonesia. Aim: The core activities of the PPRA are to implement standardized surveillance emergence of antibiotic resistant bacteria, and the surveillance of antibiotic use in terms of quantity and quality. Method: Our research in the years 2003 showed the proportion of antibiotic use 84% of patients in a hospital. The use of inappropriate antibiotics was very high, 42% no indication. Result: In 2012 the results of surveillance showed decline of inappropriate use of antibiotic, but prevalence extended-spectrum b-lactamase (ESBL)-producing K.pneumoniae (58%), and E.coli (52%) andmethicillin-resistant S.aures (MRSA) (24%) were increasing. Conclusion: It was needed to implement the most appropriate programs to prevent the growth and development of bacteria resistant to antibiotics.

Clinical guidelines for the management of gastrointestinal fistula – developed by experts of the Polish Surgical Society

2021 ◽  
Vol 93 (4) ◽  
pp. 57-69
Author(s):  
Jacek Sobocki ◽  
Marek Jackowski ◽  
Adam Dziki ◽  
Wiesław Tarnowski ◽  
Tomasz Banasiewicz ◽  
...  
Keyword(s):  
Delphi Method ◽  
Gastrointestinal Surgery ◽  
Cochrane Library ◽  
High Morbidity ◽  
Review Of The Literature ◽  
Cost Of Treatment ◽  
Gastrointestinal Fistula ◽  
Mortality And Morbidity ◽  
Based Medicine ◽  
Related Mortality

Introduction: Gastrointestinal fistula is one of the most difficult problems in gastrointestinal surgery. It is associated with high morbidity and mortality, numerous complications, prolonged hospitalization, and high cost of treatment. </br>Aim: This project aimed to develop recommendations for the treatment of gastrointestinal fistulas, based on evidence-based medicine and best clinical practice to reduce treatment-related mortality and morbidity. </br>Material and methods: The preparation of these recommendations is based on a review of the literature from the PubMed, Medline, and Cochrane Library databases from 1.01.2010 to 31.12.2020, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations in the form of a directive were formulated and assessed using the Delphi method. </br>Results and conclusions: Nine recommendations were presented along with a discussion and comments of experts. Treatment should be managed by a multidisciplinary team (surgeon, anesthetist, clinical nutritionist/dietician, nurse, pharmacist, endoscopist).

Abstract 2471: Contemporary Results of Isolated Aortic Valve Replacement in High-Risk Patients in the Context of Emerging Percutaneous Approaches

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Pierre Voisine ◽  
Siamak Mohammadi ◽  
Josep Rodés-Cabau ◽  
Patrick Mathieu ◽  
Jean Perron ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Survival Benefit ◽  
Control Group ◽  
Perioperative Mortality ◽  
High Risk Patients ◽  
All Cause Mortality ◽  
Risk Patients ◽  
Related Mortality ◽  
Parsonnet Score

Percutaneous aortic valve replacement (AVR) is emerging as an alternative therapeutic approach for high-risk surgical patients, but criteria for patient selection are not clearly established. We sought to evaluate the perioperative and mid-term outcomes in a contemporary cohort of high-risk patients undergoing isolated AVR. Between 1997 and 2006, 855 consecutive patients underwent isolated AVR at our institution. High-risk patients (n=162, 19%) were defined by a preoperative Parsonnet score ≥ 30 or Euroscore ≥ 9. The remaining 693 patients (81%) composed the control group for comparison of perioperative mortality and mid-term freedom from all-cause and cardiac-related mortality. Mean follow up was 2.9±2.1 years. Perioperative mortality was 8.6% in the high-risk and 2.9% in the control group (p=0.0007), lower than that predicted by both scores (p<0.05). Freedom from all-cause mortality at 1 and 5 years were 94% and 82% for the control group and 87% and 65% for high-risk patients (p<0.0001). Freedom from cardiac-related mortality was also higher in the control (96% at 1 year, 91% at 5 years) than the high-risk (89% and 82%, p=0.0003) group. When considering patients who survived the 3-month perioperative period (537 in control, 114 in high-risk group), freedom from all-cause mortality was still higher in the former group at 1 and 5 years (99% vs 99% and 85% vs 75%, respectively, p=0.005), but freedom from cardiac-related mortality was not different (99% vs 100% and 94% vs 92%, respectively, p=0.3). By multivariate analysis, chronic renal failure, emergent procedures and reoperations were identified as independent predictors of mortality in high-risk patients. Contemporary perioperative mortality for isolated AVR in high-risk patients is lower than predicted by the Parsonnet score and Euroscore. Five-year survival in these patients is acceptable, and survivors of the operation experience the same cardiac-related survival benefit as those with standard perioperative risk. The perioperative survival benefit of percutaneous approaches for high-risk patients undergoing AVR remains to be demonstrated and, if present, should be weighed against mid-term outcome benefits of conventional surgical AVR.

scholarly journals Being Pregnant during the Kivu Ebola Virus Outbreak in DR Congo: The rVSV-ZEBOV Vaccine and Its Accessibility by Mothers and Infants during Humanitarian Crises and in Conflict Areas

Vaccines ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 38 ◽  
Author(s):  
David A. Schwartz
Keyword(s):  
Ebola Virus ◽  
Virus Disease ◽  
Humanitarian Assistance ◽  
Lactating Women ◽  
Conflict Zone ◽  
Ring Vaccination ◽  
Humanitarian Crises ◽  
Republic Of The Congo ◽  
Violent Acts ◽  
Very High

The Ebola virus disease (EVD) outbreak that began in Kivu province of the Democratic Republic of the Congo (DRC) in July 2018 is the second largest in history. It is also the largest and most deadly of the ten Ebola outbreaks to occur in DRC, the country where Ebola was first identified during the 1976 Yambuku outbreak. The Kivu region is one of the most challenging locations in which to organize humanitarian assistance. It is an active conflict zone in which numerous armed groups are conducting violent acts, often directed against the inhabitants, healthcare and relief workers and peacekeepers. EVD has been especially problematic in pregnancy—previous outbreaks both in DRC and other countries have resulted in very high mortality rates among pregnant women and especially their infants, with maternal mortality in some outbreaks reaching over 90% and perinatal mortality 100%. The development and implementation of the Merck rVSV-ZEBOV vaccine for Ebola infection has been a tremendous public health advance in preventing EVD, being used successfully in both the West Africa Ebola epidemic and the Équateur DRC Ebola outbreak. But from the start of the Kivu outbreak, policy decisions had resulted in excluding pregnant and lactating women and their infants from receiving it during extensive ring vaccination efforts. In June 2019, this policy was reversed, 10 months after the start of the outbreak. Pregnant and lactating women are now permitted not only the rVSV-ZEBOV vaccine in the continuing Kivu outbreak but also the newly implemented Ad26.ZEBOV/MVA-BN vaccine.

Helicobacter Pylori Is Not the Predominant Etiology for Peptic Ulcers Requiring Operation

2011 ◽  
Vol 77 (8) ◽  
pp. 1054-1060 ◽  
Author(s):  
Marc S. Zelickson ◽  
Cathy M. Bronder ◽  
Brent L. Johnson ◽  
Joseph A. Camunas ◽  
Dane E. Smith ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Gastric Resection ◽  
Emergency Operation ◽  
Etiologic Factor ◽  
Peptic Ulcers ◽  
Surgical Service ◽  
Perioperative Mortality ◽  
Ulcer Disease ◽  
Number Of Patients ◽  
Patch Closure

As the number of patients requiring operation for peptic ulcer disease (PUD) declines, presumed contemporary ulcer etiology has largely been derived from medically treated patients not subjected to surgery. The purpose of this study was to examine the specific causes of PUD in patients requiring surgery. Our Acute Care Surgical Service registry was reviewed for patients operated on for complications of PUD from 2004 to 2009. Emphasis was placed on individual etiologic factors for PUD. There were 128 patients (52% male, 81% white) who underwent emergency operation including: simple patch closure (n = 61, 48%); gastric resection (n = 22, 17%); gastric resection with vagotomy (n = 21,16%); vagotomy and pyloroplasty (n = 18,14%); or other procedures (n = 6, 5%). Complications necessitating operation were perforation (n = 79, 62%); bleeding (n = 29, 23%); obstruction (n = 12, 9%); and intractability (n = 8, 6%). Perioperative mortality was 12.5 per cent. Risk factors for PUD included tobacco use (50%), alcohol abuse (34%), and steroids (21%). Nonsteroidal anti-inflammatory use was confirmed in 68 (53%) patients. Of the 128 patients, 82 (64%) were tested for Helicobacter pylori, 33 (40%) of which were positive and 49 (60%) negative. Helicobacter pylori, thus, was the confirmed ulcer etiology in only 26 per cent of cases. Unlike contemporary series of medically treated PUD, Helicobacter pylori may not be the predominant etiologic factor in patients who experience complications requiring surgery. A “traditional” surgical approach with liberal use of vagotomy, not antibiotic triple therapy, may well be the preferred treatment consideration in such cases.

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