IntroductionC-reactive protein (CRP) is a sensitive marker of systemic inflammation and is an independent risk factor for cardiovascular disease. The aim of the study was to examine the relationship between salivary CRP, cardio-respiratory fitness and body composition in a paediatric population.MethodsThis was a cross-sectional study of 170 black South African children (age 9.41 ± 1.55 years, 100 females, 70 males) in grades 3 to 7. Unstimulated whole saliva samples were obtained for the analysis of CRP. Height, mass, skin-fold thickness, resting blood pressure, and waist and hip circumference measurements were obtained. Cardio-respiratory fitness was assessed using a 20-m multi-stage shuttle run. Children were classified as overweight/obese according to the Center for Disease Control and Prevention (CDC) body mass index (BMI) percentile ranking, and meeting percentage body fat recommendations, if percentage body fat was ≤ 25% in boys and ≤ 32% in girls. The cut-off point for low cardio-respiratory fitness was a predicted aerobic capacity value ≤ the 50th percentile for the group. Contributions of low cardio-respiratory fitness, overweight/obesity, and not meeting percentage body fat recommendations, to elevated salivary CRP (≥ 75th percentile) concentration and secretion rate were examined using binary logistic regression analysis with a backward stepwise selection technique based on likelihood ratios.ResultsPoor cardio-respiratory fitness was independently associated with elevated salivary CRP concentration (OR 3.9, 95% CI: 1.7–8.9, p = 0.001). Poor cardio-respiratory fitness (OR 2.7, 95% CI: 1.2–6.1, p = 0.02) and overweight/obesity (BMI ≥ 85th percentile) (OR 2.5, 95% CI: 1.1–5.9, p = 0.03) were independent predictors of elevated salivary CRP secretion rate.ConclusionThe results suggest a strong association between poor cardio-respiratory fitness and/or overweight/obesity and inflammatory status in children, based on elevated salivary CRP levels.

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We compared simultaneous regional cerebral oxygen saturation and central venous oxygen saturation at different time periods in 20 adult patients (median age, 57.9; range, 35 to 76 years) undergoing off-pump coronary artery bypass (OPCAB) graft surgery (n= 20). Mean arterial pressure (MAP), partial pressure of carbon dioxide (PcvCO(2)), heart rate, haematocrit (Hct), lactate and patient oxygen saturation (SpO(2)) were also recorded as a secondary analysis to determine independent predictors of cerebral desaturation and interactions between predictors. The cross-sectional analysis performed at each time point showed several significant moderate to strong positive correlations between central venous oxygen saturation and both right and left cerebral oxygen saturations; however, right cerebral saturations correlated better with central venous saturations than left cerebral saturation. Partial pressure of carbon dioxide (PcvCO(2)) was identified as a major predictor of cerebral saturation 0.59 (p < 0.001). Central venous saturation can be used as a surrogate measure of cerebral oxygen saturation during OPCAB surgery.

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Background Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. Despite being rapidly taken up by practitioners, datapoints from which to derive them were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define - for the first time - the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care. Methods and findings The Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a two day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high, middle, and low income countries. Considering each of the six indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2-5 (intermediate) and &gt;5 year (full) timeframes. We removed one of the original six indicators (one of two financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. Conclusions To track global progress toward timely access to quality SAO care, these indicators &ndash; at the basic level - should be implemented universally. Intermediate and full evolutions will assist in developing national surgical plans, and collecting data for research studies.

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