Summary Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov , NCT03471494 . Findings Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding National Institute for Health Research Global Health Research Unit.

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To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

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SummaryObjective: To describe the prevalence of cardiac abnormalities in the echocardiogram of children with AIDS followed up in a reference service at 18± months of AIDS confirmed diagnosis.Methods: A cross-section study with a cohort after 18± months of AIDS diagnosis. The study included a total of 93 children with a confirmed diagnosis of AIDS with vertical transmission, with no malignancies and who underwent echocardiogram (echo) during cardiologic evaluation. Cardiac abnormalities were assessed in patients who were not treated (G1) and patients who were treated (G2) with combination antiretroviral therapy.Results: When diagnosed with AIDS, the children were on average 3.07 years old and 50.50% were female. The combination regimen with antiretroviral agents was used by 47 patients (G2).

Objective: To assess the quality of life of patients with rheumatic fever receiving outpatient treatment at two hospitals.Methods: Cross-sectional study using the Child Health Questionnaire (CHQ) administered to the parents of 133 patients with rheumatic fever aged between 5 and 18 years. The scores of the several dimensions of the questionnaire were calculated and compared within the categories of clinical and sociodemographic variables using a nonparametric test. Results:Patients' age ranged from 5 to 18 years old, with a mean age of 12 years and standard deviation of 2.8 years. The most common manifestation of the disease was articular symptoms associated with cardiac problems, present in 74 cases (56.1%). Most patients belonged to low-income families. Subjects had higher scores on the following concepts of the questionnaire: physical functioning, role/social-physical; role/social-emotional/behavioral; bodily pain; and family activities. The items with the lowest scores were: family cohesion; general health; global behavior; and parental impact-emotional. Girls had higher scores on: self-esteem; role/social-emotional/behavioral; and general health. Patients belonging to middle-income families had higher scores on: mental health; physical functioning; role/social-physical; and family activities. Children from the lowest social class had higher scores on bodily pain and psychosocial aspects. Conclusions:The quality of life of patients with rheumatic fever is similar to that of patients with other chronic diseases, showing intermediate scores on the several concepts included both in the physical and the psychosocial domains. Social class was the variable most frequently associated with the CHQ concepts. J Pediatr (Rio J) IntroduçãoA definição de qualidade de vida é muito subjetiva e pode ser descrita como a percepção do indivíduo da sua própria posição na vida, no contexto da sua cultura e dos valores do país onde vive, dependendo dos seus objetivos, expectativas, padrões e preocupações 1 . Constata-se uma preocupação maior em portadores de doenças crônicas, quando se deseja identificar quais são os aspectos da vida que estão sendo mais afetados pela doença e/ou tratamento.A febre reumática é uma doença que necessita de tratamento profilático prolongado, com aplicação dolorosa de medicação intramuscular, o que pode ocasionar distúrbios psicológicos frequentes e abandono de tratamento. Outro

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Quality of life is a very subjective concept and it can be defined as the perception of the individuals of their own position in life in the context of the culture and value systems of the country where they live in relation to their goals, expectations, standards, and concerns. 1 When trying to identify the aspects of life that are the most deeply affected by the disease and/or treatment, patients with chronic diseases reveal stronger concerns.Rheumatic fever requires long-term prophylactic treatment, including painful administration of intramuscular medication, which can result in frequent psychological disorders and treatment dropout. Another factor that Abstract Objective: To assess the quality of life of patients with rheumatic fever receiving outpatient treatment at two hospitals.Methods: Cross-sectional study using the Child Health Questionnaire (CHQ) administered to the parents of 133 patients with rheumatic fever aged between 5 and 18 years. The scores of the several dimensions of the questionnaire were calculated and compared within the categories of clinical and sociodemographic variables using a nonparametric test.Results: Patients' age ranged from 5 to 18 years old, with a mean age of 12 years and standard deviation of 2.8 years. The most common manifestation of the disease was articular symptoms associated with cardiac problems, present in 74 cases (56.1%). Most patients belonged to low-income families. Subjects had higher scores on the following concepts of the questionnaire: physical functioning, role/social-physical; role/social-emotional/behavioral; bodily pain; and family activities. The items with the lowest scores were: family cohesion; general health; global behavior; and parental impact-emotional. Girls had higher scores on: self-esteem; role/social-emotional/behavioral; and general health. Patients belonging to middle-income families had higher scores on: mental health; physical functioning; role/social-physical; and family activities. Children from the lowest social class had higher scores on bodily pain and psychosocial aspects. Conclusions:The quality of life of patients with rheumatic fever is similar to that of patients with other chronic diseases, showing intermediate scores on the several concepts included both in the physical and the psychosocial domains. Social class was the variable most frequently associated with the CHQ concepts.