Objectives Shock is a life-threatening condition in children in low- and middle-income countries (LMIC), with several controversies. This systematic review summarizes the etiology, pathophysiology and mortality of shock in children in LMIC. Methods We searched for studies reporting on children with shock in LMIC in PubMed, Embase and through snowballing (up to 1 October 2019). Studies conducted in LMIC that reported on shock in children (1 month–18 years) were included. We excluded studies only containing data on neonates, cardiac surgery patients or iatrogenic causes. We presented prevalence data, pooled mortality estimates and conducted subgroup analyses per definition, region and disease. Etiology and pathophysiology data were systematically collected. Results We identified 959 studies and included 59 studies of which six primarily studied shock. Definitions used for shock were classified into five groups. Prevalence of shock ranged from 1.5% in a pediatric hospital population to 44.3% in critically ill children. Pooled mortality estimates ranged between 3.9-33.3% for the five definition groups. Important etiologies included gastroenteritis, sepsis, malaria and severe anemia, which often coincided. The pathophysiology was poorly studied but suggests that in addition to hypovolemia, dissociative and cardiogenic shock are common in LMIC. Conclusions Shock is associated with high mortality in hospitalized children in LMIC. Despite the importance few studies investigated shock and as a consequence limited data on etiology and pathophysiology of shock is available. A uniform bedside definition may help boost future studies unravelling shock etiology and pathophysiology in LMIC.
Background :There is increasing interest among specialists in the complications after abdominal surgery due to adhesions. Objective: Exploration of experiences, attitudes and expectations of general practitioners concerning bowel obstruction and postoperative abdominal adhesions. Methods : In October 2012 a postal questionnaire was sent to a random sample of 800 Dutch GPs. Results: The response rate was 45%, 24% ( n ϭ 190) fi lled out the questionnaire completely, 12% ( n ϭ 99) had no experience with the subject and 7% ( n ϭ 57) had no time to respond. A history of abdominal surgery does play a part in more than 80% of GP ' s diff erential diagnosis of abdominal complaints. Seventy-fi ve per cent consider some types of surgery to induce more adhesions. Eighty-fi ve per cent ponder the diff erentiation between adhesion related complaints and IBS as clear, however diffi cult (78%) in specifi c patients. Intestinal transit problems likely due to adhesions are treated with extra fl uid ( n ϭ 64), more fi bres ( n ϭ 85) and laxatives ( n ϭ 153). Referral to a specialist for adhesiolysis is rarely considered (11%). Forty per cent of the GPs would refer a patient with abdominal pain and suspected adhesions. Seventy-six per cent denote knowledge gaps and low experience in the treatment of intestinal transit problems. Some ( n ϭ 23) indicate the need for information about adhesions and obstruction through CME papers. Conclusion:Respondents are well equipped to deal with abdominal complaints and intestinal transit problems due to postoperative adhesions. Some indicate the need for information about adhesions and prevention of obstruction through CME papers.
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