Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federati...
Although our findings show no association between blood group and five-year survival, these results are inconclusive, and warrant further study of the association between blood type and laryngeal (and other) head and neck cancers.
Objective: We conducted a retrospective study to determine the epidemiological profile and describe the diagnostic aspects of maxillofacial trauma. Methods: It was a retrospective descriptive study over 20 years (January 1995-December 2014 in Oral and Maxillofacial Surgery Department of the Sylvanus Olympio Teaching Hospital in Lomé. All the hospitalized patients for facial trauma were included. Results: 501 cases of facial trauma were retained with an annual incidence of 25 cases. The average age was 33 years and the most represented age groups are those of 20 to 29 years (35.53%) and 30 to 39 years (30.14%); and the sex ratio was 9. Traffic roads accidents represented the main circumstance (89.81%) and the motorcycle was the most involved (80.34%). Patients were admitted in the first week (75.65%) with 35.93% on the first day. The maxillofacial CT-Scan was the most requested radiological examination (33.75%). Bone lesions were: mandible (31%), zygomatic (23.26%) and maxillary (18.99%). Dental lesions were found in 68 cases. Extra-facial lesions were found in 44 cases. The patients were treated in the first week (62.48%) and in the first day after admission (20.76%). Conclusions: Maxillofacial trauma is increasing, mainly in young adults due to road traffic accidents.
Objective: The aim of this study was to determine the prevalence and histological types of skin cancers in people with albinism (PWA) in Togo in 2019.Methods: This is a cross-sectional study of medical records of PWA systematically examined during two mobile skin care clinics in 2019, as part of a programme for the prevention and management of skin cancers in these subjects. Results: During the study period, 280 (95.2%) of the 294 PWA consulted, had developed skin lesions. Of the 280 patients, the pathological reports from the medical records of 33 patients (11.8%) had concluded to keratinocytes skin cancers. The mean age of these 33 patients was 38.6±15.2 years and the sex-ratio was 1. Their occupations were mainly resellers (21.2%), traders (15.2%) and farmers (12.2%). In the 33 patients, 54 cases of keratinocytes skin cancers were identified, with some patients having more than one case or histological type. These 54 keratinocytes skin cancers were divided into 21 cases of invasive squamous cell carcinomas, 2 cases of Bowen’s disease and 31 cases of basal cell carcinomas. These keratinocytes skin cancers mainly occurred in the cephalic region (33 cases; 61.1%), the upper limbs (15 cases; 27, 8%) and the trunk (4 cases; 7.4%).Conclusion: The results of this study show a high prevalence of skin cancers among PWAs in Togo in 2019, only keratinocytes skin cancers. In addition, they illustrate the role of ultraviolet rays with regard to the localization of skin cancers and the occupations of patients. Popularization and compliance with photo protection measures, systematic and regular examination of the skin of these PWAs will allow early detection and treatment of these skin cancers.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.