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Outcomes after surgery for children in Africa (ASOS-Paeds): a 14-day prospective observational cohort study

Research Abstract

Summary

Background

Safe anaesthesia and surgery are a public health imperative. There are few data describing outcomes for children undergoing anaesthesia and surgery in Africa. We aimed to get robust epidemiological data to describe patient care and outcomes for children undergoing anaesthesia and surgery in hospitals in Africa.

Methods

This study was a 14-day, international, prospective, observational cohort study of children (aged <18 years) undergoing surgery in Africa. We recruited as many hospitals as possible across all levels of care (first, second, and third) providing surgical treatment. Each hospital recruited all eligible children for a 14-day period commencing on the date chosen by each participating hospital within the study recruitment period from Jan 15 to Dec 23, 2022. Data were collected prospectively for consecutive patients on paper case record forms. The primary outcome was in-hospital postoperative complications within 30 days of surgery and the secondary outcome was in-hospital mortality within 30 days after surgery. We also collected hospital-level data describing equipment, facilities, and protocols available. This study is registered with ClinicalTrials.gov, NCT05061407.

Findings

We recruited 8625 children from 249 hospitals in 31 African countries. The mean age was 6·1 (SD 4·9) years, with 5675 (66·0%) of 8600 children being male. Most children (6110 [71·2%] of 8579 patients) were from category 1 of the American Society of Anesthesiologists Physical Status score undergoing elective surgery (5325 [61·9%] of 8604 patients). Postoperative complications occurred in 1532 (18·0%) of 8515 children, predominated by infections (971 [11·4%] of 8538 children). Deaths occurred in 199 (2·3%) of 8596 patients, 169 (84·9%) of 199 patients following emergency surgeries. Deaths following postoperative complications occurred in 166 (10·8%) of 1530 complications. Operating rooms were reported as safe for anaesthesia and surgery for neonates (121 [54·3%] of 223 hospitals), infants (147 [65·9%] of 223 hospitals), and children younger than 6 years (188 [84·3%] of 223 hospitals).

Interpretation

Outcomes following anaesthesia and surgery for children in Africa are poor, with complication rates up to four-fold higher (18% vs 4·4–14%) and mortality rates 11-fold higher than high-income countries in a crude, unadjusted comparison (23·15 deaths vs 2·18 deaths per 1000 children). To improve surgical outcomes for children in Africa, we need health system strengthening, provision of safe environments for anaesthesia and surgery, and strategies to address the high rate of failure to rescue.

Funding

Jan Pretorius Research Fund of the South African Society of Anaesthesiologists and Association of Anesthesiologists of Uganda.
Research Authors
Hesham Mohamed Elbaseet Abdelghani
Research Date
Research Image
Outcomes after surgery for children in Africa ASOS-Paeds a 14-day prospective observational cohort study
Research Journal
lancet
Research Pages
30
Research Publisher
Elsevier B.V.
Research Rank
Q1
Research Vol
Volume 403, Issue 10435
Research Website
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00103-X/abstract
Research Year
2024

Analysis of the association between the Slit2 biomarker and systemic lupus erythematosus

Research Abstract
To assess the association between various systemic lupus erythematosus (SLE) disease manifestations, SLE disease activity index 2000 (SLEDAI-2K), systemic lupus international collaborating clinics/American College of Rheumatology Damage Index (SLICC/ACR- SDI) and serum levels of Slit2 in SLE patients.
Research Authors
ايمان صفوت محمد حسانين
Research Date
Research Member

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List of approved hours for doctors who have been registered for the master’s degree on the new list in October 2024

List of approved hours for doctors who have been registered for the master’s degree on the new list in October 2024

Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion for Adult Low-Grade Isthmic Spondylolisthesis: Analysis of Sagittal Radiographic Parameters - A Randomized Controlled Trial

Research Abstract

Study Design

Randomized controlled trial.

Objectives

To compare the effect of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) on sagittal radiographic parameters in patients with low-grade isthmic spondylolisthesis. Additionally, to explore the correlation between changes in these parameters and clinical outcomes.

Methods

Forty-six consecutive patients with single-level low-grade isthmic spondylolisthesis were initially enrolled. They were randomly assigned to undergo either PLF or PLIF. Patients were followed up for at least 24 months. Radiographic outcomes included pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, sagittal vertical axis, T1 pelvic angle, slip angle, slip degree and disc height. Clinical outcomes were assessed by the Oswestry Disability Index (ODI) and visual analogue scale (VAS).

Results

Four participants were lost to follow-up. Of the remaining 42 patients, 29 were …

Research Authors
Mahmoud Fouad Ibrahim, Fady Samy Saeed, Essam Mohammed El-Morshidy, Khaled Mohammed Hassan, Mohamed Gamal Hassan, Mohammad El-Sharkawi, Belal Elnady
Research Date
Research Journal
Global Spine Journal
Research Pages
21925682241254317
Research Publisher
SAGE Publications
Research Website
https://journals.sagepub.com/doi/full/10.1177/21925682241254317
Research Year
2024

Validation of the AO Spine CROST (Clinician Reported Outcome Spine Trauma) in the clinical setting

Research Abstract

Purpose

To evaluate feasibility, internal consistency, inter-rater reliability, and prospective validity of AO Spine CROST (Clinician Reported Outcome Spine Trauma) in the clinical setting.

Methods

Patients were included from four trauma centers. Two surgeons with substantial amount of experience in spine trauma care were included from each center. Two separate questionnaires were administered at baseline, 6-months and 1-year: one to surgeons (mainly CROST) and another to patients (AO Spine PROST—Patient Reported Outcome Spine Trauma). Descriptive statistics were used to analyze patient characteristics and feasibility, Cronbach’s α for internal consistency. Inter-rater reliability through exact agreement, Kappa statistics and Intraclass Correlation Coefficient (ICC). Prospective analysis, and relationships between CROST and PROST were explored through descriptive statistics and Spearman correlations …

Research Authors
Said Sadiqi, Erin EA de Gendt, Sander PJ Muijs, Marcel WM Post, Lorin M Benneker, Martin Holas, Jin W Tee, Christoph E Albers, Sonja Häckel, Juraj Svac, Richard J Bransford, Mohammad M El-Sharkawi, Frank Kandziora, Shanmuganathan Rajasekaran, Klaus J Schn
Research Date
Research Journal
European spine journal
Research Publisher
Springer Berlin Heidelberg
Research Website
https://link.springer.com/article/10.1007/s00586-024-08145-5
Research Year
2024

AO Spine Guideline for the Use of Osteobiologics (AOGO) in Anterior Cervical Discectomy and Fusion for Spinal Degenerative Cases

Research Abstract

Study design

Guideline

Objectives

To develop an international guideline (AOGO) about the use of osteobiologics in anterior cervical discectomy and fusion (ACDF) for treating degenerative spine conditions.

Methods

The guideline development process was guided by AO Spine Knowledge Forum Degenerative (KF Degen) and followed the Guideline International Network McMaster Guideline Development Checklist. The process involved 73 participants with expertise in degenerative spine diseases and surgery from 22 countries. Fifteen systematic reviews were conducted addressing respective key topics and evidence was collected. The methodologist compiled the evidence into GRADE Evidence-to-Decision frameworks. Guideline panel members judged the outcomes and other criteria and made the final recommendations through consensus.

Results

Five conditional recommendations were created. A conditional …

Research Authors
Hans Jörg Meisel, Amit Jain, Yabin Wu, Christopher T Martin, Juan Pablo Cabrera, Sathish Muthu, Waeel O Hamouda, Ricardo Rodrigues-Pinto, Jacobus J Arts, Arun-Kumar Viswanadha, Gianluca Vadalà, Pieter-Paul A Vergroesen, Stipe Ćorluka, Patrick C Hsieh, And
Research Date
Research Journal
Global Spine Journal
Research Pages
6-13
Research Publisher
SAGE Publications
Research Website
https://journals.sagepub.com/doi/full/10.1177/21925682231178204
Research Year
2024

Do Osteobiologics Augment Fusion in Anterior Cervical Discectomy and Fusion Surgery Performed With Mechanical Interbody Devices (Polyether ether ketone, Carbon Fiber, Metal …

Research Abstract

Study design

Systematic Review of the Literature.

Objective

The purpose of this study was to perform a systematic review describing fusion rates for anterior cervical discectomy and fusion (ACDF) using autograft vs various interbody devices augmented with different osteobiologic materials.

Methods

A systematic review limited to the English language was performed in Medline, Embase and Cochrane library using Medical Subject Heading (MeSH) terms. Studies that evaluated fusion after ACDF using autografts and osteobiologics combined with PEEK, carbon fibre, or metal cages were searched for. Articles in full text that met the criteria were included in the review. The main outcomes evaluated were the time taken to merge, the definition of the fusion assessment, and the modality of the fusion assessment. The risk of bias of each article was assessed by the MINORS score or ROB 2.0 depending on the randomisation …

Research Authors
Viswanadha Arun-Kumar, Stipe Corluka, Zorica Buser, Yabin Wu, Mohammad El-Sharkawi, Charles André Carazzo, Nikhil Ponugoti, Jeffrey C Wang, Hans Jörg Meisel, AO Spine Knowledge Forum Degenerative
Research Date
Research Journal
Global Spine Journal
Research Pages
24-33
Research Publisher
SAGE Publications
Research Website
https://journals.sagepub.com/doi/full/10.1177/21925682231188626
Research Year
2024

Interobserver reliability in the classification of thoracolumbar fractures using the AO spine TL injury classification system among 22 clinical experts in spine trauma care

Research Abstract

Study Design

Reliability study utilizing 183 injury CT scans by 22 spine trauma experts with assessment of radiographic features, classification of injuries and treatment recommendations.

Objectives

To assess the reliability of the AOSpine TL Injury Classification System (TLICS) including the categories within the classification and the M1 modifier.

Methods

Kappa and Intraclass correlation coefficients were produced. Associations of various imaging characteristics (comminution, PLC status) and treatment recommendations were analyzed through regression analysis. Multivariable logistic regression modeling was used for making predictive algorithms.

Results

Reliability of the AO Spine TLICS at differentiating A3 and A4 injuries (N = 71) (K = .466; 95% CI .458 – .474; P < .001) demonstrated moderate agreement. Similarly, the average intraclass correlation coefficient (ICC) amongst A3 and A4 injuries was excellent (ICC …

Research Authors
Jose A Canseco, Taylor Paziuk, Gregory D Schroeder, Marcel F Dvorak, Cumhur F Öner, Lorin M Benneker, Emiliano Vialle, Shanmuganathan Rajasekaran, Mohammad El-Sharkawi, Richard J Bransford, Rishi M Kanna, Martin Holas, Sander Muijs, Eugen Cezar Popescu, C
Research Date
Research Journal
Global spine journal
Research Publisher
SAGE Publications
Research Website
https://journals.sagepub.com/doi/full/10.1177/21925682231202371
Research Year
2024

AO Spine-DGOU Osteoporotic Fracture Classification System: Internal Validation by the AO Spine Knowledge Forum Trauma

Research Abstract

Study Design

Cross-sectional survey.

Objectives

Injury classifications are important tools to identify fracture patterns, guide treatment-decisions and aid to identify optimal treatment plans. The AO Spine-DGOU Osteoporotic Fracture (OF) classification system was developed, and the aim of this study was to assess the reliability of this new classification system.

Methods

23 Members of the AO Spine Knowledge Forum Trauma participated in the validation process. Participants were asked to rate 33 cases according to the OF classification at 2 time points, 4 weeks apart (assessment 1 and 2). The kappa statistic (κ) was calculated to assess inter-observer reliability and intra-rater reproducibility. The gold master key for each case was determined by approval of at least 5 out of 7 members of the DGOU.

Results

A total of 1386 ratings (21 raters) were performed. The overall inter-rater agreement was moderate with a combined …

Research Authors
Julian Scherer, Andrei Joaquim, Alex Vaccaro, Rishi Kanna, Mohammad El-Sharkawi, Masahiko Takahata, Mohamed M Aly, Gaston Camino-Willhuber, Ulrich Spiegl, Cumhur Oner, Jose A Canseco, Ratko Yurac, Lorin Michael Benneker, Eugen Cezar Popescu, Richard Brans
Research Date
Research Journal
Global Spine Journal
Research Publisher
Sage Publications
Research Website
https://journals.sagepub.com/doi/full/10.1177/21925682241288187
Research Year
2025
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