NAGEIA YOUNIS | University of Benghazi (original) (raw)
Papers by NAGEIA YOUNIS
Lancet, Apr 1, 2024
Background Safe anaesthesia and surgery are a public health imperative. There are few data descri... more 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 inhospital 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.
SVOA Paediatrics, Sep 20, 2023
Objective: To examine the natural history and detailed outcome of diagnosed cases of abdominal wa... more Objective: To examine the natural history and detailed outcome of diagnosed cases of abdominal wall defects that admitted to The Children`s Hospital at Westmead. Methods: This was A retrospective single centre study of all cases of abdominal wall defects admitted between the 1 st of October 1998 and the 1 st of January 2007 to The Children`s Hospital at Westmead. The study had been conducted through a retrospective review of the neonatal, pediatric surgery records and subsequent follow-up information of all cases of Omphalocele and Gastroschisis diagnosed. Results: Ninety cases with anterior abdominal wall defects were admitted. Majority of the cases were born at Westmead Hospital. There were 25 neonates with Gastroschisis (27 females, 28 males), and 35 neonates with Exomphalos (15 females, 20 males). Eighty-one neonates had prenatal ultrasound diagnosis. Some neonates had associated congenital anomalies which results in five deaths (4 Exomphalos, 1 Gastroschisis). Post operative complications were common and the postoperative hospital stay was often lengthy. Twenty-five patients out of the ninety (15 Gastroschisis, 10 exomphalos) required further operations which were related to their primary diagnosis of Gastroschisis or Exomphalos, mostly for abdominal wall hernias. Conclusions: Long-term outcome was favourable in majority of cases with abdominal wall defects and mortality substantially happened in neonates with associated anomalies. Reoperations were necessary in those patients who had postoperative hernias.
Background Safe anaesthesia and surgery are a public health imperative. There are few data descri... more 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 inhospital 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.
Alimentary tract duplications are rare congenital lesions. About 5% are gastric duplication. Two ... more Alimentary tract duplications are rare congenital lesions. About 5% are gastric duplication. Two forms of gastric duplications tubular & cyst, with variable presenting features and the treatment is surgical resection. Herein we present a case report of 40 days male transferred from Sabha hospital with progressive abdominal distension since birth, bilious vomiting, respiratory distress, and constipation. Perinatal history unremarkable. The patient was full term vaginal delivery discharged home after birth. On examination, there were distension mainly upper abdomen. Blood investigation within normal apart from hyperbilirubinemia. Radiological investigations exhibited Uss abdomen showed huge cystic lesion either duplication or mesenteric. computer tomography abdomen showed large cyst pushing the stomach up. Exploration laparotomy was done, and the finding was huge gastric duplication cyst at the greater curvature, the cyst excised & was sent for histopathology. The patient discharged home within few days after uneventful recovery. The microscopic description shows multiple sections reveal cystic structure lined by cuboidal to flat epithelium with underlying fibrocollagenous tissue wall that shows few chronic inflammatory cells infiltration and congested blood vessels along with few mucosal glands lined by benign-looking epithelial cells. In conclusion, gastric duplication is rare entity account for 2% of GIT duplication. Gastric duplications more commonly diagnosed in young children.
Objective: To examine the natural history and detailed outcome of diagnosed cases of abdominal wa... more Objective: To examine the natural history and detailed outcome of diagnosed cases of abdominal wall defects that admitted to The Children`s Hospital at Westmead. Methods: This was A retrospective single centre study of all cases of abdominal wall defects admitted between the 1 st of October 1998 and the 1 st of January 2007 to The Children`s Hospital at Westmead. The study had been conducted through a retrospective review of the neonatal, pediatric surgery records and subsequent follow-up information of all cases of Omphalocele and Gastroschisis diagnosed. Results: Ninety cases with anterior abdominal wall defects were admitted. Majority of the cases were born at Westmead Hospital. There were 25 neonates with Gastroschisis (27 females, 28 males), and 35 neonates with Exomphalos (15 females, 20 males). Eighty-one neonates had prenatal ultrasound diagnosis. Some neonates had associated congenital anomalies which results in five deaths (4 Exomphalos, 1 Gastroschisis). Post operative complications were common and the postoperative hospital stay was often lengthy. Twenty-five patients out of the ninety (15 Gastroschisis, 10 exomphalos) required further operations which were related to their primary diagnosis of Gastroschisis or Exomphalos, mostly for abdominal wall hernias. Conclusions: Long-term outcome was favourable in majority of cases with abdominal wall defects and mortality substantially happened in neonates with associated anomalies. Reoperations were necessary in those patients who had postoperative hernias.
Lancet, Apr 1, 2024
Background Safe anaesthesia and surgery are a public health imperative. There are few data descri... more 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 inhospital 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.
SVOA Paediatrics, Sep 20, 2023
Objective: To examine the natural history and detailed outcome of diagnosed cases of abdominal wa... more Objective: To examine the natural history and detailed outcome of diagnosed cases of abdominal wall defects that admitted to The Children`s Hospital at Westmead. Methods: This was A retrospective single centre study of all cases of abdominal wall defects admitted between the 1 st of October 1998 and the 1 st of January 2007 to The Children`s Hospital at Westmead. The study had been conducted through a retrospective review of the neonatal, pediatric surgery records and subsequent follow-up information of all cases of Omphalocele and Gastroschisis diagnosed. Results: Ninety cases with anterior abdominal wall defects were admitted. Majority of the cases were born at Westmead Hospital. There were 25 neonates with Gastroschisis (27 females, 28 males), and 35 neonates with Exomphalos (15 females, 20 males). Eighty-one neonates had prenatal ultrasound diagnosis. Some neonates had associated congenital anomalies which results in five deaths (4 Exomphalos, 1 Gastroschisis). Post operative complications were common and the postoperative hospital stay was often lengthy. Twenty-five patients out of the ninety (15 Gastroschisis, 10 exomphalos) required further operations which were related to their primary diagnosis of Gastroschisis or Exomphalos, mostly for abdominal wall hernias. Conclusions: Long-term outcome was favourable in majority of cases with abdominal wall defects and mortality substantially happened in neonates with associated anomalies. Reoperations were necessary in those patients who had postoperative hernias.
Background Safe anaesthesia and surgery are a public health imperative. There are few data descri... more 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 inhospital 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.
Alimentary tract duplications are rare congenital lesions. About 5% are gastric duplication. Two ... more Alimentary tract duplications are rare congenital lesions. About 5% are gastric duplication. Two forms of gastric duplications tubular & cyst, with variable presenting features and the treatment is surgical resection. Herein we present a case report of 40 days male transferred from Sabha hospital with progressive abdominal distension since birth, bilious vomiting, respiratory distress, and constipation. Perinatal history unremarkable. The patient was full term vaginal delivery discharged home after birth. On examination, there were distension mainly upper abdomen. Blood investigation within normal apart from hyperbilirubinemia. Radiological investigations exhibited Uss abdomen showed huge cystic lesion either duplication or mesenteric. computer tomography abdomen showed large cyst pushing the stomach up. Exploration laparotomy was done, and the finding was huge gastric duplication cyst at the greater curvature, the cyst excised & was sent for histopathology. The patient discharged home within few days after uneventful recovery. The microscopic description shows multiple sections reveal cystic structure lined by cuboidal to flat epithelium with underlying fibrocollagenous tissue wall that shows few chronic inflammatory cells infiltration and congested blood vessels along with few mucosal glands lined by benign-looking epithelial cells. In conclusion, gastric duplication is rare entity account for 2% of GIT duplication. Gastric duplications more commonly diagnosed in young children.
Objective: To examine the natural history and detailed outcome of diagnosed cases of abdominal wa... more Objective: To examine the natural history and detailed outcome of diagnosed cases of abdominal wall defects that admitted to The Children`s Hospital at Westmead. Methods: This was A retrospective single centre study of all cases of abdominal wall defects admitted between the 1 st of October 1998 and the 1 st of January 2007 to The Children`s Hospital at Westmead. The study had been conducted through a retrospective review of the neonatal, pediatric surgery records and subsequent follow-up information of all cases of Omphalocele and Gastroschisis diagnosed. Results: Ninety cases with anterior abdominal wall defects were admitted. Majority of the cases were born at Westmead Hospital. There were 25 neonates with Gastroschisis (27 females, 28 males), and 35 neonates with Exomphalos (15 females, 20 males). Eighty-one neonates had prenatal ultrasound diagnosis. Some neonates had associated congenital anomalies which results in five deaths (4 Exomphalos, 1 Gastroschisis). Post operative complications were common and the postoperative hospital stay was often lengthy. Twenty-five patients out of the ninety (15 Gastroschisis, 10 exomphalos) required further operations which were related to their primary diagnosis of Gastroschisis or Exomphalos, mostly for abdominal wall hernias. Conclusions: Long-term outcome was favourable in majority of cases with abdominal wall defects and mortality substantially happened in neonates with associated anomalies. Reoperations were necessary in those patients who had postoperative hernias.