Introduction

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Mahmoud Elfiky

Dr Mahmoud ElFiky is Associate Professor of Pediatric Surgery at Cairo University

as well as a

Consultant of Pediatric Surgery at As Salam Hospitals, Air Force Hospital, Andalusia Group Hospitals and International Affairs Coordinator at Cairo University

Harvard Medical School graduate of Global Clinical Scholars Training Program and Secretary for Harvard Club of Egypt

Administrative Secretary for IPEG Middle East Chapter and co-chair for IT

WOFAPS webmaster and executive board member and PAPSA webmaster

Founding Faculty at EDU Medical University

Survival for Newborns with Congenital Birth Defects is determined by Geography

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A study published in The Lancet examined the risk of mortality for nearly 4000 babies born with birth defects in 264 hospitals around the world. The study found babies born with birth defects involving the intestinal tract have a two in five chance of dying in a low-income country compared to one in five in a middle-income country and one in twenty in a high-income country.

The team of researchers included many distinguished Paediatric Surgeons from around the Globe under Dr Naomi Wright. The list included key figures from around the World as Prof Adesoji Ademuyiwa (Nigeria), Prof Kokila Lakhoo (Oxford, UK), Dr Emrah Aydin (Turkey), Prof Mahmoud Elfiky (Egypt) and Prof Milind Chitnis (South Africa).

LANCET

The study also highlights the importance of perioperative care (the care received either side of the corrective operation or procedure) at the children’s surgical centre. Babies treated at hospitals without access to ventilation and intravenous nutrition when needed had a higher chance of dying. Furthermore, not having skilled anaesthetic support and not using a surgical safety checklist at the time of operation were associated with a higher chance of death.

The team of researchers found that improving survival from these conditions in low- and middle-income countries involves three key elements:

1) improving antenatal diagnosis and delivery at a hospital with children’s surgical care,
2) improving surgical care for babies born in district hospitals, with safe and quick transfer to the children’s surgical centre,
3) improved perioperative care for babies at the children’s surgical centre.

Problem of Post-operative Death in Africa

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The African Surgical OutcomeS-2 (ASOS-2) trial, recently published in the Lancet Global Health journal, is a landmark trial that aimed to address the problem of post-operative death in patients in Africa.

The trial identified those patients at the greatest risk of death, in order to focus the limited available care to these high-risk patients. The ASOS-2 Investigators randomised hospitals in clusters across Africa to provide either enhanced postoperative surveillance to high-risk patients or standard of care. The enhanced postoperative surveillance interventions included admitting the patient to a 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.

This study was developed in response to the findings of the original African Surgical Outcomes Study (ASOS) which showed that death after surgery is a major public health problem in Africa. Surgical patients in Africa are twice as likely to die in hospital following surgery when compared to the global average. These excess deaths appeared to be due to a failure to recognise and/ or respond to common postoperative complications resulting in death. Death following complications is known as ‘failure to rescue’.

ASOS

Prof Mahmoud Elfiky, of Cairo University, Egypt explains that although the intervention did not decrease mortality following surgery, the trial demonstrated a number of possible explanations for this finding.

“While the intervention was designed and piloted before the trial to improve postoperative surveillance, the implementation of increased postoperative surveillance was less successful than we had hoped for. The work required of healthcare providers and investigator teams to implement increased surveillance was more than weanticipated; making it hard to implement the intervention in these resource-limited environments. Furthermore, even when patient deterioration was correctly identified, it is unclear whether the local teams had the means to escalate care appropriately to improve outcomes.”

Prof. Elfiky said that “a generic fix” for the excess surgical mortality in Africa didn’t workin this trial. However, the African Perioperative Research Group (or APORG) which conducted the trial, has demonstrated that it has the capacity to do perioperative research atscale in Africa. It is important that the APORG network continues to work towards solutions to decrease mortality following surgery through research in Africa.

ASOS-2

Prof. Elfiky concluded that; “Future projects will have an increased focus on co-designing interventions with the local teams and the use of proven strategies to ensure successful implementation.” There is an urgent need for novel solutions to surgical mortality in Africa, given the severe financial and human resource restrictions in this environment.  Despite this salient trial showing a dispiriting outcome, further work is to be published that looked at the contextual and environmental factors that contributed to the ASOS-2 trial findings (in British Journal of Anaesthesia). This work will provide the strategic direction necessary to ensure successful implementation of interventions to improve surgical outcomes in resource limited environments.

Dr. Mahmoud El Fiky Joins CDHi Medical Advisory Board

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CDHI

CDH International is proud to add Dr. Mahmoud ElFiky to the organization’s Medical Advisory Board.

Dr. El Fiky is an Associate Professor of Pediatric Surgery at Cairo University. Harvard Medical School graduate of Global Clinical Scholars Training Program.

He is also the Administrative Secretary for IPEG Middle East Chapter and co-chair for IT and WOFAPS webmaster and executive board member.

Happy Easter Everyone

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Hello world!

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Welcome to Weblogs at Harvard. This is your first post. Edit or delete it, then start blogging!

I wanted to introduce myself as an Assistant Professor of Pediatric Surgery and for my other interests as well. I have helped build a magazine for Men’s interests and another Global directory for offers and deals. I cofounded a Sportswear and Fitness store and launched a Woman’s interests magazine. Lastly, I am testing an English news website, a Funny Pictures, Quotes and Posts website, an American news website and an Arabic blog.

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