Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Activity Recognition by Classification Method for Weight Variation Measurement with an Insole Device for Monitoring Frail People

International audienceHealthcare has become a major field of scientific research and is beginning to merge with new technologies to become connected. Measurement of motor activity provides physicians with indicators in order to improve patient follow up. One important health parameter is weight variation. Measuring these variations is not obvious when a person is walking. This paper highlights the difficulty of providing reliable weight variation values with good accuracy. To reach this objective, the paper presents ways to classify the activity of walking, in order to propose a method to measure weight variation at the right time and in a good position. Many methods were studied and compared, using Matlab. We propose a classification tree that uses the standard deviation of acceleration magnitude to define normal walking. The algorithm was embedded in an insole equipped with two force-sensing resistors and tested in laboratory

Manufacturing and finite element assessment of a novel pressure reducing insole for Diabetic Neuropathic patients

Diabetes is one of the metabolic diseases. Uncontrolled diabetes can lead to diabetic foot ulcers and if it was not treated would lead to amputation. Foot ulcers can be prevented by using suitable insoles which are made of appropriate material and geometrically designed by constituent layers. In this study, single-layer and three-layer insoles have been compared during static and dynamic loading. The selected materials were silicone gel (SG), plastazote foam (PLZ), polyfoam (PF) and ethyl vinyl acetate foam (EVA). Four single-layer and 18 combinations of three-layer insoles were selected. Materials behaviors were determined by using a uniaxial pressure test. The description of stress and strain is obtained by using the model of three dimensional nonlinear Finite Element Method (FEM). Then samples were tested by using commercially available plantar pressure measurement system. The FEM results showed that the SG and PLZ insoles are more appropriate compared to single-layer insoles. The combinations of PLZ, SG and EVA (from top to bottom) are recognized as the best between three-layer insoles. Also the best three-layer insole is more effective in promoting a favourable stress and strain distribution than single-layer insoles, especially in dynamic mode. According to simulation results, three-layer insole decreases stress concentration by 9 %. Also experimental tests showed that using three-layer insole decreases plantar pressure by 63 % compared to barefoot condition bare foot