4 research outputs found
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Summary
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 middleincome
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 lowincome
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 lowincome,
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
Distribución vertical de aves en un bosque templado con diferentes niveles de perturbación
Composición y variación de la dieta del tecolote moteado mexicano (Strix occidentalis lucida) en ValparaÃso, Zacatecas, México
El tecolote moteado mexicano (Strix occidentalis lucida) es una subespecie amenazada (DOF, 2002). Para conocer la variación y composición de la dieta del tecolote moteado en ValparaÃso, Zacatecas, México, se recolectaron de mayo a junio de 2001 y 2002, y de abril a junio de 2003, 86 egagrópilas. Conocer la composición de su dieta en esta zona ampliará el conocimiento de su biologÃa, y permitirá el diseño de estrategias para su manejo y conservación. Los componentes de las egagrópilas se separaron y analizaron, identificándose los restos de 198 presas. La dieta del tecolote moteado mexicano durante 2001, 2002 y 2003 fue similar, entre 60 y 80%. Los pequeños vertebrados constituyeron 75.8% de la frecuencia y 99.3% de la biomasa total. Las especies más frecuentes fueron los ratones de campo (Peromyscus sp.) e insectos. Sin embargo, la especie más importante en la dieta fue la rata cambalachera mexicana (Neotoma mexicana), que aportó 52.2% de la biomasa
Conservación de aves en México, una instantánea de 2015
Más del 26% de las especies de aves que habitan en México está declinando. Los ornitólogos han propuesto diversas acciones
para conservar algunas de ellas; sin embargo, se han hecho pocos esfuerzos por difundirlas. En este escrito, tomando en cuenta las
nueve pláticas presentadas en un simposio cientÃfico realizado en 2015, resumimos la información sobre los esfuerzos de conservación
de aves que se están llevando a cabo en el paÃs. Dividimos los estudios en tres categorÃas: los que analizan cómo se hace
la conservación en México, los que hacen conservación práctica y los que constituyen investigación ecológica básica tendiente
a la conservación de dichas especies. Concluimos que los esfuerzos de conservación de aves en el paÃs son insuficientes y que se
necesitan realizar más acciones para evitar la pérdida de la diversidad de aves en México