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

Evaluation of state nutritional, photosynthetic ratio, biomass production in sorghum sweet submitted to nitrogen and potassium rates

O crescimento da população mundial promove o aumento por consumo de alimentos e energia, além da necessidade de uso sustentável dos recursos naturais, a planta sorgo sacarino tem demonstrado eficiência na absorção e consumo de nutrientes fornecendo matérias-primas importantes como celulose, etanol, bioetanol e alimentos na forma de açúcares e farinhas. Porém, informações quanto à exigência nutricional e a adubação de sorgo sacarino são escassas. Sendo o N e o K os nutrientes mais exigidos por esta espécie, desenvolveu-se estudo aplicando combinações de doses de N e K na solução fornecida para o sorgo sacarino. Foi adotado o esquema fatorial 5² incompleto perfazendo treze combinações de N e K, das respectivas doses de N: 28, 112, 210, 336 e 462 mg.L-1 combinados com as doses de K: 19.5, 117, 234, 312 e 429 mg.L-1. O delineamento experimental foi de blocos casualizados e quatro repetições. Durante o experimento as variáveis avaliadas foram: determinação do índice SPAD, atividade da enzima redutase do nitrato (RNO3-), taxa de assimilação de CO2 ¬¬(A), carboxilação instantânea de CO2 (A/Ci) e os acúmulos de N e K nas sementes, folhas, caule e raiz das plantas, posteriormente calculou-se o desenvolvimento radicular e a produção de biomassa seca por planta. Os resultados demonstraram aumento no índice SPAD com o crescimento do sorgo sacarino em todos os tratamentos, porém as maiores atividades da redutase do nitrato foram verificadas nas plantas dos tratamentos 112N/117K e 112N/312K. A maior produção de biomassa, área foliar e acúmulo de N na parte aérea e raízes foram no tratamento 336N/117K. As maiores quantidades acumuladas de K nas plantas foram observadas no caule dos tratamentos 336N/117K, 336N/312K e 462N/429K. Quanto à taxa de assimilação de CO2 (A), verificou-se no sorgo sacarino maiores taxas fotossintéticas com as combinações 210N/429K. As combinações de doses de 28N/429K e 336N/117K apresentaram maior eficiência instantânea de carboxilação (A/Ci). A massa seca das folhas contabilizadas para a área foliar foi inferior àquela obtida no tratamento da combinação de dose de N e K de 210N/234K. Notou-se maior crescimento e desenvolvimento das plantas de sorgo sacarino com a combinação de doses de N e K de 336N/117K em termos de produção de biomassaThe world population growth promotes the increase in demand a consumption of foods, fibres and energy, besides the need to save the natural resources. Among the plants researched, sweet sorghum demonstrated efficiency when using for nutrients and water and providing important feedstocks such as cellulose, ethanol, bioethanol and food in the way of sugars and flours. However, information from sweet sorghum crop management practices is still scarce, mainly concerning the mineral nutrition and fertilization. As the nutrients nitrogen and potassium the most required up by the plant of nitrogen combinations were nitrogen rates and potassium in sweet sorghum, hybrid BRS 506. It was set up a factorial scheme 5² incomplete, accounting thirteen combinations of nitrogen (N) and potassium (K). The respective doses of N: 28, 112, 210, 336 and 462 mg L-1 combined with K rates: 19.5, 117, 234, 312 and 429 mg L-1. The experimental design was a randomized block with four replications. Throughout the experiment, major variables were: evaluated estimating chlorophyll content, the activity of nitrate reductase, leaf CO2 assimilation rate, instantaneous carboxylation efficiency, accumulation N and K, root development and dry mass production of the plant. The findings were analyzed statistically using the SAS statistical software and graphics by surface response design and mean comparison. The results demonstrated increased in the SPAD index with growth of sweet sorghum in all treatments, but the highest activities of nitrate reductase were found in plants of 112N / 112N and 117K / 312K treatments. The largest production of biomass, leaf area and Nitrogen accumulation of in the shoot and roots were found in the combination of doses 336N and 117K. For K the greatest quantities are accumulated on the stem, with the combinations of doses of 336N / 117K, 336N / 462N and 312K/429K. As to CO2 assimilation rate observed on the sweet sorghum higher photosynthetic rates with 210N / 429K combinations. The combinations of doses of 28 N / 429K and 336N / 117K had higher instantaneous carboxylation efficiency. The dry mass of the leaf area was less than 83% compared with that of control treatments. In growth and development of sweet sorghum plant to 336N and 117K combination provided better results in terms of the biomass productivit

Produção de biomassa, diagnose nutricional e absorção de nitrogênio e cálcio durante crescimento inicial do pinhão-manso

RESUMO As maiores exigências em nitrogênio (N) e cálcio (Ca) têm sido relatadas para as espécies da família Euforbiaceae. Objetivou-se avaliar o suprimento combinado de doses de N e Ca e seu efeito na avaliação do estado nutricional da Jatropha curcas, por meio das diagnoses visual, foliar e bioquímica (redutase do nitrato RNO3- e o teor de clorofila), além de determinar o rendimento de biomassa e os acúmulos de N e Ca durante o crescimento inicial das plantas. Foram utilizadas as doses 2; 9; 16; 23 e 30 mmol L-1 de N e 0,5; 1,75; 3,0; 4,25 e 5,5 mmol L-1 de Ca na solução nutritiva. As concentrações de N, Ca e K, nas folhas utilizadas para diagnose, foram alteradas pelas combinações de doses de N e Ca, enquanto que as concentrações de Mg foram alteradas somente pelas doses de Ca. O aumento das concentrações de N e Ca na solução resultou em incrementos na área foliar e na produção de biomassa de folhas em 400% e 245%, respectivamente. Em média, as quantidades de N e Ca acumuladas nas folhas corresponderam a 29% e 39% do total acumulado nas plantas. O rendimento de biomassa guarda relação direta com a atividade da RNO3- e teor de clorofila, sendo a faixa de concentração de N nestas folhas de 43 a 45 g kg-1 para a máxima produção. O nitrogênio promove maior impacto no rendimento de biomassa das plantas, todavia, os efeitos são mais expressivos com o aumento da absorção de Ca

Photosynthesis rate, chlorophyll content and initial development of physic nut without micronutrient fertilization

Few studies in Brazil have addressed the need for micronutrients of physic nut focusing on physiological responses, especially in terms of photosynthesis. The objective of this study was to evaluate the effects of omission of boron (B), copper (Cu), iron (Fe), manganese (Mn) and zinc (Zn) on Jatropha curcas L.. The experimental design was a randomized block with four replications. The treatments were complete solution (control) and solution without B, Cu, Fe, Mn, and Zn. We evaluated the chlorophyll content (SPAD units), photosynthetic rate, dry matter production and accumulation of micronutrients in plants, resulting from different treatments. The first signs of deficiency were observed for Fe and B, followed by Mn and Zn, while no symptoms were observed for Cu deficiency. The micronutrient omission reduced the dry matter yield, chlorophyll content and photosynthetic rate of the plants differently for each omitted nutrient. It was, however, the omission of Fe that most affected the development of this species in all parameters evaluated. The treatments negatively affected the chlorophyll content, evaluated in SPAD units, and the photosynthetic rate, except for the omission of B. However this result was probably due to the concentration effect, since there was a significant reduction in the dry matter production of B-deficient plants