21 research outputs found
Growth ring analysis of fossil coniferous woods from early cretaceous of Araripe Basin (Brazil)
EVALUATION OF THE MOLLUSCICIDAL POTENTIAL OF HYDROALCOHOLIC EXTRACTS OF Jatropha gossypiifolia Linnaeus, 1753 ON Biomphalaria glabrata (Say, 1818)
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
Osteology of the first skull of Aetosauroides scagliai Casamiquela 1960 (Archosauria: Aetosauria) from the Upper Triassic of southern Brazil (Hyperodapedon Assemblage Zone) and its phylogenetic importance.
Aetosauria, which includes 30 species, is a diverse group of armored pseudosuchian archosaurs restricted to Upper Triassic beds. Three species occur in Brazil, and one of these, Aetosauroides scagliai Casamiquela, 1960, also occurs in Argentina. The specimen UFSM 11505, found at Faixa Nova-Cerrito I Outcrop, Santa Maria Formation (Hyperodapedon Assemblage Zone), Santa Maria, Rio Grande do Sul State, Brazil, is here referred to as Aetosauroides scagliai. This specimen preserves most of the skull with both hemimandibles in association with most of the postcranium, thus representing one of the most complete aetosaur skeletons found in Brazil. The premaxilla, one of the key elements of the cranial morphology of aetosaurs, along with the posterior portion of the mandible, was not described until now for A. scagliai. In contrast to the typothoracinae aetosaurs, the premaxilla of UFSM 11505 presents a shovel-shaped tip, but it is not as prominent as the lateral expansion of desmatosuchian aetosaurs, including both species of Stagonolepis, S. robertsoni Agassiz, 1844 and S. olenkae Sulej, 2010. The retroarticular process of the mandible is elongate and not tall, as in Stenomity huangae Small & Martz, 2013 and other typothoracinae aetosaurs. Unlike previous descriptions of A. scagliai, the maxillary teeth are recurved ziphodont-like with serrations on the entire length of both margins. Premaxillary teeth are also present, being less recurved than the maxillary teeth and cylindrical. We recovered Aetosauroides scagliai as the most basal taxon within Aetosauria, like previous phylogenetic analyses. Furthermore, our analyses reinforce that recurved and unconstricted maxillary teeth, the shovel-shaped premaxilla and the presence of a tuber on the surangular are plesiomorphic features of Aetosauria