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

Indoor radon in Tunisian spas

Indoor radon concentrations were measured in four well-known spas of Tunisia using nuclear track detectors. The radon concentrations in these spas were found to be in the range of 19 - 870 Bq.m-3. The equilibrium factor F between radon and its progeny was found to vary in the range of 0.2 - 0.5, depending upon the ventilation rates within the buildings of the spas. Using the exposure-dose conversion factor, the effective doses to patients and workers were estimated and the dose was found to vary in the range 3.7 × 10-3 - 12.5 × 10-3 mSv.y-1 and 0.45 - 1.5 mSv.y-1 for patients and workers, respectively. These values are well inside the limit recommended for the annual dose limit of 20 mSv.y-1 for an occupational worker. The radium content in the groundwater of all four spas was measured and the results showed no correlation between the 226Ra concentration in water and radon concentration in indoor air of the investigated spas

Assessment of artisan's exposure to heavy metals from tantalite ore mining sites in Oke-Ogun, Oyo State, Nigeria

Mining activities cause disequilibrium in the bound states of heavy metals in rocks, soils and mineral ore. These heavy and toxic metals find their ways into the food chain thereby posing health risks along the chain. Furthermore, the work scenarios in mining activities have exposure pathways such as inadvertent ingestion and inhalation of dust and materials from the sites . The dose levels due to heavy metals in tantalite samples from Oke-Ogun, Oyo State have been estimated. Twelve samples of tantalite ore [(Fe, Mn) Ta2O6], were obtained from the mining sites. 500mg of the pulverized samples were pelletized for their elemental analysis using proton Induced X-ray Emission technique. Hazard indices due to exposure to carcinogenic elements in Tantalite were estimated based on United State Environmental Protection Agency (USEPA) dose model. Chromium, Lead and Arsenic are the only carcinogenic elements found in the samples and average concentrations 311.05, 2533.26 and 127.35 ppm respectively and are higher than permissible limit recommended by Abundance elements in average crustal rock (AEACR) (100, 10.1 and 2-0 ppm respectively). The summation of hazard indices values estimated for carcinogenic elements are greater than unity. The estimated Life time average daily dose for the carcinogenic elements is 6.86E-06 mg/kg. The cancer risk estimated for the carcinogenic elements in Komu and Eluku is of the order Cr (1.32E-05) > Pb (5.83E-08). The total risk for these elements is 1.32E-05 and this value is within the permissible limit range of 10-4 - 10-6 recommended by USEPA, 1998

Comparison of Radon and Thoron Concentration Measuring Systems Among Asian Countries

Comparison is an important role in the quality control and quality assurance for any measuring system. Due to the future legal regulations regarding radon levels in the air, maintaining the system quality and harmonization of results as well as validation of radon and thoron measuring systems is important. The aim of this work is to validate the degrees of equivalence and measurement precisions of the existing five radon and four thoron measuring systems located in four Asian countries (China, India, Japan and Thailand) through comparison experiment. In this project, comparison experiment was performed in order to derive the ratio between assigned value obtained from one transfer measurement device for radon and one transfer measurement device for thoron belongs to National Institutes for Quantum and Radiological Science and Technology and participants’ value from their measuring instrument. As a result, the ratio value associated with measurement uncertainty was derived for each activity concentration. Finally, measurement bias and degrees of equivalence between the assigned values and values of measurement quantity from participants’ measuring instruments were statistically analysed and presented

Comparison of Radon and Thoron Concentration Measuring Systems Among Asian Countries

Comparison is an important role in the quality control and quality assurance for any measuring system. Due to the future legal regulations regarding radon levels in the air, maintaining the system quality and harmonization of results as well as validation of radon and thoron measuring systems is important. The aim of this work is to validate the degrees of equivalence and measurement precisions of the existing five radon and four thoron measuring systems located in four Asian countries (China, India, Japan and Thailand) through comparison experiment. In this project, comparison experiment was performed in order to derive the ratio between assigned value obtained from one transfer measurement device for radon and one transfer measurement device for thoron belongs to National Institutes for Quantum and Radiological Science and Technology and participants&rsquo; value from their measuring instrument. As a result, the ratio value associated with measurement uncertainty was derived for each activity concentration. Finally, measurement bias and degrees of equivalence between the assigned values and values of measurement quantity from participants&rsquo; measuring instruments were statistically analysed and presented

A walk-in type calibration chamber facility for 222Rn measuring devices and inter-comparison exercises

A walk-in type 222Rn calibration chamber of volume 22.7 m3, which has traceability to international standards, is established at the Centre for Advanced Research in Environmental Radioactivity, Mangalore University, India. It has a human–machine interface communication system, a programmable logic controller and sensor feedback circuit for controlling and data acquisition of relative humidity (RH) and temperature (T). An innovative method for the generation of desired 222Rn concentration (a few hundred Bq m−3 up to about 36 kBq m−3) using soil gas as a source was adopted. Leak rates of 222Rn from the chamber for the mixing fan ON and OFF conditions were determined to be 0.0011 and 0.00018 h−1 respectively. With the exhaust system fully turned on, the maximum clearance rate of the chamber was 0.58 ± 0.07 h−1. Excellent spatial uniformity in 222Rn concentration in the chamber was confirmed (with a mean value of relative standard deviation < 12%) through measurements at 23 locations using CR-39 film-based passive devices. Demonstration of calibration applications was performed using charcoal canister and PicoRad vials as the 222Rn adsorption devices. The study shows that gamma spectrometry is a convenient alternative approach to liquid scintillation analysis of PicoRad vials for 222Rn measurement