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

CONTROL DEL ENTRENAMIENTO DEPORTIVO EN DEPORTISTAS ESCOLARES

Con el objetivo de determinar si a los deportistas escolares les fueron aplicados pruebas de control durante su proceso de entrenamiento para los IV Juegos Deportivos Escolares Centroamericanos y del Caribe, realizados en Armenia, Colombia, en 2013, fue desarrollado un estudio con enfoque cuantitativo, de corte transversal y alcance descriptivo, a una muestra por conveniencia de 233 deportistas escolares (102 hombres y 131 mujeres), quienes participaron en 12 deportes, representando a nueve países. El promedio de edad fue de 16,9 años ±0,76, con una edad deportiva de 7,26 años±3,27. Fue administrada una encuesta elaborada por el grupo investigador y sometida a criterio de expertos. La información fue tratada con el programa SPSS (versión 17). Se encontró que a nueve de cada 10 deportistas les fueron aplicadas pruebas de control, siendo la más utilizada las físicas, con 169 respuestas, seguida de las médicas y obteniendo el menor número, las psicológicas. Hubo una fuerte asociación entre aplicación de las pruebas de control y deportistas, que pertenecen a ligas en sus respetivos países y medallería de oro obtenida, por diferentes países

Sports training control in the Southamerican games Medellin 2010

Con el objeto de determinar sí los entrenadores que asistieron a los deportistas de los Juegos Suramericanos Medellín 2010 aplicaban diferentes pruebas para hacer el control a los deportistas fue realizado un estudio cuantitativo, con alcance descriptivo, en el cual, fueron encuestados 93 entrenadores (86 hombres y 7 mujeres), con una edad media de 46,1 años (±10,2), con un mínimo de 24 y una máxima de 79 . La experiencia como entrenadores promedio fue de 20,5 (±9,8) años, entre 16,3 y 27,2 años, provenientes de 13 países en 28 deportes . La muestra fue intencional, puesto que no se conoció el dato exacto de los entrenadores asistentes al evento . La técnica utilizada fue la encuesta . Para el análisis de la información, se utilizó el programa Excel bajo Windows 2007, hallando que el 90,3% de los instructores consultados aplican diferentes pruebas de control, 79, entrenadores de campo, 45, de laboratorio y 41, ambas pruebas . Se presentó la tendencia que los deportistas entrenados por instructores de paises que aplicaban más pruebas de control (terreno y laboratorio), obtuvieron un mayor número de medallas.With the objective to determine if trainers that supported sportspeople in the South-American Games Medellin 2010, applied different tests in order to control sportsmen, a quantitative analysis was made which had a descriptive scope in which 93 trainers were surveyed (86 men and 7 women), aged in average 46 .1 years (±10 .2) with a minimum age of 24 and a maximum of 79. The average experience as trainer was of 20 .5 years (±9 .8); they came from 13 countries and were experts in 28 different sports. An intentional sample was taken, since the exact data of trainers attending the event was unknown. The technique used was the survey . In order to analyze the information an Excel program Windows 2007 was used. Results showed that 90 .3% of the consulted coaches, applied different control tests, 79 trainers employed field control, 45 lab control and 41 both ways. A tendency, that the participants trained by coaches from countries where control tests were applied (field and lab) achieved a higher number of medals was detected.Incluye referencias bibliográfica

Evaluating Late Blight Severity in Potato Crops Using Unmanned Aerial Vehicles and Machine Learning Algorithms

This work presents quantitative prediction of severity of the disease caused by Phytophthora infestans in potato crops using machine learning algorithms such as multilayer perceptron, deep learning convolutional neural networks, support vector regression, and random forests. The machine learning algorithms are trained using datasets extracted from multispectral data captured at the canopy level with an unmanned aerial vehicle, carrying an inexpensive digital camera. The results indicate that deep learning convolutional neural networks, random forests and multilayer perceptron using band differences can predict the level of Phytophthora infestans affectation on potato crops with acceptable accuracy

Agroclimatic zoning methodology for agricultural production systems in dry Caribbean region of Colombia

The agricultural sector in Colombia and especially, small-scale agriculture subsector in the Colombian Caribbean has been very vulnerable to the negative impacts of climate variability in part due to the poor existence and lack of access to agroclimatic information. The objective was to build a methodology for agroclimatic zoning for crops growing in Colombian dry Caribbean. To achieve this goal, a case study of tomato crop growing in the municipality of Repelon (Atlantico, Colombia) was selected. The methodology was based in the combination of crop-specific soil suitability assessment and the monthly probability of a humidity condition occurrence in the soil for tomato production under water deficit. Probability was constructed through water balances generated from the Palmer drought severity index, calculated for each month of crop production cycle during the 1980 to 2011 series. The resulting maps show defined areas called Productive Niches with lower limitations per soil and low probabilities of soil water deficit in the growth of tomato crop in the municipality. The methodology can be used to delineate areas suitable for planting tomato or other crops in climate variability events in the dry Caribbean region of Colombi

Agroclimatic zoning methodology for agricultural production systems in dry Caribbean region of Colombia

The agricultural sector in Colombia and especially, small-scale agriculture subsector in the Colombian Caribbean has been very vulnerable to the negative impacts of climate variability in part due to the poor existence and lack of access to agroclimatic information. The objective was to build a methodology for agroclimatic zoning for crops growing in Colombian dry Caribbean. To achieve this goal, a case study of tomato crop growing in the municipality of Repelon (Atlantico, Colombia) was selected. The methodology was based in the combination of crop-specific soil suitability assessment and the monthly probability of a humidity condition occurrence in the soil for tomato production under water deficit. Probability was constructed through water balances generated from the Palmer drought severity index, calculated for each month of crop production cycle during the 1980 to 2011 series. The resulting maps show defined areas called Productive Niches with lower limitations per soil and low probabilities of soil water deficit in the growth of tomato crop in the municipality. The methodology can be used to delineate areas suitable for planting tomato or other crops in climate variability events in the dry Caribbean region of Colombi

Efficacy and safety of two whole IgG polyvalent antivenoms, refined by caprylic acid fractionation with or without β-propiolactone, in the treatment of Bothrops asper bites in Colombia

The efficacy and safety of two whole IgG polyvalent antivenoms (A and B) were compared in a randomised, blinded clinical trial in 67 patients systemically envenomed by Bothrops asper in Colombia. Both antivenoms were fractionated by caprylic acid precipitation and had similar neutralising potencies, protein concentrations and aggregate contents. Antivenom B was additionally treated with β-propiolactone to lower its anticomplementary activity. Analysing all treatment regimens together, there were no significant differences between the two antivenoms (A = 34 patients; B = 33 patients) in the time taken to reverse venom-induced bleeding and coagulopathy, to restore physiological fibrinogen concentrations and to clear serum venom antigenaemia. Blood coagulability was restored within 6–24 h in 97% of patients, all of whom had normal coagulation and plasma fibrinogen levels 48 h after the start of antivenom treatment. Two patients (3.0%) had recurrent coagulopathy and eight patients suffered recurrence of antigenaemia within 72 h of treatment. None of the dosage regimens of either antivenom used guaranteed resolution of venom-induced coagulopathy within 6 h, nor did they prevent recurrences. A further dose of antivenom at 6 h also did not guarantee resolution of coagulopathy within 12–24 h in all patients. The incidence of early adverse reactions (all mild) was similar for both antivenoms (15% and 24%; P > 0.05).Instituto Colombiano para el Desarrollo de la Ciencia y la Tecnología Francisco José de Caldas//COLCIENCIAS/ColombiaUniversidad de Antioquia/[206PI0281]/CYTED/ColombiaUniversidad de Costa Rica//UCR/Costa RicaUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto Clodomiro Picado (ICP