Correction: A Seroepidemiological Study of Serogroup A Meningococcal Infection in the African Meningitis Belt.

[This corrects the article DOI: 10.1371/journal.pone.0147928.]

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

Genetic diversity of North African Thymus algeriensis in Tunisia: Population structure and implication for conservation

The genetic diversity within and among nine natural populations of Thymus hirtus Willd. subsp. algeriensis (Boiss. et Reut.) Murb. from different geographical and bioclimatic zones were assessed using Random Amplified Polymorphic DNA data. A total of 154 bands were generated from seven selected primers. 141 bands were polymorphic (P=91.56%). The genetic diversity within a population based on Shannon's index which was high (H' pop=0.307) and varied according to bioclimatic zones. Ahigh genetic differentiation among populations (G ST=0.335 and F{cyrillic} ST=0.296) was revealed, suggesting a population isolation and a low level of gene flow among them. The major proportion of the variation was attributable to individual differences within populations. The genetic structure is in accordance with geography distances. The Neighbour- joining tree based on Nei's and Li's genetic distance among individuals showed that individuals from each population clustered together. The UPGMA dendrogram based on F{cyrillic} ST values revealed three clusters each of them includes populations closuring to their geographical origin. The high genetic structure of populations resulted from genetic drift caused both by the habitat fragmentation and the low size of most populations. The in situ conservation should interest all populations. The ex situ conservation should be based on the collection of seeds rather within than among populations because of the maximum of variation was revealed within populations.Esta investigación fue financiada por una beca del Ministerio de Investigación, Ciencia y Tecnología y el Instituto Nacional de Ciencias Aplicadas y Tecnología (Beca de Investigación 99 / UR/09-10).Esta investigación fue financiada por una beca del Ministerio de Investigación, Ciencia y Tecnología y el Instituto Nacional de Ciencias Aplicadas y Tecnología (Beca de Investigación 99 / UR/09-10)Peer Reviewe

Genetic diversity and structure of wild Tunisian Thymus capitatus (L.) Hoffm. et Link. (Lamiaceae) assessed using isozyme markers

The genetic diversity and population structure of 25 natural populations of Thymus capitatus, from five ecological areas, were analysed using eight isozymes. For all populations, 11 polymorphic loci were detected, and several of them showed rare alleles. A high genetic diversity within populations (A p=1.82; P=62.88%; H o=0.116) and an excess of heterozygosity were observed. A high level of inbreeding within populations was observed (F IS=0.471). High differentiation and low gene flow (N m=0.821) were detected among populations (F ST=0.219). The genetic variation within and among ecological groups varied according to the bioclimate. Population structuration depends on geographic distance between sites rather than on bioclimate (Mantel's test; r=0.251; P=0.004). Nei's genetic distances (D) values calculated between pairs of populations were globally low with a mean of 0.047. The unweighted pairwise groups method using arithmetic average dendrogram showed fourth sub-clusters. Population groupings occur with evident relationship to geographic location. The substantial differentiation and the high genetic similarities between populations indicate that populations have been recently isolated as a result of anthropic pressure. In situ conservation must first focus on populations with a high level of genetic diversity and rare alleles. Ex situ preservation should be elaborated by collecting seeds within populations that showed a high level of genetic diversity in each ecological group. © 2011 Blackwell Publishing Ltd.This research was supported by a grant of the Ministry of Scientific Research and Technology and the National Institute of Applied Science and Technology (Research grant 99/UR/09-10).Peer Reviewe