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

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

دراسة عن حبوب اللقاح والأنواع الفطرية بهواء مدينة الاسكندرية - جمهورية مصر العربية

The present study provides a survey of atmospheric pollen and fungal spores in the city of Alexandria with the aim of supplying information that may be useful in the treatment of aeroallergies. Considerable attention has been given to the correlation between pollen grain concentration in the atmosphere and concurrent values of meteorological variables. Air sampling using Burkard volumetric spore trap was undertaken daily for two years (1981, 1982). Fungal spores were counted weekly for one year (from April 1983 to April 1984) using culture plate technique. Pollen grains related to 18 families were identified and estimated. Those of Poaceae, Casuarinaceae, Chenopodiaceae, Asteraceae, Brassicaceae, Fabaceae, Rosaceae, Urticaceae, Cupressaceae, and Pinaceae were recorded in high frequency. The pollen peaks of common allergenic plants (Poaceae, Casuarina, Artemisia, and Urtica) and their distribution are presented in this study. They were correlated with frequencies of Spring catarrh. Twenty one genera of moulds and actinomycete were identified, of which only Cladosporium, AIternaria, and Streptomyces were frequently recorded.درست حبوب اللقاح والأنواع الفطرية الموجودة بهواء مدينة الاسكندرية بهدف الحصول على معلومات قد تفيد في علاج أمراض الحساسية التي تنتج عن وجود هذه الجسيمات في الهواء ، وتهتم الدراسة على وجه الخصوص بالعلاقة بين تركيز حبوب اللقاح في الهواء وقيم المتغيرات المناخية كما أنها توفر معلومات أساسية قد يكون لها فائدة في الأبحاث المستقبلية عن الكساء الخضري والفلورا في منطقة ساحل البحر المتوسط بمصر . استخدمت مصيدة بركارد لحبوب اللقاح لأخذ عينات يومية من الهواء لمدة عامين (1981 ، 1982) فأمكن رصد ثمانية عشر نوعا من حبوب اللقاح بدرجة عالية وهي تابعة لثمانية عشر فصيلة نباتية . أوضحت النتائج التركيزات العالية لحبوب لقاح النباتات المسببة للحساسية وتوزيعها خلال عامي الدراسة متل ما يتبع الفصيلة النجيلية وهذه النتائج تساعد المختصين في علاج بعض حالات الحساسية . كما أتضح أن هناك علاقة طردية ملحوظة بين تكرارية حبوب القاح التابعة لهذه النباتات ومعدلات الاصابة بالرمد الربيعي . وتم حصر وتعريف واحدا وعشرين جنسا من الفطريات وجنسا واحدا من ا لاكتينوميسيتات وظهرت الأجناس "الترناريا" وكلادوسبوريم و "ستربتوميسين بنسب عالية . ويتبع العديد من أجناس الفطريات المسجلة في هذه الدراسة أنواعا تسبب أمراضا للإنسان والحيوان والنبات

Orbicules in angiosperms: Morphology, function, distribution, and relation with tapetum types

Orbicules, or Ubisch bodies, are sporopollenin particles lining the inner tangential and sometimes also the radial tapetal cell walls, They occur only in species with a secretory tapetum, The surface ornamentation of orbicules and pollen of the same species is often strikingly similar. Although orbicules were discovered more than a century ago, these structures remain enigmatic since their function is still obscure. Proposed hypotheses about their possible function are discussed. We also deal here with topics such as the possible allergenicity of orbicules and their representation in the fossil record. The use of orbicule characters for systematics is reviewed. The distribution of orbicules throughout the angiosperms, based on a literature review from the first report until today, is shown in a list with 314 species from 72 families. Those species found in the literature without orbicules are presented together with their tapetum type. We plotted this information on a dahlgrenogram to visualize the distribution of orbicules. Orbicules occur in all subclasses of the angiosperms, Their occurrence is not correlated with certain modes of pollination or habitats.status: publishe

الشكل الخارجي لحبوب لقاح العائلة البوراجينية في قطر

The pollen morphology of six species belonging to six genera of Boraginaceae in Qatar have been investigated by LM and SEM. The examined species proved to be eurypalynous, having different morphological types and can be recognized individually from their pollen grains. The only exception is Lappula spinocarpos and Echiochilon kotschyi, where their pollen grains are morphologically similar. In general, the pollen grains are small and isopolar. There are five different types of apertures encountered in the examined species. These types range from tricolporate, 8-colporate and 6 to 8 colpate, pollen grains. Clear variations were also observed in sexine ornamentations, particularly around apertures.أظهرت الدراسة التي تمت بواسطة المجهر الضوئي والمجهر الالكتروني الماسح لحبوب لقاح ستة أنواع تعود لستة أجناس تمثل العائلة البوراجينية في الفلورا القطرية ، اختلافا واضحاً في هذه الأنواع من حيث الشكل الخارجي ونوع الفتحات وزخارف السطح الخارجي . ،يمثل الاختلاف في نوع وعدد فتحات اللقاح صفة هامة للتمييز بسهولة بين الأنواع المختلفة ، وتتراوح فتحات اللقاح في عددها من ثلاثة إلى ثمانية فتحات ، وتتميز إلى أربعة أنواع واضحة . وبينت الدراسة أن العائلة البوراجينية تعتبر تصنيفياً غير متجانسة ، وهذا يتفق مع الدراسات السابقة

دراسة سيتولوجية وبلينولوجية على نباتات مريوط : النباتات الشائعة للفصائل البصلية والزنبقية

The present sludy includes cytological and palynological investigations of five species belonging to the families Alliaceae and Liliaceae, as an impetus for more in-depth floristic, taxonomic and phytogeographical investigations of common species of Mariut (Egypt). Interplant and intraplant variations in chromosome number and cell and chromosome size were recorded. These differences were accompanied by some morphological differences in both plants and pollen grains. These were related to habitat differences.تتناول هذه الدراسة خمس أنواع نباتية تتبع فصيلتين هما الفصيلة البصلية والزنبقية وقد جُمعت نباتات مختلفة لكل نوع من بيئات مختلفة لتلقي بعض الضوء على نباتات منطقة مريوط والعلاقة التقسيمية لها وتوزيعها على البيئات المختلفة . وقد وجدت اختلافات في عدد الكروموسومات بين نباتات النوع الواحد الموجودة في بيئات مختلفة . وهذه الاختلافات وجدت مصاحبة لبعض الاختّلافات المورفولوجية للشكل العام وأشكال حبوب اللقاح . ومثال الاختلاف الموجود في نفس النبات : أليم زيزيرتورم وأورجينيا ماريتما ، أما الاختلاف في النباتات من بيئات مختلفة فيبينه نبات أليم روزم وأورجينيا ماريتما

Pollen development of Rondeletia odorata (Rubiaceae)

Pollen wall ontogeny of Rondeletia odorata was studied with transmission electron microscopy (TEM) and scanning electron microscopy (SEM) from tetrad stage until maturity. The ontogenetic sequence of wall development in Rondeletia follows, to some extent, the basic scheme in the angiosperms, i.e., development starts centripetally with the pro-columellae in a plasmalemma surface coating (primexine) at the early tetrad stage when the microspores are still enveloped by callose, until intine formation in young pollen grains. The main ontogenetical features of Rondeletia odorata pollen are (1) the very thin irregular foot layer, (2) development of a continuous layer of radially oriented membranous granular material under the thick endexine, (3) initiation of intine before first mitosis with characteristic radial plasmalemma invaginations, and (4) a strong stretching force upon engorgement just prior to dehiscence, which leads to reduction in thickness of all wall layers. The possible function of Golgi vesicles in the considerable increase in surface area of the plasmalemma at intine initiation is discussed. The endocingulum observed on acetolyzed and sectioned mature grains is explained ultrastructurally.status: publishe