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

Epidemiology of Mosquito-Borne Viruses in Egypt: A Systematic Review

There are at least five common mosquito-borne viruses (MBVs) recorded in Egypt, including dengue virus (DENV), Rift Valley fever virus (RVFV), West Nile virus (WNV), Chikungunya virus, and Sindbis virus. Unexpected outbreaks caused by MBVs reflect the deficiencies of the MBV surveillance system in Egypt. This systematic review characterized the epidemiology of MBV prevalence in Egypt. Human, animal, and vector prevalence studies on MBVs in Egypt were retrieved from Web of Science, PubMed, and Bing Scholar, and 33 eligible studies were included for further analyses. The monophyletic characterization of the RVFV and WNV strains found in Egypt, which spans about half a century, suggests that both RVFV and WNV are widely transmitted in this nation. Moreover, the seropositive rates of DENV and WNV in hosts were on the rise in recent years, and spillover events of DENV and WNV to other countries from Egypt have been recorded. The common drawback for surveillance of MBVs in Egypt is the lack of seroprevalence studies on MBVs, especially in this century. It is necessary to evaluate endemic transmission risk, establish an early warning system for MBVs, and develop a sound joint system for medical care and public health for managing MBVs in Egypt

Comparative study between efficacy of dexamethasone-prostaglandin-receptal combination and mechanical correction in uterine torsion cases in Egyptian buffalo-cows (Bubalus bubalis)

Abstract Background According to reports, the majority of domesticated species exhibited uterine torsion. It was occasionally noted as a cause of dystocia in buffaloes. The uterus might twist more frequently late in pregnancy because of certain animal traits. The current research monitored the clinical findings and laboratory assays associated with uterine torsion cases in pregnant buffalo-cows through comparing between normal labored buffalo-cows (Norm-Labgr; n = 20), mechanically corrected uterine torsed animals without medicament interference (UtrTorsgr; n = 160), and mechanically corrected uterine torsed animals with medicament interference (UtrTors-Medgr; n = 40) through focusing on placental characterization, calves body weight, milk constituents and milk somatic cell count (SCC) in normal labored buffaloes and uterine torsed ones. Through clinical and laboratory investigations of these buffaloes (N = 220) had been conducted 3 times; 7 h pre-calving and post calving (Post uterine correction) i.e. 48 and 96 h. Uterine torsion prevalence parameters, placental characterization, calves body weight, milk constituents and milk somatic cell counts were evaluated in normal labored buffaloes and uterine torsed ones. Results and Conclusions The study concluded pre-calving remarkable variations in clinical findings, leukogram picture, calf birth weight and some placental characterization parameters between Norm-Labgr and each of UtrTorsgr and UtrTors-Medgr whereas these variations disappeared post-partum as a result to either only mechanical correction or mechanical correction plus medicaments interference. No pre-or post-calving significant changes between UtrTorsgr and UtrTors-Medgr except for the abnormal clinical findings were more representative in UtrTors-Medgr than those in UtrTorsgr particularly pre-calving. The applied pre-calving therapeutic regimen including dexamethasone-prostaglandin-receptal combination had a powerful potential efficacy that induced vaginal delivery of calves in UtrTors-Medgr as well as prepartum mechanical correction of torsed uterus approved higher efficacy in UtrTorsgr. The applied prepartum mechanical correction of torsed uterus and/or pre-calving therapeutic regimen as well as subsequent post-calving, post uterine correction applied medicament treatment accelerated rapid recovery of affected buffalo-cows through achieving rapid restoring of their physiological parameters. Buffalo-cow’s milk composition, milk pH and milk SCC were not affected whereas no significant variations were reported between Norm-Labgr, UtrTorsgr and UtrTors-Medgr