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

Biosorción de cromo y niquel por la cáscara de la bellota de encino: Quercus Crassipes Humb. & Bonpl.

Tesis (Maestría en Ciencias Quimicobiológicas), Instituto Politécnico Nacional, SEPI, ENCB, 2010, 1archivo PDF, (128 páginas). tesis.ipn.m

Hexavalent chromium removal and total chromium biosorption from aqueous solution by Quercus crassipes acorn shell in a continuous up-flow fixed-bed column: Influencing parameters, kinetics, and mechanism.

Continuous fixed-bed column studies were carried out, utilizing acorn shell from Quercus crassipes Humb. & Bonpl. (QCS), in order to remove total chromium and Cr(VI) from aqueous solution. Effects of various fixed-bed column parameters such as influent solution pH, influent flow rate, QCS bed height, and influent Cr(VI) concentration were investigated. Results from the fixed-bed column experiments demonstrate that total chromium biosorption and Cr(VI) removal by QCS depend strongly on the pH of influent solution. The highest capacities for Cr(VI) removal and total chromium biosorption are about 181.56 and 110.35 mg g-1 and are achieved at influent solution pH of 1.0 and 2.0, respectively. Besides this, total chromium biosorption capacities increased from 104.25 to 116.14 mg g-1, 109.07 to 117.44 mg g-1, and 85.02 to 129.87 mg g-1, as bed height, inlet flow rate, and influent Cr(VI) concentration increased from 1.7 to 6.5 cm, 0.25 to 1 mL min-1, and 50 to 400 mg L-1, respectively. The dose-response model defines the entire breakthrough curve for total chromium biosorption onto QCS, under all experimental conditions. X-ray photoelectron spectroscopy (XPS) and biosorption kinetic studies revealed that QCS is able to remove toxic Cr(VI) from acidic liquid solution by means of a complex mechanism that involves the binding of Cr(VI) oxyanions to positively charged groups present at the QCS surface, after which the Cr(VI) species are reduced to Cr(III) by adjacent electron donor groups, and the generated Cr(III) ions then become partially bound to the QCS biomass and partially released into the liquid phase. Results show that QCS can be employed as an easily accessible, abundant, eco-friendly, and inexpensive biosorbent for the removal of total chromium and Cr(VI) from Cr(VI) solutions, in continuous operation

Chromium Recovery from Chromium-Loaded <i>Cupressus lusitanica</i> Bark in Two-Stage Desorption Processes

Hexavalent chromium (Cr(VI)) contamination poses serious health and environmental risks. Chromium biosorption has been employed as an effective means of eradicating Cr(VI) contamination. However, research on chromium desorption from chromium-loaded biosorbents is scarce despite its importance in facilitating industrial-scale chromium biosorption. In this study, single- and two-stage chromium desorption from chromium-loaded Cupressus lusitanica bark (CLB) was conducted. Thirty eluent solutions were evaluated first; the highest single-stage chromium desorption efficiencies were achieved when eluent solutions of 0.5 M NaOH, 0.5 M H2SO4, and 0.5 M H2C2O4 were used. Subsequently, two-stage kinetic studies of chromium desorption were performed. The results revealed that using 0.5 M NaOH solution in the first stage and 0.5 M H2C2O4 in the second stage enabled the recovery of almost all the chromium initially bound to CLB (desorption efficiency = 95.9–96.1%) within long (168 h) and short (3 h) desorption periods at each stage. This study clearly demonstrated that the oxidation state of the recovered chromium depends on the chemical nature and concentration of the eluent solution. The results suggest the possible regeneration of chromium-loaded CLB for its subsequent use in other biosorption/desorption cycles

Effect of Ionic Strength and Coexisting Ions on the Biosorption of Divalent Nickel by the Acorn Shell of the Oak Quercus crassipes Humb. &amp; Bonpl.

This study investigated the effect of ionic strength and background electrolytes on the biosorption of Ni2+ from aqueous solutions by the acorn shell of Quercus crassipes Humb. &amp; Bonpl. (QCS). A NaCl ionic strength of 0.2 mM was established to have no effect on the Ni2+ biosorption and the biosorption capacity of the heavy metal decreased as the ionic strength increased from 2 to 2000 mM. The background electrolytes (KCl, NaNO3, Na2SO4, CaCl2, MgSO4, and MgCl2) had no adverse effects on the biosorption of Ni2+ at a concentration of 0.2 mM. However, at background electrolyte concentrations of 2 and 20 mM, divalent cations (Ca2+ and Mg2+) had greater negative effects on the biosorption of Ni2+ compared to the monovalent cations (Na+ and K+). Additionally, the SO42&minus; and Cl&minus; anions affected the biosorption of Ni2+. The fractional power, Elovich, and pseudo-second order models represented the kinetic processes of the biosorption of Ni2+ adequately. The results show that QCS can be a promising and low-cost biosorbent for removing Ni2+ ions from aqueous solutions containing various types of impurities with different concentrations

Termografía infrarroja en la detección de la función endotelial normal

Antecedentes: La sospecha de disfunción endotelial (DE) permitirá prevenir la aterosclerosis acelerada y la muerte prematura. Objetivo: Establecer la utilidad de la termografía en el cribado de la función endotelial en adultos con factores de riesgo cardiovascular. Material y métodos: Estudio transversal analítico de prueba diagnóstica. El incremento del diámetro de la arteria braquial < 11 % a un minuto posisquemia significó probable DE, confirmada si el diámetro fue ≥ 11 % posnitroglicerina sublingual. Se obtuvieron fotografías termográficas al minuto de la región palmar. Se aplicó estadística descriptiva, curva ROC, pruebas U de Mann-Whitney, chi cuadrada o exacta de Fisher. Resultados: Se incluyeron 38 sujetos, mediana de edad de 50 años, con 624 mediciones termográficas; nueve presentaron DE (vasodilatación mediada por flujo de 2.5 %). El mejor punto de corte para la función endotelial normal en sujetos con factores de riesgo cardiovascular fue ≥ 36 °C al minuto de isquemia, con sensibilidad de 85%, especificidad de 70%, valores predictivos positivo y negativo de 78 y 77%, área bajo la curva de 0.796, razón de verisimilitud positiva de 2.82 y razón de verisimilitud negativa de 0.22. Conclusión: La medición de la temperatura en la región palmar mediante termografía infrarroja ≥ 36 °C tras un minuto de isquemia es práctica, no invasiva y económica para el cribado de la función endotelial normal en adultos con factores de riesgo cardiovascular

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research