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

Unravelling feeding territoriality in the Little Blue Heron, Egretta caerulea, in Cananéia, Brazil

Habitat use by the Little Blue Heron (Egretta caerulea) and discovery of feeding territoriality are discussed here. The results showed the existence of a territorial individual defending an area (2,564.46 ± 943.56 m²) close to the mangrove, and non-territorial individuals (9.17 ± 2.54) in the rest of a demarcated area (mean area for the non-territorial: 893.25 ± 676.72). A weak positive correlation (r = 0.47, df = 46, p < 0.05) was found between the overlapping of territorial and non-territorial individuals (2.85 ± 3.07 m²) and the mean overlapped area for territorial individuals (171.41 ± 131.40 m²). Higher capture (1.52 ± 1.14 × 1.00 ± 1.37 catches/minutes) and success rates (0.45 ± 0.31 × 0.21 ± 0.27) and lower energy expenditure rates (45.21 ± 14.96 × 51.22 ± 14.37 steps/minutes; and 3.65 ± 2.55 × 4.94 ± 3.28 stabs/minutes) were observed for individuals foraging in areas close to the mangrove. The results suggest that the observed territorial behaviour is more related to a number of food parameters than to intruder pressure, and also that the observed territoriality might be related to defense of areas with higher prey availability

Expression of an Oxalate Decarboxylase Impairs the Necrotic Effect Induced by Nep1-like Protein (NLP) of Moniliophthora perniciosa in Transgenic Tobacco

Oxalic acid (OA) and Nep1-like proteins (NLP) are recognized as elicitors of programmed cell death (PCD) in plants, which is crucial for the pathogenic success of necrotrophic plant pathogens and involves reactive oxygen species (ROS). To determine the importance of oxalate as a source of ROS for OA- and NLP-induced cell death, a full-length cDNA coding for an oxalate decarboxylase (FvOXDC) from the basidiomycete Flammulina velutipes, which converts OA into CO(2) and formate, was overexpressed in tobacco plants. The transgenic plants contained less OA and more formic acid compared with the control plants and showed enhanced resistance to cell death induced by exogenous OA and MpNEP2, an NLP of the hemibiotrophic fungus Moniliophthora perniciosa. This resistance was correlated with the inhibition of ROS formation in the transgenic plants inoculated with OA, MpNEP2, or a combination of both PCD elicitors. Taken together, these results have established a pivotal function for oxalate as a source of ROS required for the PCD-inducing activity of OA and NLP. The results also indicate that FvOXDC represents a potentially novel source of resistance against OA- and NLP-producing pathogens such as M. perniciosa, the causal agent of witches' broom disease of cacao (Theobroma cacao L.).247839848Fundacao de Amparo a Pesquisa do Estado da Bahia (Salvador, Brazil)National Council for Scientific and Technological Development (Brasilia, Brazil)Coordination of Higher Education and Graduate Training (Brasilia, Brazil

Estresse ocupacional: avaliação de enfermeiros intensivistas que atuam no período noturno

Estudo descritivo, transversal, que teve como objetivo avaliar o nível de estresse de enfermeiros intensivistas do período noturno. Aplicou-se a Escala Bianchi de Stress em 26 (100%) enfermeiros de cinco hospitais. Na análise dos dados, utilizou-se o teste Qui-quadrado de Pearson e constatou-se que o estresse entre enfermeiros da instituição pública (3,36 pontos) e privada (3,02 pontos) se classificou em nível mediano e que não houve relevância estatística (p=0,90) à sua ocorrência, conforme o tipo de instituição. Os domínios que mais contribuíram ao acontecimento de estresse foram: condições de trabalho (labor noturno, setor crítico e fechado), gravidade do paciente e atividades gerenciais associadas à assistência direta. Concluiu-se que o ambiente laboral se associou positivamente ao estresse em enfermeiros do turno noturno e que o seu aparecimento e efeitos podem ser minimizados por meio de melhorias na estrutura e na organização dos locais onde atuam.