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

Concentración y extracción de macronutrimentos en cuatro variedades de fresa

Strawberry (Fragaria x ananassa) nutrition is a fundamental factor in achieving high yields and fruit quality. For this, fertilizer sources, timing and concentrations must be considered. The plant is adapted to subtropical and temperate conditions butis sensitive to ionic fluctuations in the nutrient solution and to the nutrient content in soil and substrate. The analysis of nutrient absorption dynamics is one of the most used strategies to inferthe needs at each phenological stage. For this the need arises to formulate an algorithm that allows toknow the amount of nutrient that the plant requires in each phenological stage. The objective was to determine, through regression models, the nutritional demand during the crop cycle of the strawberry varieties Albion, Festival, Jacona and Zamorana. The hypothesis was that the concentration and absorption of nutrients is differential in each variety and phenological stage of the plant, in addition the absorption of nutrients can be described by multiple linear regression models. The study was conducted using a completely random sampling for the collection of plant material under field cultivation conditions. Nutrient concentration was determined by chemical analysis. The nutritional extraction was obtained and related to each phenological stage. The reference values for the concentration and nutritional extraction were obtained for N, P, K, Ca, Mg and S, using mathematical models that determine the nutritional needs of the plants at each stage of their development.La nutrición en fresa (Fragaria x ananassa) es un factor fundamental para alcanzar rendimientos y calidad altos del fruto. Para esto deben considerarse las fuentes fertilizantes, la oportunidad y las concentraciones aplicadas. La planta está adaptada a las condiciones subtropicales y templadas, pero es sensible a fluctuaciones iónicas en la solución nutritiva y al contenido de nutrientes en suelo y sustrato. El análisis de la dinámica de absorción de nutrientes es una de las estrategias más usadas para inferir las necesidades en cada etapa fenológica. Para ello surge la necesidad de formular un algoritmo que permita conocer la cantidad de nutriente que la planta requiere en cada etapa fenológica. El objetivo fue determinar, mediante modelos de regresión, la demanda nutrimental durante el ciclo de cultivo de las variedades de fresa Albión, Festival, Jacona y Zamorana. La hipótesis fue que la concentración y absorción de nutrientes es diferencial en cada variedad y etapa fenológica de la planta, además la absorción de nutrientes puede ser descrita mediante modelos de regresión lineal múltiple. El estudio se realizó usando un muestreo completamente aleatorio para la colecta del material vegetal bajo las condiciones de cultivo en campo. La concentración de nutrientes se determinó mediante análisis químico. La extracción nutrimental se obtuvo y se relacionó con cada etapa fenológica. Los valores de referencia para la concentración y extracción nutrimental se obtuvieron para N, P, K, Ca, Mg y S, mediante modelos matemáticos que determinan las necesidades nutrimentales de las plantas en cada etapa de su desarrollo

Huella genética de variedades de fresa obtenidas en el Colegio de Postgraduados, México

In a breeding program for strawberry (Fragaria × ananassa) it is important to have a methodology to evaluate the genetic integrity of the plant in all the stages of increase, from different criteria, such as morphological, physiological and molecular; for this purpose one of the most appropriate tools are the Simple Sequence Repeats (SSR`s) molecular markers, since they allow, for example, identifying populations with a reduced genetic diversity, revealing genealogies, knowing the degree of relatedness between individuals, providing solid elements in the defense of intellectual property, evaluation of the purity of the plant material, identification of somaclonal variation and to avoid the mixture of plant material in germplasm banks. In this sense the objective of this study was to obtain the genetic fingerprint of strawberry varieties CP0201, CP0204, CP0615, CPLE7 developed at Colegio de Postgraduados and variety Festival developed at Florida, US, with the use of nine microsatellite (SSR`s) loci. The process included the DNA extraction from strawberry leaf tissue, as well as the amplification by means of PCR of the SSR`s loci grouped in multiplex reactions. The PCR products were separated by capillary electrophoresis and their size in base pairs was determined with the GeneMapper® v. 4 software. From the allele frequencies distance matrices were calculated the Jaccard and Dice coefficients. 63 different alleles were found, each pair of primers amplified between 3 and 12 alleles. The markers that presented the highest number of alleles were EMFn181 (11 alleles) and EMFv104 (12 alleles). The genetic fingerprint of each variety was generated. Differences between the CP0615, CPLE7 and Festival were found based on their allelic profiles; CP0204 and CP0201 had a similar genetic fingerprint, since they are related through their female parent; the allelic diversity index within the populations ranged from 3.96 to 5.93. The varieties had a low uniformity index due to the high level of polymorphism of the markers used.En un programa de mejoramiento genético de fresa (Fragaria × ananassa) es importante contar con la metodología para evaluar la integridad genética de la planta en todas las etapas de incremento, desde diferentes criterios, como el fisiológico, morfológico y el molecular; para este propósito, una de las herramientas más apropiadas son los marcadores moleculares denominados Secuencias Simples Repetidas del inglés Simple Sequence Repeats (SSR), ya que permiten, por ejemplo, identificar poblaciones con una diversidad genética reducida, revelar genealogías, conocer el grado de parentesco entre individuos, proporcionar elementos sólidos en la defensa de la propiedad intelectual, evaluar la pureza del material vegetal, identificar el grado de variación somaclonal y evitar la mezcla de material vegetal en bancos de germoplasma. En este sentido, el presente estudio tuvo como objetivo obtener la huella genética de las variedades de fresa CP0201, CP0204, CP0615, CPLE7 desarrolladas en el Colegio de Postgraduados y como testigo la variedad Festival, desarrollada en Florida, USA, con el uso de nueve loci de microsatélites (SSR). El proceso incluyó la extracción de ADN a partir de tejido foliar de fresa, así como de la amplificación mediante PCR de punto final de los loci SSR agrupados en reacciones multiplex. Los productos de PCR fueron separados mediante electroforesis capilar y su tamaño en pares de bases se determinó con el programa GeneMapper® v. 4. A partir de las frecuencias alélicas se calcularon las matrices de distancia con los coeficientes de Jaccard y Dice. Se encontraron 63 alelos distintos, cada par de iniciadores amplificó entre 3 y 12 alelos. Los marcadores que presentaron mayor número de alelos fueron EMFn181 (11 alelos) y EMFv104 (12 alelos). Se generó la huella genética de cada variedad. Mediante los perfiles alélicos se encontraron diferencias entre las variedades CP0615, CPLE7 y Festival; CP0201 y CP0204 tuvieron una huella genética similar, ya que están emparentadas a través de su progenitor femenino; el índice de diversidad alélica dentro de las poblaciones varió de 3.96 a 5.93. Las variedades tuvieron un índice de uniformidad bajo debido al alto nivel de polimorfismo de los marcadores usados