4 research outputs found
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
Theoretical Porosity of Elastic Single Jersey Knitted Fabric Based on 3D Geometrical Model of Stitch Overlapping
To improve the dimensional stability of weft knitted fabrics, spandex yarns are incorporated with the base yarn by the plaiting technique. Adding spandex leads to stitch overlapping, increases the fabric thickness, and affects the pore’s size and distribution. This in turn affects the geometrical and physical properties of weft knitted fabrics such as air permeability. In this paper, the theoretical 3D modeling of stitch overlap, maximum set, and open structures is presented by using AutoCAD software. Fabric thickness was divided into several sections, and the theoretical porosity at each section was analyzed and calculated. Furthermore, single jersey knitted fabrics SJKF with and without spandex were produced to obtain overlapping (by using spandex weight percent, SWP 8%), and open structures. The calculated and theoretical overall porosity were calculated and compared. The study showed the influence of stitch overlapping on fabric porosity. Moreover, the results show that the proposed model captured to some extent the change in fabric porosity as its structure changes
Comprehensive Assessment of the Properties of Cotton Single Jersey Knitted Fabrics Produced From Different Lycra States
This research aims to evaluate the properties of cotton single jersey knitted fabrics (SJKF) produced from cotton/spandex yarns at different Lycra states. So, four different SJKF were produced, namely 100% cotton, cotton with additional Lycra (full-platted), core, and dual-core-spun (DCS) yarns with the same loop length. The thermal comfort properties, fabric recovery, total hand value (THV), moisture management parameters, and air permeability were measured. The experimental results showed that the use of DCS yarns in the SJKF improves the fabric elastic recovery by 100%. The obtained values of air permeability, THV, and overall moisture management capacity of stretched SJKF are lower than 100% cotton fabric sample. Thermal absorptivity of core and dual-core samples increased by 27% and the water vapor permeability decreased by 18% compared to 100% cotton fabric sample