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

Complex polymer particles via microfluidics

The main objective of this thesis has been the preparation of novel polymer particles and their chemical modification in efficient ways. For the preparation, a tubing-needle based microfluidic system was installed. Two types of microgels, namely non-porous particles, were prepared, the first one being degradable dextran microgels. These large and monodisperse particles were used as templates for layer-by-layer coating of a polyelectrolyte and a nanoparticle. Dissolution of the microgels after coating resulted in giant capsules. Secondly, the recently developed thiol-yne chemistry has been utilized for the construction of microgels. Both thiol- and yne- functionalized microgels were obtained, which were then applied as platforms for thio-click modifications. Also the inner and outer morphology of the particles has been engineered. Porous methacrylate beads, prepared by making use of a porogen, constitutes the third class of particles of this thesis. These isotropic epoxy-functionalized beads were then used in a reactive “sandwich” microcontact printing method, which resulted in anisotropic beads with two different chemical “patches” on opposite faces, also referred to as Janus particles. The last and most complex class of particles prepared in this thesis was poly(HIPE) particles, obtained by introducing high internal phase emulsion (HIPE) formulations to microfluidics. In the beginning, highly reactive beads and rods possessing “mega”-pores were obtained. Later, hollow versions of these particles were prepared. Finally, “liquid marbles” were obtained by the self-assembly of hydrophobic poly(HIPE) beads around water droplets

Highly porous monodisperse polymer particles via microfluidics: novel shapes, novel structures, novel features

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The effect of T'ai Chi and Qigong training on patients with obstructive sleep apnea: A randomized controlled study

WOS: 000450066500001PubMed ID: 30427696Objectives: This study aims to investigate the effects of T'ai Chi and Gigong (TCQ) training on severity of obstructive sleep apnea (OSA). Design: A prospective, 12-week, single-center, double-blinded, randomized controlled trial. Setting: Sleep Disorders Center of Medical Faculty in Istanbul, Turkey. Subjects: Fifty adult patients with mild and moderate OSA. Interventions: Patients were randomly allocated into either an intervention group or a control group. The intervention group (n=25) received TCQ training under physiotherapist supervision for 1h, three times per week, for 12 weeks and a home exercise program was provided for another 2 days. The control group (n=25) received only a home exercise program for 12 weeks, 5 days per week. Outcome measures: All patients were assessed before and after the exercise program. Objective parameters of sleep were measured by polysomnography, while subjective parameters of sleep were assessed using the Epworth Sleepiness Scale (ESS) and the 3-factor Pittsburgh Sleep Quality Index (PSQI). Pulmonary functions were assessed with a pulmonary function test; health-related quality of life was evaluated through the Short Form-36. Results: In the intervention group, there was a statistically significant decrease in the apnea-hypopnea index (AHI) (p=0.001) and percentage and duration of stage N2 sleep (p=0.041 and p=0.037, respectively), while there was a statistically significant increase in percentage and duration of stage N3 sleep when compared with the controls (p=0.048 and p=0.043, respectively). There was a statistically significant decrease in the ESS, PSQI sleep efficiency, and total scores (p=0.001, p=0.003, and p=0.003, respectively). Conclusions: Our study results suggest that TCQ training may reduce AHI and daytime sleepiness, while improving subjective sleep quality, in patients with mild and moderate OSA.Research Fund of Bezmialem Vakif University [12.2015/5]The authors would like to thank Melih Zeren, PhD (PT), for his support in writing the manuscript. The authors are indebted to Esra Pehlivan, PhD (PT), and Arif Balci (PT), for their assistance with data collection. They also thank Tai Chi and Qi Gong Healing Institute Board member Master (instructor) Tarik Tekman for his valuable contribution to the TCQ training program. Patients' PFT and PSG expenses were supported by the Research Fund of Bezmialem Vakif University (Project No: 12.2015/5)

The Influence of Birth Weight on Physical Fitness in Children Between 8 to 10 Years

Objective: The aim of this study was to investigate the influence of birth weight on the physical fitness parameters of children. Materials and Methods: The sample consisted of 180 (90 boys and 90 girls) children aged between 8-10 years. Participants were grouped as low (n = 60), normal (n= 60), and high (n= 60) birth weight groups based on their birth weight and gestation weeks. In the research, anthropometric measurements (height, weight, and BMI) and Eurofit test battery (flamingo balance, plate tapping, sit and reach, standing broad jump, handgrip strength, 30s sit-ups, bent-arm hang, and 10x5m shuttle run tests) were performed. Results: No statistically significant difference was found between the birth weight groups in terms of the results of anthropometric measurements and scores of Eurofit physical fitness tests (p > .05). Conclusion: It was determined that birth weight has no influence on the measured anthropometric and physical fitness parameters of children aged 8 to10 years