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

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

Prenatal retinoic acid improves lung vascularization and VEGF expression in CDH rat

OBJECTIVE: We sought to investigate the effects of antenatal retinoic acid on the pulmonary vasculature and vascular endothelial growth factor (VEGF) and VEGF receptors (VEGFR) expression in a nitrofen-induced congenital diaphragmatic hernia (CDH) model. STUDY DESIGN: Rat fetuses were exposed to nitrofen at gestational day 9.5 and/or all-trans retinoic acid (ATRA) at gestational days 18.5-20.5. We assessed lung growth, airway, and vascular morphometry. VEGF, VEGFR1, and VEGFR2 expression was analyzed by Western blotting and immunohistochemistry. Continuous data were analyzed by analysis of variance and Kruskal-Wallis test. RESULTS: CDH decreased lung to body weight ratio, increased mean linear intercept and mean transection length/airspace, and decreased mean airspace cord length. ATRA did not affect lung growth or morphometry. CDH increased proportional medial wall thickness of arterioles while ATRA reduced it. ATRA recovered expression of VEGF and receptors, which were reduced in CDH. CONCLUSION: Retinoic acid and VEGF may provide pathways for preventing pulmonary hypertension in CDH

Prenatal retinoic acid improves lung vascularization and VEGF expression in CDH rat

OBJECTIVE: We sought to investigate the effects of antenatal retinoic acid on the pulmonary vasculature and vascular endothelial growth factor (VEGF) and VEGF receptors (VEGFR) expression in a nitrofen-induced congenital diaphragmatic hernia (CDH) model. STUDY DESIGN: Rat fetuses were exposed to nitrofen at gestational day 9.5 and/or all-trans retinoic acid (ATRA) at gestational days 18.5-20.5. We assessed lung growth, airway, and vascular morphometry. VEGF, VEGFR1, and VEGFR2 expression was analyzed by Western blotting and immunohistochemistry. Continuous data were analyzed by analysis of variance and Kruskal-Wallis test. RESULTS: CDH decreased lung to body weight ratio, increased mean linear intercept and mean transection length/airspace, and decreased mean airspace cord length. ATRA did not affect lung growth or morphometry. CDH increased proportional medial wall thickness of arterioles while ATRA reduced it. ATRA recovered expression of VEGF and receptors, which were reduced in CDH. CONCLUSION: Retinoic acid and VEGF may provide pathways for preventing pulmonary hypertension in CDH.Sao Paulo Research FoundationSao Paulo Research Foundation [08/50347-9, 11/00794-1, 08/52772-9, 11/12587-0

Alguns apontamentos sobre a trajetória da Psicologia social comunitária no Brasil

Este artigo aborda a trajetória da Psicologia social comunitária no Brasil tomando como material privilegiado de análise os anais dos encontros nacionais da Associação Brasileira de Psicologia Social (ABRAPSO). O objetivo foi o de historiar os argumentos produzidos por autores da PSC em busca de uma identidade para a área. A análise buscou evidenciar a especificidade da PSC, os objetivos de suas intervenções e a noção de comunidade. Tomamos os anais dos encontros nacionais da ABRAPSO como fonte principal pela importância da associação na produção de dispositivos conceituais e de novas formas de atuação profissional dos psicólogos no Brasil. Concluímos o trabalho indicando a ênfase na diferença e na oposicão entre uma psicologia latino e norte-americana como recurso estratégico de afirmação identitária da área. Apontamos a importância do trabalho em comunidade para a renovação das práticas do psicólogo no Brasil e para a relativa carência de reflexão conceitual sobre a noção de comunidade

Checklist das esp\ue9cies de Euphorbiaceae Juss. ocorrentes no semi-\ue1rido pernambucano, Brasil

É apresentado o check-list das Euphorbiaceae da região semi-árida do Estado de Pernambuco (zona da Caatinga, subzonas do Agreste e do Sertão), nordeste do Brasil. Foram estudados os materiais oriundos das coletas realizadas durante os anos de 1997-1999 e aqueles depositados nos Herbários locais (IRA, PEUFR, TASH e UFP). Foram registradas 89 espécies, distribuídas em 22 gêneros, sendo Croton L., Cnidoscolus Pohl, Dalecliampia Plum, ex L., Euphorbia L. e Phyllanthus L. os melhor representados, com 21, 7, 6, 6 e 6 táxons, respectivamente. Caperonia castanefolia A. St.-Hil, Euphorbia phosphorea Mart, e Rotnanoa tamnoides (A. Juss.) Radcl.-Sm. são novas citações para a flora pernambucana.<br>This paper presents a checklist of Euphorbiaceae of the semi-arid area - Caatinga zone, subzones Agreste and Sertão - in Pernambuco State (Northeast of Brazil). Materials from field work done from 1997 to 1999 and from the local Herbaria (IRA, PEUFR, TASH and UFP), were studied. Up to now, 89 species, distributed within 22 genera have been listed. Croton L. (21), Cnidoscolus Pohl (7), Dalecliampia Plum, ex L. (6), Euphorbia L. (6) and Phyllanthus L. (6), were the most important genera as regards number of species. Caperonia castanefolia A. St.-Hil, Euphorbia phosphorea Mart, and Rotnanoa tamnoides (A. Juss.) Radcl.-Sm. are new records for Pernambuco State

Características evolutivas en Prosopis spp.: citogenética, genética e hibridaciones

Fil: Fontana, María Laura. Universidad Nacional del Nordeste. Facultad de Ciencias Agrarias; Argentina.Fil: Pérez, Víctor Ramón. Universidad Nacional de Formosa. Facultad de Recursos Naturales; Argentina.Fil: Luna, Claudia Verónica. Universidad Nacional del Nordeste. Facultad de Ciencias Agrarias; Argentina.Fil: Luna, Claudia Verónica. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Botánica del Nordeste; Argentina.Prosopis es un género dentro del clado Mimosoid caracterizado por las disyunciones que presentan sus actuales áreas de distribución y las dificultades para esclarecer su filogenia. Este trabajo presenta un análisis bibliográfico actualizado sobre las características evolutivas, citogenéticas, genéticas e hibridaciones del género. Los datos disponibles sugieren que divergió tempranamente en varios linajes principales, aunque dentro de algunos de ellos han ocurrido episodios recientes de especiación parcial. La forma en que se distribuye la variabilidad genética dentro y entre poblaciones depende, entre otros factores, del sistema reproductivo y la estrategia adaptativa. La estructura de las poblaciones, a su vez, establece restricciones a los procesos evolutivos tendientes a la adaptación creciente al ambiente y/o la diferenciación específica. . Es un género esencialmente diploide (2n = 28) pero se ha informado poliploidía y frecuentes procesos de hibridación e introgresión interespecífica. La alta similitud genética y cromosómica entre las distintas especies del género permite la obtención de híbridos viables, reforzando la idea de que algunas especies del género están evolutivamente activas, y pone de manifiesto las dificultades que esto ocasiona en el tratamiento taxonómico y la filogenia del grupo