Association of cortisol serum levels as a prognostic factor in threat of pre-term birth

Background: Prematurity is one of the leading causes of death in children. In Mexico there is a frequency of 12% of preterm birth and this leads to significant maternal-fetal complications comprising 31.5% of neonatal morbidity and mortality. The patient who receives obstetric care in the gynecology service at the naval medical center requires prevention, diagnosis and treatment of threat of preterm birth to reduce perinatal and neonatal complications. Serum cortisol levels was determined as a prognostic factor for the threat of preterm birth in patients with obstetric care at the Naval Medical Center, it is a relatively easy parameter to obtain and would support a timely treatment.Methods: We used a quantitative, non-experimental, retrospective descriptive study of 30 patients with risk factors to develop preterm birth threats in gynecology service of the naval medical center from January to December 2018, which were taken 3 milliliters of peripheral blood to measure serum cortisol concentrations for later analysis. For statistical analysis of the present study, it was used Shapiro Wilk test. Likewise, Pearson's test was performed to measure the degree of association between the dependent and independent variable. Student's t-test was implemented to compare cortisol levels of pregnant women.Results: A total of 30 patients of these were analyzed, the mean age was 30.4 years (SD±5.184). The gestation weeks the average value was 30.63 weeks (SD±4.781). A student t test was performed where the cortisol values of pregnant women were compared with an average value of 2,586 (95% CI 0.45-472) and a t value=2,476 and a p=0.019 lower value of the significance value of 0.05 rejecting the null hypothesis. Which indicates that cortisol levels can be used as a predictive marker of the threat of preterm birth, considering it as an independent factor for this situation to occur in pregnant patients. The variables of the cortisol level and the weeks of gestation Pearson=-0.061 and a significance of p=0.747 were correlated (there being no strong enough relationship between the study variables). Regarding the triggers, it is observed that the highest factor was for urinary tract infection 40% n=12, abnormal uterine activity 20% n=6, followed by premature membrane rupture 16.7% n=5.Conclusions: The risk factors associated with the threat of preterm birth can be multiple, encompassing them in three important areas such as socioeconomic, psycho-emotional and clinicopathological, of the latter, nine of which are most frequent in our population are urinary infection, abnormal uterine activity and premature rupture of membranes. Regarding the association of cortisol levels as a prognostic factor for the threat of preterm birth taking it into account as an independent factor, it can be concluded that it is not statistically significant, however, according to what is reported in the literature, It should be considered as one of the multiple risk factors, considering this timely premise to boost the development of new research in the field

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

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN