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

Design and implementation of irrigation prototype system based GSM

Smart farming is one of the keys for future agriculture because it is a management to use modern technology for increasing the quality and quantity of the agriculture. And because of the planet quality depend on the amount of water and the characteristics of soil, it is necessary to study the soil using the soil moisture sensor to investigate whether the soil is dry or wet, also to consider the challenges that could be faced in agricultural environment by maintain the soil and the planets irrigated without extra usage of water. In this paper, a prototype irrigation system uses Arduino Uno microcontroller which is programmed in C++ language to sense the degree of moisture by using soil moisture sensor. According to moisture sensor readings, when the moisture sensor above 1000, Arduino triggers to supply the water by using 5V mini water pump and stop when the soil moisture sensor reading reaches below 400. GSM technology enables the user to be notified in any changes happening in agricultural area by sending SMS (Short Message Service). Whenever the soil become wet or dry and the mini water pump switched on or off, a message delivered to user’s cellular phone indicating the condition of the soil and the action of water pump. In that capacity, this prototype will reduce the time for the user by monitoring remotely without going to his land, and also to reduce the usage of water by allow the water pump to flow the water for limited time until the moisture degree raise again

COVID-19 clinical outcomes in patients with and without ongoing therapy with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers

Background: The are conflicting reports on the effects of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) continued treatment on clinical outcomes in COVID-19 patients. Material and methods: Patients presented with symptoms suggestive of COVID-19 infection were enrolled between 5 April 2021,and 5 June 2021. Patients who survived acute stage of the disease were asked to attend out-patient clinic after six months following COVID-19 infection diagnosis. Results: A total of 162 patients were enrolled in this study. ARB users showed significant independent association with lower fatality rate as compared to ACEI/ARB-naïve patients [OR (CI) = 0.1(0.0–0.5), p = 0.01]. The prevalence of respiratory support use and intensive care unit (ICU) admission was numerically, but not statically significant, lower among ARB users than non-ARB users. The distribution of in-hospital adverse outcome was numerically lower among ACEI users than in non ACEI users, though the association did not reach statistical significance. ARB users showed significant independent association with persistent cough [OR (CI) = 2 (1.1–10), p = 0.02]. No significant differences in other long term symptoms were found between ARB users and nonusers. On the other hand, chest pain showed higher prevalence among ACEI users than in non-ACEI users. After adjusting for baseline comorbidities, chest pain association with ACEI user was not persisted. No significant differences in other long term symptoms were found between ACEI users and nonusers. Conclusion: ARB and ACEI users showed low prevalence of in-hospital adverse outcome compared to ARB/ACEI nonusers. ARB showed significant and independent association with persistent cough

Insight into Structural Changes and Electrochemical Properties of Spark Plasma Sintered Nanostructured Ferritic and Austenitic Stainless Steels

Nanostructured ferritic (Fe(82&minus;x)-Cr18-Six, x = 0&ndash;3 wt %) and austenitic (Fe(73&minus;x)-Cr18-Ni9-Six, x = 0&ndash;3 wt %) stainless steel (SS) alloys were developed by mechanical alloying (MA) and spark plasma sintering (SPS). The unit cell parameter estimated from X-ray diffraction spectra exhibited a decreasing trend with an increase in wt % of Si content in both alloy systems. The particle size of powders estimated using bright field transmission electron microscopy images for ferritic (3 wt % Si) and austenitic (3 wt % Si) SS powders was found to be 65 &plusmn; 5 nm and 18 &plusmn; 3 nm, respectively. In case of the ferritic system, 3 wt % Si exhibited the highest densification (~98%) and micro-hardness of about 350.6 &plusmn; 11.2 HV, respectively. Similarly, for the austenitic system (3 wt % Si), maximum densification and micro-hardness values were about 99% and 476.6 &plusmn; 15.2 HV, respectively. Comparative analysis of potentiodynamic polarization, linear polarization, and electrochemical impedance spectroscopy results indicates an increase in electrochemical performance of both alloy systems as the wt % Si was increased. The increase in electrochemical performance is directly related to the increase in densification owing to Si addition in these alloys

Determination of antibodies to Caprine arthritis encephalitis virus in goats and sheep in some localities in Sudan

Objective: Caprine arthritis encephalitis (CAE) infection is existing worldwide causing economic loss in goat production. This work was conducted to investigate the prevalence of CAE in local and foreign goat breeds and sheep in different localities in Sudan. Materials and methods: A total of 368 sera samples were prepared; among these, 112 were collected from cross (n=39) and foreign (n=73) breeds of goat in Khartoum state, equal number of sera (n=23) were collected from goats and sheep from each of River Nile, Gedarif, Sinnar and North Kordofan states. Eighteen cross bred goats were tested from River Nile state. From foreign bred goats, 28 and 26 sera were collected from Gazira and Northern states, respectively. The collected sera were examined for the presence of antibodies to CAE virus using Enzymed-Linked Immunosorbent Assay (ELISA). Results: The overall seroprevalence of CAE was 2.99% (n=11/368). Positive results were found only in 11 of foreign breed of goats (Cyprus shami) collected from Gazira (39.29%; n=11/28). Statistically, there was an association between breed and location (P=0.001 and P=0.671, respectively). Conclusion: The CAE virus infection exists only in foreign goat breeds. Gazira state showed the highest seroprevalence as compared to other states considered in this study. Strict hygienic measures should be adopted to control the disease and to prevent its spread to local breeds. [J Adv Vet Anim Res 2016; 3(3.000): 259-262