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

Pauvreté monétaire versus non monétaire au Burundi

L’objectif général de l’étude est d’analyser la situation de la pauvreté au Burundi. Pour ce faire, trois objectifs spécifiques sont considérés : évaluer la pauvreté monétaire à l’aide d’une échelle d’équivalence ; construire un indicateur composite de la pauvreté basé sur l’approche multidimensionnelle ; et enfin identifier les principaux déterminants de la pauvreté. L’estimation du modèle d’Engel a permis de dégager trois échelles associées à trois tranches d’âges qui se sont révélées significatives. Il convient dès lors d’utiliser ces coefficients dans les études sur les conditions de vie au Burundi. Nos résultats montrent une sensibilité des mesures de pauvreté selon notre échelle empirique, si l’on ne tient pas compte des échelles. L’application de la méthode de l’analyse des correspondances multiples évalue la prévalence de la pauvreté multidimensionnelle à 70%, c’est à dire légèrement au-dessus de la prévalence de la pauvreté monétaire, évaluée à 69% selon le modèle empirique. Le caractère rural de la pauvreté a été mis en exergue par l’utilisation des approches monétaires et non monétaires. De plus, les tests de dominance stochastique révèlent que le sud et le nord sont les régions les plus touchées par le phénomène de pauvreté. L’utilisation du modèle Probit et Biprobit a permis de mettre en exergue les caractéristiques sociodémographiques qui contribuent le plus à la probabilité d’être pauvre. Des recommandations de politiques de lutte contre la pauvreté sont formulées à partir des résultats de l’étude

Morphology of testate amoeba Difflugia australis (Playfair, 1918) Gautier-Lièvre et Thomas, 1958 from a subtropical reservoir (southeast China)

Ndayishimiye, Jean Claude, Nyirabuhoro, Pascaline, Wang, Wenping, Mazei, Yuri, Yang, Jun (2020): Morphology of testate amoeba Difflugia australis (Playfair, 1918) Gautier-Lièvre et Thomas, 1958 from a subtropical reservoir (southeast China). Zootaxa 4890 (1): 97-108, DOI: https://doi.org/10.11646/zootaxa.4890.1.

Distribution of Soil Microbes in Urban Parks: An Effect of Under-Tree Crown and Hillside Position on Testate Amoeba Assemblages in Subtropics (Shenzhen, China)

Testate amoebae (TA) are important components of soil ecosystems, where they play an essential role in belowground food webs. In this study, we examined species composition, diversity, and structure of TA assemblages in soils beneath tree crowns (microscale) at three slope positions (mesoscale) in subtropical urban parks in Shenzhen, China. Forty-two species of TA belonging to 18 genera were identified in 81 samples. TA assemblages were the most diverse and abundant in the center of the tree crown comparing with other under-tree habitats. Foot of the hills harbored higher TA abundance and diversity comparing with upper locations along the hillslopes. The distribution of TA was mostly driven by under-crown and hillside positions but not by elementary environmental conditions such as pH, moisture content and thickness of leaf litter layer. None of later factors were sufficient in shaping TA assemblage composition. The findings of our study suggest that in regional studies of soil microbial eukaryotes both micro- (i.e., under-crown) and mesoscale (i.e., the slope position) heterogeneity should be considered

Distribution of Soil Microbes in Urban Parks: An Effect of Under-Tree Crown and Hillside Position on Testate Amoeba Assemblages in Subtropics (Shenzhen, China)

Testate amoebae (TA) are important components of soil ecosystems, where they play an essential role in belowground food webs. In this study, we examined species composition, diversity, and structure of TA assemblages in soils beneath tree crowns (microscale) at three slope positions (mesoscale) in subtropical urban parks in Shenzhen, China. Forty-two species of TA belonging to 18 genera were identified in 81 samples. TA assemblages were the most diverse and abundant in the center of the tree crown comparing with other under-tree habitats. Foot of the hills harbored higher TA abundance and diversity comparing with upper locations along the hillslopes. The distribution of TA was mostly driven by under-crown and hillside positions but not by elementary environmental conditions such as pH, moisture content and thickness of leaf litter layer. None of later factors were sufficient in shaping TA assemblage composition. The findings of our study suggest that in regional studies of soil microbial eukaryotes both micro- (i.e., under-crown) and mesoscale (i.e., the slope position) heterogeneity should be considered

Potential Uses of Artisanal Gold Mine Tailings, with an Emphasis on the Role of Centrifugal Separation Technique

Few investigations have focused on the potential uses of artisanal gold (Au) mine tailings, despite the fact that artisanal gold mining activity contributes to environmental issues such as greenhouse gas. Mineralogical characterizations of artisanal gold mine tailings in Miyove gold mine (Baradega and Masogwe) in Rwanda were investigated for potential utilization as a source of valuable gold, using the centrifugal separation technique. Results of X-ray diffraction analysis, energy dispersive X-ray spectroscopy, inductively coupled plasma mass spectrometry, inductively coupled plasma&ndash;optical emission spectroscopy, and X-ray fluorescence showed that artisanal gold mine tailings samples have significant amounts of gold to justify economical gold extraction opportunity. The gold grades in the ores and artisanal gold mine tailings were in the ranges of 37&ndash;152 and 2&ndash;7 g t&minus;1, respectively. Quartz was a major phase, with minor impurities in two different types of gold ores and their respective tailings. The beneficiation carried out using centrifugal separation, regarded as an extension of gravity separation, showed gold grades in the range of 535&ndash;1515 g t&minus;1 for gold ores and 36&ndash;302 g t&minus;1 for artisanal gold mine tailings. The gold recoveries for ores and artisanal gold mine tailings were in the range of 21.8&ndash;47.3% and 46.9&ndash;63.8%, respectively. The results showed that the centrifugal separation technique was more efficient in boosting gold recovery compared to the present panning approach employed at the site, which sometimes recover as low as 10%. The results suggest that mineralogical characterization of artisanal gold mine tailings allows for the development and design of a suitable methods for improving gold ore beneficiation and artisanal gold mine tailings reprocessing