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

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

The Neogene fluvial systems of the Ecuadorian foreland basin and dynamic inferences

International audienceA sedimentological study of the Neogene continental infill of the Subandean foreland basin of Ecuador led us to define an evolution of the fluvial system from an alluvial plain to an alluvial fan with an increasing slope in the same time as the drainage changed from mostly longitudinal to transverse. Combined with the data presently available on palaeotopography, exhumation, tectonic evolution and geomorphology, these results enable us to infer that, in contrast with the other Subandean foreland basins of Bolivia and Peru, the progradation of the Neogene alluvial fans proceeded by an overall expansion, associated with a relatively small tectonic shortening and not as a result of the development of successive thrust-related depocentres. This also indicates that the surrection of the Cordillera progressed in Ecuador throughout the Neogene

Long-term denudation rates from the Central Andes (Chile) estimated from a digital elevation model using the black top hat function and inverse distance weighting: implications for the neogene climate of the Atacama Desert

International audienceA methodology for determining long-term denudation rates from morphologic markers in a Digital Elevation Model (DEM) is checked by a comparative study of two drainage basins in the Precordillera of the Central Andes. In both cases the initial configuration of an incised pediment surface has been restored by using two different methods: the Black Top Hat (BTH) function and the Inverse Distance Weighting (IDW) interpolation. Where vertical incision and hillslope erosion are recorded, the 1DW appears to be the most adequate to reconstitute the pediment surfaces. Conversely, where only vertical incision is observed, the BTH describes more precisely the former pediment surfaces and it is easier to solve. By subtracting the DEM from the reconstructed marker we calculated an eroded volume, and estimated its uncertainty by considering Root Mean Square Error (RMSE) and DEM grid error. For the last similar to 10 Myr we obtained long-term denudation rates of 7.33 +/- 1.6 m/Myr in the San Andres drainage basin and 13.59 +/- 1.9 m/Myr in the El Salado drainage basin. These estimations are largely in agreement with other reported estimates of long-term denudation rates in the Atacama Desert. Comparison with long-term denudation rates reported in a wide range of climatic regimes suggests that our estimates cannot be explained by the current rainfall in the Precordillera. However they could be explained by a rainfall similar to that reported 40 km to the east in the Puna. This suggests that during the time span concerned the geomorphologic evolution of the study area, this evolution is dominated by an orographically controlled rainfall pattern. The preserved pediment surface and the small long term denudation rates determined in this study also indicate that the Precordillera was never reached by humid tropical air masses and precipitation as currently observed in the Altiplano during the summer months

Cuantificación de las erosiones terciaria y plio-cuaternaria en la parte sur de la Cuenca Oriente

Los sistemas de cuencas de ante-país son zonas de tránsito donde los sedimentos provenientes de la erosión de lascadenas montañosas son primero acumulados, luego transferidos progresivamente hacia los océanos. La Cuenca oriente que se sitúa sobre el borde oriental de los andes ecuatorianos, constituye un buen ejemplo de cuenca de ante-país, donde los procesos de transferencia de sedimentos son relativamente rápidos. La evolución geodinámica de la Cuenca oriente es bien conocida, sin embargo no existen análisis cuantitativos de los procesos de la erosión del eoceno medio y del fin del neógeno y Cuaternario. Este artículo presenta las primeras cuantificaciones de dichos procesos. Los cálculos son realizados a partir de indicadores térmicos y marcadores de enterramiento sedimentario tales como la reflectancia de vitrinita y trazas de fisión de apatitas. ellos han permitido la calibración de modelizaciones simulando la subsidencia y erosión de la cuenca desde el eoceno, a lo largo de un corte regional que pasa sobre su parte sur. en el eoceno medio, la erosión (entre 0,6 mm/a - 1 mm/a) decrece hacia el este, y está ligada a un período con poca deformación y rebote isóstatico (descarga orogénica). Al final del neógeno y en el Cuaternario, en el oeste de la Cuenca oriente la erosión es intensa (0,8 mm/a), producto del emplazamiento y deformación de la Zona subandina, mientras que en la parte central de la cuenca, la erosión es nula y por el contrario muestra subsidencia (zona de foredeep). Al este de la Cuenca, la erosión reciente es estimada en 0,16 mm/a y se explicaría por el levantamiento del forebulge del sistema de ante-país

Thrust-related, diapiric, and extensional doming in a frontal orogenic wedge: example of the Montagne Noire, Southern French Hercynian Belt

International audienceThe Montagne Noire, which is situated at the toe of the orogenic wedge of the French Massif Central South European Variscides, appears to be a well-suited area for studying the origin and evolution of middle to upper crustal domes adjacent to foreland basins. The data reported in the present paper show that the Montagne Noire dome is a particular type of basement-involved frontal culmination in an orogenic wedge and foreland basin system. This frontal culmination is characterized by a syn-contractional HT decompression recorded by clockwise PTt paths and widespread strata overturning in thrust and fold structures, which controlled the sedimentation in the adjacent foreland basin. These unusual characteristics are interpreted to be a result of the succession of thrusting, diapirism and extensional collapse. Antiformal stacking of syn-metamorphic thrust sheets controlled the first stages of the foreland basin development. Diapirism was essentially responsible for the HT decompression and widespread strata overturning. Extensional doming was a result of late- to post-metamorphic collapse acting on the pre-existing high-amplitude dome. Diapirism and associated isothermal decompression metamorphism, which constitute the essential difference between the Montagne Noire and 'ordinary' frontal ridges in orogenic wedges, were probably enhanced by a local partial melting of the upper to middle crust. It is suggested that the occurrence of these phenomena in front of an orogenic wedge was related to local over-thickening due to the superposition of an upper crustal antiformal stack on top of a lower crustal ramp anticline

Late Glacial and Holocene avulsions of the Rio Pastaza Megafan (Ecuador- Peru): frequency and controlling factors

International audienceThe geomorphological study by mean of remote sensing imagery of the Rio Pastaza Megafan (Ecuador and northern Peru), reveals the traces of numerous avulsions. 108 avulsion sites have been defined. The location of these sites, the available radiocarbon ages as well as historical maps of the 17th century, enable us to propose an evolution history of the migration and avulsions of the Rio Pastaza since the Last Glacial Maximum. The first avulsions of the Río Pastaza occurred after the LGM in a zone close to and roughly parallel to the sudandean front, where the developed avulsion gave a distributive pattern to the ancient stream of the Río Pastaza in an area located between the modern Río Morona and Pastaza, where they caused the Rio Pastaza to develop a fan-like distributary pattern. This is interpreted as a response to thrust related forelimb tilt, progressively shifting eastward the Rio Pastaza and the apex of the megafan. This sequence of events ended with the Great Diversion of the Rio Pastaza toward the modern Rios Corrientes and Tigre. Avulsions occurred in the Tigre-Corrientes Area between 9200 and 8500 yrsCal BP. Afterward, the Río Pastaza was diverted to its present-day north-south course. This last significant avulsion occurred before AD 1691. In the area located between the modern Río Morona and Pastaza, avulsion frequency - probably overestimated - ranges between 100 to 200yrs. In the Ríos Tigre and Corrientes area, avulsion frequency - probably underestimated - ranges from 300 to 400 yrs. Regional tectonics is likely to have triggered most of the avulsions in the Morona-Pastaza area but its influence is restricted to this area. The factors controlling the avulsions in the Tigre-Corrientes area are less clear because the frequently described "hydrologic"-driven avulsion as observed in areas characterized by contrasted hydrologic cycles are inconsistent with the characteristics of the hydrologic cycles of the Rio Pastaza