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

Substituição parcial do milho pela palma forrageira em dietas para cabras em lactação

The objective of this trial was to evaluate the effect of the partial replacement of corn by forage cactus (Nopalea cochenillifera Salm Dyck) in the diets of lactating goats on the nutrient intake, milk production and composition and ingestive behavior. Five crossbreed Saanen x Pardo Alpina goats with body weights of 47 ± 3.3 kg were used in the study. The design was 5x5 Latin square design, in which the treatments were as follows: 20, 25, 30, 35 and 40% of girl cactus included in the diet as a partial replacement of corn, with 0, 18, 36, 54 and 72% of the added the cactus comprising of gliricidia (Gliricidia sepium (Jacq) Walp) as roughage in all treatments. Treatment did not affect (P > 0.05) the dry matter intake, crude protein, neutral detergent fiber, acid detergent fiber and total digestible nutrients with the increasing levels of cactus in the diet, presenting means of 1.64, 0.26, 0.82, 0.54 and 1.17 kg day-1, respectively. In the same way, no influence was observed on the daily milk production and levels of fat, protein, lactose and total solids of milk, which averaged 1.18 kg day-1; 3.74, 3.34, 5.06 and 13.56%, respectively. The inclusion of cactus also had no influence (P > 0.05) on the ingestion behavior. The treatment with 35% cactus showed a lower impairment of food intake (31%). The partial replacement of the corn by the girl cactus in the diets of dairy goats can be accomplished because it does not alter the intake, milk yield and composition and feeding behavior. The replacement of up to 54% corn by the cactus is recommended to reduce producer costs for food.Objetivou-se avaliar a substituição parcial do milho (Zea mays L.) pela palma forrageira miúda (Nopalea cochenillifera- Salm Dyck) em dietas de cabras em lactação sobre o consumo de nutrientes, produção e composição do leite, comportamento ingestivo e o comprometimento da receita com alimentação. Foram utilizadas 5 cabras mestiças de Saanen x Pardo Alpina, com peso corporal de 47 ± 3,3 kg. O delineamento utilizado foi o quadrado latino 5x5, em que os tratamentos consistiram em níveis de 20, 25, 30, 35 e 40% de palma forrageira miúda incluídos na dieta em substituição ao milho que foram de 0, 18, 36, 54 e 72% tendo o feno de gliricídia (Gliricídia sepium (Jacq) Walp) como volumoso em todos os tratamentos. Os tratamentos não influenciaram (P > 0,05) o consumo de matéria seca, proteína, fibra em detergente neutro, fibra em detergente ácido e nutrientes digestíveis totais apresentando médias iguais a 1,64; 0,26; 0,82; 0,54 e 1,17 kg dia-1, respectivamente. Do mesmo modo, não houve influência dos níveis sobre a produção de leite e os teores de gordura, proteína, lactose e sólidos totais do leite apresentando médias iguais a 1,18 kg dia-1; 3,74; 3,34; 5,06 e 13,56%, respectivamente. O comportamento ingestivo também não sofreu influência com a inclusão de palma nas dietas. O tratamento com 35% de palma demonstrou menor comprometimento da receita com alimentação (31%). A substituição parcial do milho pela palma forrageira miúda em dietas para cabras leiteiras pode ser realizada, pois não altera o consumo, a produção de leite e sua composição e o comportamento ingestivo. Recomenda-se substituir em até 54% o milho pela palma por apresentar menor comprometimento da receita do produtor com a alimentação

Concentrações de oleandrina nas folhas de Nerium oleander de diferentes cores da floração

Nerium oleander é uma planta ornamental responsável por intoxicações em animais e humanos. Todas as partes da planta contém glicosídeos cardiotóxicos, principalmente a oleandrina. Alguns autores apontam que a toxicidade da planta apresentaria variação em função da cor da flor. O objetivo deste trabalho foi determinar se existe variação na concentração de oleandrina nas folhas de N. oleander de exemplares da planta com diferentes cores de inflorescências. Foram coletadas 10 amostras de folhas para cada tipo de flor (branca, rosea e vermelha). Os níveis de oleandrina foram determinados por meio de HPLC-UV após extração com metanol, precipitação com acetato de chumbo e separação em cartucho de C18. A média da concentração obtida em todas as folhas analisadas foi de 4,89mg g-1, sendo 6,20±4,08mg g-1 na variedade de flores brancas, 4,16±3,44mg g-1 na de flores roseas e 4,31±1,99mg g-1 na de flores vermelhas. As concentrações de oleandrina não apresentaram diferença estatisticamente significante entre as variedades de flore

Utilização de doses reduzidas de eCG aplicadas por diferentes vias em programa de IATF em ovelhas da raça Santa Inês

 The aims of this study were to improve the cost-benefit ratio of the application of artificial insemination in fixed time (TAI) by the transcervical route in sheep, to test the dosage reduction and the use of the vulvar submucosa (VSM) route as an alternative for the application of equine chorionic gonadotropin (eCG) on the efficiency of the synchronization protocol and fertility to artificial insemination (AI) and to measure the level of cortisol in ewes as a result the application of this biotechnique. Blood samples were collected before AI, immediately after AI and seven days after AI. Six groups of twenty animals were used, and each group received doses of 200, 300 and 400 IU of eCG by the intramuscular route (IM) and VSM. Estrus was detected, and 48 hours later, the inseminations were performed by the transcervical route. Among the 120 treated ewes, 87.5% came in estrus. The percentage of the intrauterine deposition of semen was 88.3%. The pregnancy rate ranged from 20 to 70% between treatments, with an average of 46.66%. The VSM route was viable for the application of eCG in doses of 300 and 400 IU. The reduction in the eCG dose to 200 IU by the IM route reduces costs while maintaining the efficiency of estrus synchronization protocols and TAI with frozen semen in Santa Ines ewes. The average levels of cortisol were significant, at 1.15, 2.86 and 0.52 ?g/dL according to the three collections, being higher after the animal was off the easel at the end of AI. The procedures for performing the transcervical AI technique indicate that stress in the animals produces satisfactory fertility results and a low cost in multiparous ewes of the Santa Ines breed. Os objetivos deste trabalho foram melhorar a relação custo benefício da aplicação da técnica de inseminação artificial pela via transcervical em tempo fixo (IATF) em ovinos, testando a redução da dose e da utilização da via submucosa vulvar (SMV) como alternativa na aplicação da gonadotrofina coriônica equina (eCG) sobre a eficiência do protocolo de sincronização e fertilidade à inseminação artificial (IA), e mensurar o nível de cortisol nas ovelhas em conseqüência da aplicação desta biotécnica. As coletas de sangue foram realizadas antes da IA, após a IA e sete dias após IA. Foram utilizados seis grupos de vinte animais, onde cada grupo recebeu dosagens de 200, 300 e 400 UI de eCG pela via intramuscular (IM) e SMV. O estro foi detectado e 48 horas após feitas as inseminações pela via transcervical. Das 120 ovelhas tratadas, 87,5% manifestaram estro. O percentual de deposição intra-uterina de sêmen foi de 88,3%. A taxa de gestação variou de 20 a 70% entre os tratamentos, obtendo-se média de 46,66%. A via SMV foi viável para aplicação de eCG em doses de 300 e 400 UI. A dose de eCG para 200 UI pela via IM apresentou melhor custo/benefício mantendo a eficiência dos protocolos de sincronização de estro e IATF com sêmen congelado em ovelhas da raça Santa Inês. Os níveis médios de cortisol foram significativos com 1,15; 2,86 e 0,52 ?g/dL de acordo com os três momentos de coleta, sendo maior após a IA. Apesar dos procedimentos para realização da técnica de IA transcervical indicar estresse nos animais, apresenta resultados satisfatórios de fertilidade e baixo custo em ovelhas multíparas da raça Santa Inês.

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data