Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

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 middle-income 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 low-income 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 low-income, 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

The competing effect of ammonia in the synthesis of iron oxide/silica nanoparticles in microemulsion/sol-gel system

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Combined microemulsion/sol-gel processes may be used to prepare composite nanoparticles. In this work, iron oxide/silica nanoparticles were synthesized in such a combined system, having ammonium hydroxide acting in both processes: as precipitating agent in the synthesis of iron oxide and as catalyst in the sol-gel process of silica. The nanoparticles were synthesized in microemulsions containing tetraethoxysilane (TEOS) and composed by Triton X-100/hexyl alcohol/cyclohexane/aqueous solution, with different amounts of ammonium hydroxide. Powder materials were obtained after centrifugation, washing and drying, and they were analyzed as synthesized and after heating at 350, 500 and 1000 degrees C. The influence of base quantity was evaluated in relation to the size of the particles and the iron oxide phase synthesized. TEM analysis showed that nanometric iron oxide particles were formed and that they were percolated by a net of amorphous silica. The higher amount of ammonia seems to have induced TEOS condensation process instead of iron oxide particles' growth, indicating that the quantity of base influenced both the microemulsion system and the sal-gel process, but with minor influence over the iron oxide composition, as evidenced by FT-IR and DRX. (C) 2013 Elsevier B.V. All rights reserved.422136142Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Leukoencephalopathy with vanishing white matter: report of four cases from three unrelated Brazilian families

Four patients with leukoencephalopathy with vanishing white matter from three unrelated Brazilian families are reported. in all cases the initial symptoms occurred in the three first years of life. in three cases the onset was acute and at least in two patients the involvement of the white matter preceded the clinical symptoms. Only cerebellar and pyramidal signs were present and persisted throughout the evolution. An episodic course with worsening of the symptoms during febrile illnesses was noted in one patient. in three patients a significant deceleration of the head growth was noted. in one family. brother and sister were affected but the twin brother of the boy was free from the disease. in another family, the patient had a sister who died at 13 years of age from an identical disease not diagnosed at that time. in one family, the parents were first cousins. in all patients, serial magnetic resonance imaging and magnetic resonance spectroscopy showed the characteristic picture of the involvement of the white matter with increasing signal intensity close to that of the cerebrospinal fluid. (C) 2002 Elsevier Science B.V. All rights reserved.Santa Casa São Paulo Sch Med, Dept Pediat, Neuropediat Div, BR-01221900 São Paulo, BrazilUniv São Paulo, Sch Med, Dept Radiol, São Paulo, BrazilWeb of Scienc

Unusual case of epigastric heteropagus twinning

Asymmetrical conjoined twins or heteropagus twins are extremely rare. They are characterized by an incomplete component (parasite) that is normally smaller and dependent on the host (autosite). in cases of an epigastric heteropagus twin, the insertion occurs in the epigastrium. There are few reports of epigastric heteropagus twinning in the English-language literature. ne authors report an extremely rare case of epigastric heteropagus twinning in which the parasite presented with head, thorax, and a rudimentary heart. (c) 2005 Elsevier Inc. All rights reserved.Universidade Federal de São Paulo, Div Pediat Surg, Pediat Surg Sect, BR-04025000 São Paulo, BrazilUniversidade Federal de São Paulo, Sect Fetal Med, BR-04025000 São Paulo, BrazilUniversidade Federal de São Paulo, Div Pediat Surg, Pediat Surg Sect, BR-04025000 São Paulo, BrazilUniversidade Federal de São Paulo, Sect Fetal Med, BR-04025000 São Paulo, BrazilWeb of Scienc

Factors associated with exclusive breastfeeding in children under four months old in Botucatu-SP, Brazil Factores asociados a la situación de lactancia materna exclusiva en niños menores de 4 meses en Botucatu-SP Fatores associados à situação do aleitamento materno exclusivo em crianças menores de 4 meses, em Botucatu-SP

This study aimed to identify factors associated with exclusive breastfeeding (AME) and the reasons mothers presented to introduce complementary feeding in the first four months of life. A total of 380 mothers (92.2%) of children under four months old vaccinated in a Multi-vaccination Campaign were interviewed. To identify factors associated to AME, univariate and multiple logistic regressions analyses were performed. Thirty-eight percent of the children were on AME; 33.4% consumed cow milk; 29.2% tea; and 22.4% water. The mothers justified introduction of cow milk by factors related to quantity/quality of maternal milk and "necessity" of the child. The use of a pacifier (odds ratio=2.63; CI95%=1.7-4.06) and difficulty to breastfeed (odds ratio=1.57; CI95%=1.02-2.41) were associated with the absence of AME. The populational attributable risk percentage for the use of a pacifier was estimated at 46.8 %. Thus, modifiable risk factors were associated with AME interruption.<br>El objetivo fue identificar factores asociados a la lactancia materna exclusiva (AME) y los motivos presentados por las madres para la introducción de alimentos complementares en los primeros 4 meses de vida. Se les entrevistaron a 380 madres (92,2%) de niños menores de 4 meses vacunados en una Campaña de Multivacunación. Para identificación de los factores asociados a la situación del niño con relación al AME, se realizaron análisis de regresión logísticas univariadas y múltiplas. En AME estaba el 38,0% de los niños; el 33,4% consumía leche de vaca; el 29,2% té y el 22,4% agua. Las madres justificaron la introducción de leche de vaca por factores relativos con la cantidad/calidad de la leche materna y "necesidad" del niño. El uso de chupete (odds ratio=2,63; IC95%=1,7-4,06) y relato de dificultad con la lactancia (odds ratio=1,57; IC95%=1,02-2,41) se asociaron a la ausencia de AME. El riesgo atribuible poblacional asociado al uso de chupete fue 46,8%. Así, factores modificables fueron identificados como de riesgo para interrupción de AME.<br>Objetivou-se identificar fatores associados ao aleitamento materno exclusivo (AME) e os motivos apresentados pelas mães para a introdução de alimentação complementar nos primeiros 4 meses de vida. Foram entrevistadas 380 mães (92,2%) de crianças menores de 4 meses vacinadas em Campanha de Multivacinação. Para identificação dos fatores associados à situação da criança em relação ao AME, realizaram-se análises de regressão logística univariadas e múltiplas. Em AME, estavam 38,0% das crianças; 33,4% consumiram leite de vaca; 29,2%, chás, e 22,4%, água. As mães justificaram a introdução de leite de vaca por fatores relativos à quantidade/ qualidade do leite materno e "necessidade" da criança. Uso de chupeta (odds ratio=2,63; IC95%=1,7-4,06) e relato de dificuldade com a amamentação (odds ratio=1,57; IC95%=1,02-2,41) associaram-se à ausência de AME. O risco atribuível populacional associado ao uso de chupeta estimado foi 46,8%. Assim, fatores modificáveis foram identificados como de risco para interrupção do AME