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

Nutritional quality changes of fresh-cut tomato during shelf life

Effects of dip treatments on nutritional quality preservation during the shelf life of fresh-cut tomato (Licopersicum esculentum Mill.) cv. Eufrates were investigated. Fresh-cut tomatoes were dipped in solutions of 2% ascorbic acid, citric acid, and calcium lactate for 2 min, then stored at 4°C for 20 days. Color (L*, a*, and b*), firmness, °Brix, phenolics, ascorbic acid content, antioxidant activity (DPPH), and sugars were measured during storage. Pathogen development was monitored, and a sensory evaluation was performed. Ascorbic acid was better in maintaining firmness. No treatments significantly affected °Brix, color, or sugars. Ascorbic acid maintained a higher antioxidant capacity, phenolics, and ascorbic acid content, and was better at reducing bacterial growth, while citric acid treatment was better at prevention of yeast and molds proliferation. Fresh-cut tomatoes showed good quality after 10 days of shelf life, except for flavor with the calcium lactate treatment. Ascorbic acid treatment better preserved the general and nutritional quality parameters. © 2013 The Korean Society of Food Science and Technology and Springer Science+Business Media Dordrecht

Polyphenolic profiles in lettuce (Lactuca sativa L.) after CaCl2 treatment and cold storage

Lettuce (Lactuca sativa L.) is a popular vegetable with the health-enhancing properties determined by high levels of antioxidant polyphenols as chlorogenic acids and other derivatives of caffeic acid or flavonoids. In this study, changes in the phenolic compound profiles in the lettuce leaves induced by application of CaCl2 before harvest and cold storage were studied. For the first time quantitative analysis of individual phenolic compounds on the basis of standards isolated from lettuce leaves was performed. Compounds were identified using HPLC, LC-MS, 1H and 13CNMR techniques. The dominant compounds were 2,3-dicaffeoyltartaric (2,3-diCTA), 5-O-caffeoylquinic (5-OCQA) and caffeoyltartaric (CTA) acids, with content of 5.7, 2.5 and 0.981&nbsp;mg/g DM, respectively. The levels of individual phenolic compounds, total phenolics and antioxidant activity (DPPH assay) in plants treated by CaCl2 were determined throughout the storage period (7 and 14&nbsp;days) at 4&nbsp;°C. To ascertain the relationship between the content of individual compounds, total phenols, antioxidant activities and storage time, Pearson’s correlation analysis was used. The best correlation between the storage length and compound concentration was observed for 2,3-diCTA (R2 = 0.866) and caffeoylmalic acid (CMA) (R2 = 0.750). Application of CaCl2 (0.05M) on lettuce resulted in an increase in the levels of CTA, 2.3-diCTA and 5-OCQA about 120, 65 and 57%, respectively, compared to the control stored for 7 days in the same conditions and had a favourable effect on the antioxidant activity (R2 = 0.985). The present paper shows that CaCl2 may be used as an agent that influences the stability of health-promoting compounds of cold-stored lettuce