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 CONTROL OF POLYPHENOL OXIDASE ACTIVITY IN FRUITS AND VEGETABLES - A STUDY OF THE INTERACTIONS BETWEEN THE CHEMICAL-COMPOUNDS USED AND HEAT-TREATMENT

Objective of this research was to find alternative methods for the control of polyphenol oxidase (PPO) activity in fruits and vegetables with the purpose of reducing or eliminating the use of SO2 for this purpose. Interactions between the use of ascorbic acid, citric acid, EDTA, sodium metabisulphite and heat treatment (70 degrees C for 2 min) in the control of PPO activity were studied in avocado (var. Fortuna), banana (var. Nanica), apple (var. Ana, Fuji, Gala & Golden), pear (var. D'Agua), peach (var. Real), potato (var. Bintje), eggplant (var. Super F100), mushroom (Agaricus bisporus) and hearts-of-palm (Euterpe edulis Mart.). The results demonstrated that PPO of avocado and eggplant was most resistant to inhibition by the methods used. The least efficient method tested for the control of PPO was the addition of ascorbic acid and EDTA, while the most efficient methods investigated included the use of ascorbic acid, citric acid, sodium metabisulphite and heat treatment. The results indicated that, with the exception of PPO from avocado, the most adequate alternative method to substitute for the use of SO2 in the control of PPO was a combination of ascorbic acid, citric acid and heat treatment.47324525

EVALUATION OF SOYBEAN OIL DEORDIZATION DESTILLATE FOR VITAMIN-E RECOVERY

Deodorizer destillate, a by product of the sor bean oil refining process, was demonstrated to be a good raw material for production of vitamin E. In this paper we report the composition of tocopherols, free fatty acids, unsaponifiable matter and some physicochemical properties of the deodorizer destillates from three industrial samples obtained from industries in the State of Sao Paulo. Diferences in the destillates were total tocopherol and isomers of observed for unsaponifiable matter, tocopherol (alpha,beta,gamma,delta) between the samples. This allowed us to select the mast suitable sample for further studies as a vitamin E source. Analysis of the destillate samples showed an unsaponifiable matter of 27.1%, 18.6% and 3.5% and total tocopherol of 8.6%, 9.3% and 3.7% respectively. The sample that contained 9.3% of total tacopherol and 1.1% of a-tocopherol was selected as the most suitable for vitamin E recovery research.3741003101

The determination of dehydrated apple shelf-life using accelerated assays

preview a food shelf-life is essential to evaluate the kinetics of degradation reactions beyond the orientation of the more appropriate conservation conditions of the products. For the dehydrated apple shelf-life estimative, the product was packed in PE film of 140 and stored at 5 degrees C (control), 25 degrees C (room) and 35 degrees C (accelerated) temperatures and then evaluated based on objective color readings of L, a and b Hunter during 6 months at a 15-day interval. Experimental data showed that the color degradation follows the model of a zero order kinetic reaction. The Arrhenius model was applied to reaction rates (k) at each temperature and an activation energy (E-a) of 7.6 kcal.mol(-1) and Q(10) of = 2.0 was obtained. Shelf-life evaluation was based on subjective (Difference from Control Sensorial Discriminative Test) measurements over 4 months at 15 day intervals. The results suggest that the product stored at 35 T has 100 days shelf-life time; Since Q(10)= 2.0, the product stored at room temperature might be 200 days shelf-life time.27114114

Characterization of thiol-, aspartyl-, and thiol-metallo-peptidase activities in Madin-Darby canine kidney cells

We combined fluorogenic substrates or internally quenched fluorescent peptides with specific inhibitors in the pH profile of proleolytic activity experiments in order to detect proteolytic activities in lysates of MDCK cells. Hydrolytic activities related to cathepsin B, L, and D were observed. Serine-proteinase was not detected; however, we clearly demonstrated the presence of a thiol-metallo-endo-oligopeptidase, also called thimet-oligopeptidase (TOP). This peptidase from MDCK cells has substrate and inhibitor specificities as well as an activation profile with mercaptoethanol that are indistinguishable from the recombinant rat testis TOP (EC 3.4.24.15). in addition, polyclonal purified antibodies to this enzyme depleted the TOP activity of MDCK cells in whole homogenate. Although we present only preliminary data, TOP is secreted by MDCK cells. the presence of TOP in a phenotype polarized MDCK cells can have special significance in the cytoplasmic selection, transport, or clearance of short peptides due to restriction of the enzyme to sequences from 6 to 17 amino acids. Therefore, the MDCK cell could be a very useful cellular model with which to study some of the suggested TOP biological functions as processing of biological active peptides and antigen presentation. (C) 2000 Wiley-Liss, Inc.Escola Paulista Med, Dept Biophys, São Paulo, BrazilUniv São Paulo, Inst Biomed Sci, Dept Histol, São Paulo, BrazilUniv São Paulo, Inst Biomed Sci, Dept Physiol, São Paulo, BrazilEscola Paulista Med, Dept Biophys, São Paulo, BrazilWeb of Scienc