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

Compuestos emergentes: implementación de métodos analíticos para extraer y cuantificar 17β-estradiol, 17⍺-etinilestradiol, ibuprofeno y naproxeno en agua

Los métodos implementados permitieron la cuantificación de dos esteroides (17β-estradiol y 17⍺-etinilestradiol) y dos fármacos (ibuprofeno y naproxeno) utilizando extracción en fase sólida (EFS) y cromatografía de líquidos de alta resolución con detector de arreglo de diodos (CLAR-DAD). Las condiciones de EFS con cartuchos C18 se evaluaron variando los tipos y las cantidades de disolvente de elución, condiciones de pH y la masa de muestra en el cartucho. La eficiencia se evaluó mediante la fortificación de muestras de agua con cantidades conocidas de los analitos en tres niveles de concentración distintos. Las recuperaciones encontradas indican que la eficiencia de los métodos es independiente de la cantidad de analito tratada en el rango de ensayo (p > 0.05) con recobros (promedio ± desviación estándar) para 17β-estradiol (86.9% ± 4.2), 17⍺-etinilestradiol (87.1% ± 6.1), ibuprofeno (89.4% ± 5.3) y naproxeno (85.9% ± 15), que reúnen criterios de aceptación suficientes para el control de calidad de futuras aplicaciones. Por lo tanto, los métodos propuestos son confiables para ser aplicados a muestras acuosas. Sin embargo será necesario probar su desempeño y ajustar sus condiciones cuando se analicen muestras más complejas

Composition and mutagenicity of PAHs associated with urban airborne particles in Córdoba, Argentina

The comet assay and micronucleous test were used to assess the genotoxicity of organic compounds associated with particulate material collected in the city of Córdoba, Argentina. Samples were collected on fiber glass filters and their organic extracts were analyzed by GC-MS. These extracts were used for the comet assay on human lymphocytes and for the MCN test with Tradescantia pallida. The concentrations of polycyclic aromatic hydrocarbons as well as some of their nitro derivates were higher during winter. Their composition suggested that their main emission sources were gasoline and diesel vehicles. We observed genotoxic effects of these organic extracts due to the presence of both direct and indirect acting mutagens. We found a good agreement between the two test systems employed, which encourages the further use of plant bioassays for air pollution monitoring, especially in developing countries, due to their flexibility, low cost and efficiency.Fil: Carreras, Hebe Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Calderon Segura, María Elena. Universidad Nacional Autónoma de México; MéxicoFil: Gomez Arroyo, Sandra. Universidad Nacional Autónoma de México; MéxicoFil: Murillo Tovar, Mario A.. Universidad Nacional Autónoma de México; MéxicoFil: Amador Munoz, Omar. Universidad Nacional Autónoma de México; Méxic

Spectral Characteristics Related to Chemical Substructures and Structures Indicative of Organic Precursors from Fulvic Acids in Sediments by NMR and HPLC-ESI-MS

The aim of this work was to determine Fulvic Acids (FAs) in sediments to better know their composition at the molecular level and to propose substructures and structures of organic precursors. The sediment samples were obtained from a priority area for the conservation of ecosystems and biodiversity in Mexico. FAs were extracted and purified using modifications to the International Humic Substances Society method. The characterization was carried out by 1D and 2D nuclear magnetic resonance (NMR) and high-performance liquid chromatography-electrospray ionization-mass spectrometry (HPLC-ESI-MS) in positive (ESI+) and negative (ESI−) modes. Twelve substructures were proposed by the COSY and HSQC experiments, correlating with compounds likely belonging to lignin derivatives obtained from soils as previously reported. The analysis of spectra obtained by HPLC-ESI-MS indicated likely presence of compounds chemically similar to that of the substructures elucidated by NMR. FAs studied are mainly constituted by carboxylic acids, hydroxyl, esters, vinyls, aliphatics, substituted aromatic rings, and amines, presenting structures related to organic precursors, such as lignin derivatives and polysaccharides