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

Estudo dos cátions cálcio, magnésio, sódio, potássio e da salinidade na água intersticial do sedimento do manguezal de Bragança - NE do Pará

CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológic

Proposta de metodologia para avaliação da qualidade das águas na área de influência de minas a céu aberto : caso da mina N5SUL em Carajás-PA

Indicadores de qualidade ambiental tem o objetivo de medir as variações de qualidade atribuídas pelas atividades humanas sobre os ecossistemas ambientais. Muitos desses indicadores resultam da composição de variáveis distintas voltadas para objetivos específicos diversos. Definir quais são as variáveis mais importantes dentro de um processo de avaliação ambiental é, sem dúvida, um dos maiores desafios dos responsáveis por esse tipo de estudo. Dentro do processo produtivo, é muito comum que se construa um banco de dados com informações de monitoramento da qualidade ambiental, composto de informações que não se integram de modo simplificado, indicando ações de ajustes ou mitigação de possíveis impactos sobre a qualidade do compartimento ambiental estudado. Quando se trata da avaliação da qualidade das águas é incomparável o volume de informações que geralmente se processa para viabilizar a medição da qualidade. Comumente se utilizam medições quantitativas e qualitativas de parâmetros físico-químicos, biológicos e hidrobiológicos, associados a efeitos antrópicos, geológicos, geomorfológicos, conectados entre si, ou dispersos em medições individuais. Diante do desafio de definir um modo de avaliação específico para a qualidade das águas na área de influência direta de uma mina a céu aberto, o presente trabalho propõe uma metodologia que possa indicar quais roteiros devem ser seguidos para que uma avaliação ambiental da qualidade das águas garanta que as variáveis escolhidas sejam medidas e classificadas ao longo das diferentes fases operacionais de uma mina céu aberto, iniciando no planejamento, se estendendo durante as fases de implantação, operação e descomissionamento. É essencial que as diretrizes estabelecidas sejam prontamente utilizadas pelos gestores operacionais de modo que mudanças de procedimentos operacionais possam ser realizadas em função do objetivo principal da manutenção da qualidade ambiental. A proposta metodológica foi aplicada em um projeto de mineração a céu aberto, Mina de N5Sul no Complexo Minerador de Carajás, no estado do Pará, Brasil, sendo possível efetuar medições ambientais para uma mesma rede de monitoramento da qualidade das águas em três fases distintas: planejamento, instalação e operação, onde os resultados iniciais demonstraram que mudanças nos procedimentos operacionais foram aplicados com sucesso para a manutenção da qualidade das águas no entorno da mina. Além disso, é de fundamental importância que a rede de medições seja mantida até a fase de descomissionamento, pois com a composição do banco de dados de informações será possível avaliar de forma efetiva os impactos da operação de uma mina sobre a qualidade das águas do entorno ao longo do tempo de sua vida útil.Environmental quality indicators are intended to measure quality changes attributed by human activities on environmental ecosystems. Many of these indicators results from the composition of different variables have focused on several specific objectives. Defining which are the most important variables within an environmental assessment process is undoubtedly one of the greatest challenges for those responsible for this type of study. Inside of the production process, it is very common to build a database with environmental quality monitoring information consists of information that are not integrated in a simplified manner, indicating needs of adjustments or mitigation of potential impacts on the quality of environmental compartment studied. When it comes to the assessment of water quality, is unparalleled the amount of information that usually is processed to enable the measurement quality. Commonly are used quantitative and qualitative measurements of physical and chemical parameters, biological and hydro-biological associated with anthropogenic effects, geological, geomorphological, connected with each other, or dispersed in individual measurements. Faced to the challenge of defining a specific evaluation mode for the water quality in the area of direct influence of an open pit mine, this paper proposes a methodology that can indicate which routes should be followed for an environmental assessment of water quality to ensure that the chosen variables are measured and classified throughout the different operational phases of an open pit mine, starting in the planning, extending during the deployment phase, operation and decommissioning. It is essential that the guidelines established can be readily used by operational managers, so that changes in operational procedures to occur based on the primary objective of maintaining environmental quality. The methodology was applied in a mining project in the open, N5Sul mine in Complex Miner Carajás, in the state of Pará, Brazil, where it was possible to make environmental measurements for the same quality monitoring network of water in three distinct phases : planning, installation and operation, where initial results showed that changes in operational procedures have been successfully applied to the maintenance of water quality in the vicinity of the mine. Besides, it is very important that the network is maintained until the decommissioning phase, as to the composition of bank information will be possible to assess effectively the impact of a mine operation on the quality of the surrounding water over time of its life

Proposta de metodologia para avaliação da qualidade das águas na área de influência de minas a céu aberto : caso da mina N5SUL em Carajás-PA

Indicadores de qualidade ambiental tem o objetivo de medir as variações de qualidade atribuídas pelas atividades humanas sobre os ecossistemas ambientais. Muitos desses indicadores resultam da composição de variáveis distintas voltadas para objetivos específicos diversos. Definir quais são as variáveis mais importantes dentro de um processo de avaliação ambiental é, sem dúvida, um dos maiores desafios dos responsáveis por esse tipo de estudo. Dentro do processo produtivo, é muito comum que se construa um banco de dados com informações de monitoramento da qualidade ambiental, composto de informações que não se integram de modo simplificado, indicando ações de ajustes ou mitigação de possíveis impactos sobre a qualidade do compartimento ambiental estudado. Quando se trata da avaliação da qualidade das águas é incomparável o volume de informações que geralmente se processa para viabilizar a medição da qualidade. Comumente se utilizam medições quantitativas e qualitativas de parâmetros físico-químicos, biológicos e hidrobiológicos, associados a efeitos antrópicos, geológicos, geomorfológicos, conectados entre si, ou dispersos em medições individuais. Diante do desafio de definir um modo de avaliação específico para a qualidade das águas na área de influência direta de uma mina a céu aberto, o presente trabalho propõe uma metodologia que possa indicar quais roteiros devem ser seguidos para que uma avaliação ambiental da qualidade das águas garanta que as variáveis escolhidas sejam medidas e classificadas ao longo das diferentes fases operacionais de uma mina céu aberto, iniciando no planejamento, se estendendo durante as fases de implantação, operação e descomissionamento. É essencial que as diretrizes estabelecidas sejam prontamente utilizadas pelos gestores operacionais de modo que mudanças de procedimentos operacionais possam ser realizadas em função do objetivo principal da manutenção da qualidade ambiental. A proposta metodológica foi aplicada em um projeto de mineração a céu aberto, Mina de N5Sul no Complexo Minerador de Carajás, no estado do Pará, Brasil, sendo possível efetuar medições ambientais para uma mesma rede de monitoramento da qualidade das águas em três fases distintas: planejamento, instalação e operação, onde os resultados iniciais demonstraram que mudanças nos procedimentos operacionais foram aplicados com sucesso para a manutenção da qualidade das águas no entorno da mina. Além disso, é de fundamental importância que a rede de medições seja mantida até a fase de descomissionamento, pois com a composição do banco de dados de informações será possível avaliar de forma efetiva os impactos da operação de uma mina sobre a qualidade das águas do entorno ao longo do tempo de sua vida útil.Environmental quality indicators are intended to measure quality changes attributed by human activities on environmental ecosystems. Many of these indicators results from the composition of different variables have focused on several specific objectives. Defining which are the most important variables within an environmental assessment process is undoubtedly one of the greatest challenges for those responsible for this type of study. Inside of the production process, it is very common to build a database with environmental quality monitoring information consists of information that are not integrated in a simplified manner, indicating needs of adjustments or mitigation of potential impacts on the quality of environmental compartment studied. When it comes to the assessment of water quality, is unparalleled the amount of information that usually is processed to enable the measurement quality. Commonly are used quantitative and qualitative measurements of physical and chemical parameters, biological and hydro-biological associated with anthropogenic effects, geological, geomorphological, connected with each other, or dispersed in individual measurements. Faced to the challenge of defining a specific evaluation mode for the water quality in the area of direct influence of an open pit mine, this paper proposes a methodology that can indicate which routes should be followed for an environmental assessment of water quality to ensure that the chosen variables are measured and classified throughout the different operational phases of an open pit mine, starting in the planning, extending during the deployment phase, operation and decommissioning. It is essential that the guidelines established can be readily used by operational managers, so that changes in operational procedures to occur based on the primary objective of maintaining environmental quality. The methodology was applied in a mining project in the open, N5Sul mine in Complex Miner Carajás, in the state of Pará, Brazil, where it was possible to make environmental measurements for the same quality monitoring network of water in three distinct phases : planning, installation and operation, where initial results showed that changes in operational procedures have been successfully applied to the maintenance of water quality in the vicinity of the mine. Besides, it is very important that the network is maintained until the decommissioning phase, as to the composition of bank information will be possible to assess effectively the impact of a mine operation on the quality of the surrounding water over time of its life

Trichomonas vaginalis perturbs the junctional complex in epithelial cells

Trichomonas vaginalis, a protist parasite of the urogenital tract in humans, is the causative agent of trichomonosis, which in recent years have been associated with the cervical cancer development. In the present study we analyzed the modifications at the junctional complex level of Caco-2 cells after interaction with two isolates of T. vaginalis and the influence of the iron concentration present in the parasite's culture medium on the interaction effects. Our results show that T. vaginalis adheres to the epithelial cell causing alterations in the junctional complex, such as: (a) a decrease in transepithelial electrical resistance; (b) alteration in the pattern of junctional complex proteins distribution as observed for E-cadherin, occludin and ZO-1; and (c) enlargement of the spaces between epithelial cells. These effects were dependent on (a) the degree of the parasite virulence isolate, (b) the iron concentration in the culture medium, and (c) the expression of adhesin proteins on the parasite surface

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London