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

セイジョウ ドウブツ ケッセイ ノ コウウイルス カッセイ ニ ツイテ ノ ケンキュウ

要旨には「Studies on the Antiviral Activity of the Normal Animal Serum」とあり京都大学0048新制・課程博士博士(薬学)甲第9507号薬博第489号新制||薬||193(附属図書館)UT51-2002-G265京都大学大学院薬学研究科生命薬科学専攻(主査)教授 河合 明彦, 教授 川嵜 敏祐, 教授 市川 厚学位規則第4条第1項該当Doctor of Pharmaceutical SciencesKyoto UniversityDA

Molecular Detection of Avian Pathogenic Escherichia coli (APEC) for the First Time in Layer Farms in Bangladesh and Their Antibiotic Resistance Patterns

Avian pathogenic Escherichia coli (APEC) causes significant economic losses in poultry industries. Here, we determined for the first time in Bangladesh, the prevalence of APEC-associated virulence genes in E. coli isolated from layer farms and their antibiotic resistance patterns. A total of 99 samples comprising internal organs, feces, and air were collected from 32 layer farms. Isolation was performed by culturing samples on eosin&ndash;methylene blue agar plates, while the molecular detection of APEC was performed by PCR, and antibiograms were performed by disk diffusion. Among the samples, 36 were positive for the APEC-associated virulence genes fimC, iucD, and papC. Out of 36 isolates, 7, 18, and 11 were positive, respectively, for three virulence genes (papC, fimC, and iucD), two virulence genes, and a single virulence gene. Although the detection of virulence genes was significantly higher in the internal organs, the air and feces were also positive. The antibiograms revealed that all the isolates (100%) were resistant to ampicillin and tetracycline; 97.2%, to chloramphenicol and erythromycin; 55.5%, to enrofloxacin; 50.0%, to norfloxacin and ciprofloxacin; 19.4%, to streptomycin; 11.1%, to colistin; and 8.33%, to gentamicin. Interestingly, all the isolates were multidrug-resistant (MDR). Spearman&rsquo;s rank correlation coefficient analysis revealed the strongest significant correlation between norfloxacin and ciprofloxacin resistance. This is the first study in Bangladesh describing the molecular detection of APEC in layer farms. Isolated APEC can now be used for detailed genetic characterization and assessing the impact on public health

Molecular detection and antibiogram of Salmonella spp. from apparently healthy Japanese quails of three different quail farms in Mymensingh

Objective: The present study was carried out for the isolation, identification and antibiogram study of Salmonella spp. from apparently healthy Japanese quails (Coturnix japonica) at three different quail farms in Mymensingh, Bangladesh. Materials and methods: A total of 75 cloacal swab samples were randomly collected from apparently healthy Japanese quails from three different farms at Mymensingh, Bangladesh. The samples were subjected to a series of cultural and biochemical examination for the isolation of Salmonella followed by molecular detection by polymerase chain reaction (PCR). Motility of the Salmonella was performed by motility test and amplification of speF gene. The antibiogram profile of the isolates was also evaluated against commonly used antimicrobials by disc diffusion method. Results: The overall prevalence of Salmonella spp. in quails was found to be 13.33%(n=10/75). Out of the 10 isolates, seven were found to be motile. Farmwise, the prevalence of Salmonella spp. were 10%(n=3/30), 24%(n=6/25) and 5%(n=1/20) at the quail farms of Bangladesh Agricultural University (BAU), Shikarikanda and Akua, respectively. The antibiogram study revealed that all the isolates were resistant to both Erythromycin and Tetracycline. On the other hand, 100% isolates were sensitive to both Ciprofloxacin and Imipenem. Ninety percent isolates of Salmonella were resistant to Colistin sulphate. Neomycin was found to be sensitive to 80% Salmonella isolates. All the Salmonella isolates were found to be multidrug resistant (MDR). Conclusion: The presence of MDR Salmonella spp. in quails signifies public health importance of the organisms, which may be associated with food-borne illness. [J Adv Vet Anim Res 2018; 5(1.000): 60-66

Reverse transcription polymerase chain reaction (RT-PCR) based detection and serotyping of FMD Virus from field samples of Gazipur, Bangladesh, and adaptation of the virus in BHK-21 cell

The study aimed for the detection and serotyping of Foot and Mouth Disease virus (FMDV) circulating in Kapasia Upazila, Gazipur district of Bangladesh during 2013. Twelve samples comprising of tongue epithelium (n=8) and inter digital tissue (n=4) were collected from suspected cattle, and inocula were prepared. The inocula were inoculated into confluent BHK-21 cell line for virus propagation. After 3 subsequent passages; progressive cytopathic effects (CPE) specific for FMDV i.e., rounding and flattening of cells, breaking down of the intercellular bridge and finally cell death (almost 100%) were observed; these were indicative of successful virus propagation in the cells. Viral RNA was extracted, and Reverse Transcription Polymerase Chain Reaction (RT-PCR) was performed using three sets of primers corresponding to the serotype and lsquo;O', and lsquo;Asia-1' and and lsquo;A', respectively. Out of the 12 samples, 10 (83.33%) were found to be positive for FMDV, and all of those were of serotype and lsquo;O'. It is concluded that FMDV serotype and lsquo;O' is circulating among the cattle of Gazipur district, Bangladesh. [J Adv Vet Anim Res 2015; 2(3.000): 291-295

Prevalence and characteristics of Shiga-toxin producing Escherichia coli (STEC) isolated from beef slaughterhouse

Objective: Shiga-toxin producing Escherichia coli (STEC) is the most important foodborne bacterial pathogen worldwide and the bovine animals are assumed as a reservoir of this pathogen. The present study was conducted to assess the role of bovine animals as the source of STEC. Materials and methods: To assess the role of bovine animals as the source of STEC, we examined 100 samples (50 rectal swab and 50 beef samples) collected from the local beef slaughterhouses by cultural, morphological, biochemical tests and polymerase chain reaction. Finally, the drug resistance pattern of isolated organisms has been examined. Result: In the preliminary screening by polymerase chain reaction (PCR), E. coli was more prevalent in rectal swab (n=21/50) than beef samples (n=16/50). Among 39 isolated E. coli, 10 isolates were confirmed as STEC (Rectal swab=7, Beef=3) by PCR, where stx2 gene (n=7/10) was predominant than stx1 gene (n=3/10). Remaining 29 isolates did not react to stx primers in PCR. Presence of STEC in beef samples was significantly associated with the fecal contamination at P&#8804;0.1 (0.074818) in Pearsons correlation coefficient method. In addition, most of the isolated STEC strains were resistant to one or more commonly used antimicrobials in the country. Conclusion: The bovine animals and its products could be an important source of multidrug-resistant STEC in the country. [J Adv Vet Anim Res 2018; 5(2.000): 218-225

Assessment of immune response in cattle against experimentally prepared trivalent (O, A, and Asia-1) FMD vaccine in Bangladesh

This research work was conducted to investigate the effects of age, sex and breed on the induction of immune response against experimentally prepared inactivated trivalent (type O, A, and Asia-1) FMD vaccine. Twenty six cattle were divided into four test groups (Group A, B, C, and D; 5 cattle in each group) and one control group (n=6) based on breed (local and cross), age (≤12 months and >12 months), and sex (male and female). Test cattle were vaccinated with the experimentally prepared trivalent FMD vaccine. Pre- and post vaccinated sera from the vaccinated cattle were collected upto 63 days, and the sera were tested using liquid phase blocking enzyme linked immunosorbent assay (LPBE) that was specific for FMD serotypes O, A, and Asia-1. Antibody titers of all the pre-vaccinated serum samples were found to be under protection level. The females were found to be more protected (90%; n=9/10) as compared to males (70%; n=7/10). The titers obtained were statistically analyzed using t–test to observe the effects of age, breed and sex. It was observed that the mean values of antibody titer in cattle aging >12 months against O, A, and Asia-1 serotypes were significant (P12 months showed better immune response towards trivalent FMD vaccine

Isolation and identification of Clostridium chauvoei from cattle in Mymensingh

Black quarter (BQ), caused by Clostridium chauvoei, is an economically important, highly infectious bacterial disease of cattle, goat and sheep. The present study was conducted to isolate and identify the causal agent of BQ from field cases. A total of 32 samples from necropsied areas of cattle presented to the Teaching Veterinary Hospital, Bangladesh Agricultural University were collected. The samples were subjected for bacteriological culture followed by identification through a series of conventional bacteriological techniques, staining properties and biochemical tests. The bacteria were cultured in anaerobic condition using candle jar. Morphological characters of bacteria were observed after Gram stain. The suspected samples were subjected for several passages in liver infusion broth to get pure culture. On neomycin blood agar, the bacteria showed hemolysis. Based on the cultural and staining characteristics and biochemical tests, 4 (12.5%) out of 32 samples were confirmed as Cl. chauvoei. It is concluded that Cl. chauvoei has been successfully isolated and identified from BQ affected cattle. [Fundam Appl Agric 2019; 4(1.000): 649-654

Isolation of Pasteurella multocida from chickens, preparation of formalin killed fowl cholera vaccine, and determination of efficacy in experimental chickens

Objectives: The objectives of this study were to isolate and identify Pasteurella multocida from fowl cholera (FC) suspected chicken, and to prepare and efficacy determination of formalin killed fowl cholera vaccine using the isolated P. multocida strain. Materials and methods: A total of five suspected dead chickens were collected from Brothers Poultry Farm located at Gazipur district, Bangladesh. The samples were processed and the P. multocida was isolated through conventional bacteriological techniques, were finally confirmed by polymerase chain reaction using P. multocida specific primers targeting cap gene. The P. multocida isolate was used to develop a formalin killed fowl cholera vaccine. The efficacy of the newly prepared vaccine was determined in Starcross-579 chickens (n=30) aging 15 weeks either by injecting 1 mL (group-A; n=10) or 0.5 mL (group-B; n=10) vaccine containing approximately 3.2x108 CFU/mL P. multocida organism; 10 birds were kept as unvaccinated control. The sera from the vaccinated and control birds were collected and were subjected for antibody titre determination by enzyme-linked immunosorbent assay (ELISA). Finally the vaccinated birds were challenged using virulent strains of P. multocida to confer the protection against FC. Results: P. multocida could be isolated from both the samples. The formalin killed vaccine prepared from the isolated bacteria was subjected for the determination of antibody titre in chicken, and found that the antibody titres in the birds of group A and group B were 4.513 and 4.07 respectively after primary vaccination, and 4.893 and 4.37 respectively after booster vaccination. Most of the vaccinated birds were found to be survived after challenging with virulent strain of P. multocida. Conclusion: It is concluded that the causal agent of FC (P. multocida) was successfully isolated from FC affected dead chickens. The prepared formalin killed fowl cholera vaccine induces protective immune response and conferred protection against challenge infection caused by the virulent strain of P. multocida. [J Adv Vet Anim Res 2016; 3(1.000): 45-50