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

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

Studies in iodine metabolism. Progress report and publications, 1979-1980

Research programs for the years 1978-1980 is reported. The following subject areas are discussed: (1) iodine 131 monitoring in thyroids of sheep, cattle and humans; (2) radium monitoring in cattle thyroids; (3) the relationship of thyroid function to seizures in rats; (4) the effect of KSCN on thyroglobulin in mice; and (5) studies on excessive iodide intake. (ACR

Adaptación de las ratas a bajas presiones de oxígeno

In a recent publication the author reported on the depressant effect of anoxia on the activity of the thyroid gland of rats. This thyroid depression can be interpreted as an adaptive change that would help adaptation to anoxia. H.E. Himwitch drew attention to information Barrach and others, which indicated that thyroidectomy increases the tolerance of rats to anoxia.En una publicación reciente el autor informó acerca del efecto depresor que tiene la anoxia sobre la actividad de la glándula tiroides de las ratas. Esta depresión tiroidea puede interpretarse como un cambio adaptativo que ayudaría la adaptación a la anoxia. H.E. Himwitch llamó la atención sobre la información de Barrach y otros, los cuales indicaron que la tiroidectomía aumenta la tolerancia de las ratas a la anoxia

Adaptación de las ratas a bajas presiones de oxígeno

In a recent publication the author reported on the depressant effect of anoxia on the activity of the thyroid gland of rats. This thyroid depression can be interpreted as an adaptive change that would help adaptation to anoxia. H.E. Himwitch drew attention to information Barrach and others, which indicated that thyroidectomy increases the tolerance of rats to anoxia.En una publicación reciente el autor informó acerca del efecto depresor que tiene la anoxia sobre la actividad de la glándula tiroides de las ratas. Esta depresión tiroidea puede interpretarse como un cambio adaptativo que ayudaría la adaptación a la anoxia. H.E. Himwitch llamó la atención sobre la información de Barrach y otros, los cuales indicaron que la tiroidectomía aumenta la tolerancia de las ratas a la anoxia

Adaptación de las ratas a bajas presiones de oxígeno

In a recent publication the author reported on the depressant effect of anoxia on the activity of the thyroid gland of rats. This thyroid depression can be interpreted as an adaptive change that would help adaptation to anoxia. H.E. Himwitch drew attention to information Barrach and others, which indicated that thyroidectomy increases the tolerance of rats to anoxia.En una publicación reciente el autor informó acerca del efecto depresor que tiene la anoxia sobre la actividad de la glándula tiroides de las ratas. Esta depresión tiroidea puede interpretarse como un cambio adaptativo que ayudaría la adaptación a la anoxia. H.E. Himwitch llamó la atención sobre la información de Barrach y otros, los cuales indicaron que la tiroidectomía aumenta la tolerancia de las ratas a la anoxia

An analysis of selected respiratory and cardiovascular characteristics of wind instrument performers

v, 48 leaves : ill. ; 28 cm. Bibliography: leaves 45-48.Little objective information on wind instrument performance physiology is available or accessible to musicians. Research on wind instrument performance physiology includes: measurements of specific airflow pressures while playing wind instruments, measurements of lung volumes and capacities, and electrocardiograms taken during wind instrument performance. The purpose of this study was to examine selected respiratory and cardiovascular responses of wind instrumen-talists and non-wind instrumentalists at the Eastman School of Music. Lung volumes, breathing patterns at rest, maximal airway pressures, peak flow rates, and pulse rate responses to thirty-second breath holds at increased airway pressures were determined. Equipment included a Wright Peak Flow Meter, a six-liter fast-recording spirometer, a six-liter recording respirometer, a photoelectric finger plethysmograph, a water manometer, and a polygraph. The data indicated that: 1) Wind instrumentalists do not have greater vital capacities than predicted for their sex, height, and age; therefore, assumptions that wind instru-mentalists need large vital capacities, and that wind instru-ment performance changes vital capacity are irrelevant to successful wind instrument performance. 2) At rest, some wind instrumentalists may breathe slightly slower, but not deeper, than controls. These results support results of earlier studies. 3) Male and female wind instrumentalists are able to produce significantly greater maximal airway pressures than controls, indicating a possible adaptation in the strength of respiratory muscles. This strength may be related to the demands of wind instrument performance. 4) Pulse rate responses of wind players and controls do not differ from each other significantly before, during, and after a thirty-second breath hold producing airway pressure of 40 cm H20. However, there is a significant difference in pulse rate responses of males when compared with those of females. Pulse rate of the female does not vary as greatly as the pulse rate of the male

Construction of a human X-chromosome-enriched phage library which facilitates analysis of specific loci.

A human X-chromosome-enriched MboI-partial-digest recombinant library in phage lambda Charon30 has been constructed. Twelve out of the thirteen X-chromosome DNA sequences that were tested were present in the library. Most regions were covered in overlapping phage inserts; mean insert size was 13.7 kb. One phage from the library allowed detection of a 225-bp insertion of DNA into a region near the Duchenne muscular dystrophy (DMD) locus. Another recombinant phage represents an expansion of a region which exhibits extensive and varying homology with other human chromosomes, including the Y, as well as with rodent DNA. The present library should have widespread use for examining DNA sequences on the human X chromosome