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

Efectos de la exposición crónica a plaguicidas en los trabajadores agrícolas de Bailadores, Municipio Rivas Dávila, Estado Mérida, Venezuela

A pesar de sus efectos adversos sobre la salud, los plaguicidas se encuentran dentro de las sustancias químicas más frecuentemente utilizadas a nivel mundial, afectando a los trabajadores y pobladores de las zonas de explotación agrícola y a los consumidores de los productos agrícolas contaminados. Varios informes sugieren que la exposición crónica a plaguicidas puede afectar la calidad del semen y la fertilidad del hombre. El objetivo de este estudio fue evaluar la asociación entre la exposición ocupacional a los plaguicidas organofosforados (OFs) y carbamatos (CBs) y la calidad del semen, así como los niveles de hormonas reproductivas y de la glándula tiroides de los agricultores. Fueron estudiados 35 hombres sanos (grupo no expuesto) y 64 trabajadores agrícolas (grupo expuesto). Se evaluó la calidad del esperma en muestras de semen fresco y se analizó el Índice de Fragmentación de ADN Espermático (IDF) por citometría de flujo. La exposición a plaguicidas se evaluó mediante la medición de la acetilcolinesterasa eritrocitaria (AChE) y butirilcolinesterasa plasmática (BuChE) con el kit de prueba de campo “Test Mate ChE”. Los niveles séricos de testosterona total (TT), la hormona estimulante del folículo (FSH), hormona luteinizante (LH), la prolactina (PRL), hormona estimulante de la tiroides (TSH) y tiroxina libre (T4L) se analizaron utilizando kits de inmunoensayo enzimático

Información Investigador: Miranda de Contreras, Leticia

http://www.ing.ula.ve/~cme/Leticia.htmlResumen Curricular Leticia Miranda de Contreras nació en Manila, Filipinas, donde cursó sus primeros estudios universitarios obteniendo el grado de Química. Posteriormente se trasladó a los EE.UU. y trabajó en la Case Websty University, en el Departamento de Farmacología de la Facultad de Medicina, bajo la tutoría del Dr. Donald D. Anthony. En Venezuela bajo la tutoría del Dr. Ernesto Palacios Prü obtiene el título de Maestría y posteriormente el de Doctorado en el postgrado de Ciencias Medicas Fundamentales. Actualmente, es profesora Titular de la Universidad de Los Andes y Coordina la Unidad de Neuroquímica en el Centro de Microscopia Electrónica (CME).Doctorado1081I - 200288 - 2005; 65 - 2003; 26 - 2001Neuroquímica; Neurobiología del Desarrollo.Mayo de 2006Química+58 274 2403160Vicerrectorado Acadé[email protected]

Sulfonamide residues in muscle of porcine slaughtered at the northwestern of Mexico

Los residuos de antibióticos en las canales de animales sacrificados han sido el foco de atención de las autoridades de salud por algún tiempo. Las sulfonamidas representan una clase de compuestos ampliamente utilizados en la producción animal como agentes antimicrobianos y suministrados vía el alimento. Los residuos de estos antimicrobianos en los alimentos derivados de animales tratados representan un riesgo para la salud de los consumidores de carne. Los métodos tradicionales de detección de sulfonamidas han mostrado ser poco confiables. En este estudio, se planteó monitorear los niveles de residuos de sulfonamidas mediante un ensayo microbiológico rápido (Charm II), y su confirmación por cromatografía de líquidos de alta resolución (HPLC), en músculos de porcino colectados en plantas Tipo Inspección Federal de la Región Noroeste de México. Se analizaron 1635 muestras de músculo de porcino, durante 1993-1999. Los resultados obtenidos mediante la prueba Charm II mostraron que el 6,1% de las muestras estuvieron contaminadas con sulfonamidas, las concentraciones detectadas variaron en el rango de 0,01 - 0,24 μg/g. Del total de muestras analizadas, 21 (1,3%) presentaron niveles violatorios de sulfonamidas de acuerdo a la Norma Oficial Mexicana, que establece un Límite Máximo de Residuos (LMR) permitidos para sulfonamidas de 0,1 μg/g. Estos datos revelan que la incidencia de residuos violatorios de sulfonamidas es baja, aunque los problemas aún persisten.127 - 132BimestralAntimicrobial residues in carcasses of slaughtered animals have been the focus of attention by health authorities for some time. Sulfonamides represent a class of compounds widely used as antibacterial agents in animal production as antibacterial agents and are commonly administered via medicated feeds. Residues of these drugs in food derived from treated animals could pose a health threat to consumers of meat. Traditional detection methods of sulfonamides have been shown to be unreliable. In this study, sulfonamide residue levels were monitored by a microbiological receptor assay (Charm II) and confirmed by high performance liquid chromatography (HPLC), in porcine muscles collected at federally-inspected packing plants of Northwestern Mexico. The number of analyzed pork samples was 1635 during 1993-1999. Results obtained by the Charm II test of the meat extracts showed that 6.1% of the samples were contaminated with sulfonamides. The concentrations varied in the range from 0.01-0.24 μg/g, 21 samples (1.3%) had violative levels of sulfonamides based on the Mexican tolerances (0.1 μg/g). These data revealed that the incidence of violative sulfonamide residues is low, although problems still persist

Tolerability and physical-chemical comparison between lots registered and no registered lots of antimony (Glucantime® and Ulamina) in the treatment of cutaneous Leishmaniasis.

Editorial. Emponzoñamiento por escorpiones, arañas, insectos y otros invertebrados.Envenomation by scorpions, spiders, insects and other invertebrates.Salinas, Pedro JoséComparación de tolerabilidad y fisico-química entre lotes de antimonial comercial y no comercializado (Glucantime® vs. Ulamina) en el tratamiento de la Leishmaniasis cutánea.Tolerability and physical-chemical comparison between lots registered and no registered lots of antimony (Glucantime® and Ulamina) in the treatment of cutaneous Leishmaniasis.Vásquez de Ricciardi, LauraScorza, José VicenteVicuña-Fernández, NelsonPetit de P., YaneiraLópez, SabrinaRojas Moreno, ElinaMorales, Carmen CeciliaBendezú, HerminiaScorza Dagert, JoséMiranda de Contreras, LeticiaMecanismos moleculares en la patogenia de los edemas del síndrome nefrótico. Una revisión.Molecular mechanisms in the pathogenesis of edema in nephrotic syndrome. A review.Rondón Nucete, MiguelGuerra de Rondón, Ana OfeliaRondón Guerra, Ana VerónicaManejo de espasticidad en miembros superiores con infiltraciones de fenol y toxina botulínica.Phenol and botulinum toxin infiltrations in the treatment of upper extremities spasticity.Sepúlveda Corzo, Ángel JavierSalinas, Pedro JoséMonzón de Briceño, YolandaCastillo Trujillo, David JoséNiveles séricos de cinc (Zn), hierro (Fe) y cobre (Cu) de preescolares que acuden a consulta en los ambulatorios urbanos tipo III de la Ciudad de Mérida.Serum levels of zinc (Zn), iron (Fe) and copper (Cu) of preschool children who attended the urban ambulatories type III at Mérida City (Mérida state).Silva Larralte, TaniaAlarcón Corredor, Oscar MarinoAlarcón Silva, Angel O.Ramírez de Fernández, MaríaD´Jesús A., IraimaMejia de Díaz, María ArnoldaFuncionalidad familiar, estrato socio-económico y red de apoyo social de los residentes de postgrado de la Facultad de Medicina de la Universidad de Los Andes. Mérida. Venezuela.Family functionality, socioeconomic level and social support network in graduate residents of the Faculty of Medicine, University of the Andes, Mérida, Venezuela.González, CarmenMejia de Díaz, María ArnoldaAngulo, LuísD`Avila, MaríaRelación entre estrato socio-económico y presencia de gastritis en adultos que acuden a consulta en el IAHULA. Mérida.Relationship between socioeconomical status and gastritis in adults consulting at the IAHULA Mérida.Ramírez, V.E.Alarcón Corredor, Oscar MarinoVillasmil, Luis M.Dávila de Arriaga, Ana J.Villarroel, A.Periodontitis agresiva causada por Porphyromonas gingivalis. Reporte de un caso.Aggressive periodontitis caused by Porphyromonas gingivales. Case report.Ruiz A., MelinaBurguera G., LilianaRodríguez M., Antonio JesúsEmponzoñamiento escorpiónico en pacientes atentidos en el Hospital de Santa Cruz de Mora, Mérida, Venezuela.Scorpion envenomation in patients attending the Hospital at Santa Cruz de Mora, Mérida, Venezuela.Salinas, Perla R.Salinas, Pedro José4 - [email protected]@[email protected]@ula.veNivel analíticosemestra

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

Background: Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. Methods: Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. Findings: In 2021, there were 529 million (95% uncertainty interval [UI] 500-564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8-6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7-9·9]) and, at the regional level, in Oceania (12·3% [11·5-13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1-79·5) in individuals aged 75-79 years. Total diabetes prevalence-especially among older adults-primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1-96·8) of diabetes cases and 95·4% (94·9-95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5-71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5-30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22-1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1-17·6) in north Africa and the Middle East and 11·3% (10·8-11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. Interpretation: Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers. Funding: Bill & Melinda Gates Foundation