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

Population Assessment and Degree of Threat of Chalybea Macrocarpa (Melastomataceae) Endemic Specie from Colombia.

<p>Population assessment results from <em>Chalybea macrocarpa </em>are shown, the specie is considerate <strong>ENDANGERED (EN) </strong>by its restricted area, threatened is generated by crops and extensive cattle farming. The study was conducted in the Boyacá department, municipality of Arcabuco, in three established localities using herbarium and literature information; field work made possible identified distribution, density and phenology like sub criteria, allowing identify the presence extension and occupancy area. We took structural data (height, coverage and DBH) to determinate the population age’s classes. Whit the gathered information and the associated vegetation, the specie is re-categorized with the<strong> B </strong>IUCN criteria. It is distributed to the northwest and southern in Arcabuco, in an area of 59.9 km², 4 km²of occupancy and a population density of 73 individual/km². Flowering and fruiting is continuous through the year, however, most of the flowering is from March to August and fruiting from September to February. Age structure allows identified ten species between seedlings, juveniles and adults. Population is represented by few seedling individuals (10.6 %) and juveniles (20.9 %) versus adults (68.5 %). Finally, <em>C. macrocarpa</em> is upgraded to Critical Risk (CR B1ab (iii)).</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: 200%; tab-stops: 118.5pt;"> </p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: 200%; tab-stops: 118.5pt;">Evaluación poblacional y grado de amenaza de <em>Chalybea macrocarpa </em>(Melastomataceae) especie endémica de Colombia</p><p>Se presentan los resultados de la evaluación poblacional de <em>Chalybea macrocarpa</em>, considerada En Peligro (EN) por su área de distribución restringida, presión generada por cultivos y ganadería extensiva. El estudio se realizó en el departamento de Boyacá, en el municipio de Arcabuco, en tres localidades establecidas con información de herbario y bibliografía; con trabajo de campo se identificó la distribución, densidad y fenología como subcriterios para delimitar el área de extensión de presencia y de ocupación de la misma. Se tomaron datos estructurales (altura, cobertura y DAP) para determinar las clases de edades de la población. Con la información recopilada y de vegetación asociada, se re-categorizó la especie bajo el criterio B de la UICN. Se distribuye hacia el noroccidente y sur de Arcabuco, en un área de extensión de 59.9 km², de ocupación 4 km², y una densidad poblacional de 73 individuos/km². La floración y fructificación es continua en el año, sin embargo, la mayor floración es de marzo a agosto y la fructificación de septiembre a febrero. La estructura por edades, permitió identificar diez clases entre plántulas, juveniles y adultos. La población está representada por pocos individuos de plántulas (10.6 %) y juveniles (20.9 %), comparado con adultos (68.5 %). Finalmente, dadas las condiciones actuales de la población de <em>C</em>. <em>macrocarpa</em> se propone la recategorización del riesgo de extinción En Peligro Crítico (CR B1ab (iii)).</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: 200%; tab-stops: 118.5pt;"><em><br /></em></p

Evaluación poblacional y grado de amenaza de Chalybea macrocarpa (Melastomataceae) especie endémica de Colombia

Se presentan los resultados de la evaluación poblacional de Chalybea macrocarpa, considerada En Peligro (EN) por su área de distribución restringida, presión generada por cultivos y ganadería extensiva. El estudio se realizó en el departamento de Boyacá (Colombia), en el municipio de Arcabuco, en tres localidades establecidas con información de herbario y bibliografía; con trabajo de campo se identificó la distribución, densidad y fenología como subcriterios para delimitar el área de extensión de presencia y de ocupación de la misma. Se tomaron datos estructurales (altura, cobertura y DAP) para determinar las clases de edades de la población. Con la información recopilada y de vegetación asociada, se re-categorizó la especie bajo el criterio B de la UICN. Se distribuye hacia el noroccidente y sur de Arcabuco, en un área de extensión de 59,9 km2, de ocupación 4 km2, y una densidad poblacional de 50 individuos/km2. La floración y fructificación es continua en el año, sin embargo, la mayor floración es de marzo a agosto y la fructificación de septiembre a febrero. La estructura por edades, permitió identificar diez clases entre plántulas, juveniles y adultos. La población está representada por pocos individuos de plántulas (10,6 %) y juveniles (20,9 %), comparado con adultos (68,5 %). Finalmente, dadas las condiciones actuales de la población de C. macrocarpa se propone la recategorización del riesgo de extinción En Peligro Crítico (CR B1ab (iii)).Population assessment results from Chalybea macrocarpa are shown, the specie is considerate ENDANGERED (EN) by its restricted area, threatened is generated by crops and extensive cattle farming. The study was conducted in the Boyacá department (Colombia), municipality of Arcabuco, in three established localities using herbarium and literature information; field work made possible identified distribution, density and phenology like sub criteria, allowing identify the presence extension and occupancy area. We took structural data (height, coverage and DBH) to determinate the population age’s classes. Whit the gathered information and the associated vegetation, the specie is re-categorized with the B IUCN criteria. It is distributed to the northwest and southern in Arcabuco, in an area of 59.9 km2 , 4 km2 of occupancy and a population density of 50 individual/km2 . Flowering and fruiting is continuous through the year, however, most of the flowering is from March to August and fruiting from September to February. Age structure allows identified ten species between seedlings, juveniles and adults. Population is represented by few seedling individuals (10.6 %) and juveniles(20.9 %) versus adults(68.5 %). Finally, C. macrocarpa is upgraded to Critical Risk (CR B1ab (iii))

Uso de organismos vegetales no vasculares como indicadores de contaminación atmosférica urbana (Tunja, Boyacá, Colombia)

Los líquenes y briófitos son organismos útiles en la determinación de la calidad del aire. En la ciudad de Tunja (departamento de Boyacá, Colombia), es evidente la escasez de zonas verdes por el aumento en las construcciones, lo que contribuye al detrimento de la pureza atmosférica y trae consigo el deterioro de la salud de la ciudadanía y la reducción de los hábitats y poblaciones de las plantas criptógamas. Mediante la determinación del Índice de Pureza Atmosférica (IPA) se identificaron las zonas con mayor influencia de contaminantes del aire. Parmotrema austrosinense corresponde a la especie másfrecuencia; y la estación de la Normal Femenina, con IPA de 52,2196 es influenciada por los contaminantes atmosféricos; las estaciones de los Parques Santander y Semáforos son las más contaminadas (IPA 8,5333) con solo dos especies (Heterodermia albicans y Lobariaceae sp.). Se destaca la evaluación en la Reserva Forestal Protectora El Malmo con un IPA de 34,0281 y 23 especies. Los valores de IPA se agruparon en zonas de isocontaminación para ser representados cartográficamente. El uso de organismos bioindicadores es una estrategia natural y económica que permite zonificar las urbes y enfocar planes para revegetalización de ciudades, generando la disminución del impacto de contaminantes en el aire con el fin de mejorar la calidad de vida de los pobladores.Lichens and bryophytes are useful organisms in air quality determination. In the city of Tunja (Boyacá, Colombia), is evident the lack of green areas by the increase of building, which contributes to the detriment of the atmospheric purity making unhealthy conditions to the citizens and habitats and population reduction of cryptogamic plants. Using the Index of Atmospheric Purity (IAP) we identified the greater influence air pollutants areas. Parmotrema austrosinense has the highest frequency; and the Normal Femenina station with an IAP of 52,2196 is an atmospheric pollutants influenced area; Parque Santander and Semáforos, are the most contaminated (IAP 8,5333) with only two species (Heterodermia albicans and Lobariaceae sp.). We highlight the evaluation in the Reserva Forestal Protectora El Malmo with an IAP of 34,0281 and 23 species. IAP values were grouped in isocontamination areas to be represented cartographically. The use of bioindicators organisms is a natural and economic strategy allowing us to mapping urban areas and make revegetation cities designs, generating the contaminants diminution air impact improving the citizen’s life quality

Use of Non Vascular Plant Organisms as Indicators of Urban Air Pollution (Tunja, Boyacá, Colombiano)

<p class="p1">Lichens and bryophytes are useful organisms in air quality determination. In the city of Tunja (Boyacá, Colombia), is evident the lack of green areas by the increase of building, which contributes to the detriment of the atmospheric purity making unhealthy conditions to the citizens and habitats and population reduction of cryptogamic plants. Using the Index of Atmospheric Purity (IAP) we identified the greater influence air pollutants areas. <span class="s1">Parmotrema </span> austrosinense has the highest frequency; and the Normal Femenina station with an IAP of 52,2196 is an atmospheric pollutants influenced area; Parque Santander and Semáforos, are the most contaminated (IAP 8,5333) with only two species (<span class="s1"><em>Heterodermia albicans</em> </span>and <span class="s1">Lobariaceae </span> sp.). We highlight the evaluation in the Reserva Forestal Protectora El Malmo with an IAP of 34,0281 and 23 species. IAP values were grouped in isocontamination areas to be represented cartographically. The use of bioindicators organisms is a natural and economic strategy allowing us to mapping urban areas and make revegetation cities designs, generating the contaminants diminution air impact improving the citizen’s life quality.</p><p class="p1"> </p><p class="p1">USO DE ORGANISMOS VEGETALES NO VASCULARES COMO INDICADORES DE CONTAMINACIÓN ATMOSFÉRICA URBANA (TUNJA, BOYACÁ, COLOMBIA)</p><p class="p1">Los líquenes y briófitos son organismos útiles en la determinación de la calidad del aire. En la ciudad de Tunja (departamento de Boyacá, Colombia), es evidente la escasez de zonas verdes por el aumento en las construcciones, lo que contribuye al detrimento de la pureza atmosférica y trae consigo el deterioro de la salud de la ciudadanía y la reducción de los hábitats y poblaciones de las plantas criptógamas. Mediante la determinación del Índice de Pureza Atmosférica (IPA) se identificaron las zonas con mayor influencia de contaminantes del aire. <span class="s1">Parmotrema </span> austrosinense corresponde a la especie más frecuencia; y la estación de la Normal Femenina, con IPA de 52,2196 es influenciada por los contaminantes atmosféricos; las estaciones de los Parques Santander y Semáforos son las más contaminadas (IPA 8,5333) con solo dos especies <em>(</em><span class="s1"><em>Heterodermia albicans</em> </span>y <span class="s1">Lobariaceae </span>sp.).Se destaca la evaluación en la Reserva Forestal Protectora El Malmo con un IPA de 34,0281 y 23 especies. Los valores de IPA se agruparon en zonas de isocontaminación para ser representados cartográficamente. El uso de organismos bioindicadores es una estrategia natural y económica que permite zonificar las urbes y enfocar planes para revegetalización de ciudades, generando la disminución del impacto de contaminantes en el aire con el fin de mejorar la calidad de vida de los pobladores</p

An updated checklist of Araceae, Leguminosae and Myrtaceae of the department of Boyacá, Colombia, including keys to genera and new occurrence records.

Baseline checklists for the Leguminosae (Fabaceae), Araceae and Myrtaceae from the Colombian department of Boyacá are available from the Catalogue of Plants and Lichens of Colombia. These lists were supplemented by thorough herbarium and literature searches by a collaborative group of local and international experts, and further enhanced by local field collections. The result is authoritative taxonomic checklists for the three families including data regarding habit, plant uses and species conservation risk assessments for a subset of species. The checklists have notably increased the number of species reported from Boyacá and provide reliable, taxonomically up-to-date inventories for those families. Checklists are based on specimens vouchered in local herbaria and revised specimen metadata is lodged in the Colombian biological information platform CEIBA. The initiative demonstrates how relatively low levels of funding allow taxonomic experts working in networks to rapidly improve the taxonomic understanding of angiosperm species diversity in megadiverse countries like Colombia