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

Imogolite: A nanotubular aluminosilicate: Synthesis, derivatives, analogues, and general and biological applications

Imogolite is an aluminosilicate mineral originally found in volcanic ash derived soils. Through the use of chemical synthesis methods this mineral has been successfully synthesized and a number of modified similar nanomaterials have also been produced. Due to its nanotubular arrangement this mineral shows a similar structure to carbon nanotubes and as such has been investigated for possible applications in a range of fields like polymer composites, gas storage, adsorption and catalysis. This review will start with an introduction to the basic characteristics of imogolite, followed by the synthetic methods of production, techniques for the production of composite and hybrid materials, characterization, potential applications, and, finally, biological applications, focusing particularly on composites with biological molecules and interactions with living cells as well as toxicological activity. This journal i

Sources and fates of perchlorate in soils in Chile : A case study of perchlorate dynamics in soil-crop systems using lettuce (Lactuca sativa) fields.

Perchlorate occurs naturally in the environment in deposits of nitrate and can be formed in the atmosphere and precipitate into soil. However, little is known about the occurrence and levels of perchlorate in soils and fertilizers in Chile and its impacts on agricultural systems and food safety. In this study, concentrations of perchlorate were determined in 101 surface soils and 17 fertilizers [nitrogenous (n = 8), nitrogen-phosphorous-potassium (NPK; n = 3), phosphate (n = 2) and non-nitrogenous (n = 4)] collected across Chile from 2017 to 2018. Our results show that perchlorate was detected mainly in agricultural soils (mean: 0.32 ng g−1), grassland rotation sites (0.41 ngg−1) and urban locations (0.38 ng g−1). Interestingly, elevated concentrations of perchlorate (9.66 and 54.0 ng g−1) were found in agricultural soils. All fertilizers contained perchlorate: nitrogenous fertilizers (mean: 32.6 mg kg−1), NPK (mean: 12.6 mg kg−1), non-nitrogenous fertilizers (mean: 10.2 mg kg−1) and phosphates (mean: 11.5 mg kg−1). Only one type of nitrogenous fertilizer (KNO3: 95.3 mg kg−1) exceeded the international regulation limit (50 mg kg−1). For two agronomic practices, the content of perchlorate in lettuce increased as the fertilizer application rate increased, with fertigation promoting a more significant accumulation. However, the concentrations generally remained below regulatory values. Our results suggest that fertilizers constitute an important source of perchlorate in soils.</p

Copper/Silver Bimetallic Nanoparticles Supported on Aluminosilicate Geomaterials as Antibacterial Agents

This study aims to understand how properties of modified aluminosilicate geomaterials influence the antibacterial performance of nanocomposites when prepared with bimetallic nanoparticles (NPs). Copper/silver (Cu/Ag) bimetallic NPs were synthesized in the presence of imogolite (Imo), montmorillonite (Mtt), or zeolite (Zeo) using a simple one-pot method and characterized for their crystal phases, micro- and nanomorphologies, particle size, elemental composition, and electrophoretic mobility. The antibacterial activity was evaluated through minimum inhibition concentration assays of NPs and nanocomposites for Gram (-) Escherichia coli and Gram (+) Staphylococcus aureus bacteria. Deposition of metallic Cu0, Ag0, and cuprite NPs was confirmed in Zeo_Cu/Ag and Imo_Cu/Ag nanocomposites, whereas only Cu0 and Ag0 were identified in Mtt_Cu/Ag. The bimetallic NPs were more uniformly distributed on Zeo and Mtt than Imo. Particle sizes of 28.1 ± 5.0, 9.4 ± 2.3, 10.1 ± 1.7, and 12 ± 1.3 nm were determined for Cu/Ag NPs, Imo_Cu/Ag, Mtt_Cu/Ag, and Zeo_Cu/Ag, respectively. The release rate of Cu and Ag ions from Zeo_Cu/Ag was higher than those of pristine Cu/Ag NPs and the other two nanocomposites. The antimicrobial action of bimetallic NPs and nanocomposites was dose-dependent in relation to the concentration of concerned materials and their stability in the medium. The physicochemical characteristics of Zeo resulted in a homogeneous distribution and low oxidation and agglomeration of Cu/Ag NPs, consequently increasing the antibacterial activity. Results of this study highlight the benefits of using a geomaterial support to achieve high antibacterial activity of bimetallic NPs, which could help reduce the consumption of pure Cu/Ag salts in NP-based antibacterial applications