4 research outputs found
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
Compuestos fotovoltaicos del sistema Cu-Sn-S por el mĂ©todo de rocĂo pirolĂtico como alternativa ambientalmente amigable
"A lo largo del presente trabajo se sintetizaron y caracterizaron con Ă©xito capas delgadas del compuesto ternario del sistema cobre-estaño-azufre, el cual se propone como alternativa para la capa absorbente de una celda solar. La propuesta se basa en que los elementos usados para el compuesto son amigables con el medio ambiente y son abundantes, fáciles de reciclar, menos costosos y no tĂłxicos. Su posible uso para fines fotovoltaicos impulsarĂa el incremento en el uso de una energĂa renovable que estarĂa al alcance de un mayor sector de la poblaciĂłn. TambiĂ©n hay beneficios al medio ambiente por el uso de una energĂa no contaminante. El mĂ©todo de sĂntesis usado fue el rocĂo pirolĂtico por ser econĂłmico, sencillo, fácil de usar y podrĂa ser implementado para una producciĂłn a gran escala. Se adaptĂł tambiĂ©n el mĂ©todo SILAR (Successive Ion Layer Adsorption and Reaction) a esta tĂ©cnica para el depĂłsito de las capas delgadas. Se realizaron caracterizaciones de espectroscopĂa Raman, microscopĂa Ăłptica, UV visible y perfilometrĂa. Del análisis se infiere que hay una alta probabilidad de haber obtenido el compuesto ternario Cu2SnS3, con un band gap alrededor de 1.28 eV, cerca del Ăłptimo para capas absorbentes de celdas solares. El espesor calculado es aproximadamente 300 nm. Algunas sugerencias contemplan un tratamiento tĂ©rmino más prolongado asĂ como los depĂłsitos SILAR multicapa para pruebas futuras con miras a mejorar sus propiedades fotovoltaicas.