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

Postura teórico-crítica acerca de los conceptos relacionados con la experiencia de vida trans*: un análisis bibliométrico

Esta investigación fue creada a partir de los intereses de tres estudiantes, las cuales tuvieron la iniciativa de hacer una crítica frente a conceptos que se encuentran relacionados con la experiencia de vida Trans*, para llevar a cabo este proyecto se entrevistó a unos expertos e inexpertos en el tema, por medio de sus respuestas se planteó la dirección del proyecto a desarrollar, igualmente se desprenden apartados que abordan la historia de la experiencia de vida Trans* y las diferentes investigaciones relacionadas al tema de investigación. Después de haber escogido las categorías, se comenzó el proceso de investigación, recolectando autores y sus posturas frente a las categorías a analizar en esta investigación, como lo son: Sexo, género, deseo, Transgenero, Transexual y No binario. Para esta recolección de datos, se usó una matriz, mediante la cual se desarrollaron los resultados de esta investigación, seguido a eso se desarrolla la discusión con base al marco teórico acompañado con las conclusiones para esta investigación. Palabras clave: Transgenero, transexual, genero, sexo, orientación sexual.This research was created based on the the interests of three students who had the initiative to make a critique of concepts that are related to the experience of Trans* life, to carry out this project, some experts and non-experts on the subject were interviewed, through their answers the direction of the project to develop was proposed, there also sections that deal with the history of Trans* life experience and the different research related to the research topic are also included. After having chosen the categories, the research process began, collecting authors and their positions regarding the categories to be analyzed in this research, such as: sex, gender, desire, transgender, transsexual and non-binary. For this data collection, a matrix was used, through which the results of this research were developed, then the discussion based on the theoretical framework accompanied by the conclusions for this research. Key words: transgender, transsexual, gender, sex, sexual orientation1. Introducción. -- 2. Justificación. -- 3. Problema de Investigación. -- 4. Pregunta Problema. -- 5. Objetivos. -- 6. Marco de Referencia. -- 7. Marco Empírico. -- 8. Marco Histórico. -- 9. Referentes Teórico-Conceptual. -- 10. Referentes Teórico-Conceptual. -- 11. Marco Legal y Consideraciones Éticas. -- 12. Metodología. -- 13. Tipo de Investigación. -- 14. Población y Muestra. -- 15. Procedimiento. -- 16. Resultados. -- 17. Discusión. -- 18. Conclusiones. -- 19. Recomendaciones. -- 20. Referencias Bibliográficas. -- 21. Apé[email protected]@[email protected]