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

Deep Multi-OMICs and Multi-Tissue Characterization in a Pre- and Postprandial State in Human Volunteers: The GEMM Family Study Research Design

Cardiovascular disease (CVD) and type 2 diabetes (T2D) are increasing worldwide. This is mainly due to an unhealthy nutrition, implying that variation in CVD risk may be due to variation in the capacity to manage a nutritional load. We examined the genomic basis of postprandial metabolism. Our main purpose was to introduce the GEMM Family Study (Genetics of Metabolic Diseases in Mexico) as a multi-center study carrying out an ongoing recruitment of healthy urban adults. Each participant received a mixed meal challenge and provided a 5-hours&#8217; time course series of blood, buffy coat specimens for DNA isolation, and adipose tissue (ADT)/skeletal muscle (SKM) biopsies at fasting and 3 h after the meal. A comprehensive profiling, including metabolomic signatures in blood and transcriptomic and proteomic profiling in SKM and ADT, was performed to describe tendencies for variation in postprandial response. Our data generation methods showed preliminary trends indicating that by characterizing the dynamic properties of biomarkers with metabolic activity and analyzing multi-OMICS data it could be possible, with this methodology and research design, to identify early trends for molecular biology systems and genes involved in the fasted and fed states

Proceedings Of The 23Rd Paediatric Rheumatology European Society Congress: Part Two

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International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN

Energy dependence of coherent photonuclear production of J/ψ mesons in ultra-peripheral Pb-Pb collisions at sNN \sqrt{{\textrm{s}}_{\textrm{NN}}} = 5.02 TeV

The cross section for coherent photonuclear production of J/ψ is presented as a function of the electromagnetic dissociation (EMD) of Pb. The measurement is performed with the ALICE detector in ultra-peripheral Pb-Pb collisions at a centre-of-mass energy per nucleon pair of $\sqrt{{\textrm{s}}_{\textrm{NN}}}$ = 5.02 TeV. Cross sections are presented in five different J/ψ rapidity ranges within |y| < 4, with the J/ψ reconstructed via its dilepton decay channels. In some events the J/ψ is not accompanied by EMD, while other events do produce neutrons from EMD at beam rapidities either in one or the other beam direction, or in both. The cross sections in a given rapidity range and for different configurations of neutrons from EMD allow for the extraction of the energy dependence of this process in the range 17 < W$_{γ Pb,n}$ < 920 GeV, where W$_{γ Pb,n}$ is the centre-of-mass energy per nucleon of the γPb system. This range corresponds to a Bjorken-x interval spanning about three orders of magnitude: 1.1 × 10$^{−5}$ < x < 3.3 × 10$^{−2}$. In addition to the ultra-peripheral and photonuclear cross sections, the nuclear suppression factor is obtained. These measurements point to a strong depletion of the gluon distribution in Pb nuclei over a broad, previously unexplored, energy range. These results, together with previous ALICE measurements, provide unprecedented information to probe quantum chromodynamics at high energies

Study of flavor dependence of the baryon-to-meson ratio in proton-proton collisions at s\sqrt{s} = 13 TeV

The production cross sections of D0 and Λc+ hadrons originating from beauty-hadron decays (i.e., nonprompt) were measured for the first time at midrapidity (|y|<0.5) by the ALICE Collaboration in proton-proton collisions at a center-of-mass energy s=13 TeV. They are described within uncertainties by perturbative QCD calculations employing the fragmentation fractions of beauty quarks to baryons measured at forward rapidity by the LHCb Collaboration. The bb¯ production cross section per unit of rapidity at midrapidity, estimated from these measurements, is dσbb¯/dy||y|<0.5=83.1±3.5(stat)±5.4(syst)-3.2+12.3(extrap) μb. The baryon-to-meson ratios are computed to investigate the hadronization mechanism of beauty quarks. The nonprompt Λc+/D0 production ratio has a similar trend to the one measured for the promptly produced charmed particles and to the p/π+ and Λ/KS0 ratios, suggesting a similar baryon-formation mechanism among light, strange, charm, and beauty hadrons. The pT -integrated nonprompt Λc+/D0 ratio is found to be significantly higher than the one measured in e+e- collisions

Charm production and fragmentation fractions at midrapidity in pp collisions at s \sqrt{\textrm{s}} = 13 TeV

Measurements of the production cross sections of prompt D$^{0}$, D$^{+}$, D$^{*+}$, ${\textrm{D}}_{\textrm{s}}^{+}$, ${\Lambda}_{\textrm{c}}^{+}$, and ${\Xi}_{\textrm{c}}^{+}$ charm hadrons at midrapidity in proton-proton collisions at $\sqrt{s}$ = 13 TeV with the ALICE detector are presented. The D-meson cross sections as a function of transverse momentum (p$_{T}$) are provided with improved precision and granularity. The ratios of p$_{T}$-differential meson production cross sections based on this publication and on measurements at different rapidity and collision energy provide a constraint on gluon parton distribution functions at low values of Bjorken-x (10$^{−5}$–10$^{−4}$). The measurements of ${\Lambda}_{\textrm{c}}^{+}$ (${\Xi}_{\textrm{c}}^{+}$) baryon production extend the measured p$_{T}$ intervals down to p$_{T}$ = 0(3) GeV/c. These measurements are used to determine the charm-quark fragmentation fractions and the $\textrm{c}\overline{\textrm{c}}$ production cross section at midrapidity (|y| < 0.5) based on the sum of the cross sections of the weakly-decaying ground-state charm hadrons D$^{0}$, D$^{+}$, ${\textrm{D}}_{\textrm{s}}^{+}$, ${\Lambda}_{\textrm{c}}^{+}$, ${\Xi}_{\textrm{c}}^0$ and, for the first time, ${\Xi}_{\textrm{c}}^{+}$, and of the strongly-decaying J/ψ mesons. The first measurements of ${\Xi}_{\textrm{c}}^{+}$ and ${\Sigma}_{\textrm{c}}^{0,++}$ fragmentation fractions at midrapidity are also reported. A significantly larger fraction of charm quarks hadronising to baryons is found compared to e$^{+}$e$^{−}$ and ep collisions. The $\textrm{c}\overline{\textrm{c}}$ production cross section at midrapidity is found to be at the upper bound of state-of-the-art perturbative QCD calculations.[graphic not available: see fulltext