Spatial distribution and community structure of megabenthic bivalves in the subtidal area of the Gulf of Cádiz (SW Spain)

VENUSEstudio integral de los bancos naturales de moluscos bivalvos en el Golfo de Cádiz para su gestión sostenible y la conservación de sus hábitats asociado

Spatial distribution patterns of the striped venus clam (Chamelea gallina, L. 1758) natural beds in the Gulf of Cádiz (SW Spain)

VENUSEstudio integral de los bancos naturales de moluscos bivalvos en el Golfo de Cádiz para su gestión sostenible y la conservación de sus hábitats asociado

Investigación y gestión pesquera como elementos clave para alcanzar la sostenibilidad de la pesquería de chirla Chamelea gallina (Linnaeus, 1758) en las aguas españolas del Golfo de Cádiz

Fondos FEMP Andalucí

Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch

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

First insights into population parameters and spatial distribution of the two morphotypes of Mactra stultorum (brownish and whitish) (Linnaeus, 1758) (Mollusca: Bivalvia) along the southwestern Spanish coast

The aim of this study was to address an analysis of spatial distribution, reproduction, population parameters and secondary production of the natural beds of the well-defined morphotypes of the clam Mactra stultorum (brownish and whitish variants) along the SW Spanish coast. The main findings showed that the presence and the frequencies of both morphotypes increased near the estuaries of rivers, particularly the Guadalquivir River. However, subtle differences in habitat preferences have been revealed and the brownish variant showed a wider and deeper distribution. High similarity in the gonadal development was recorded for both variants. It started in January, continued into late winter and early spring and ended with a spawning period from April to August. An energy storage-utilization cycle, coupled to the reproductive and resting periods and driven by sea water temperature variations and food availability, was also observed. The abovementioned period of gamete emissions resulted in a recruitment pattern with a one-time settlement period per year. Von Bertalanffy growth functions provided an asymptotic length of 46.7 mm (whitish) and 50 mm (brownish) and growth constants of 0.55 (whitish) and 0.50 yr−1 (brownish). The mean annual biomass (B ̅) ranged between 0.062 (whitish) and 0.076 g AFDW m−2 yr−1 (brownish) (AFDW: ash-free dry mass). Individual somatic production showed the highest value at 32 and 34 mm shell length, and annual production (P) ranged between 0.075 and 0.113 g AFDW m−2 yr−1, resulting in renewal rate (P/B ̅) values between 1.21 and 1.37, for the whitish and brownish variants, respectively. These results provide basic knowledge about the reproduction and population dynamics of this species along the Atlantic coast, particularly in the sandflats near the estuary of the Guadalquivir River. They could also shed additional light upon taxonomic differentiation and clarify the ecological role of both variants when compared with two bivalve sympatric species of the intertidal and subtidal areas.Versión del editor1,48