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

Study of structural and thermal changes in endosperm of quality protein maize during traditional nixtamalization process

This work presents the study of the structural changes of the endosperm of Quality Protein Maize (QPM H-368C), modified by alkaline cooking at two different temperatures (72 and 92 degrees C) and steeping time of 0-7 hr. Structural changes in the outermost 10% layers, the subsequent 10%, and the remaining 80% of the endosperm as a function of the steeping time were studied using scanning electron microscopy (SEM), X-ray diffraction, and differential scanning calorimetry (DSC) techniques. SEM images revealed that soft and hard endosperm have different shapes and packing factors. The X-ray diffraction patterns of the hard and soft endosperm from raw corn suggest that the hard endosperm consists mainly of amylopectin and has a bigger relative crystallinity quality than the soft endosperm. Samples cooked at 72 and 92 degrees C with and without the Ca(OH)(2) and steeped for 0, 3, and 7 hr, showed structural changes, X-ray diffraction patterns from the outermost 10% layers and subsequent 10% of the endosperm were completely amorphous. This fact is related to the total or partial gelatinization of the starch. The crystallinity in the internal layers of endosperm (remaining 80%) did not have significant changes after the treatments and exhibited the characteristic patterns of crystalline amylose and amylopectin. DSC measurements in the outermost layers of the endosperm did not exhibit the characteristic endothermic peak of starch (from 64 to 81 degrees C) compared with the raw sample, while the endotherm peak for 80% of the endosperm internal layers appears in all cases (72 and 92 degrees C). According to these results, a new definition of the nixtamalization process can be developed as follows. During the nixtamalization process there is a total gelatinization of the starch granules from the most external layers, and a partial gelatinization of the innermost internal layers of the endosperm

Analysis of quality protein changes in nixtamalized QPM flours as a function of the steeping time

This study showed the protein changes in Quality Protein Maize (QPM H-368C) during the traditional nixtamalization process as a function of the steeping time from 0 to 15 hr. Protein content (N x 6.25), pH, protein fractionation, reactive lysine, essential amino acids, and protein digestibility were analyzed to explain the protein quality modifications in nixtamalized corn flours (NQF). The thermoalkaline process increased significantly (P <= 0.05) the protein content (5.57 +/- 0.86%) in NQF obtained at 3, 5, 7, 9, 11, 13, and 15 hr of steeping time compared with native corn or corn without treatment (NC). The pH values of NQF were not proportional to the steeping time and significantly different (P <= 0.05) between them. At 5 hr critical steeping time, the total lysine and reactive lysine content decreased severely (36 and 32%, respectively) with statistical differences (P <= 0.05) compared with NC. On the other hand, the tryptophan content decreased significantly (P <= 0.05) at steeping times of 5-15 hr (38.70 +/- 6.7%) compared with NC. The changes in the lysine and tryptophan content were not proportional to the steeping time. The protein recovery in the albumin and globulin fraction diminished (P <= 0.05) with respect to raw corn. The protein recovery for gamma-zeins, glutelin-like proteins, glutelins, and residue increased. A significant (P <= 0.05) decrease was found in the essential amino acids in NQF with 3-7 hr of steeping time compared with NC. Equally important was the reduction in protein digestibility observed in NQF steeped at long steeping times (11-15 hr) with significant (P <= 0.05) differences compared with NC. The protein solubility distribution along the steeping step and the essential amino acids location, specifically lysine in corn kernel, could explain partially the protein quality changes observed in this research. Finally, these results contribute to reconciling discrepancies associated with the protein quality modifications in nixtamalized corn reported previously in literature

Protein markers and seed size variation in common bean segregating populations

18 páginas, 7 tablas.Selection and random genetic drift are the two main forces affecting allele frequencies in common bean breeding programs. Therefore, knowledge on allele frequency changes attributable to these forces is of fundamental importance for breeders. The changes in frequencies of alleles of biochemical markers were examined in F2 to F7 populations derived from crosses between cultivated Mesoamerican and Andean common bean accessions (Phaseolus vulgaris L.). Biochemical markers included the seed proteins phaseolin, lectin and other seed polypeptides, and six isozymes. The Schaffer’s test detected a high significant linear trend of the 63% of the polymorphic loci studied, meaning that directional selection was acting on those loci. Associations between seed size traits, phaseolin seed-storage protein and isozyme markers were detected based on the comparisons of the progeny genotypic means. In the interracial populations the intermediate form PhaH/T, b6, and Rbcs 98 alleles had a positive effect on seed size. In the inter-gene pool populations, a higher transmission of Mesoamerican alleles in all loci was showed, although the Andean alleles PhaT, Skdh 100 , Rbcs 98 , and Diap 100 showed positive effects on seed weight. Our results suggest that phaseolin and other seed proteins markers are linked to loci affecting seed size. These markers have good potential for improving the results of the selection and should be considered as a strategy for germplasm enhancement and to avoid the reduced performance of the inter-gene pool populations.Research was supported by the projects AGF97-0324 and AGL2005-01268/AGR from the Spanish Government, PGIDIT02RAG40301PR from the Galician Government (Spain), and EU-FEDER Funds. A. M. González thanks her fellowship to Ministry of Education, Culture and Sports of Spain. M. De la Fuente is grateful to the Xunta de Galicia for awarding her a fellowship grant.Peer reviewe