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

Molecular interaction study of some ortho and para substituted anilines with 1-octanol

Interactions between ortho and para substituents of anilines such as chloroaniline, methylaniline and methoxyaniline with 1-octanol have been studied in carbon tetrachloride. The most likely association of complex between 1-octanol and substituents of anilines is 1: 1 stoichiometric complex, through hydroxyl group of 1-octanol and amine group of ortho and para substituents of anilines. Interactions are studied on the bases of formation constant and free energy changes. Formation constant of the complex has been calculated using Nash method. The result shows that molecular interaction of 1-octanol as proton donor with methyl and chloride substitution of anilines in ortho position is smaller than the para position substitution of anilines. The results shows, the ability of acceptors is in the order p-methoxyaniline<o-chloroaniline<o-methylaniline<o-methoxyaniline<p-chloroaniline<p-methylaniline

Variation of amino acids in some biological and pharmaceutical sample ft-ir study

Abstract: Variation of amino acids between biological sample ( Rice powder, nelli powder an lemon powder) and pharmaceutical sample ( Vitamin A , Vitamin B12 and Vitamin C) has been studied using FTIR spectroscopy. Spectroscopic analyses of biological and pharmaceutical samples are discussed. It has been found that the variation in amino acids with the variation in biological and pharmaceutical samples are correlated and the present study confirms the total amino acid content is very much lower in biological samples compared to pharmaceutical sample. Also an attempt has been made to correlate the extinction co-efficient (K) values with the changes in amino acid and phenols of the biological and pharmaceutical sample. The result shows amino acid and phenol groups are more in pharmaceutical samples then biological sample.

Molecular interaction study of n-benzylformamide with 1-alcohols using x-band microwave

The secondary amide unit is a subject of particular interest, because of its occurrence in peptides and proteins. Molecular interaction between N-benzylformamide (NBF) with 1-alcohols (1-propanol, 1-butanol, 1-pentanol) has been studied in carbon tetrachloride by using X-band microwave bench at 936 GHz. Dielectric constant (ε') and dielectric loss (ε″) of alcohol and NBF and their binary mixture for different mole fractions of NBF have been determined. Dielectric relaxation time (τ) of the binary system is obtained by both Higasi's method and the Gopalakrishna single-frequency concentration variational method. The results show that the most likely interaction between alcohols and NBF is 1:1 complex for binary mixture through the free hydroxyl group of the alcohol and the carbonyl group of NBF. The alkyl chain-length of both alcohol and amide plays an important role in the determination of the strength of hydrogen bond (O–H: C=O) formed. The variation of relaxation time of NBF+1-alcohol mixtures in CCl4 indicates a weak solute-solvent type of molecular association. The result shows that as the relaxation time of the proton acceptor increases, the donating ability of the solute environment increase

Influence of KI salt concentration on the hydroxypropyl methylcellulose films: Optical study

Herein the optical properties of Hydroxypropyl methylcellulose/Potassium iodide (HPMC/KI) composite films were determined. The casting technique was introduced to make HPMC/KI films with different KI salt concentrations (0.1-1) wt%. The absorbance model was used to determine parameters like absorption edge, refractive index, real and imaginary sections of the optical dielectric function, extinction coefficient, Urbach energy, band gap, and optical conductivity in the spectral range 200-800 nm. As shown by the study, KI salt doping affects the optical properties of HPMC. The absorption edge (Ee) was widely displaced towards a region of lower photonic energy. The direct and indirect optical bandwidth gaps were lowered from 5.6 to 2.56 eV and 5.86 to 2.5 eV for the 1 wt % HPMC/KI film, respectively. The optical dielectric loss method was effectively employed as an alternate method for estimating the optical band gap. In addition, Tauc's extrapolation method identified the kind of electronic transition. The variation of the optical energy band gap and optical dielectric constant (epsilon 1) based on KI salt concentration was used to investigate the credibility of Penn's model. In KI salt-composite films, an increase in Urbach energy and optical conductivity was observed which may be evidence of a large shift from tail-to-tail and band-to-tail transitions. Meanwhile, X-ray diffraction (XRD) examination revealed that the KI salts damaged the HPMC polymer's crystalline phase. Lastly, the films were subjected to Fourier Transform Infrared Spectroscopy (FTIR). The considerable variation in transmittance and band change was observed for doped films in FTIR spectra