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

Effect of decontamination treatment on the quality of dehydrated thyme, coriander, and mustard

The objective of this work was to evaluate the effects of different decontamination treatments on the quality of dehydrated thyme, coriander, and mustard. Treatments applied were: (i) ultraviolet radiation treatment irradiation; (ii) steam, (iii) steam–ultraviolet radiation treatment; (iv) humidification–ultraviolet radiation treatment, and (v) steam–humidification–ultraviolet radiation treatment. Their effectiveness to control indigenous aerobic mesophiles and yeasts and molds population was assessed by plate count. The effect of proposed treatments on total polyphenol contents and antioxidant activity was also evaluated. Furthermore, the effect of treatments on spices performance to prevent canola oil oxidation was also analyzed. The use of steam– ultraviolet radiation treatment in aqueous medium was the most effective for decontamination, reducing the aerobic mesophiles and yeasts and molds counts between 1.0 and 2.2 log CFU/g dry spice. This treatment decreased significantly the polyphenol content and the antioxidant capacity of the three spices analyzed. However, in the case of mustard, the residual antioxidant compounds were able to control canola oil oxidation more efficiently than butylated hydroxytoluene. Results suggest that the use of steam–ultraviolet radiation treatment in aqueous medium can be useful in food preservation processes.Fil: Ferriccioni, Natalia. Universidad Tecnológica Nacional. Facultad Regional Buenos Aires; ArgentinaFil: Mateucci, Ricardo Rafael. Universidad Tecnológica Nacional. Facultad Regional Buenos Aires; ArgentinaFil: Zangrando, Agustina. Universidad Tecnológica Nacional. Facultad Regional Buenos Aires; ArgentinaFil: Santana, Susana Noemi. Universidad Tecnológica Nacional. Facultad Regional Buenos Aires; ArgentinaFil: Campos, Carmen Adriana. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias. Instituto de Tecnología de Alimentos y Procesos Químicos. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Tecnología de Alimentos y Procesos Químicos; Argentin

Desarrollo de un aderezo saludable a base de aceite de canola: influencia de la viscosidad en la percepción del sabor y preferencias de los consumidores

El aceite de canola (fuente de vitamina E)contiene grasos esenciales, omega 3 y omega 6.El objetivo de este trabajo fue desarrollar un aderezo con bajo contenido graso, saludable y sabroso. Para la mezcla base se probaron dos gomas –guar y xántica- con el agregado de inulina como fibra saludable, aceite de canola, mostaza en polvo y betacaroteno como colorante. La saborización se realizó ensayando siete condimentos y sus combinaciones. Las muestras fueron caracterizadas por su comportamiento reológico y la preferencia de los consumidores.Fil: Whelan, María Rosario. Universidad Tecnológica Nacional. Facultad Regional Buenos Aires; ArgentinaFil: Cairo, Federico. Universidad Tecnológica Nacional. Facultad Regional Buenos Aires; ArgentinaFil: Zangrando, Agustina. Universidad Tecnológica Nacional. Facultad Regional Buenos Aires; ArgentinaFil: Hovsepian, Julieta. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Facultad de Ciencias Agrarias; ArgentinaFil: Santana, Susana Noemi. Universidad Tecnológica Nacional. Facultad Regional Buenos Aires; ArgentinaFil: Zamora, María Clara. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires"; ArgentinaFil: de Breier, Rosa M.. Universidad Tecnológica Nacional. Facultad Regional Buenos Aires; Argentin