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

Long-Term Evaluation of Mesophilic Semi-Continuous Anaerobic Digestion of Olive Mill Solid Waste Pretreated with Steam-Explosion

13 Páginas.-- 5 Tablas.-- 7 FigurasSteam-explosion is a promising technology for recovering phenolic compounds from olive mill solid waste (OMSW) due to its high impact on the structure of the fibre. Moreover, the recovery of the phenols, which are well-known microbial inhibitors, could improve the subsequent biomethanization of the dephenolized OMSW to produce energy. However, there is a considerable lack of knowledge about how the remaining phenolic compounds could affect a long-term biomethanization process of steam-exploded OMSW. This work evaluated a semi-continuous mesophilic anaerobic digestion of dephenolized steam-exploited OMSW during a long operational period (275 days), assessing different organic loading rates (OLRs). The process was stable at an OLR of 1 gVS/(L·d), with a specific production rate of 163 ± 28 mL CH4/(gVS·d). However, the increment of the OLR up to 2 gVS/(L·d) resulted in total exhaust of the methane production. The increment in the propionic acid concentration up to 1486 mg/L could be the main responsible factor for the inhibition. Regardless of the OLR, the concentration of phenolic compounds was always lower than the inhibition limits. Therefore, steam-exploited OMSW could be a suitable substrate for anaerobic digestion at a suitable OLRThis research was funded by the [Spanish Ministry of Economy and Competitiveness] through Project grant number CTM2014-55095-R and the Ramon y Cajal Programme (RyC 2012-10456). Sergio López acknowledges the financial support from the ‘V Own Research Plan’ of the University of Seville (VPPI-US) for his research contract. This contracts is cofunded by the European Social Fund.Peer reviewe

Aportes a la Investigación Educativa en la Región Altos de Jalisco

Hoy, más que nunca, la generación y aplicación del conocimiento requiere de la participación de toda la comunidad académica, ya que ésta propicia el incremento en la producción y calidad de la investigación de cualquier disciplina científica, especialmente en el campo de las ciencias de la educación. Tal afirmación se desprende del hecho de que la educación, como mecanismo social que ha permitido transmitir de generación en generación conocimientos, valores, costumbres y formas de actuar, requiere siempre de la participación activa de diversas personas, grupos o comunidades para el logro de sus objetivos. En tal sentido, resulta evidente que para la elaboración del presente texto, el trabajo en grupo ha sido fundamental, como se observará en sus capítulos. Para quien nos lee, resulta interesante saber que los tópicos que se abordan en la presente obra giran fundamentalmente alrededor de la instrucción que se imparte de manera formal en los diversos niveles educativos de la región Altos Sur de Jalisco, y que además, aparecen capítulos que tratan tópicos de interés actual, como son los procesos lecto-escriturales y los relacionados con la calidad de la educación superior. De forma específica, las temáticas que se tocan en las diversas secciones son las siguientes: en primer orden se presenta el panorama actual y el futuro de la educación básica en la región de los Altos del Estado de Jalisco; posteriormente, se aborda un tema de interés general, a saber, la lectura y redacción como competencias para la transformación personal y social; enseguida, se muestra el estado que guarda en materia de educación superior la región geográfica antes señalada. Se reflexiona en torno a la identidad docente que ante los procesos de evaluación y acreditación ha asumido un sector importante de los profesores del nivel superior universitario

Blood transfusion and iatrogenic risks in Mexico city: anti-Trypanosoma cruzi seroprevalence in 43,048 blood donors, evaluation of parasitemia, and electrocardiogram findings in seropositive

Iatrogenous transmission of Trypanosoma cruziby blood transfusion was suggested as a potential risk by Pellegrino (1949). Seropositive blood donors in Mexico were first reported in 1978, however, limited information is available due to small sampling, the use of heterogeneous serologic assays, and geographically limited studies. A wide survey carried out in 18 out of the 32 states of Mexico, showed a national mean of 1.6% seropositive among 64,969 donors, ranging from 0.2 to 2.8%. In the present study, we have screened 43,048 voluntary blood donors in a period of five years at the Instituto Nacional de Cardiología I. Chávez, a concentration hospital located in Mexico city which serves mainly the metropolitan area and accepts from all over the country. Standardized ELISA and IIF were used to identify seropositive individuals in addition to hemoculture, PCR and standard 12 lead ECG tests that were applied to a group of seropositive patients (29/161). The result showed a seropositivity of 0.37% (161/43,048). From the group of seropositive individuals 40% (12/29) were potential carriers of T. cruzi at the donation time and 5/29 had subclinical ECG abnormalities. Parasitological tests performed in 70 erythrocyte and platelet fractions from seropositive units (70/161) showed negative results. Our findings strongly support T. cruzi screening in the transfusion medicine practice and identify subclinical heart disease among seropositive blood donors

Investigaciones en construcción

El Instituto Unidad de Investigaciones Jurídico-Sociales Gerardo Molina, UNIJUS promueve y apoya el desarrollo e implementación de programas y proyectos de investigación que aporten al conocimiento de la realidad nacional e internacional, de las instituciones jurídicas, políticas y sociales, así como de las teorías jurídicas y políticas que contribuyan a la construcción de nuevas propuestas para la solución de las problemáticas que aquejan la sociedad. Por tal motivo, es fundamental el apoyo constante a la formación de semilleros de investigación en la Facultad de Derecho, Ciencias Políticas y Sociales de la Sede Bogotá, así como la consolidación de los semilleros ya existentes. En el año 2012, se desarrollaron las Convocatorias No. 12 y No. 13 para la selección de semilleros de Investigación en modalidad I y modalidad II. Como resultado de dicho proceso fueron seleccionadas doce propuestas de investigación integradas por un total de 32 estudiantes, quienes a su vez se encontraban vinculados a nueve grupos de investigación

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2