4 research outputs found
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
Exploring gene networks in two sunflower lines with contrasting leaf senescence phenotype using a system biology approach
Background: Leaf senescence is a complex process, controlled by multiple genetic and environmental variables. In sunflower, leaf senescence is triggered abruptly following anthesis thereby limiting the capacity of plants to keep their green leaf area during grain filling, which subsequently has a strong impact on crop yield. Recently, we performed a selection of contrasting sunflower inbred lines for the progress of leaf senescence through a physiological, cytological and molecular approach. Here we present a large scale transcriptomic analysis using RNA-seq and its integration with metabolic profiles for two contrasting sunflower inbred lines, R453 and B481-6 (early and delayed senescence respectively), with the aim of identifying metabolic pathways associated to leaf senescence. Results: Gene expression profiles revealed a higher number of differentially expressed genes, as well as, higher expression levels in R453, providing evidence for early activation of the senescence program in this line. Metabolic pathways associated with sugars and nutrient recycling were differentially regulated between the lines. Additionally, we identified transcription factors acting as hubs in the co-expression networks; some previously reported as senescence-associated genes in model species but many are novel candidate genes. Conclusions: Understanding the onset and the progress of the senescence process in crops and the identification of these new candidate genes will likely prove highly useful for different management strategies to mitigate the impact of senescence on crop yield. Functional characterization of candidate genes will help to develop molecular tools for biotechnological applications in breeding crop yield.Fil: Moschen, Sebastián Nicolás. Instituto Nacional de TecnologĂa Agropecuaria. Centro Regional Tucuman-Santiago del Estero. EstaciĂłn Experimental Agropecuaria Famaillá; Argentina. Instituto Nacional de TecnologĂa Agropecuaria. Centro de InvestigaciĂłn en Ciencias Veterinarias y AgronĂłmicas. Instituto de AgrobiotecnologĂa y BiologĂa Molecular. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Oficina de CoordinaciĂłn Administrativa Parque Centenario. Instituto de AgrobiotecnologĂa y BiologĂa Molecular; ArgentinaFil: Marino, Johanna Magali. Universidad Nacional de San MartĂn; ArgentinaFil: Nicosia, Salvador. Instituto Nacional de TecnologĂa Agropecuaria. Centro de InvestigaciĂłn en Ciencias Veterinarias y AgronĂłmicas. Instituto de AgrobiotecnologĂa y BiologĂa Molecular. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Oficina de CoordinaciĂłn Administrativa Parque Centenario. Instituto de AgrobiotecnologĂa y BiologĂa Molecular; ArgentinaFil: Higgins, Janet. Earlham Institute; Reino UnidoFil: Alseekh, Saleh. No especifĂca;Fil: Astigueta, Francisco Horacio. Instituto Nacional de TecnologĂa Agropecuaria. Centro de InvestigaciĂłn en Ciencias Veterinarias y AgronĂłmicas. Instituto de AgrobiotecnologĂa y BiologĂa Molecular. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Oficina de CoordinaciĂłn Administrativa Parque Centenario. Instituto de AgrobiotecnologĂa y BiologĂa Molecular; ArgentinaFil: Bengoa Luoni, Sofia Ailin. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Centro CientĂfico TecnolĂłgico Conicet - La Plata. Instituto de Investigaciones BiotecnolĂłgicas. Instituto de Investigaciones BiotecnolĂłgicas "Dr. RaĂşl AlfonsĂn" (sede ChascomĂşs). Universidad Nacional de San MartĂn. Instituto de Investigaciones BiotecnolĂłgicas. Instituto de Investigaciones BiotecnolĂłgicas "Dr. RaĂşl AlfonsĂn" (sede ChascomĂşs); ArgentinaFil: Rivarola, Maximo Lisandro. Instituto Nacional de TecnologĂa Agropecuaria. Centro de InvestigaciĂłn en Ciencias Veterinarias y AgronĂłmicas. Instituto de AgrobiotecnologĂa y BiologĂa Molecular. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Oficina de CoordinaciĂłn Administrativa Parque Centenario. Instituto de AgrobiotecnologĂa y BiologĂa Molecular; ArgentinaFil: Fernie, Alisdair R.. No especifĂca;Fil: Blanchet, Nicolas. Centre National de la Recherche Scientifique; FranciaFil: Langlade, Nicolas B.. Centre National de la Recherche Scientifique; FranciaFil: Paniego, Norma Beatriz. Instituto Nacional de TecnologĂa Agropecuaria. Centro de InvestigaciĂłn en Ciencias Veterinarias y AgronĂłmicas. Instituto de AgrobiotecnologĂa y BiologĂa Molecular. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Oficina de CoordinaciĂłn Administrativa Parque Centenario. Instituto de AgrobiotecnologĂa y BiologĂa Molecular; ArgentinaFil: Fernández, Paula. No especifĂca;Fil: Heinz, Ruth Amelia. Instituto Nacional de TecnologĂa Agropecuaria. Centro de InvestigaciĂłn en Ciencias Veterinarias y AgronĂłmicas. Instituto de AgrobiotecnologĂa y BiologĂa Molecular. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Oficina de CoordinaciĂłn Administrativa Parque Centenario. Instituto de AgrobiotecnologĂa y BiologĂa Molecular; Argentin