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

Successful production of antibodies against extra cytoplasmic loops of the Mycobacterium tuberculosis ABC transporter Rv1819c

Antibodies are important tools for the study of membrane proteins in biological, biophysics andstructural analyses. However, the production of purified membrane proteins is still a formidable challenge due to the amphipathic character and inherent instability of these proteins. In this work, we tested a strategy for producing antibodies against an ATP-Binding Cassette (ABC) transporter without the need to produce the full membrane complex. Instead, just the extra cytoplasmic regions of the ABC-type transporter Rv1819c from Mycobacterium tuberculosis were presented in the RAD-display, a scaffold system based on the engineered Pyrococcus furiosus RadA protein developed for exposition of peptides. The RadA scaffold protein is highly stable, can tolerate long insertions and easy to produce in Escherichia coli. Based on the three-dimensional structure of Rv1891c, we selected two versions of the main extracellular loops of the permease to use as test cases for this approach. Rv1819c-derived peptides displayed on RAD display system were used for immunization of mice and production of polyclonal antibodies. These antibodies were able to recognize the transporter in M. tuberculosis cell extracts, on intact cells by fluorescence-activated cell sorting (FACS), and aspurified protein. The results showed the approach can be a useful tool for in vitro analyses, screening, andevaluation of different epitopes in membrane proteins

BIOTECNOLOGIA PARA DESENVOLVIMENTO RURAL EM ASSENTAMENTOS DO MUNICÍPIO DE CARAPEBUS-RJ EE MITIGAÇÃO DOS IMPACTOS AMBIENTAIS NO PARNA JURUBATIBA

A agricultura familiar é praticada por grande quantidade de agricultores na Região Norte Fluminense que estão inseridos de diferentes formas no sistema agrícola de produção regional. Em função do arranjo produtivo, existem localidades agrícolas com diferentes graus de deterioração ambiental, de problemas agrários e de dificuldades econômicas. Porém, a produtividade das lavouras geralmente são baixas quando comparadas com as de outras regiões. Este tem sido um dos principais motivos para a perda de espaço deste setor na economia local. Este fato é atribuído às condições edafoclimáticas da região, infra-estrutura sócio-econômicas pouco adequadas e os baixos níveis de tecnologia empregados por estes agricultores. Estudos feitos na região mostram que uma reversão do atual quadro, passaria por aprimoramento tecnológico, com a inserção de novas tecnologias que proporcione um substancial crescimento da produtividade na região. Isso pode provocar abandono da prática agrícola, gerar situações de insegurança alimentar e nutricional. Esse problema pode afetar não só as próprias famílias agricultoras, mas também a sociedade em geral, que depende dos produtos para consumo. Nesse cenário, a utilização de biotecnologias de micropropagação é uma alternativa viável para a produção de mudas de alta qualidade de espécies vegetais de interesse econômico, seja para utilização própria ou comercialização com terceiros. Isso permite o aumento da rentabilidade do agricultor em função da melhora na produtividade e possibilidades de novos negócios. Além disso, essa tecnologia, aliada a produção de fertilizantes orgânicos possibilita o desenvolvimento e manejo de agrossistemas sustentáveis aliando a produção, conservação tanto da agrobiodiversidade como da biodiversidade em geral.   Nesse contexto, o projeto “Integrando Tecnologias Agroecológicas para Promoção do Desenvolvimento Rural em Assentamentos do Município de Carapebus-RJ e Mitigação dos Impactos Ambientais no PARNA Jurubatiba” objetiva transferir conhecimento biotecnológico de produção agrícola sustentável, fortalecendo o sistema produtivo de agricultores do entorno do Parque Nacional de Jurubatiba para mitigar impactos provocados pelas atividades agrícolas. Para isso, realizamos de cursos (teóricos e práticos) ministrados por pesquisadores especialistas a) Curso básico de Botânica aplicada a exploração sustentável; b) Micropropagação: produção de mudas para agricultura familiar; c) Produção de adubos orgânicos sólidos e líquidos para produção de hortaliças e d) Manejo de plantas daninhas na sustentabilidade agrícola. Os cursos propostos foram ministrados e obtivemos forte participação dos agricultores dos Assentamentos João Batista Soares (Fazenda Boa Sorte) e o Assentamento 25 de Março (Fazenda Santo Antônio), bem como de alunos de graduação dos Cursos de Ciências Biológicas (Bacharelado e Licenciatura) e Pós-Graduação (PPG-CiAC). Através da interação durante os cursos foi possível identificar demandas dos agricultores, como a disponibilização de cultivares apropriados para a região e apoio técnico especializado. Além disso, também foi possível identificar agricultores com potencial para receberem aperfeiçoamento continuado, difundir nos discentes participantes os diferentes desafios da produção agrícola familiar e que existe a necessidade de fortes investimentos de diferentes instituições para mudar esse quadro.

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora