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

Serum Cystatin C as a predictor of cardiac surgery associated-acute kidney injury in patients with normal preoperative renal functions. A prospective cohort study

Introduction: Cardiac surgery-associated acute kidney injury (CSA-AKI) remains a known complication, where postoperative (PO) Cystatin C (Cys C) has been shown to be an earlier marker than the relatively late appearing creatinine (Cr). We sought to evaluate the reliability of preoperative (pre-OP) Cys C as a predictor for CSA-AKI in patients with normal renal functions. Methodology: Our study included consecutive patients undergoing on-pump cardiac surgery from July 2011 to April 2012. Pre-OP and PO Cystatin C and renal profiles were compared in AKI (GP I) and non-AKI (GP II) patients. RIFLE and AKIN criteria were calculated at baseline and daily during the successive three PO days. Results: Out of 40 patients (16 males; mean age = 59 years), 20 developed AKI. Both Pre-and PO Cys C were significantly higher in GP I, and positively correlated with PO Cr. (r: 0.38 P; 0.01; r: 0.68, p 0.04 respectively). Using ROC curve, a cutoff value of 1.8 mg/l and 1.88 (sensitivity 50 and 80%; specificity 90 and 65%) for Pre-OP and PO Cys C respectively in predicting AKI. Multivariate analysis showed the Pre-OP Cys C and cardiopulmonary bypass time were independent predictors for AKI. Conclusion: In patients with apparently normal renal functions, preoperative Cys C may be a predictor of post cardiac surgery AKI. In those patients, especially diabetics, Cys C may uncover subtle nephropathy which makes them more prone to AKI posed by stresses of cardiac surgery

Using millimeter‐waves for rapid detection of pathogenic bacteria in food based on bacteriophage

The accessibility of a rapid method for detection and identification of food‐borne pathogens is crucial for food industry worldwide. Antibiotic resistance bacteria (eg, E. coli ) that can enter the food chain in different ways, can indeed survive on foods causing disease to humans. Hence, the introduction of a rapid detection technology becomes necessary for the food industry to ensure consumer safety, especially for products with short shelf lives. Bacteriophages can be used to detect and identify bacteria. In this study, a novel biosensor is proposed to detect pathogens by means of phage‐based baroreceptor. The biosensing technique is based on millimeter‐waves technology in the 30 to 60 GHz frequency range. The proposed biosensor can detect the pathogenic bacteria in different food samples by using a diamond‐shape microstrip slot antenna. The bacteriophage‐bacterium interaction is detected through the dynamic changes in transmission lines and antennas responses. The correctness of the antenna to detect E. coli in real food sample (tomato) is also investigated. The results indicate that, through the designed sensing elements, the transient interaction between bacteria and phage can effectively be detected. This sensing mechanism allows for a faster, more accurate, and low‐cost detection of pathogenic bacteria than traditional assays. Finally, the results are compared with previously reported sensing techniques

Gray blood late gadolinium enhancement cardiovascular magnetic resonance for improved detection of myocardial scar

Background: Low scar-to-blood contrast in late gadolinium enhanced (LGE) MRI limits the visualization of scars adjacent to the blood pool. Nulling the blood signal improves scar detection but results in lack of contrast between myocardium and blood, which makes clinical evaluation of LGE images more difficult. Methods: GB-LGE contrast is achieved through partial suppression of the blood signal using T2 magnetization preparation between the inversion pulse and acquisition. The timing parameters of GB-LGE sequence are determined by optimizing a cost-function representing the desired tissue contrast. The proposed 3D GB-LGE sequence was evaluated using phantoms, human subjects (n = 45) and a swine model of myocardial infarction (n = 5). Two independent readers subjectively evaluated the image quality and ability to identify and localize scarring in GB-LGE compared to black-blood LGE (BB-LGE) (i.e., with complete blood nulling) and conventional (bright-blood) LGE. Results: GB-LGE contrast was successfully generated in phantoms and all in-vivo scans. The scar-to-blood contrast was improved in GB-LGE compared to conventional LGE in humans (1.1 ± 0.5 vs. 0.6 ± 0.4, P < 0.001) and in animals (1.5 ± 0.2 vs. -0.03 ± 0.2). In patients, GB-LGE detected more tissue scarring compared to BB-LGE and conventional LGE. The subjective scores of the GB-LGE ability for localizing LV scar and detecting papillary scar were improved as compared with both BB-LGE (P < 0.024) and conventional LGE (P < 0.001). In the swine infarction model, GB-LGE scores for the ability to localize LV scar scores were consistently higher than those of both BB-LGE and conventional-LGE. Conclusion: GB-LGE imaging improves the ability to identify and localize myocardial scarring compared to both BB-LGE and conventional LGE. Further studies are warranted to histologically validate GB-LGE. Electronic supplementary material The online version of this article (10.1186/s12968-018-0442-2) contains supplementary material, which is available to authorized users