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

Bartolomé de Mesa Túpac Yupanqui: trayectoria de un comerciante de la élite indígena limeña (1774-1810)

Analysis of the trajectory of Bartolomé de Mesa Túpac Yupanqui, a member of Lima’s trader elite of indigenous descent, in a period of great changes that go from the implementation of the Bourbon reforms and their consequences in the Limeña economy, passing through the rebellion of Túpac Amaru II until the French invasion of Spain and the emergence of government boards in several American territories.His study allows us to see the similarities and differences between his actions and that of any Spanish or Creole merchant of the same category and the process of changing his political position, which went from total loyalty to the Spanish Crown, because he was the main financier of the indigenous festivities in honor of Charles IV that were held in Lima in 1790, to participate actively in the conspiracies that occurred in the city with the aim of achieving greater autonomy for local elites. He was linked to Mateo Silva, a lawyer from Lima, main organizer of the secret autonomist meetings in which Bartolomé de Mesa actively participated and for which he was imprisoned and accused of conspiracy.Análisis de la trayectoria de Bartolomé de Mesa Túpac Yupanqui, miembro de la élite comercial limeña de ascendencia indígena, en un periodo de grandes cambios que van desde la implementación de las reformas borbónicas y sus consecuencias en la economía limeña, pasando por la rebelión de Túpac Amaru II hasta la invasión francesa de España y el surgimiento de juntas de gobierno en diversos territorios americanos. Su estudio permite ver las similitudes y diferencias entre su accionar y el de cualquier comerciante español o criollo de su misma categoría y el proceso de cambio de su posición política, que pasó de la total fidelidad a la Corona española, pues fue el principal financista de las fiestas indígenas en honor de Carlos IV que se realizaron en Lima en 1790, a participar activamente en las conspiraciones que ocurrieron en la ciudad con el objetivo de conseguir una mayor autonomía para las elites locales. Se vinculó con Mateo Silva, abogado limeño, principal organizador de las reuniones secretas autonomistas en las que Bartolomé de Mesa participó activamente y por las que fue encarcelado y acusado de conspirador

Migración y trabajo femenino a principios del siglo XVII: el caso de las indias en Lima

No presenta resumen

Inhibición del crecimiento de chufa ( Cyperus esculentus L.) y pasto bermuda ( Cynodon dactylon (L.) Pers.) con mulch vegetal proveniente de centeno ( Secale cereale L.)

Two field trials (Los Andes 1998-1999 and Santiago 2004-2005) were carried out to determine growth inhibition of yellow nutsedge ( Cyperus esculentus L.) and bermudagrass ( Cynodon dactylon (L.) Pers.), growing on the plantation row, by mulch derived from a rye ( Secale cereale L.) cover crop established between grapevine ( Vitis vinifera L.) rows on overhead (cv. Flame Seedless) and vertical (cv. Cabernet Sauvignon) training. Spring mowing of the rye sown in the fall allowed for developing a thick and long lasting mulch along the grape rows. Nutsedge and bermudagrass control was 81 and 82%, respectively, and was more effective than conventional chemical (in the row) + mechanical (between rows) control. Glyphosate at 2% for nutsedge and 1% for bermudagrass control, applied twice (October and December), was insufficient to control either perennial weed adequately. Total broadleaved and grass/sedge weed control was 67.3 and 43.0% more effective with the rye mulch than with conventional treatments at Los Andes and Santiago, respectively. Perennial weed control levels could be explained as the new foliage of yellow nutsedge and bermudagrass was particularly susceptible to the shading provided by the rye mulch assembled prior to mid spring shoot emergence, and this effect remained active up until the beginning of autumn. The subsequent rye foliage mowing at the vegetative stage fully expressed the allelopathic effect produced by this local rye cultivar. The use of rye cover crop management and mulch could be applied as an effective weed control technique in conventional, as well as organic deciduous tree orchards.En dos ensayos de campo (Los Andes 1998-1999 y Santiago 2004-2005) se determinó el efecto inhibitorio sobre chufa ( Cyperus esculentus L.) y pasto bermuda ( Cynodon dactylon (L.) Pers.) de residuos de centeno (Secale cereale L.) establecido en otoño entre las hileras de vides ( Vitis vinifera L.) en parronal (cv. Flame Seedless) y espaldera (cv. Cabernet Sauvignon). Las siegas sucesivas del centeno formaron un mulch vegetal denso y duradero sobre las hileras de vides. El mulch orgánico fue un 81 y 82% más efectivo para controlar chufa y pasto bermuda, respectivamente, que el control químico (sobre la hilera) + mecánico (entre las hileras). Dos aplicaciones de glifosato (octubre/diciembre) al 2% para chufa y 1% para pasto bermuda no fueron suficientes para controlar efectivamente las dos malezas. El grado de control del total de malezas fue 67,3 y 43,0% más efectivo con el mulch vegetal que con los tratamientos químicos en Los Andes y Santiago, respectivamente. El alto control ejercido por el mulch de centeno se debió a que el crecimiento de los nuevos brotes de chufa y pasto bermuda fueron particularmente susceptibles al sombreamiento del mulch, formado antes de su emergencia primaveral y que permaneció hasta inicios del otoño, y a que la siega del centeno maximizó los efectos alelopáticos de esta variedad local de centeno. Se sugiere utilizar este tipo de manejo de las cubiertas vegetales y mulch para el control efectivo de malezas en otros frutales caducifolios tanto en huertos de agricultura convencional como orgánicos