Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

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 middle-income 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 low-income 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 low-income, 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

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

Tamanho ótimo de parcela para avaliação do rendimento de grãos do girassol

Propôs-se, neste trabalho, determinar o tamanho adequado de parcela para avaliação do rendimento de grãos do girassol, razão pela qual foi realizado, no período de maio a julho de 2011, um experimento no delineamento em blocos completos casualizados com 14 cultivares de girassol e 10 repetições. As parcelas foram constituídas de quatro fileiras com seis metros de comprimento espaçadas de 0,7 m e entre plantas de 0,3 m. A área útil da parcela, composta das duas fileiras centrais, foi dividida em 12 unidades básicas (UBs) cada uma de três plantas na fileira, medindo-se o rendimento de grãos do girassol por unidade básica. O rendimento de grãos das UBs adjacentes foi agrupado de modo a formar sete tipos de parcelas de cinco tamanhos diferentes pré-estabelecidos. O tamanho ótimo da parcela experimental foi estimado por meio do método da máxima curvatura modificado (3,74 m2) e do modelo linear segmentado com platô (2,48 m2) cujo tamanho de 3,74 m2 de área útil foi considerado adequado para avaliação do rendimento de grãos do girassol e menor que o tamanho geralmente usado nas pesquisas com o girassol

Weed management in maize using hoeing and intercropping with Mimosa caesalpiniifolia

ABSTRACT The objective of this study was to evaluate the weed management in maize using hoeing and intercropping with Mimosa caesalpiniifolia ('sabi&#225;'). A randomized block design that consisted of split plots and five replicates was used. The hybrids AG1051 and BR205 (plots) received the following treatments: A = hoeing [20 and 40 days after sowing the maize (DASM) and without intercropping]; B = hoeing 20 DASM followed by the planting of 'sabi&#225;'; C = planting of 'sabi&#225;' at the time the maize was sown followed by hoeing 40 DASM; D = planting of 'sabi&#225;' at the time the maize was sown; and E = no hoeing and without intercropping. Lesser weed growth in the plots of two hybrids was observed with the treatments that involved hoeing. The highest yields for maize were obtained with two hoeings. The combinations of hoeing and intercropping provided higher grain yield compared to only intercropping with sabi&#225;. Grain yield with hoeing 20 DASM and intercropping with sabi&#225; was higher compared to intercropping with sabi&#225; and hoeing 40 DASM

Soil fertility beneath the crown of tree species submitted to planting densities

The aim of this study was to evaluate the nutrient content of leaf litter and the soil beneath the crown of gliricidia (Gliricidia sepium) and sabiá (Mimosa caesalpiinifolia) under different planting densities (400, 600, 800, 1000 and 1200 plants ha-1). The experiment was carried out in a randomized block in split plot design, with three replications. The species were assigned to the plots and the densities to the subplots. Samples of litter and soil were collected three years after the trees were planted and submitted for chemical analysis. The Mg content in the litter from the gliricidia was higher than that from the sabiá. There was no difference between the species as to the other elements. The increase in planting density reduced the levels of N and Mg, but did not alter the levels of Ca and P in the litter. The nutrient content in the litter from both species presented the sequence Ca > N > Mg > K > P. There was no difference in soil fertility between soils planted with both species. An increase in density resulted in an increase in the levels of P and Mg in the soil. The contents of Na and Ca first increased and then decreased with the increase in density. The density had no effect on organic matter, K, pH or the potential acidity