Comparative effectiveness and safety of interventions for acute diarrhea and gastroenteritis in children: A systematic review and network meta-analysis

Q2Q1Artículo de investigación1-22Background Many interventions have shown effectiveness in reducing the duration of acute diarrhea and gastroenteritis (ADG) in children. Yet, there is lack of comparative efficacy of interventions that seem to be better than placebo among which, the clinicians must choose. Our aim was to determine the comparative effectiveness and safety of the pharmacological and nutritional interventions for reducing the duration of ADG in children. Methods Data sources included Medline, Embase, CENTRAL, CINAHL, LILACS, and Global-Health up to May 2017. Eligible trials compared zinc (ZN), vitamin A, micronutrients (MN), probiotics, prebiotics, symbiotics, racecadotril, smectite(SM), loperamide, diluted milk, lactose-free formula(LCF), or their combinations, to placebo or standard treatment (STND), or among them. Two reviewers independently performed screening, review, study selection and extraction. The primary outcome was diarrhea duration. Secondary outcomes were stool frequency at day 2, diarrhea at day 3, vomiting and side effects. We performed a random effects Bayesian network meta-analysis to combine the direct and indirect evidence for each outcome. Mean differences and odds ratio with their credible intervals(CrI) were calculated. Coherence and transitivity assumptions were assessed. Meta-regression, subgroups and sensitivity analyses were conducted to explore the impact of effect modifiers. Summary under the cumulative curve (SUCRA) values with their CrI were calculated. We assessed the evidence quality and classified the best interventions using the Grading of Recommendations, Assessment, Development & Evaluation (GRADE) approach for each paired comparison. Results A total of 174 studies (32,430 children) proved eligible. Studies were conducted in 42 countries of which most were low-and middle-income countries (LMIC). Interventions were grouped in 27 categories. Most interventions were better than STND. Reduction of diarrhea varied from 12.5 to 51.1 hours. The combinations Saccharomyces boulardii (SB)+ZN, and SM+ZN were considered the best interventions (i.e., GRADE quality of evidence: moderate to high, substantial superiority to STND, reduction in duration of 35 to 40 hours, and large SUCRA values), while symbiotics (combination of probiotics+prebiotics), ZN, loperamide and combinations ZN+MN and ZN+LCF were considered inferior to the best and better than STND [Quality: moderate to high, superior to STND, and reduction of 17 to 25 hours]. In subgroups analyses, effect of ZN was higher in LMIC and was not present in high-income countries (HIC). Vitamin A, MN, prebiotics, kaolin-pectin, and diluted milk were similar to STND [Quality: moderate to high]. The remainder of the interventions had low to very-low evidence quality. Loperamide was the only intervention with more side effects than STND [Quality: moderate]. Discussion/Conclusion Most interventions analyzed (except vitamin A, micronutrients, prebiotics, and kaolin-pectin) showed evidence of superiority to placebo in reducing the diarrhea. With moderate-to highquality of evidence, SB+ZN and SM+ZN, demonstrated the best combination of evidence quality and magnitude of effect while symbiotics, loperamide and zinc proved being the best single interventions, and loperamide was the most unsafe. Nonetheless, the effect of zinc, SB+ZN and SM+ZN might only be applied to children in LMIC. Results suggest no further role for studies comparing interventions against no treatment or placebo, or studies testing loperamide, MN, kaolin-pectin, vitamin A, prebiotics and diluted milk

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

Desarrollo de adhesivos naturales a partir de almidón de yuca bajo estándares internacionales

IP 3271-08-11020Contrato 230-2001Almidón--Harina de yuca--Molino de pines--Dextrinas--Activación enzimática

Biotransformación de diterpenoides por hongos filamentosos nativos :

IP 1203-12-10404Incluye anexos.Javergraf. -- p. ; 28 cm. -- Contribucion al estudio de los hongos filamentosos en la zona de frailejones del;paramo de Guasca - Colombia / Adriana Chitiva ... [et al.]--p.193 -- En: Congreso Nacional de Ciencias;Biologicas. (37 : 2001 oct : Cartagena de Indias, Colombia) --[s.l : s.n], 2001 -- p. ; 23 cm. -- Produccion;de metabolitos secundarios de la cepa EB-406-05 / Ruben DarioTorrenegra,Giovana Salamanca. -- p. 193 -- En:;Congreso Nacional de Ciencias Biologicas. (37 : 2001 oct :Cartagena de Indias, Colombia) -- [s.l : s.n],;2001 -- p. ; 23 cm -- Una cepa nativa colombiana de Penicilliumverrucosumcomo fuente de acido micofenolico /;Ruben D. Torrenegra, Jose E. Baquero. -- p. 108 -- En: CongresoItalo-latinoamericano de etnomedicina Nuno;Alvares Pereira. (12 : 2003 sep. 8-12 : Rio de Janeiro) --[s.l: s.n], 2003 -- p. ; 28 cm. -- Mohos de los;paramos de Guasca y El tablazo / Adriana J. Chitiva. -- En: Congreso la Investigacion en la Pontificia;Universidad Javeriana. (7 : 2003 ago. 26-29 : Bogotá) -- [s.l:s.n], 2003-- p. ; 28 cm. -- Biotransformacion;de diterpenos y voacangina, evaluacion de metabolitos secundarios del Aspergillus niger 511 y su actividad;PONENCIA(S) EN CONGRESO: Metabolitos secundarios del Aspergillusniger 511y su actividad antimicrobiana /;R.D. Torrenegra, P.M. Daza. -- p. 103-104 -- En: CongresoNacional de Fitoquimica. (7 : 2002 : Bogotá) --;antimicrobiana / Ruben D. Torrenegra G. -- En: Congreso laInvestigacion en la Pontificia Universidad;Javeriana. (7 : 2003 ago. 26-29 : Bogotá) -- [s.l : s.n],2003-- p. ; 28cm.;Bogotá : Javergraf., 2002 -- p. ; 28 cm. -- Un metabolitosecundario antimicrobiano / J.E. Baquero, R.D.;Torrenegra, M. Bayona. -- p.124-125 -- En: Congreso NacionaldeFitoquimica. (7 : 2002 : Bogotá) -- Bogotá

Evaluación bioecológica y ambiental de áreas arrecifales del Caribe colombiano

IP 2105-09-120-97ARTICULO(S) EN REVISTA: Maps for Colombian reefs / Juan M.Diaz.'-- en: Reef Encounter. -- No. 25 (July;1999); p. 13. -- ISSN 02552787. -- Isla Arena, una formacion coralina saludable en el area de influencia de la;pluma del rio Magdalena, plataforma continental del Caribecolombiano / Jorge H. Pinzon, Adriana M. Perdomo y;Juan M. Diaz. -- En: Revista de investigaciones marinas ycosteras. -- Vol. 27 (1998); p. 21-37. -- ISSN;01229761. -- Patterns of octocoral and black coral distributionin the oceaniz barrier reef-complex of;Providencia Island, Southwstern Caribbean / Juan A. Sanchez, Sven Zea, Juan M. Diaz. -- En: Caribbean journal;of science. -- Vol. 34, no. 3-4 (Dec. 1998); p. 250-264. -'- isSN86452-- Arrecifes coralinos : ñun tesoro;camino a la extincion? / Jaime Garzon Ferreira. -- En: Colombia: cienciay tecnologia. -- Vol. 15, no. 1;(mar. 1997); p. 11-19. -- ISSN 01205595. -- Peces registradosenlos complejos arrecifales de los cayos;Courtdown, Albuquerque y los bancos Serrana y Roncador, Caribeoccidental,Colombia / Luz Stella Mejia ...;[et.al.]. -- En: Boletin ecotropica. -- No. 32 (1998); p.413892.-- ISSN 01223313. -- Gorgonian communities in;two contrasting enviroments on oceanic atolls of the southwestern caribbean / Juan A. Sanchez, Juan M. Diaz,;spread of diseases in Caribbean coral reefs / Thomas J. Goreau... [et.al.]. -- En: Revista de biologia;tropical -- Vol. 46, sup. 5 (1998); p. 157-171. -- ISSN 00347744. -- A newspecies of Antupatharian Coral;(Cnidaria: Anthozoa) from the caribbean coast of Colombia/ Dennis M. Opresko, Juan A. Sanchez. -- En:;Caribbean journal of science. -- Vol. 33, no. 1-2 (1997);p. 7-581. -- ISSN 00086452. -- PONENCIA(S) EN;CONGRESO: Habitat maps as a tool for assessment and managementof oral reef areas in Colombia /Juan Manuel;Diaz. -- En: Reunion Cientifica Bienal de la IMIA (1 : 1999 nov.9-11 : Panama) -- Mapping reefs and;associated habitats in the SW caribbean / Juan Manuel Diaz. --En: ReunionCientifica Bienal de la IMIA (1 :;1999 nov. 9-11 : Panama) -- Evaluacion de las principalescondiciones de deterioro en algunas formaciones;coralinas de la plataforma continental del Caribe colombiano /Lina M. Barrios Suarez, Jaime Garzon Ferreira,;Sven Zea. -- En: Reunion Asociacion de Laboratorios Marinos delCaribe (ALMC) (29 : 1999 jul. 18-24 : Cumana,;Venezuela) -- Geomorfologia y distribucion de las formacionesarrecifalesde Bajo Tortugas y Bajo Salmedina,;plataforma continental del Caribe Colombiano / Fernando J.ParraVelandia,Juan M. Diaz, Gloria H. Ospina. --;En: Reunion Asociacion de Laboratorios Marinos del Caribe(ALMC)(29 : 1999 jul. 18-24 : Cumana, Venezuela) --;Zonacion y estructura de los fondos coralinos del archipielagode san Bernardo, Caribe colombiano / Mateo;Lopez Victoria, Juan M. Diaz. -- En: Reunion Asociacion deLaboratorios Marinos del Caribe (ALMC) (29 : 1999;jul. 18-24 : Cumana, Venezuela) -- Caracterizacion de lasareascoralinasdel Caribe colombiano : rasgos;morfologicos y ecologicos / Juan Manuel Diaz. -- En: Reunion Asociacion deLaboratorios Marinos del Caribe;(ALMC) (29 : 1999 jul. 18-24 : Cumana, Venezuela) -- Coralhealth assessment in four southwestern caribbean;atolls / J. Garzon Ferreira, S. Zea, J.M. Diaz. -- En: Atlanticand Gulf Assessment (AGRA) workshop (1998 Jun.;2-6 : Miami);Sven Zea. -- En: Bulletin of marine science. -- Vol. 61, no. 2(1997); p.453-465. -- ISSN 00074977. -- Rapi

Uncovering Causes of Childhood Death Using the Minimally Invasive Autopsy at the Community Level in an Urban Vulnerable Setting of Argentina: A Population-Based Study

Background: Precise determination of the causal chain that leads to community deaths in children in low-and middle-income countries is critical to estimating all causes of mortality accurately and to planning preemptive strategies for targeted allocation of resources to reduce this scourge. Methods: An active surveillance population-based study that combined minimally invasive tissue sampling (MITS) and verbal autopsies (VA) among children under 5 was conducted in Buenos Aires, Argentina, from September 2018 to December 2020 to define the burden of all causes of community deaths. Results: Among 90 cases enrolled (86% of parental acceptance), 81 had complete MITS, 15.6% were neonates, 65.6% were post-neonatal infants, and 18.9% were children aged 1-5 years. Lung infections were the most common cause of death (CoD) in all age groups (57.8%). Among all cases of lung infections, acute bronchiolitis was the most common CoD in infants aged 12 months (8 of 11, 72.7%). The most common comorbid condition in all age groups was undernutrition in 18 of 90 (20%). It was possible to find an immediate CoD in 78 of 81 subjects where MITS could be done. With this combined approach, we were able to determine that sudden infant death syndrome was overestimated in state reports. Conclusions: CoD determination by a combination of MITS and VA provides an accurate estimation of the chain of events that leads to death, emphasizing possible interventions to prevent mortality in children.Fil: Caballero, Mauricio Tomás. Fundación Infant; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Diaz Grigaites, Sebastian. Gobierno de la Provincia de Buenos Aires. Ministerio Publico; ArgentinaFil: de la Iglesia Niveyro, Paola Ximena. Instituto Universitario del Hospital Italiano de Buenos Aires; ArgentinaFil: Esperante, Sebastian. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación Infant; ArgentinaFil: Bianchi, Alejandra M.. Fundación Infant; ArgentinaFil: Nuño, Alejandra. Fundación Infant; ArgentinaFil: Valle, Sandra. Fundación Infant; ArgentinaFil: Afarian, Gabriela. Gobierno de la Provincia de Buenos Aires. Ministerio Publico; ArgentinaFil: Ferretti, Adrian Julio Pantaleon. Fundación Infant; ArgentinaFil: Baglivo, Sofia Jares. Fundación Infant; ArgentinaFil: De Luca, Julian. Fundación Infant; ArgentinaFil: Zea, Cristian M. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Caporal, Paula. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; ArgentinaFil: Labanca, Maria Jose. Instituto Universitario del Hospital Italiano de Buenos Aires; ArgentinaFil: Diamanti, Adriana. Gobierno de la Provincia de Buenos Aires. Ministerio Publico; ArgentinaFil: Álvarez Paggi, Damián Jorge. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación Infant; ArgentinaFil: Bassat, Quique. Consorcio de Investigación Biomédica En Red de Epidemiología y Salud Pública; España. Centro de Investigação Em Saúde de Manhiça; Mozambique. Universidad de Barcelona; España. Institució Catalana de Recerca i Estudis Avancats; EspañaFil: Polack, Fernando Pedro. Fundación Infant; ArgentinaFil: Carballo, Ana M. Gobierno de la Provincia de Buenos Aires. Ministerio Publico; ArgentinaFil: Hernandez, Gabriela. Gobierno de la Provincia de Buenos Aires. Ministerio Publico; ArgentinaFil: Figueroa, Paola. Gobierno de la Provincia de Buenos Aires. Ministerio Publico; ArgentinaFil: Ares, Patricia E.. Gobierno de la Provincia de Buenos Aires. Ministerio Publico; ArgentinaFil: Rodriquez Paquete, Cesar A.. Gobierno de la Provincia de Buenos Aires. Ministerio Publico; Argentin

Proceedings Of The 23Rd Paediatric Rheumatology European Society Congress: Part Two

PubMe

Reduced Cancer Incidence in Huntington's Disease: Analysis in the Registry Study

Background: People with Huntington's disease (HD) have been observed to have lower rates of cancers. Objective: To investigate the relationship between age of onset of HD, CAG repeat length, and cancer diagnosis. Methods: Data were obtained from the European Huntington's disease network REGISTRY study for 6540 subjects. Population cancer incidence was ascertained from the GLOBOCAN database to obtain standardised incidence ratios of cancers in the REGISTRY subjects. Results: 173/6528 HD REGISTRY subjects had had a cancer diagnosis. The age-standardised incidence rate of all cancers in the REGISTRY HD population was 0.26 (CI 0.22-0.30). Individual cancers showed a lower age-standardised incidence rate compared with the control population with prostate and colorectal cancers showing the lowest rates. There was no effect of CAG length on the likelihood of cancer, but a cancer diagnosis within the last year was associated with a greatly increased rate of HD onset (Hazard Ratio 18.94, p < 0.001). Conclusions: Cancer is less common than expected in the HD population, confirming previous reports. However, this does not appear to be related to CAG length in HTT. A recent diagnosis of cancer increases the risk of HD onset at any age, likely due to increased investigation following a cancer diagnosis