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

Peperomia pellucida leaf extract as immunostimulator in controlling motile aeromonad septicemia due to Aeromonas hydrophila in red hybrid tilapia, Oreochromis spp. farming

Aim: This study was revealed the potential of Peperomia pellucida leaf extract as an immunostimulator agent in controlling motile aeromonad septicemia due to Aeromonas hydrophila in red hybrid tilapia, Oreochromis sp. Materials and Methods: In the present study, minimum inhibitory concentration (MIC) of P. pellucida leaf extract against A. hydrophila was determined through two-fold microbroth dilution method. The plant extract was screening for its active compound using a gas chromatograph mass spectrometer, and the effectiveness of P. pellucida leaf extract as an immunostimulator agent was evaluated. The experimental fish were fed with medicated feed at three different concentrations (25 mg/kg, PP-25; 50 mg/kg, PP-50; and 100 mg/kg, PP-100) of P. pellucida leaf extract for 1 week before they were intraperitoneally exposed to A. hydrophila. Enzyme-linked immunosorbent assay was carried out to determine the value of antibody response to A. hydrophila in fish from a group of fish that received medicated feed, and the percentage of total cumulative mortality of the experimental fish were observed at the end of the experiment. Results: The results showed that the major bioactive compound is phytol (40%), and the MIC value was 31.5 mg/L. The value of antibody response to A. hydrophila in fish from a group of fish which received medicated feed (PP-25, 0.128±0.014 optical density [OD]; PP-50, 0.132±0.003 OD; and PP-100, 0.171±0.02 OD) was found significantly higher (p<0.05) compared to fish did not receive medicated feed (0.00 OD). Whereas, percentage cumulative mortality of fish from all groups of fish received medicated feed (PP-25, 18.0±3.2%; PP-50, 18.2±2.8%; and PP-100, 17.7±1.8%) were found significantly lower (p<0.05) compared to a group of fish did not receive medicated feed (83.2±1.4%). Conclusion: The findings of the present study indicated the huge potential of P. pellucida leaf extract as natural immunostimulator agent for aquaculture uses

Virtuální výuka bezpečnosti, proč ne se smartphonem?

This article aims to examine the effectiveness of a Virtual Learning Environment (VLE) using Kolb&apos;s Experiential Learning Theory (ELT) for chemical laboratory safety. A VLE model of a distillation column rig situated at the chemical engineering department, at the University of Nottingham (UK) was designed for the purpose of safety and hazard awareness training for first year laboratory students. The basic pedagogical ideas behind the model were to compare the effectiveness of passive learning used in traditional safety training with the way a VLE can deliver an active learning platform. Based on the collected experience, this article investigates issues that arose while correlating a VLE model with Kolb&apos;s ELT. Some of the drawbacks of the VLE model have been taken into consideration while designing a mobile game application for the purpose of laboratory safety training at the Research Laboratory of Energetic Materials at Pardubice University (Czech Republic). This is believed to offer more scope to develop constructivist learning using a smartphone. (c) 2018 American Institute of Chemical Engineers Process Saf Prog 38: e12005, 2019Cílem tohoto článku je zkoumat efektivitu virtuálního učebního prostředí (VLE) při používání Kolbovy Experiential Learning Theory (ELT) pro bezpečnost chemických laboratoří. VLE model destilační kolony umístěný na oddělení chemického inženýrství na univerzitě v Nottinghamu byl navržen pro účely školení o bezpečnosti a uvědomování si nebezpečí pro studenty prvního ročníku. Základními pedagogickými myšlenkami modelu bylo porovnat účinnost pasivního učení používaného v tradičním bezpečnostním školení s tím, jak může VLE poskytnout aktivní platformu pro učení. Na základě shromážděných zkušeností tento článek zkoumá problémy, které vyvstaly, když byl model VLE vztažen ke Kolbovu ELT. Některé nevýhody modelu VLE byly vzaty v úvahu při navrhování mobilní herní aplikace pro účely laboratorního bezpečnostního výcviku ve Výzkumné laboratoři energetických materiálů Univerzity Pardubice (Česká republika). Předpokládá se, že nabízí více prostoru pro rozvoj konstruktivistické výuky pomocí smartphon

Selenium nanoparticles as a natural antioxidant and metabolic regulator in aquaculture: A review

Balanced aquafeed is the key factor for enhancing the productivity of aquatic animals. In this context, aquatic animals require optimal amounts of lipids, proteins, carbohydrates, vitamins, and minerals. The original plant and animals’ ingredients in the basal diets are insufficient to provide aquafeed with suitable amounts of minerals. Concurrently, elements should be incorporated in aquafeed in optimal doses, which differ based on the basal diets’ species, age, size, and composition. Selenium is one of the essential trace elements involved in various metabolic, biological, and physiological functions. Se acts as a precursor for antioxidative enzyme synthesis leading to high total antioxidative capacity. Further, Se can enhance the immune response and the tolerance of aquatic animals to infectious diseases. Several metabolic mechanisms, such as thyroid hormone production, cytokine formation, fecundity, and DNA synthesis, require sufficient Se addition. The recent progress in the nanotechnology industry is also applied in the production of Se nanoparticles. Indeed, Se nanoparticles are elaborated as more soluble and bioavailable than the organic and non-organic forms. In aquaculture, multiple investigations have elaborated the role of Se nanoparticles on the performances and wellbeing of aquatic animals. In this review, the outputs of recent studies associated with the role of Se nanoparticles on aquatic animals’ performances were simplified and presented for more research and development

Impacts of Dietary Selenium Nanoparticles from <i>Spirulina platensis</i> on Growth Performance, Physio-Biochemical Components and Alleviating Effect against Cadmium Toxicity in Pacific White Shrimp <i>Litopenaeus vannamei</i>

Shrimp culture is quite important and popular across the world. This study aimed to evaluate the growth-promoting potential of synthesized selenium nanoparticles from Spirulina platensis extract (SP-SeNPs) as a food source for Pacific whiteleg shrimp (Litopenaeus vannamei). However, pollution is considered a significant element affecting shrimp health and development. The effectiveness of SP-SeNPs in alleviating the negative effects of cadmium toxicity was also evaluated. Firstly, the shrimps (about 120 individuals with 6.0 ± 0.12 g of initial weight) were divided randomly into four groups in triplicates (30 shrimps/ treatment). The control group (SP-SeNPs—0 mg/kg diet) and three treatments were fed dietary SP-SeNPs (0.250, 0.50, and 1.0 mg/kg diet) for 56 days. Growth performance, digestive enzymes activities (protease, amylase, and lipase), and other biochemical components (total protein, lipid, amino acids, and carbohydrate) were evaluated. After 56 days of growth, another 150 adult shrimps were used under laboratory conditions to determine median lethal concentration of cadmium (96 h LC50), and 30 individuals were treated with cadmium (1/2 of LC50, 0.2 mg L−1) for 10 days only. Tissue samples were collected for measuring catalase (CAT), total antioxidant capacity (TAC), superoxide dismutase (SOD), malondialdehyde (MDA) levels, cadmium bioaccumulation, and histopathological investigation. The results illustrated that the application of SP-SeNPs as feed additives at varying levels significantly improved growth performance (high weight gain, specific growth rate, and low feed conversion rates) relative to the control group. Furthermore, dietary SP-SeNPs enhanced digestive enzyme activities and the concentrations of biochemical components more than the control group. Upon concurrent exposure to cadmium, the antioxidative status was significantly enhanced, and histopathological alterations were mitigated. In conclusion, this study recommended supplementation of SP-SeNPs at 0.50 mg/kg diet to enhance optimal growth rate, digestive enzyme activities, levels of antioxidants in Litopenaeus vannamei, and mitigate the pathological alternations induced with Cd toxicity