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

Near fifty percent sodium substituted lanthanum manganites-A potential magnetic refrigerant for room temperature applications

Nearly half of lanthanum sites in lanthanum manganites were substituted with monovalent ion-sodium and the compound possessed distorted orthorhombic structure. Ferromagnetic ordering at 300K and the magnetic isotherms at different temperature ranges were analyzed for estimating magnetic entropy variation. Magnetic entropy change of 1.5 J.kg(-1).K-1 was observed near 300 K. An appreciable magnetocaloric effect was also observed for a wide range of temperatures near 300K for small magnetic field variation. Heat capacity was measured for temperatures lower than 300K and the adiabatic temperature change increases with increase in temperature with a maximum of 0.62K at 280 K. (C) 2014 AIP Publishing LLC

Dissipative behavior and gamma-irradiation of silver-sheathed Bi1.8Pb0.4Sr2Ca2Cu3Ox tape

Dissipative mechanisms in Bi1.8Pb0.4Sr2Ca2Cu3Ox tapes were investigated using magnetoresistance measurements and V-I characteristics. A considerable broadening of the resistive transition in applied magnetic field was observed up to a field of 0.5 T. The temperature and magnetic field dependence of the resistance R(T,B) were fitted to the Arrhenius relation and from which the magnetic field dependence of the pinning energy U-0(B) similar to B-alpha with alpha approximate to 0.9 was derived. The variations of the critical current densities J(c) with temperature and magnetic field before and after gamma-irradiation were also studied. The temperature dependence of J(c)(T) was fitted to the relation J(c)(T) similar to (1 - T/T-c)(n) with n = 1.9 and discussed in terms of thermally activated flux flow (TAFF). However, J(c)(B) results were explained based on the weak links, grain boundaries, and Josephson junctions in which it shows a power law behaviour J(c)(B) similar to B-0.5. At relatively low temperatures and magnetic fields, the critical current density was increased with a gamma-irradiation up to a dose of 100 MR

On the dielectric dispersion and absorption in nanosized manganese zinc mixed ferrites

The temperature and frequency dependence of dielectric permittivity and dielectric loss of nanosized Mn1-xZnxFe2O4 (for x = 0, 0.2, 0.4, 0.6, 0.8, 1) were investigated. The impact of zinc substitution on the dielectric properties of the mixed ferrite is elucidated. Strong dielectric dispersion and broad relaxation were exhibited by Mn1-xZnxFe2O4. The variation of dielectric relaxation time with temperature suggests the involvement of multiple relaxation processes. Cole-Cole plots were employed as an effective tool for studying the observed phenomenon. The activation energies were calculated from relaxation peaks and Cole-Cole plots and found to be consistent with each other and indicative of a polaron conduction

The association of corticosteroid therapy and the outcome of critically ill patients with the Middle East Respiratory Syndrome

Systematic corticosteroids are commonly used among critically ill patients with the Middle East Respiratory Syndrome (MERS), but their impact on outcome is uncertain. Studies that adjust only for baseline characteristics do not account for the clinical condition at the time of corticosteroid initiation. The objective of this study is to investigate the association of corticosteroids on mortality accounting for time-dependent variables during critical illness up-to the time of corticosteroid initiation

The association of corticosteroid therapy and the outcome of critically ill patients with the Middle East Respiratory Syndrome

Systematic corticosteroids are commonly used among critically ill patients with the Middle East Respiratory Syndrome (MERS), but their impact on outcome is uncertain. Studies that adjust only for baseline characteristics do not account for the clinical condition at the time of corticosteroid initiation. The objective of this study is to investigate the association of corticosteroids on mortality accounting for time-dependent variables during critical illness up-to the time of corticosteroid initiation

Effect of ribavirin and interferon on the outcome of critically ill patients with mers

Interferon and ribavirin have been used in the treatment of the Middle East Respiratory Syndrome (MERS), but the efficacy of this therapy remains uncertain. Existing data are limited by the lack of adjustment to time-dependent covariates at the time of initiation of therapy. This study objective is to examine the association of ribavirin/interferon in critically ill MERS patients using marginal structural models