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

Synthèse et évaluation pharmacologique de 3,6-diaryl-2,5-dihydroxy-1,4-benzoquinones à activité insulinomimétique

La déméthylasterriquinone B1 est une molécule naturelle, non peptidique, récemment découverte, après screening, pour ses propriétés insulinomimétiques. C'est dans ce cadre que nous avons développé une stratégie de synthèse pour la préparation de 3,6-diaryl-2,5-dihydroxy-1,4-benzoquinones, analogues de ce composé. Ainsi, l'accès à ces benzoquinones peut-être envisagé à partir de 3-aryl-1-hydroxypropan-2-ones via des 4-aryl-6-arylméthylidène-3-hydroxypyrane-2,5-diones, produits provenant de la condensation de 4-aryl-3-hydroxypyrane-2,5-diones et de dérivés aromatiques formylés. Aussi, de nombreuses méthodes pour la synthèse des cétols et des aldéhydes aromatiques intermédiaires ont été étudiées dans ce mémoire. Les benzoquinones synthétisées ont été soumises à des tests in vitro, de phosphorylation du récepteur à insuline et de la protéine kinase B, molécule clé du signal de transduction de l'insuline. Les structures les plus actives ont été administrées, par voie orale, à des souris hyperglycémiques et hyperinsulinémiques. Les premiers résultats pharmacologiques confirment l'intérêt de ces molécules en tant qu'agents insulinomimétiques.Demethylasterriquinone B1 is a nonpeptidyl, small natural molecule, recently discovered, by screening, as an insulin mimetic agent. In this way, we have developped a synthetic method for the preparation of 3,6-diaryl-2,5-dihydroxy-1,4-benzoquinones, analogues of this compounds. The access to these benzoquinones may be envisaged from 3-aryl-1-hydroxypropan-2-ones via 4-aryl-6-arylméthylidène-3-hydroxypyrane-2,5-diones, products of condensation of 4-aryl-3-hydroxypyrane-2,5-diones and aromatic aldehydes. So, several methods for the synthesis of ketol and aldehyde intermediates were investigated in details in this work. The target benzoquinones were evaluated in vitro, on insulin receptor and protein kinase B phophorylation, a key molecule in the transduction signal of insulin. The most active structures were orally administrated to hyperglycemic and hyperinsulinemic mice. The first pharmacological results confirm the interest of such compounds as insulin mimetic agents.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Aminopyridines in the development of drug candidates against protozoan neglected tropical diseases

International audienceNeglected tropical diseases (NTDs) pose a major threat in tropical zones for impoverished populations. Difficulty of access, adverse effects or low efficacy limit the use of current therapeutic options. Therefore, development of new drugs against NTDs is a necessity. Compounds containing an aminopyridine (AP) moiety are of great interest for the design of new anti-NTD drugs due to their intrinsic properties compared with their closest chemical structures. Currently, over 40 compounds with an AP moiety are on the market, but none is used against NTDs despite active research on APs. The aim of this review is to present the medicinal chemistry work carried out with these scaffolds, against protozoan NTDs: Trypanosoma cruzi, Trypanosoma brucei or Leishmania spp

Antimalarial drug discovery: from quinine to the most recent promising clinical drug candidates

International audienceMalaria is a tropical threatening disease caused by Plasmodium parasites, resulting in 409,000 deaths in 2019. The delay of mortality and morbidity has been compounded by the widespread of drug resistant parasites from Southeast Asia since two decades. The emergence of artemisinin-resistant Plasmodium in Africa, where most cases are accounted, highlights the urgent need for new medicines. In this effort, the World Health Organization and Medicines for Malaria Venture joined to define clear goals for novel therapies and characterized the target candidate profile. This ongoing search for new treatments is based on imperative labor in medicinal chemistry which is summarized here with particular attention to hit-to-lead optimizations, key properties, and modes of action of these novel antimalarial drugs. This review, after presenting the current antimalarial chemotherapy, from quinine to the latest marketed drugs, focuses in particular on recent advances of the most promising antimalarial candidates in clinical and preclinical phases

Asymmetric synthesis of novel antimalarial agents with fluorene core

254th National Meeting and Exposition of the American-Chemical-Society (ACS) on Chemistry's Impact on the Global Economy, Washington, DC, AUG 20-24, 2017International audienc

Stereoselective synthesis of rhodotorulic acid analogues with potential siderophore properties

254th National Meeting and Exposition of the American-Chemical-Society (ACS) on Chemistry's Impact on the Global Economy, Washington, DC, AUG 20-24, 2017International audienc

Asymmetric synthesis of novel antimalarial agents with fluorene core

254th National Meeting and Exposition of the American-Chemical-Society (ACS) on Chemistry's Impact on the Global Economy, Washington, DC, AUG 20-24, 2017International audienc

Trojan horse strategy: synthesis of piperazine-based siderophores

International audienc

Design and synthesis of siderophore-antibiotic conjugates

254th National Meeting and Exposition of the American-Chemical-Society (ACS) on Chemistry's Impact on the Global Economy, Washington, DC, AUG 20-24, 2017International audienc