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

Alterações do nível pressórico e fatores de risco em graduandos de enfermagem Alteraciones del nível de la presión y factores de riesgo en profesionales graduandos en enfermería Risk factors and alterations in blood pressure levels in undergraduate nursing students

Objetivos: Identificar possíveis alterações do nível presóricoem graduandos de Enfermagem da Universidade Federal de São Paulo; Identificar fatores de risco para hipertensão arterial sistêmica; Verificar a associação entre os níveis pressóricos e os fatores de risco para hipertensão arterial sistêmica. Métodos: Estudo de corte transversal, desenvolvido entre novembro de 2006 a maio de 2007. A amostra foi composta por 120 graduandos de enfermagem da Universidade Federal de São Paulo. Foi aplicado um questionário específico sobre fatores de risco para hipertensão arterial e aferição da pressão arterial. O Teste de Fischer foi usado para determinar possíveis associações. Resultados: Dos graduandos, 92,5% apresentaram níveis pressóricos normais, 4,2% eram hipertensos e 3,3% com pressão limítrofe. Notou-se o aparecimento de alguns fatores de risco para hipertensão arterial e doença cardiovascular. Conclusão: De acordo com os resultados, deve-se atentar para mudanças de hábito e estilo de vida mais saudável desses futuros enfermeiros.<br>Objetivos: Medir la presión arterial para identificar posibles alteraciones en profesionales graduandos en Enfermería; identificar factores de riesgo para hipertensión arterial; verificar la asociación entre los niveles de presión y los factores de riesgo para hipertensión arterial. Métodos: Estudio de corte transversal, desarrollado entre noviembre de 2006 y mayo de 2007. La muestra fue compuesta por 120 graduandos de enfermería de la Universidad Federal de Sao Paulo. Fue aplicado un cuestionario específico sobre factores de riesgo para hipertensión arterial y para evaluar la presión arterial. La Prueba de Fischer fue usada para determinar posibles asociaciones. Resultados: 92,5% de los graduandos presentaron niveles de presión normal, 4,2% eran hipertensos y 3,3% tenían presión limítrofe. Se notó el aparecimiento de algunos factores de riesgo para hipertensión arterial y enfermedad cardiovascular. Conclusión: De acuerdo con los resultados, se deben cambiar hábitos y estilo de vida de modo que sean más saludables para los futuros enfermeros.<br>Objectives: To identify risk factors and alterations in blood pressure levels in undergraduate nursing students and to examine the associations between the risk factors and blood pressure levels. Methods: A cross-sectional descriptive study was conducted between November 2006 and May 2007. The sample consisted of 120 undergraduate nursing students from the Federal University of São Paulo. A specific questionnaire on risk factors for high blood pressure was used. Blood pressure measures were taken and recorded. Fisher's exact test was used to determine associations between risk factors and high blood pressure. Results: The majority of participants (92.5%) had normal blood pressure levels. A few students had high (4.2%) or borderline (3.3%) blood pressure levels. Students had some of the risk factors for high blood pressure and cardiovascular diseases. Conclusion: There is a need to emphasize lifestyle changes among those future nurses

Parâmetros bioquímicos e microbiológicos e suas relações com a experiência de cárie em adolescentes sadios Microbiological and biochemical parameters and their relationship with carie in healthy teenagers

OBJETIVOS: verificar a relação da experiência da doença cárie com o grau de ocorrência de Streptococcus mutans, o fluxo salivar e a capacidade tampão da saliva em 111 adolescentes sadios atendidos no Setor de Puericultura do Hospital das Clínicas de Pernambuco MÉTODOS: realizou-se o exame intraoral e o preenchimento de ficha clínica, para determinação do índice CPO-S (Número de superfícies dentárias cariadas, perdidas ou com extração indicada e restauradas). Em seguida coletou-se a saliva para determinação do fluxo salivar e da capacidade tampão. A raspagem dos dentes anteriores foi realizada para quantificação de Streptococcus mutans presente na placa bacteriana. RESULTADOS: a população avaliada foi predominantemente de baixa atividade de cárie, apresentando capacidade tampão da saliva normal e fluxo salivar deficiente. O número de S. mutans da placa bacteriana foi superior a 105 UFC/mg, na maioria da população estudada. CONCLUSÕES: a atividade de cárie foi inversamente proporcional à capacidade tampão e diretamente proporcional a presença de Streptococcus mutans presentes na placa bacteriana. A baixa atividade de cárie na população estudada pode ser atribuída à boa condição do meio bucal promovida pelo número de escovações diárias com dentufícios fluoretados.<br>OBJECTIVES: to establish a relationship between dental caries with the degree of Streptococcus mutans present in the salivary flow and saliva buffer ability in 111 healthy adolescents seen at the Pediatrics Outpatient Clinic of the Hospital das Clínicas de Pernambuco. METHODS: Intraoral examinations were performed and dental records filled to determine DMFS-S (Decayed, missing teeth and filled permanent dental surfaces). Following, saliva was collected to determined salivary flow and buffer ability. Front teeth were scrapped to quantify Streptococcus mutans present in the bacterial plaque. RESULTS: the population assessed had predominantly low caries activities with buffer ability of normal saliva and deficiency of salivary flow. The numbers of S mutans in the bacterial plaque exceeded 105 CFU/mg in the majority of individuals in the population studied. CONCLUSIONS: caries activity was inversely proportional to the buffer capacity and directly proportional to the presence of Streptococus mutans in the bacterial plaque. This low carie activity could be derived from the daily tooth-brushing with fluor dentifrices

Metabolismo do cálcio na fenilcetonúria Calcium metabolism in phenilke

A Fenilcetonúria é um erro inato do metabolismo do aminoácido fenilalanina. O tratamento é essencialmente dietético e envolve uma restrição severa no consumo de alimentos contendo aminoácido fenilalanina. Embora a alimentação seja complementada com fórmulas a fim de suprir as necessidades de vitaminas, minerais e aminoácidos essenciais, carências nutricionais ainda ocorrem. Isto se deve, principalmente, à restrição de fontes protéicas, que acarreta deficiência na ingestão de diversos nutrientes, dentre eles o cálcio. O cálcio possui importante relação com a formação mineral óssea. Estudos recentes demonstram que portadores de fenilcetonúria apresentam freqüentemente osteopenia e fraturas, sendo a maior incidência em crianças acima de 8 anos de idade. O rápido aumento da estatura, a dieta deficiente em cálcio e níveis de aminoácido fenilalanina elevados têm sido descritos como os principais fatores para a aquisição de massa óssea inadequada. A suplementação de cálcio em crianças saudáveis mostrou um efeito positivo sobre a aquisição de massa óssea na fase da pré-puberdade. Assim, torna-se relevante compreender a necessidade da suplementação de cálcio em pacientes fenilcetonúria, a fim de favorecer o desenvolvimento ósseo esperado.<br>Phenylketonuria is an inborn error of the metabolism of the amino acid phenylalanine. The treatment is essentially dietetic and involves a severe restriction in the consumption of foods containing aminoacid phenylalanine. Although the diet is complemented with supplements in order to meet the vitamin, mineral and essential amino acid requirements, nutritional deficiencies still occur. This is mainly due to restricting the consumption of protein sources, which results in low intake of several nutrients, including calcium. Calcium is strongly related to bone mineral formation. Recent studies have demonstrated that patients with phenylketonuria often present osteopenia and fractures, the greatest incidence being in children older than 8 years. Rapid growth, a calcium-deficient diet and elevated aminoacid phenylalanine plasma levels have been described as the principal factors responsible for inadequate bone formation. It has been shown that calcium-supplementation in healthy children had a positive effect on bone mass acquisition during prepuberty. Therefore, it is pertinent to understand the need of calcium-supplementation in phenylketonuria in order to promote full bone development