2 research outputs found
Sistema Integrado de Monitoreo Ambiental de Caldas – SIMAC Sistema de Vigilancia de Calidad del Aire en Manizales
La dinámica actual de la poblaciĂłn tiene mayor necesidad de consumo debido a su acelerado crecimiento. Esta dinámica trae consigo una mayor producciĂłn industrial, altos Ăndices de motorizaciĂłn y por ende mayores niveles de emisiĂłn de contaminantes, entre los cuales se destacan el monĂłxido de carbono (CO), Ăłxidos de nitrĂłgeno (NOx), diĂłxido de azufre (SO2), ozono troposfĂ©rico (O3) y material particulado (PM). Lo anterior genera impactos negativos en la calidad del aire de los centros urbanos y en los ecosistemas circundantes. En la dinámica del Sistema de Vigilancia de la Calidad del Aire (SVCA) intervienen diferentes elementos que requieren una clasificaciĂłn para lograr un mayor entendimiento del mismo. En este sentido, las emisiones son ocasionadas principalmente por fuentes antropogĂ©nicas como el parque automotor y la producciĂłn industrial, o por fuentes naturales, como en el caso de la ciudad de Manizales, las emisiones generadas por el volcán Nevado del Ruiz. Estas emisiones van a la atmĂłsfera donde se ven afectadas por las condiciones climáticas que favorecen o no las reacciones quĂmicas, deposiciĂłn, dispersiĂłn y transporte de los contaminantes. El objetivo de las estaciones de monitoreo instaladas en la ciudad es cuantificar los diferentes contaminantes presentes en el aire ambiente. Posteriormente, estos datos son procesados y publicados periĂłdicamente, generando informaciĂłn de gran utilidad para la toma de decisiones que permitan alcanzar un desarrollo sostenible para la ciudad y una adecuada gestiĂłn de la calidad del air
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