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. MethodsWe 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. FindingsWe 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•4...

Hypertonic saline and pentoxifylline, both alone and in combination, attenuated oxidative stress and the activation of NF-κB, leading to a decrease in the inflammatory response.

Heme oxygenase-1 (HO-1) has a microsatellite polymorphism based on the number of guanosine-thymidine nucleotide repeats (GT) repeats that regulates expression levels and could have an impact on organ survival post-injury. We correlated HO-1 polymorphism with renal graft function. The HO-1 gene was sequenced (N = 181), and the allelic repeats were divided into subclasses: short repeats (S) (<27 repeats) and long repeats (L) (>/=27 repeats). A total of 47.5% of the donors carried the S allele. The allograft function was statistically improved six months, two and three yr after transplantation in patients receiving kidneys from donors with an S allele. For the recipients carrying the S allele (50.3%), the allograft function was also better throughout the follow-up, but reached statistical significance only three yr after transplantation (p = 0.04). Considering only those patients who had chronic allograft nephropathy (CAN; 74 of 181), allograft function was also better in donors and in recipients carrying the S allele, two and three yr after transplantation (p = 0.03). Recipients of kidney transplantation from donors carrying the S allele presented better function even in the presence of CAN.

PURPOSE:To evaluate intestinal inflammatory and apoptotic processes after intestinal ischemia/reperfusion injury, modulated by pentoxifylline and hypertonic saline. METHODS:It was allocated into four groups (n=6), 24 male Wistar rats (200 to 250g) and submitted to intestinal ischemia for 40 min and reperfusion for 80 min: IR (did not receive any treatment); HS group (Hypertonic Saline, 4ml/kg-IV); PTX group (Pentoxifylline, 30mg/ kg-IV); HS+PTX group (Hypertonic Saline and Pentoxifylline). All animals were heparinized (100U/kg). At the end of reperfusion, ileal fragments were removed and stained on hematoxylin-eosin and histochemical studies for COX-2, Bcl-2 and cleaved caspase-3. RESULTS:The values of sO 2 were higher on treated groups at 40 minutes of reperfusion (p=0.0081) and 80 minutes of reperfusion (p=0.0072). Serum lactate values were lower on treated groups after 40 minutes of reperfusion (p=0.0003) and 80 minutes of reperfusion (p=0.0098). Morphologic tissue injuries showed higher grades on IR group versus other groups: HS (p=0.0006), PTX (p=0.0433) and HS+PTX (p=0.0040). The histochemical study showed lesser expression of COX-2 (p=0.0015) and Bcl-2 (p=0.0012) on HS+PTX group. A lower expression of cleaved caspase-3 was demonstrated in PTX (p=0.0090; PTXvsIR). CONCLUSION:The combined use of pentoxifylline and hypertonic saline offers best results on inflammatory and apoptotic inhibitory aspects after intestinal ischemia/reperfusion.

INTRODUCTION: Two anorectal manometry techniques have commonly been utilized: the perfusion technique and the balloon technique. PURPOSE: To compare both techniques in children with intestinal constipation who had not undergone surgical treatment for its correction. METHODS: Thirty-nine children aged between four and fourteen years underwent anorectal manometry using both techniques at random. Resting pressure, pressure response to voluntary contraction, coughing and perianal stimulation, maximum pressure on the anal canal pressure curve, and presence of rectosphincteric reflex were registered and submitted to statistics. Vectorgraphy of the sphincter muscle complex was obtained by perfusion technique. RESULTS: The statistical comparison between the techniques revealed statistically significant differences in resting pressure (p=0.041), pressure response to voluntary contraction (p=0.026) and maximum pressure within the pressure curve (p=0.010). The rectosphincteric reflex was demonstrated in 21 patients by both techniques. CONCLUSIONS: The perfusion technique presented greater sensitivity in the following parameters: resting pressure, pressure response to voluntary contraction and maximum pressure within the pressure curve. The methods studied are equivalent regarding the measurement of pressure responses to coughing and perianal stimulation and the investigation of rectosphincteric reflex.

Efeito da pentoxifilina e da solução salina hipertônica na isquemia/reperfusão intestinal e suas consequências no pulmão: estudo experimental em ratos SÃO PAULO 2012 Dedicatória Aos meus filhos, Luiz Guilherme e João EduardoPelo apoio e pelo carinho Pela compreensão nas horas distante de vocês Pelo amor que sempre tivemos uns pelos outros Pela certeza de serem a maior obra que já realizei em minha vida "Filho é um ser que nos emprestaram para um curso intensivo de como amar alguém além de nós mesmos, de como mudar nossos piores defeitos para darmos os melhores exemplos e de aprendermos a ter coragem. Isto mesmo ! Ser pai ou mãe é o maior ato de coragem que alguém pode ter, porque é se expor a todo tipo de dor, principalmente da incerteza de estar agindo corretamente e do medo de perder algo tão amado. Perder? Como? Não é nosso, recordam-se? Foi apenas um empréstimo".(José Saramargo) "Bendito aquele que consegue dar aos seus filhos asas e raízes", diz um provérbio.Precisamos das raízes: existe um lugar no mundo onde nascemos, aprendemos uma língua, descobrimos como nossos antepassados superavam seus problemas. Em um dado momento, passamos a ser responsáveis por este lugar.Precisamos das asas: elas nos mostram os horizontes sem fim da imaginação, nos levam até nossos sonhos, nos conduzem a lugares distantes. São as asas que nos permitem conhecer as raízes de nossos semelhantes, e aprender com eles.Bendito quem tem asas e raízes; e pobre de quem tem apenas um dos dois.(Paulo Coelho) In Memoriam... Prof.ª Dr.ª Maria Christina Anna GriegerMinha mestra... Você imprimiu sentido à minha vida de médico. A simples lembrança da sua imagem me traz a importância de servir com ética e devoção. Prof. Dr. Luiz Francisco Poli de FigueiredoSerei eternamente grato pela confiança em mim depositada. Tudo em que eu precisava acreditar era que eu sou capaz. E você acreditou nisso muito antes de mim!!! Podeis esforçar-vos por ser como eles, mas não procureis fazê-los como vós, Porque a vida não anda para trás e não se demora com os dias passados.Vós sois os arcos dos quais vossos filhos são arremessados como flechas vivas.O arqueiro mira o alvo na senda do infinito, e vos estica com toda a sua força Para que suas flechas se projetem, rápidas e para longe.Que vosso encurvamento na mão do arqueiro seja vossa alegria:Pois assim como ele ama a flecha que voa, Ama também o arco que permanece estável."Aos meus irmãos, cunhada e sobrinhos, por ficarem por perto e servirem de apoio nos momentos em que precisei e nos em que não precisei também... O Mestre na arte da vida faz pouca distinção entre o seu trabalho e o seu lazer, entre a sua mente e o seu corpo, entre a sua educação e a sua recreação, entre o seu amor e a sua religião. Ele dificilmente sabe distinguir um corpo do outro.Ele simplesmente persegue sua visão de excelência em tudo que faz, deixando para os outros a decisão de saber se está trabalhando ou se divertindo.Ele acha que está sempre fazendo as duas coisas simultaneamente. (Texto budista)

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