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...

We present a 32-year-old woman with primary cutaneous aspergillosis and an apparently normal immune status. She is a dietitian who carried out research on Aspergillus contamination of palm oil over a six-month period, during which she apparently shaved her axillae and perineum using a safety razor blade. She presented with nodular lesions, which became extensive ulcers after an attempt at incision and drainage. Diagnosis was based on culture and histology. The patient was treated with itraconazole 200 mg twice a day, with surgical excision and a rhomboid flap cover of the axillae. She has remained disease-free five years after discharge. This highlights the likely benefits of a combination of surgical excision and drug therapy, in achieving a cure in this patient.

The study was carried out to determine the characteristics and outcome of management of anorectal malformations (ARM) in Nigerian children at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) in Ile-Ife, Nigeria, between January 1986 and December 2002. Eighty-six children with ARM were studied, 48 males and 38 females. Only 12 (13.9%) presented to the hospital within 24 h of birth. Twenty-four (27.9%) patients had one or more associated congenital anomalies, with oesophageal atresia with tracheo-oesophageal fistula being the most common associated malformation. A low variety was identified in 26 (30.2%) cases, while 60 (69.8%) had intermediate or high lesions. Twenty-two patients with the low type of anomaly were offered primary anoplasty in the neonatal period, whereas 59 patients with intermediate or high malformations were offered a preliminary colostomy. A definitive pull-through procedure was ultimately performed in 27 of these 59 cases. Twenty-six patients (30.2%) died. Infection and severe associated malformations were responsible for most (65%) of the deaths. Early results of definitive surgery among survivors were generally good after a mean follow-up period of 13 months. Late presentation, inadequate facilities for neonatal intensive care, and paucity of specialist supportive personnel appear to have negatively influenced the outcome of treatment in our environment. Increasing awareness and availability of medical facilities and specialists are needed.

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The purpose of this study is to develop a method for characterisation of time-of-flight (ToF) imaging system for application in deep inspiration breath-hold radiotherapy (DIBH-RT). The performance of an Argos 3D P330 ToF camera (Bluetechnix, Austria) was studied for patient surface monitoring during DIBH-RT using a phantom to simulate the intra-patient and inter-patient stability of the camera. Patient setup error was also simulated by positioning the phantom at predefined shift positions (2, 5 and 10 mm) from the isocentre. The localisation accuracy of the phantom was measured using ToF imaging system and repeated using CBCT imaging alone (CBCT) and simultaneously using ToF imaging during CBCT imaging (ToF-CBCT). The mean and SD of the setup errors obtained from each of the imaging methods were calculated. Student t-test was used to compare the mean setup errors. Correlation and Bland-Altman analysis were also performed. The intra-and inter-patient stability of the camera were within 0.31 mm and 0.74 mm, respectively. The localisation accuracy in terms of the mean ±SD of the measured setup errors were 0.34 ± 0.98 mm, 0.12 ± 0.34 mm, and −0.24 ± 1.42 mm for ToF, CBCT and ToF-CBCT imaging, respectively. A strong correlation was seen between the phantom position and the measured position using ToF (r = 0.96), CBCT (r = 0.99) as well as ToF-CBCT (r = 0.92) imaging. The limits of agreement from Bland Altman analysis between the phantom position and ToF, CBCT and ToF-CBCT measured positions were −1.52, 2.31 mm, −0.55, 0.78 mm; and −3.03, 2.55 mm, respectively. The sensor shows good stability and high accuracy comparable to similar sensors in the market. The method developed is useful for characterisation of an optical surface imaging system for application in monitoring DIBH-RT.