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...

Since 2017, the Global Anaesthesia Surgery and Obstetric Collaboration (GASOC) has been hosting journal clubs to promote critical appraisal of global surgery publications. The COVID-19 pandemic has prompted a transition to an online-only journal club format. Attendees have rated the online GASOC journal clubs highly in terms of relevance for their learning and development, and the ability to engage with discussions. This transition has allowed more trainees in low- and middle-income countries (LMICs) to register for journal clubs, but barriers have continued to restrict their participation. Feedback submitted by participants has allowed GASOC to identify and address these barriers in order to promote bidirectional partnerships between high-income country and LMIC trainees.

Background Vertigo can have a negative impact on the quality of life of patients. Mobile health apps have the potential to promote autonomy, and improve symptoms through self-management and vestibular rehabilitation exercises. This study aimed to systematically evaluate the quality of apps for vertigo using the published literature and smartphone stores. Design A systematic review of the literature, utilising Embase, Medline, Cochrane and clinicaltrials.org, and Apple and Google Play Stores were used to identify mobile device apps relating to vertigo. Apps were evaluated for characteristics, content, healthcare involvement and quality using the Mobile App Rating Score (MARS) system (a standardised tool for assessing app quality). Results The literature search identified no eligible articles. The app search identified and evaluated 32 eligible apps. Four main categories of apps were identified: exercise provision, information provision, symptom monitoring and assessment. Six apps included healthcare professionals in their development. MARS scoring ranged between 1.8 and 4.05 (maximum 5), with only 25% of apps scoring the minimum acceptability score of 3. The highest scoring apps were those providing rehabilitation exercises and symptom monitoring. Conclusion There is great potential in the use of mobile apps to help monitor and manage vertigo. This article demonstrates that despite numerous readily available vertigo apps, few are of an acceptable standard. There is scope for apps to improve. We propose involving health professionals and patients in their development to ensure high quality evidence-based information and evaluating their efficacy through future patient-centred trials.