RESUMO
BACKGROUND: Human metapneumovirus (HMPV) is an important aetiologic agent of respiratory tract infection (RTI). This study aimed to describe the prevalence, genetic diversity, and evolutionary dynamics of HMPV. METHODS: Laboratory-confirmed HMPV were characterised based on partial-coding G gene sequences with MEGA.v6.0. WGS was performed with Illumina, and evolutionary analyses with Datamonkey and Nextstrain. RESULTS: HMPV prevalence was 2.5%, peaking in February-April and with an alternation in the predominance of HMPV-A and -B until the emergence of SARS-CoV-2, not circulating until summer and autumn-winter 2021, with a higher prevalence and with the almost only circulation of A2c111dup. G and SH proteins were the most variable, and 70% of F protein was under negative selection. Mutation rate of HMPV genome was 6.95 × 10-4 substitutions/site/year. CONCLUSION: HMPV showed a significant morbidity until the emergence of SARS-CoV-2 pandemic in 2020, not circulating again until summer and autumn 2021, with a higher prevalence and with almost the only circulation of A2c111dup, probably due to a more efficient immune evasion mechanism. The F protein showed a very conserved nature, supporting the need for steric shielding. The tMRCA showed a recent emergence of the A2c variants carrying duplications, supporting the importance of virological surveillance.
Assuntos
COVID-19 , Metapneumovirus , Infecções por Paramyxoviridae , Infecções Respiratórias , Humanos , Lactente , Metapneumovirus/genética , Infecções por Paramyxoviridae/epidemiologia , Espanha/epidemiologia , Genótipo , COVID-19/epidemiologia , SARS-CoV-2/genética , Infecções Respiratórias/epidemiologia , FilogeniaAssuntos
Imageamento por Ressonância Magnética/métodos , Miocardite/diagnóstico , Adolescente , Biópsia , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/cirurgia , Criança , Pré-Escolar , Feminino , Transplante de Coração , Humanos , Lactente , Recém-Nascido , Masculino , Miocardite/cirurgiaRESUMO
The prognosis of giant cervical teratomas is determined by the severity of the associated airway obstruction. Ex-utero intrapartum treatment (EXIT) is a technique to establish a patent airway before completion of birth, while the infant remains on placental support. We present two cases of newborns with cervical teratomas treated with the EXIT procedure. In the first, this technique allowed a tracheotomy to be performed, and in the second, correction of tracheal displacement and subsequent nasotracheal intubation was achieved.