Latin American Surgical Outcomes Study in Paediatrics (LASOS-Peds): study protocol and statistical analysis plan for a multicentre international observational cohort study.

INTRODUCTION: Surgery is a cost-effective public health intervention. Access to safe surgery is a basic human right. However, there are still significant disparities in the access to and safety of surgical and anaesthesia care between low-income and middle-income countries and high-income countries. The Latin American Surgical Outcomes Study in Paediatrics (LASOS-Peds) is an international, observational, 14-day cohort study to investigate the incidence of 30-day in-hospital complications following elective or emergency paediatric surgery in Latin American countries. METHODS AND ANALYSIS: LASOS-Peds is a prospective, international, multicentre observational study of paediatric patients undergoing both elective and non-elective surgeries and procedures, inpatient and outpatient, including those performed outside the operating room. The primary outcome is the incidence of in-hospital postoperative complications up to 30 days after surgery. Secondary outcomes include intraoperative complications and the need for intensive care unit admission. ETHICS AND DISSEMINATION: This study received approval from the Institutional Review Board of the coordinating centre (Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo) as well as from all the participating centres. The study results are expected to be published in peer-reviewed journals and disseminated at international conferences. TRIAL REGISTRATION NUMBER: NCT05934682.

Antifibrotic activity of carbon quantum dots in a human in vitro model of non-alcoholic steatohepatitis using hepatic stellate cells.

Around 33% of the global population suffers from non-alcoholic fatty liver disease (NAFLD). From these patients, 30% of them progress into non-alcoholic steatohepatitis (NASH), the critical point where lack of treatment leads to cirrhosis and hepatic failure. Moreover, to date, there are no approved therapeutic options available for NASH. It is known that hepatic stellate cell (HSC) activation contributes the most to hepatic disfunction, leading to reactive oxygen species (ROS) accumulation and chronic inflammation, and that the use of nanomaterials to deliver antioxidants may have potential to reduce the activity of activated HSCs. Therefore, we implemented a human in vitro co-culture model in which we take into consideration two factors related to NASH and fibrosis: human hepatic stellate cells from a NASH diagnosed donor (HHSC-N) and peripheral blood mononuclear cells (PBMCs), particularly lymphocytes. The co-cultures were treated with: (1) carbon quantum dots (CD) or (2) lactoferrin conjugated CD (CD-LF) for 24 h or 72 h. CD and CD-LF treatments significantly downregulated profibrotic genes' expression levels of ACTA2, COL1A1, and TIMP1 in co-cultured HHSC-N at 72 h. Also, we assayed the inflammatory response by quantifying the concentrations of cytokines IL-22, IL-10, IFN-γ and IL-4 present in the co-culture's conditioned media whose concentrations may suggest a resolution-associated response in progress. Our findings may serve as a starting point for the development of a NASH treatment using bio-nanotechnology.

Identificação de polímeros de microplásticos encontrados no trato digestivo de peixes do Lago de Amatitlán, Guatemala / Identification of microplastic polymers found in the digestive tract of fish from Lake Amatitlán, Guatemala

O objetivo desta pesquisa foi a identificação, por meio de espectroscopia no infravermelho com transformada de Fourier combinada com reflectância total atenuada (FTIR-ATR), de microplásticos extraídos do trato gastrointestinal de peixes coletados no Lago de Amatitlán, para determinar os principais polímeros e a possível origem da contaminação por esses materiais. Foram analisados 68 microplásticos, correspondendo a 10% do total de microplásticos extraídos. Estes originaram-se de 36 espécimes, sendo 35 da espécie Oreochromis niloticus e um de Parachromis managuensis, dos quais foram analisados de 1 a 5 microplásticos por espécime. Os polímeros identificados foram polipropileno (PP), nylon, polietileno de alta densidade (HDPE), tereftalato de polietileno (PET), látex, poliestireno (PE), polietileno de baixa densidade (LDPE) e poliuretano (PU). O polipropileno (32), o polietileno de alta densidade (13) e o nylon (10) foram os polímeros mais frequentes. Os possíveis itens plásticos que podem ter originado os microplásticos incluem brinquedos, equipamentos de laboratório, baldes, embalagens de alimentos, tubulações, isolamento para cabos, têxteis, cordas e móveis que são produzidos na indústria do plástico, localizada principalmente na vertente sul da cidade da Guatemala. Além disso, as espécies de peixes do presente estudo sustentam pescarias importantes, o que levanta problemas de saúde humana, uma vez que a ingestão de peixes que consomem plásticos tem o potencial de aumentar a carga corporal de substâncias químicas perigosas, pois estas aderem superficialmente aos plásticos no ambiente e são posteriormente bioacumuladas.

The objective of this research was the identification, through Fourier transform infrared spectroscopy combined with attenuated total reflectance (FTIR-ATR), of microplastics extracted from the gastrointestinal tract of fish collected in Lake Amatitlán, to determine the main polymers and the possible origin of contamination by these materials. 68 microplastics were analyzed, corresponding to 10% of the total microplastics extracted. These originated from 36 specimens, 35 of the species Oreochromis niloticus and one of Parachromis managuensis, of which 1 to 5 microplastics per specimen were analyzed. The polymers identified were polypropylene (PP), nylon, high-density polyethylene (HDPE), polyethylene terephthalate (PET), latex, polystyrene (PE), low-density polyethylene (LDPE) and polyurethane (PU). Polypropylene (32), high-density polyethylene (13) and nylon (10) were the most frequent polymers. Possible plastic items that may have caused microplastics include toys, laboratory equipment, buckets, food packaging, pipes, insulation for cables, textiles, ropes and furniture that are produced in the plastics industry, located mainly on the south side of Guatemala City. Furthermore, the fish species in the present study support important fisheries, which raises human health concerns, since the ingestion of fish that consume plastics has the potential to increase the body load of dangerous chemicals, as they adhere superficially to the plastics in the environment and are subsequently bioaccumulated.

Pulmonary arterial hypertension in children with congenital heart disease: a deeper look into the role of endothelial progenitor cells and circulating endothelial cells to assess disease severity.

Endothelial progenitor cells and circulating endothelial cells have been proposed as useful markers of severity and disease progression in certain vascular diseases, including pulmonary arterial hypertension. Our study focused on evaluating the levels of circulating endothelial progenitor cells and circulating endothelial cells in patients with congenital left-to-right shunts and pulmonary hypertension undergoing definitive repair. Endothelial progenitor cells (identified by simultaneous co-expression of CD45dim, CD34 + and KDR2 + surface antibodies) and circulating endothelial cells (identified by simultaneous co-expression of inherent antibodies CD45-, CD31+, CD146 + and CD105+) were prospectively measured in seventy-four children (including children with Down syndrome), median age six years (2.75-10), with clinically significant left-to-right shunts undergoing transcatheter or surgical repair and compared to thirty healthy controls. Endothelial progenitor cells and, particularly, circulating endothelial cells were significantly higher in children with heart disease and pulmonary arterial hypertension when compared to controls. Endothelial progenitor cells showed significant correlation with pulmonary vascular resistance index when measured both systemically (r = 0.259; p = 0.026) and in the superior vena cava (r = 0.302; p = 0.009). Children with Down syndrome showed a stronger correlation between systemic cellularity and pulmonary vascular resistance index (r = 0.829; p = 0.002). Endothelial progenitor cells were reduced along their transit through the lung, whereas circulating endothelial cells did not suffer any modification across the pulmonary circulation. In children with yet to be repaired left-to-right shunts, endothelial progenitor cells and circulating endothelial cell counts are increased compared to healthy subjects.

Prenatal Diagnosis and Outcome of Intrapericardial Teratoma: Report of Two Clinical Scenarios.

Intrapericardial teratoma is a rare tumor composed of tissue from the three germ cell layers with a rapid growth that may cause severe hemodynamic complications due to compressive effects. We present two clinical cases: the first case had severe fetal heart failure with fatal outcome, and the second underwent surgical treatment during the immediate postnatal period with a favorable evolution. Although teratomas are histologically benign tumors, rapid growth can cause serious hemodynamic complications. The importance of prenatal diagnosis is to allow appropriate monitoring of tumor growth and establish a prompt therapeutic plan. Opportune surgical treatment can prevent death and improve the prognosis of these patients.

Efectos del confinamiento sobre los hábitos saludables de adolescentes durante la pandemia de COVID-19 / Effects of confinement on the healthy habits of adolescents during the COVID-19 pandemic / Efeitos do confinamento nos hábitos saudáveis dos adolescentes durante a pandemia de COVID-19

Introducción: en marzo de 2020, en Uruguay se decretó la emergencia sanitaria al detectarse los primeros casos de infección por SARS-CoV-2 (COVID-19). El confinamiento domiciliario voluntario fue una de las medidas de salud pública adoptadas en el control de la pandemia. Objetivo: describir el efecto del confinamiento sobre los hábitos de sueño, alimentación y actividad física de adolescentes de Montevideo y Canelones durante la pandemia de COVID-19. Metodología: encuesta elaborada ad hoc, voluntaria, anónima, online y autoadministrada a adolescentes de 12 a 19 años, usuarios de CASMU, CRAMI, COMECA y Asociación Española, entre el 1 de junio y el 1 de julio de 2020. Se aplicaron cuestionarios validados para evaluar sueño, alimentación y actividad física. Resultados: se encuestaron 465 adolescentes, 70,1% mujeres y 48,2% de adolescencia media. Refirieron permanecer más de 6 horas al día conectados a internet y al celular 58,3% y 42,4%, respectivamente. La convivencia durante el confinamiento resultó agradable en la mayoría. El 76% refirió dormir menos de 9 horas/día. Señaló un consumo adecuado de frutas 6%, verduras 5,8% y lácteos 32,2%. El porcentaje de adolescentes activos descendió de 30,7% previo a la pandemia a 19,7% durante la misma. A la pregunta "¿cuál es la primera palabra que te viene a la mente cuando escuchas pandemia de COVID-19?" la mayoría brindó respuestas negativas. Conclusiones: las medidas de confinamiento no se asociaron con problemas importantes en la convivencia familiar en este grupo de adolescentes. Se observó una profundización de los problemas en los hábitos de alimentación, actividad física, sueño que favorecen el "ambiente obesogénico" y el riesgo de desarrollo de enfermedades crónicas no transmisibles. Resulta relevante considerar el impacto negativo del confinamiento y planificar las medidas preventivas tendientes a mitigar sus efectos.

Introduction: in March 2020, a Health Emergency was decreed in Uruguay when the first cases of the SARS-CoV-2 (COVID 19) infection were detected. Voluntary home confinement was one of the public health measures adopted in theto control the pandemic. Objectives: describe the effects of confinement on sleep, eating and exercise habits of adolescents assisted by private health providers in Montevideo and Canelones during the COVID-19 pandemic. Methodology: ad hoc, voluntary, anonymous, online and self-administered survey to adolescents of 12 to 19 years of age, users of CASMU, CRAMI, COMECA and Asociación Española HMOs, between June 1 and July 1, 2020. Validated questionnaires were applied to assess sleep, diet and exercise habits. Results: 465 adolescents were surveyed, 70.1% women and 48.2% in mid-adolescence. They reported having been connected to Internet and cell phone more than 6 hours a day, 58.3% and 42.4%, respectively. Coexistence during confinement was mostly pleasant. 76% reported sleeping less than 9 hours/day. They reported an appropriate consumption of fruit 6%, vegetables 5.8% and dairy 32.2%. The percentage of active adolescents fell from 30.7% before the pandemic to 19.7% during the pandemic. To the question, What is the first word that comes to mind when you hear about the COVID-19 pandemic? most gave negative responses. Conclusions: confinement measures were not linked to important problems regarding coexistence with relatives in this group of adolescents. We observed a worsening of the eating, exercise and sleep habits, which may favor the "obesogenic environment" and increase the risk of developing chronic non-communicable diseases. It is relevant to consider the negative impact of confinement and plan preventive measures aimed at mitigating its effects.

Introdução: em março de 2020, a Emergência Sanitária foi decretada no Uruguai quando foram detectados os primeiros casos de infecção por SARS-CoV-2 (COVID 19). O confinamento domiciliar voluntário foi uma das medidas de saúde pública adotadas para controlar a pandemia. Objetivo: descrever o efeito do confinamento nos hábitos de sono, alimentação e atividade física de adolescentes em Montevidéu e Canelones durante a pandemia de COVID-19. Metodologia: inquérito ad hoc, voluntário, anônimo, online e autoadministrado a adolescentes de 12 a 19 anos de idade atendido pelas prestadoras CASMU, CRAMI, COMECA e Associação Espanhola, entre 1 de junho e 1 de julho de 2020. Foram aplicados questionários validados para avaliar os seus hábitos de sono, alimentação e atividade física. Resultados: foram pesquisados 465 adolescentes, 70,1% mulheres e 48,2% na adolescência média. 58,3% e 42,4%, respectivamente, relataram ficar mais de 6 horas por dia conectados à internet e ao celular. A convivência durante o confinamento foi agradável para a maioria. 76% relataram dormir menos de 9 horas/dia. 6% deles indicou consumo adequado de frutas, vegetais 5,8% e laticínios 32,2%. O percentual de adolescentes ativos caiu de 30,7% antes da pandemia para 19,7% durante ela. Quando perguntados: Qual é a primeira palavra que vem à mente quando você ouve a pandemia do COVID-19? a maioria forneceu respostas negativas. Conclusões: as medidas de confinamento não estiveram associadas a problemas importantes na vida familiar neste grupo de adolescentes. Observou-se aprofundamento dos problemas nos hábitos alimentares, de exercício físico e de sono que favorecem o "ambiente obesogênico" e o risco de desenvolver doenças crônicas não transmissíveis. É relevante considerar o impacto negativo do confinamento e planejar medidas preventivas visando mitigar seus efeitos.

Factores asociados a la positividad de la PCR para SARS-CoV-2 en menores de 15 años / Related PCR positivity factors for SARS-CoV-2 in children under 15 years of age / Fatores associados à positividade da PCR para SARS-CoV-2 em crianças menores de 15 anos de idade

Introducción: la infección por SARS-CoV-2 en niños representa un porcentaje menor en la incidencia global de pacientes infectados por este virus. La prueba de reacción en cadena de polimerasa (PCR) para SARS-CoV-2 en muestra de secreciones nasofaríngeas es considerada como estándar de referencia, con niveles de sensibilidad y especificidad superiores a otras técnicas. Objetivo: describir las características de los pacientes menores de 15 años a los que se realizó PCR para SARS-CoV-2 en un prestador privado de salud del interior del país entre el 1° julio 2020 y el 30 de abril 2021. Analizar posibles factores asociados a la positividad de la prueba. Describir las características de los casos con PCR positiva Metodología: estudio observacional prospectivo con un análisis retrospectivo de tipo caso-control, a partir del seguimiento de una cohorte de menores de 15 años a los que se les realizó una prueba de PCR para SARS-CoV-2 en el período analizado, en un prestador integral de salud privado del interior del país. Se recabaron datos durante el seguimiento de los pacientes de acuerdo a un protocolo institucional que incluye: datos patronímicos, causa de la solicitud de la PCR, características del contacto, resultado de PCR y umbral de ciclo (CT), manifestaciones clínicas y evolución. Resultados: se solicitaron 2.361 PCR a menores de 15 años (15% del total de las PCR de la institución). Promedio de edad: 8,6 años (rango 7 días-14 años y 11 meses); 49% niñas y 51% varones. Motivo de solicitud de la prueba: 78,4% para estudio de contacto, 14,3% por síntomas sin noción de contacto y 7,3% previo a ingreso hospitalario (de urgencia o coordinación). Porcentaje de positividad de todo el período: 14,7%, con una importante variabilidad mensual (5,6% en diciembre y 27% en abril). La PCR fue positiva en 346 casos, con CT promedio de 27, y rango entre 16,8 y 37,3. No se encontraron diferencias estadísticas en relación a la edad y sexo entre casos positivos y negativos. Solo un caso fue PCR positivo previo al ingreso hospitalario (OR 0,03; IC 95% 0,004-0,22) y 20 de las 611 PCR solicitadas por contacto institucional (escolar, deportivo, etc.), siendo la diferencia estadísticamente significativa cuando el caso era mayor de 15 años (p 0,029). Del estudio retrospectivo de casos (PCR positiva) y controles (PCR negativa) surge una asociación estadísticamente significativa (p<0,000001) con la causa de solicitud por contacto en comparación con otra causa (OR 5,2; IC 95% 3,28-8,26), que el caso índice sea mayor de 15 años (OR 4,57 IC 95% 2,95 - 7,10) y que sea conviviente (OR 5,28 IC 95% 3,97 - 7,04). No hubo hospitalizaciones ni fallecimientos por COVID en la población analizada. Conclusiones: el testeo de niños y adolescentes en busca de COVID 19 continúa siendo una estrategia válida cuando existen síntomas sugestivos o contacto con un caso confirmado. En este estudio, los niños con antecedente de contacto con conviviente positivo, y mayor de 15 años, mostraron una mayor proporción de resultados positivos de PCR para SARS-CoV-2.

Introduction: the SARS-CoV-2 infection has shown a lower percentage in children compared to the global incidence of patients infected by this virus. The Polymerase Chain Reaction (PCR) test for SARS-CoV-2 in a sample of nasopharyngeal secretions is considered the reference standard test, and it has shown higher sensitivity and specificity levels than other techniques. Objective: describe the characteristics of patients under 15 years of age who underwent PCR for SARS-CoV-2 in a private health provider in the interior of the country between July 1, 2020 and April 30, 2021. Analyze possible factors linked to test positivity. Describe the characteristics of cases with positive PCR Methodology: prospective observational study with a retrospective case-control analysis based on the follow-up of a cohort of children under 15 years of age who underwent a PCR test for SARS-CoV-2 in the period analyzed, at a private health provider in the interior of Uruguay. Data were collected during patients' follow-up according to the institutional protocol that includes: personal data, reason for requesting the PCR, contact data, PCR result and cycle threshold (CT), clinical manifestations and evolution. Results: 2,361 PCRs were performed to children of under 15 years of age (15% of all PCRs in the institution). Average age 8.6 years (range 7 days - 14 years and 11 months); 49% girls and 51% boys. Reason for requesting the test: 78.4% due to previous contact, 14.3% due to symptoms without knowledge of contact and 7.3% prior to hospital admission (emergency or scheduled). Positivity percentage for the entire period 14.7% with significant monthly variability (5.6% in December and 27% in April). The PCR was positive in 346 cases, with a mean CT of 27, and a range between 16.8 and 37.3. No statistical differences were found regarding age and sex between positive and negative cases. Only 1 case was positive PCR prior to hospital admission (OR 0.03 95% CI 0.004 - 0.22) and 20 out of the 611 PCR were requested due to prior institutional contact (school, sports centers, etc.), the difference being statistically significant when the patient was older than 15 years (p 0.029). From the retrospective study of cases (PCR positive) and controls (PCR negative), a statistically significant link (p<0.000001) arose regarding: when the request resulted from a prior contact compared to other causes (OR 5.2 CI 95% 3.28-8.26), when the index case was older than 15 years of age (OR 4.57 95% CI 2.95-7.10) and when the patient and the contact had cohabited (OR 5.28 95% CI 3.97-7.04). There were no hospitalizations or deaths from COVID in the population analyzed. Conclusions: testing children and adolescents for COVID 19 continues to be a valid strategy in case of suggestive symptoms or contact with a confirmed positive case. In this study, children with a history of contact with a positive case, and older than 15 years, showed a higher proportion of positive PCR results for SARS-CoV-2.

Introdução: a infecção por SARS-CoV-2 em crianças representa um percentual menor do que na incidência global de pacientes infectados por esse vírus. O teste de reação em cadeia da polimerase (PCR) para SARS-CoV-2 em uma amostra de secreções nasofaríngeas é considerado o padrão de referência, com níveis de sensibilidade e especificidade mais elevados do que outras técnicas. Objetivo: descrever as características dos pacientes menores de 15 anos de idade que realizaram PCR para SARS-CoV-2 em uma prestadora de saúde privada do interior do país entre 1º de julho de 2020 e 30 de abril de 2021. Analisar possíveis fatores associados à positividade do teste. Descrever as características dos casos com PCR positivo. Metodologia: estudo observacional prospectivo com análise retrospectiva caso-controle a partir do acompanhamento de uma coorte de crianças menores de 15 anos que realizaram teste de PCR para SARS-CoV 2 no período analisado, em uma assistência médica de saúde no interior do país. Os dados foram coletados durante o acompanhamento dos pacientes de acordo com o protocolo institucional e incluíram: informação pessoal, motivo da solicitação do PCR, características do contato, resultado do PCR e limiar de ciclo (CT), manifestações clínicas e evolução. Resultados: foram solicitados 2.361 PCRs de menores de 15 anos (15% do total de PCRs da instituição). Idade média 8,6 anos (variação 7 dias - 14 anos e 11 meses); 49% meninas e 51% meninos. Motivo do pedido do exame: 78,4% por estudo de contato, 14,3% por sintomas sem conhecimento de contato e 7,3% antes da internação (por emergência ou coordenação). Porcentagem de positividade para todo o período 14,7% com significativa variabilidade mensal (5,6% em dezembro e 27% em abril). O PCR foi positivo em 346 casos, com média de TC de 27 e variação entre 16,8 e 37,3. Não foram encontradas diferenças estatísticas em relação à idade e sexo entre os casos positivos e negativos. Apenas 1 caso foi PCR positivo antes da admissão hospitalar (OR 0,03 IC 95% 0,004 - 0,22) e 20 dos 611 PCR solicitados por contato institucional (escola, centros de esportes, etc.), sendo a diferença estatisticamente significativa para os casos que tinham mais de 15 anos de idade (p 0,029). Do estudo retrospectivo de casos (PCR positivo) e controles (PCR negativo), emergiu uma associação estatisticamente significativa (p <0,000001) quando: a causa da solicitação do teste tinha sido um contato positivo prévio em relação a outra causa (OR 5,2 IC 95% 3,28 - 8,26), e quando o caso índice era mais velho do que 15 anos (OR 4,57 IC 95% 2,95 - 7,10) ou coabitava com o paciente (OR 5,28 IC 95% 3,97 - 7,04). Não houve internações ou óbitos por COVID na população analisada. Conclusões: a testagem de crianças e adolescentes em busca de COVID-19 continua sendo uma estratégia válida quando há sintomas sugestivos ou contato com um caso positivo confirmado. Neste estudo, crianças com histórico de contato com casos positivos na mesma casa e mais velhos do que 15 anos de idade apresentaram maior proporção de resultados positivos de PCR para SARS-CoV-2.

Surgical outcomes among children with bicuspid aortic valve: 17 years of experience in a single center. First report in Mexico.

PURPOSE: To evaluate the clinical and surgical outcomes among children with bicuspid aortic valve who underwent cardiac surgery. METHODS: This observational and retrospective study included patients with a diagnosis of bicuspid aortic valve who underwent cardiac surgery between January 1, 2003, and March 31, 2020. Demographic characteristics and perioperative conditions were described. RESULTS: One hundred and sixteen patients were included, with a mean age of 12.4 ± 4.2 years; 63.2% were male. The most frequent diagnosis was congenital aortic stenosis (23.5%), followed by connective tissue disorders (16%). Mechanical aortic prostheses were used in 87.7% of cases, with a mean size of 21 ± 2.6 mm. The main factors associated with mortality were valve prosthesis dysfunction (odds ratio [OR]: 12.44; 95% confidence interval [CI]: 1.05-147.48; p = .04) and reoperation (OR: 24.29; 95% CI: 1.03-570.08; p = .04). The overall survival was 87.9%, with better outcomes among those who did not undergo reoperation (Log Rank, p = .01). CONCLUSIONS: Outcomes after aortic valve replacement in children with bicuspid aortic valve are excellent in the short and long term, regardless of using mechanical or biological prostheses.

Reproductive disruption in adult female and male rats prenatally exposed to mesquite pod extract or daidzein.

Phytoestrogens are considered to be endocrine disruptors, since they can alter the endocrine system, thus disturbing many reproductive events. The intake of diets containing a high content of phytoestrogens has increased worldwide in human populations and in domestic animals. Phytoestrogens in maternal blood can pass through the placenta to the fetus in high amounts and can have long-term organizational effects. Mesquite (Prosopis sp) is a leguminous plant widely used to feed several livestock species, and is also used in the human diet. In this study we assessed the effects of exposure to mesquite pod extract during the periconception and pregnancy periods on the reproduction of male and female descendants. The females of three experimental groups received one of the following treatments: 1) vehicle injection; 2) mesquite pod extract or 3) the isoflavone daidzein during the periconception and pregnancy periods. Estrous cyclicity, sexual behavior and hormones, as well as uterine and vaginal epithelia were evaluated in the female descendants. In the males, sexual behavior and hormones, apoptosis in testicular cells and sperm quality were evaluated. In females the following was observed: alterations in estrous cycles, decreased sexual behavior, estradiol and progesterone levels, increased uterine and vaginal epithelia. In males, we observed a decrease in sexual behavior, testosterone and sperm quality, and apoptosis increased in testicular cells. All these effects were similar to those caused by daidzein. These results indicate that prenatal exposure to mesquite pod extract or daidzein, administered to females before and during pregnancy, can disrupt normal organizational-activational programming of reproductive physiology in female and male descendants.

Ethnic Differences in the Prevalence of Hypertension in Colombia: Association With Education Level.

BACKGROUND: A higher prevalence of hypertension is reported among Afro-descendants compared with other ethnic groups in high-income countries; however, there is a paucity of information in low- and medium-income countries. METHODS: We evaluated 3,745 adults from 3 ethnic groups (552 White, 2,746 Mestizos, 447 Afro-descendants) enrolled in the prospective population-based cohort study (PURE)-Colombia. We assessed associations between anthropometric, socioeconomic, behavioral factors, and hypertension. RESULTS: The overall prevalence of hypertension was 39.2% and was higher in Afro-descendants (46.3%) than in Mestizos (37.6%) and Whites (41.5%), differences that were due to the higher prevalence in Afro-descendant women. Hypertension was associated with older age, increased body mass index, waist circumference and waist-to-hip ratio, independent of ethnicity. Low education was associated with hypertension in all ethnic groups, and particularly in Afro-descendants, for whom it was the factor with the strongest association with prevalence. Notably, 70% of Afro-descendants had a low level of education, compared with 52% of Whites-26% of Whites were university graduates while only 7% of Afro-descendants were. We did not find that education level alone had a mediator effect, suggesting that it is not a causal risk factor for hypertension but is an indicator of socioeconomic status, itself an important determinant of hypertension prevalence. CONCLUSIONS: We found that a higher prevalence of hypertension in Colombian Afro-descendants than other ethnic groups. This was principally associated with their lower mean educational level, an indicator of lower socioeconomic status.

Comparison of antibody response to SARS-CoV-2 after two doses of inactivated virus and BNT162b2 mRNA vaccines in kidney transplant.

BACKGROUND: Antibody response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after mRNA or adenoviral vector-based vaccines is weak in kidney transplant (KT) patients. However, few studies have focused on humoral response after inactivated virus-based vaccines in KT. Here, we compare antibody response following vaccination with inactivated virus (CoronaVac®) and BNT162b2 mRNA. METHODS: A national multicentre cross-sectional study was conducted. The study group was composed of patients from all KT centres in Uruguay, vaccinated between 1 and 31 May 2021 (CoronaVac®, n = 245 and BNT162b2, n = 39). The control group was constituted of 82 healthy individuals. Participants had no prior confirmed coronavirus disease 2019 (COVID-19) test. Blood samples were collected between 30 and 40 days after the second dose. Serum-specific immunoglobulin G (IgG) antibodies against the receptor-binding domain (RBD) of SARS-CoV-2 Spike protein were determined using the COVID-19 IgG QUANT ELISA Kit. RESULTS: Only 29% of KT recipients showed seroconversion (36.5% BNT162b2, 27.8% inactivated virus, P = 0.248) in comparison with 100% in healthy control with either vaccine. Antibody levels against RBD were higher with BNT162b mRNA than with inactivated virus [median (interquartile range) 173 (73-554) and 29 (11-70) binding antibody units (BAU)/mL, P < 0.034] in KT and 10 times lower than healthy control [inactivated virus: 308 (209-335) and BNT162b2: 2638 (2608-3808) BAU/mL, P < 0.034]. In multivariate analysis, variables associated with negative humoral response were age, triple immunosuppression, estimated glomerular filtration rate and time post-KT. CONCLUSION: Seroconversion was low in KT patients after vaccination with both platforms. Antibody levels against SARS-CoV-2 were lower with inactivated virus than BNT162b mRNA. These findings support the need for strategies to improve immunogenicity in KT recipients after two doses of either vaccine.

Tuberculosis en tiempos de COVID-19: situación de la tuberculosis pediátrica en Uruguay en 2020 / Tuberculosis in times of COVID-19: pediatric tuberculosis in Uruguay in 2020 / Tuberculose em tempos de COVID-19: situação da tuberculose pediátrica no Uruguai em 2020

Introducción: la Organización Mundial de la Salud (OMS) alertó sobre el riesgo de descuidar acciones de control de la tuberculosis (TB) durante la pandemia de COVID-19. Objetivos: describir la situación de la TB en menores de 15 años en Uruguay en 2020, y compararla con 2019. Describir estrategias del Programa Nacional de Tuberculosis (PNT) para mitigar el impacto de la pandemia de COVID-19. Metodología: Estudio descriptivo, retrospectivo de menores de 15 años con TB en Uruguay entre 1/1/2020 y 31/12/2020. Datos patronímicos, diagnóstico clínico y bacteriológico, tratamiento y estudio de contactos; indicadores epidemiológicos de 2019. Se calculó tasa de incidencia, frecuencias y porcentajes. Se seleccionaron estrategias del PNT dirigidas o que impactan directamente en la atención pediátrica. Resultados: en 2020, se registraron 61 casos de TB en menores de 15 años. Tasa de incidencia 8,8/100.000. Presentaron TB pediátrica 6,3% del total de casos (61/968), y en 2019 3,9% (42/1057). Formas pulmonares 84% y extrapulmonares 16%. Confirmación bacteriológica: 25%. No hubo fallecidos en 2020 y hubo uno en 2019. Contactos: en 2020 disminuyó 11% la notificación; se estudió al 86%, se indicó quimioprofilaxis al 73%. Aumento significativo de contactos en menores 15 años enfermos (2,4% 2019 y 5% 2020). Estrategias del PNT: 1) Diagnóstico: uso de GeneXpert Ultra; 2) Tratamiento: supervisión por video (VOT); 3) Contactos: se priorizó a menores de 15 años adecuando protocolo de estudio. Conclusiones: en 2020 se mantuvieron las acciones de control de la TB en la población pediátrica. Aumentó la incidencia de TB en menores de 15 años. Los niños y adolescentes fueron priorizados en el diagnóstico (técnicas más sensibles) y estudio de contactos.

Summary: Introduction: the WHO warned about the risk of neglecting tuberculosis (TB) control actions during the COVID-19 pandemic. Objectives: describe the TB situation in children <15 years of age in Uruguay in 2020, and compare it with 2019. Describe strategies of the National Tuberculosis Program (NTP) to mitigate the impact of the COVID 19 pandemic. Material and methods: descriptive, retrospective study of children <15 years of age with TB in Uruguay 1/1/2020 - 12/31/2020. Patronymic data, clinical and bacteriological diagnosis, treatment and study of contacts; epidemiological indicators of 2019. Incidence rate, frequency and percentages were calculated. NTP strategies aimed at or directly impacting pediatric care were selected. Results: in 2020, 61 cases of TB in children < 15 years. Incidence rate 8.8/100,000. Pediatric TB 6.3% of total cases (61/968), and in 2019 3.9% (42/1057). Pulmonary forms 84% and extrapulmonary 16%. Bacteriological confirmation: 25%. No deaths in 2020 and 1 in 2019. Contacts: in 2020 the notification decreased by 11%; 86% were studied, 73% chemoprophylaxis. Significant increase in infected contacts < 15(2.4% 2019 and 5% 2020). NTP strategies: 1- Diagnosis: use of GeneXpert Ultra; 2- Treatment: video surveillance (VOT); 3- Contacts: children of <15 years were prioritized, adapting the study protocol. Conclusions: in 2020, the TB control actions were maintained in the pediatric population. The incidence of TB increased in children <15 years of age. Children and adolescents were prioritized in diagnosis (more sensitive techniques) and contact studies.

Introdução: a OMS alertou sobre o risco de negligenciar as ações de controle da tuberculose (TB) durante a pandemia de COVID-19. Objetivos: descrever a situação da TB em <15 anos no Uruguai 2020 e comparar com 2019. Descrever as estratégias do Programa Nacional de Tuberculose (PNT) para mitigar o impacto da pandemia de COVID-19. Metodologia: estudo descritivo retrospectivo de <15 anos com TB no Uruguai 01/01/2020 - 31/12/2020. Dados patronímicos, diagnóstico clínico e bacteriológico, tratamento e estudo de contatos; indicadores epidemiológicos de 2019. Calculou-se a taxa de incidência, frequência e percentuais. Estratégias de PNT destinadas ou impactando diretamente os cuidados pediátricos foram selecionadas Resultados: em 2020, 61 casos de TB em crianças <15 anos. Taxa de incidência 8,8/100.000. TB pediátrica 6,3% do total de casos (61/968), e em 2019 3,9% (42/1057). Formas pulmonares 84% e extrapulmonares 16%. Confirmação bacteriológica: 25%. Não houve falecidos em 2020 e 1 em 2019. Contatos: em 2020 a notificação diminuiu 11%; 86% foram estudados, 73% quimioprofilaxia. Aumento significativo de contatos infetados < 15 pacientes (2,4% 2019 e 5% 2020). Estratégias de NTP: 1- Diagnóstico: uso do GeneXpert Ultra; 2- Tratamento: supervisão por vídeo (VOT); 3- Contatos: <15 anos foram priorizados, adaptando o protocolo do estudo. Conclusões: em 2020, as ações de controle da TB foram mantidas na população pediátrica. A incidência de TB aumentou em <15 anos. Crianças e adolescentes foram priorizados no diagnóstico (técnicas mais sensíveis) e no estudo de contatos.

Vigilancia activa de la infección por SARS-CoV-2 en menores de 15 años con indicación de ingreso hospitalario durante la pandemia de COVID-19 / Active surveillance of the SARS-CoV-2 infection in children of under 15 years of age admitted to hospital during the COVID-19 pandemic / Vigilância ativa da infecção por SARS-CoV-2 em crianças menores de 15 anos admitidas em hospitais durante a pandemia COVID-19

Introducción: la autoridad sanitaria ha utilizado numerosas estrategias para la detección precoz de casos y control de la transmisión de SARS-CoV-2, entre ellas la vigilancia activa de infección en ingresos hospitalarios. Objetivo: describir la vigilancia activa de infección por SARS-CoV-2 en menores de 15 años con indicación de ingreso hospitalario durante la pandemia de COVID-19 en un prestador integral de salud privado del interior del país. Metodología: estudio observacional, descriptivo, prospectivo, de menores de 15 años con indicación de ingreso hospitalario del 1/4/2020 al 30/4/2021 en CRAMI-IAMPP. Vigilancia activa según pautas del MSP: PCR para SARS-CoV-2 previo al ingreso hospitalario, asociado a interrogatorio de antecedentes de contacto con caso positivo de COVID-19 y síntomas sugestivos de infección. Datos: causa de ingreso (médica o quirúrgica), tipo (coordinado, urgencia o traslado interhospitalario), vigilancia de síntomas. Se calculó incidencia de infección por SARS-CoV-2, frecuencias y porcentajes. Resultados: se indicó ingreso a cuidados moderados a 231 menores de 15 años. 129 varones (56%), promedio de edad 6,5 años. Causa de ingreso: quirúrgica 60% (coordinada 53%); 89 (40%) por patología médica (20% infecciosa, 19% neurológica, 15% respiratoria, etcétera). Ninguno ingresó por sospecha o confirmación de COVID-19. PCR positiva en un niño coordinado para procedimiento que se suspendió. Incidencia de infección por SARS-CoV-2: 0,4/100 ingresos hospitalarios. No hubo casos de infección intrahospitalaria. Conclusiones: la vigilancia activa de la infección por SARS-CoV-2 en menores de 15 años con criterio de ingreso hospitalario fue adecuada. La incidencia de infección fue muy baja y no se constató transmisión intrahospitalaria

Summary: Introduction: various strategies have been carried out by Health Authorities regarding the early detection and control of the transmission of SARS-CoV-2, including active infection surveillance in hospital admissions. Objectives: to describe the active surveillance of the SARS-CoV-2 infection in children of <15 years of age admitted to hospital during the COVID-19 pandemic at a private health provider, in the interior of the country. Methodology: observational, descriptive, prospective study of children of <15 years of age admitted to hospital from 4/1/2020 to 4/30/2021 at CRAMI IAMPP Hospital. Active surveillance according to the guidelines of the Ministry of Public Health: PCR Test for SARS-CoV-2 prior to hospital admission, plus an interview regarding contact history with a positive COVID-19 case and symptoms suggesting infection. Data: cause of admission (medical or surgical), type (coordinated, emergency or interhospital transfer), monitoring of symptoms. Incidence of SARS-CoV-2 infection, frequencies and percentages were calculated. Results: admission to moderate care was indicated for 231 children of <15 years. Males 129 (56%), average age 6.5 years. Cause of admission: surgical 60% (coordinated 53%); 89 (40%) due to medical pathology (20% infectious, 19% neurological, 15% respiratory, etc.). None were admitted due to suspicion or confirmation of COVID 19. Positive PCR was detected in a child coordinated for a procedure that was suspended. Incidence of SARS-CoV-2 infection: 0.4/100 hospital admissions. No cases of nosocomial infection. Conclusions: active surveillance of SARS-CoV-2 infection in children of <15 years of age with hospital admission criteria was adequate. The incidence of infection was very low and no intrahospital transmission was confirmed.

Introdução: as autoridades sanitárias do Uruguai têm implementado várias estratégias para a detecção precoce de casos e controle da transmissão do SARS-CoV-2, incluindo vigilância ativa de infecção em internações hospitalares. Objetivo: descrever a vigilância ativa da infecção por SARS-CoV-2 em crianças menores de 15 anos com indicação de internação durante a pandemia de COVID-19 num prestador de saúde do interior do país. Metodologia: estudo observacional, descritivo, prospectivo realizado a crianças menores de <15 anos com indicação de internação de 01/04/2020 a 30/04/2021 no Hospital CRAMI IAMPP. Vigilância ativa de acordo com as diretrizes do MSP: PCR para SARS-CoV-2 antes da admissão hospitalar, associada ao questionamento de histórico de contato com um caso positivo de COVID-19 e sintomas sugestivos de infecção. Dados: causa de admissão (médica ou cirúrgica), tipo (coordenada, emergência ou transferência inter-hospitalar), monitorização dos sintomas. Incidência de infecção por SARS-CoV-2, frequência e porcentagens foram calculadas. Resultados: a internação em cuidados moderados foi indicada para 231 crianças <15 anos. Meninos 129 (56%), idade média 6,5 anos. Causa de internação: cirúrgica 60% (coordenada 53%); 89 (40%) por patologia médica (20% infecciosa, 19% neurológica, 15% respiratória, etc.). Nenhuma delas foi admitida por suspeita ou confirmação de COVID 19. Houve um Test PCR positivo em criança coordenada para procedimento que foi suspenso. Incidência de infecção por SARS-CoV-2: 0,4/100 internações hospitalares. Nenhum caso de infecção hospitalar. Conclusões: a vigilância ativa da infecção por SARS-CoV-2 em crianças <15 anos com critérios de internação hospitalar foi adequada. A incidência de infecção foi muito baixa e nenhuma transmissão intra-hospitalar foi confirmada.

Factors Associated With Weight, Length, and BMI Change in Adolescents' Offspring in Their First Year of Life.

Background: Young maternal age is associated with negative outcomes at birth and with offspring's growth. In low- and middle-income countries, adolescents' offspring growth little has been studied. Objective: To determine the association of maternal sociodemographic characteristics with weight, length, and BMI change in adolescents' offspring in their first year of life. Methods: This is a one-year follow-up study that included adolescent mothers and their offspring from 2010 to 2017. The infant anthropometric variables were performed at birth, 3, 6, and 12 months. Maternal health, pregnancy, and social variables were evaluated as well as birth outcomes. Crude, percentage, Z score, and percentile changes of weight, length, and BMI were evaluated from birth to 1-year-old. Statistical analyses were adjusted by maternal chronological age, socioeconomic status, breastfeeding duration, the timing of introduction of complementary feeding, among other variables. Results: We examined 186 dyads (mother-infant). The median maternal age was 15.5 years, and the mean pre-pregnancy BMI was 20. The mean gestational age was 39.1 weeks for infants, birth weight was 3,039 g, and length at birth was 49.5-cm. Maternal chronological age, the timing of introduction of complementary feeding, socioeconomic status, and maternal occupation were associated with offspring's weight gain at 12 months. Length gain was associated with exclusive breastfeeding. Socioeconomic status and occupation were associated with offspring's BMI change. When performing adjusted multivariable analyses, weight and length at birth were associated weight and BMI at 12 months. Conclusions: Weight at birth may negatively predict infant's weight and BMI changes at 12 months, while length at birth may positively predict the changes. Maternal chronological age, socioeconomic level, occupation, and the timing of the introduction of complementary feeding were associated with the weight change. Only exclusive breastfeeding was associated with length Z-score change in adolescents' offspring in their first 12-months of life.

Persistent Detection of Cosavirus and Saffold Cardiovirus in Riachuelo River, Argentina.

Cosaviruses (CoSV) and Saffold cardiovirus (SAFV) are novel members of the Picornaviridae family. The Matanza-Riachuelo river basin covers a total area of 2200 km2 with approximately 60 km long. Its last section is called Riachuelo River. The aim of this study was to describe the circulation of both picornaviruses and their relationship with the environmental situation of the Riachuelo River using 274 samples collected from 2005 to 2015. CoSV and SAFV were investigated in samples available by two periods: 2005-2006 and 2014-2015 (103 and 101, respectively). Physicochemical and bacteriological parameters confirmed very high levels of human fecal contamination during the 11 years evaluated. CoSV was detected in 85.7% (66/77) and 65.4% (17/26) of the samples collected in 2005-2006 and 2014-2015 periods, respectively. Species A and D were identified, the first one being widely predominant: 74.1% (20/27) and 75.0% (3/4) in both periods. SAFV virus was detected in 47.1% (32/68) and 52.6% (10/19) in periods 2005-2006 and 2014-2015, respectively. SAFV-6 was the most identified genotype in the entire study, while SAFV-3 was predominant in 2005-2006. The contribution of genotypes 1, 2, 4 and 8 was minor. The high prevalence of CoSV and SAFV suggests that both viruses have been circulating in Argentina at least since 2005. Our results show that a watercourse with high rates of human fecal contamination can become a persistent source of new viruses which capacity to produce human diseases is unknown.