Hematopoietic Stem Cell Transplantation in Children with Inborn Errors of Immunity: a Multi-center Experience in Colombia.

PURPOSE: To characterize the pediatric population with inborn errors of immunity (IEI) that was treated with hematopoietic stem cell transplantation (HSCT) in three reference centers in Colombia. What have been the characteristics and outcomes of hematopoietic stem cell transplantation in pediatric patients with inborn errors of immunity in three reference care centers in Colombia between 2007 and 2018? METHODS: We conducted an observational, retrospective cohort study in children with a diagnosis of IEI who underwent HSCT between 2007 and 2018. RESULTS: Forty-seven patients were identified, and 5 were re-transplanted. Sixty-eight percent were male. The median age at diagnosis was 0.6 years, and for HSCT was 1.4 years. The most common diseases were chronic granulomatous disease (38%) followed by severe combined immune deficiencies (19%) and hemophagocytic lymphohistiocytosis (15%). Cord blood donors were the most used source of HSCT (44%). T cell-replete grafts from haploidentical donors using post-transplantation cyclophosphamide represent 37% of the cohort. All patients received conditioning, 62% with a non-myeloablative regimen. Calcineurin inhibitors were the main graft-versus-host disease prophylaxis (63.8%). Acute graft-versus-host disease developed in 35% of the total patients. The most frequent post-transplant infections were viral and fungal infections. The 1-year overall survival rates for the patients who received HSCT from identical, haploidentical, and cord sources were 80%, 72%, and 63%, respectively. The 5-year overall survival was 63%. CONCLUSIONS: HSCT is a curative treatment option for some IEI and can be performed with any donor type. Early and timely treatment in referral centers can improve survival.

Childhood fatalities in new Mexico: medical examiner-investigated cases, 2000-2010.

To better understand risk factors and populations at risk of childhood fatalities, a review of all records of childhood deaths (≤19 years) between 2000 and 2010 from New Mexico's statewide medical examiner was conducted. Annually, 313-383 childhood deaths were investigated (3820 total). Males and American Indians were overrepresented (62% and 20.4% of deaths, respectively). The most common manner of death was natural (44.8%), followed by accidental (31.4%), homicide (8.8%), suicide (8.8%), and undetermined (4.1%). Infants under 1 year of age accounted for 41.4% of deaths. Motor vehicle crashes were responsible for the majority of accidental deaths (69%), followed by unintentional overdoses (6.9%), and drowning (5.3%). Gunshot wounds, either intentional or unintentional, caused 10.7% of childhood deaths. Complete medico-legal investigation of childhood fatalities is needed to provide public health agencies with adequate data to evaluate and prevent childhood deaths.

Transmisión congénita de Trypanosoma cruzi en ratas Wistar de segunda generación / Congenital transmission of Trypanosoma cruzi in second generation Wistar rats

Se presentan los resultados de un estudio experimental sobre la transmisión congénita de Trypanosoma cruzi en crías de ratas albinas (Rattus norvegicus), cepa Wistar de segunda generación. El curso de la infección chagásica fue evaluado en las ratas infectadas inicialmente (RII) inyectadas con las formas metacíclicas del parásito, en las crías de la primera (C1ªG) y segunda generación (C2ªG), mediante pruebas de diagnóstico seroparasitológicas y molecular (PCR). En las RII se demostró infección aguda caracterizada por parasitemias patentes entre los 12 y 45 días post-inoculación (pi), e incremento en la respuesta inmune humoral con títulos desde 1:64 y 1:2048; en la fase crónica se evidencio ausencia de parasitemias y mantenimiento de una moderada respuesta humoral en el 100% de las madres. Las C1ªG no presentaron tripomastigotes en la sangre circulante, la prueba de IFI, reveló seropositividad apreciable en el 75% de los sueros. En las C2ªG, los exámenes directos de sangre y el hemocultivo, resultaron negativos; los xenodiagnósticos mostraron un 18,2% de positividad. Las pruebas serológicas empleadas (IFI y ELISA) detectaron un 31,8% y 34,1% anticuerpos circulantes anti-T. cruzi. La PCR aplicada a los sueros, presentó un bajo porcentaje de muestras positivas (6,8%) y en los tejidos (corazón y músculo esquelético) se observó una alta positividad de 54,5% y 45,4%, respectivamente. La presencia de formas flageladas en la sangre, la persistencia de la serología positiva por anticuerpos humorales transferidos vía materna y la permanencia de restos de ADN de T. cruzi en sueros y tejidos en un número importante de crías, confirma la infección congénita a su progenie, en segunda generación. Estos resultados son de gran importancia para una mejor comprensión de la epidemiología de la enfermedad de Chagas congénita

The results of the experimental study concerning the congenital transmission of Trypanosoma cruzi in second generation strain Wistar albino rats are presented. The course of the Chagas infection was evaluated in rats initially infected with the metacyclic forms of the parasite (RII) in first (C1stG) and second (C2ndG) generation offspring using parasitological, serological and molecular (PCR) diagnostic tests. In the RII, an acute infection characterized by patent parasitemias between 12 and 45 days post-inoculation and an increase in the humoral immune response with titers of 1:64 and 1:2048 in the chronic phase demonstrated the absence of parasitemia and maintenance of a moderate humoral response in 100% of the mothers. The C1stG did not show tripomastigotes in the blood circulation and the IIF test showed considerable seropositive in 75% of the sera. In C2ndG, direct blood and hemoculture exams performed were negative, while 18.2% of the xenodiagnosis were positive. The serological tests used (IIF and ELISA) detected 31.8% and 34.1% anti-T. cruzi circulating antibodies. The PCR applied to the serum presented a low percentage of positive (6.8%) samples and in tissues (heart and skeletal muscle) high positives of 54.5% and 45.4% respectively were observed. The presence of flagellated forms in the blood, the persistence of serological positive for humoral antibodies transferred by the mother and the permanence of remaining DNA of the T. cruzi in serum and tissues in a significant number of offspring confirm the congenital infection to their offspring in the second generation. These results are of great importance for the better understanding of the epidemiology of Chagas disease

Gene: a computerized database of monogenic dysmorphic syndromes with high mortality in the neonatal period

We selected 114 dysmorphic syndromes, and based on published data, have elaborated a general picture, including characteristic clinical, radiological and pathological signs. This database was prepared to run on personal computers. lt is possible to browse or search for the syndromes, features and references, among other characteristics.The dysmorphic syndromes were divided into two different sets, according to their mode of inheritance. The first comprises 78 monogenic syndromes with defined inheritance, while the second comprises 36 presently undefined syndromes with suggested monogenic inheritance. Among the first group, 53 have autosomal recessive inheritance. Although in almost half of the syndromes death is mostly perinatal, longer survival can be found. The organic systems involved among the 114 syndromes studied were as follows: Osteoarticular 81 per cent, cardiovascular 54 per cent, genitourinary 47 per cent, central nervous system 42 per cent, respiratory 41 per cent and gastrointestinal 37 per cent. Abnormalities of the osteoarticular system was the main cause of death in the majority of the syndromes.

Use of sibling data to estimate family mortality effects in Guatemala.

This paper examines the potential bias in estimates of child mortality determinants produced by the questionable assumption that sibling data are independent, and estimates the unmeasured familial effects shared among siblings. The parameter estimates yielded by the multivariate hazard model are very similar to those yielded by the standard hazard model. The standard errors of the parameter estimates, however, tend to be underestimated in conventional analyses. The contribution to child mortality from the familial factors seems modest net of household socioeconomic status, at least in this Guatemalan data set.