Short-term complications and post-acute sequelae in hospitalized paediatric patients with COVID-19 and obesity: A multicenter cohort study.

BACKGROUND: Obesity increases the severity of coronavirus disease 2019 illness in adults. The role of obesity in short-term complications and post-acute sequelae in children is not well defined. OBJECTIVE: To evaluate the relationship between obesity and short-term complications and post-acute sequelae of SARS-CoV-2 infection in hospitalized paediatric patients. METHODS: An observational study was conducted in three tertiary hospitals, including paediatric hospitalized patients with a confirmatory SARS-CoV-2 RT-PCR from March 2020 to December 2021. Obesity was defined according to WHO 2006 (0-2 years) and CDC 2000 (2-20 years) growth references. Short-term outcomes were intensive care unit admission, ventilatory support, superinfections, acute kidney injury, and mortality. Neurological, respiratory, and cardiological symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms were considered as post-acute sequalae. Adjusted linear, logistic regression and generalized estimating equations models were performed. RESULTS: A total of 216 individuals were included, and 67 (31.02%) of them had obesity. Obesity was associated with intensive care unit admission (aOR = 5.63, CI95% 2.90-10.94), oxygen requirement (aOR = 2.77, CI95% 1.36-5.63), non-invasive ventilatory support (aOR = 6.81, CI95% 2.11-22.04), overall superinfections (aOR = 3.02 CI95% 1.45-6.31), and suspected bacterial pneumonia (aOR = 3.00 CI95% 1.44-6.23). For post-acute sequalae, obesity was associated with dyspnea (aOR = 9.91 CI95% 1.92-51.10) and muscle weakness (aOR = 20.04 CI95% 2.50-160.65). CONCLUSIONS: In paediatric hospitalized patients with COVID-19, severe short-term outcomes and post-acute sequelae are associated with obesity. Recognizing obesity as a key comorbidity is essential to develop targeted strategies for prevention of COVID-19 complications in children.

Characterization of avian poxvirus in Anna's Hummingbird (Calypte anna) in California, USA.

Avian poxvirus (genus Avipoxvirus, family Poxviridae) is an enveloped double-stranded DNA virus that may be transmitted to birds by arthropod vectors or mucosal membrane contact with infectious particles. We characterized the infection in Anna's Hummingbird (Calypte anna; n = 5 birds, n = 9 lesions) by conducting diagnostic tests on skin lesions that were visually similar to avian poxvirus lesions in other bird species. Skin lesions were single or multiple, dry and firm, pink to yellow, with scabs on the surface, and located at the base of the bill, wings, or legs. Microscopically, the lesions were characterized by epidermal hyperplasia and necrosis with ballooning degeneration, and intracytoplasmic inclusions (Bollinger bodies) in keratinocytes. The 4b core gene sequence of avian poxvirus was detected by PCR in samples prepared from lesions. Nucleotide sequences were 75-94% similar to the sequences of other published avian poxvirus sequences. Phylogenetic analyses showed that the Anna's Hummingbird poxvirus sequence was distinguished as a unique subclade showing similarities with sequences isolated from Ostrich (Struthio camelus), Wild Turkey (Meleagris gallopavo), falcons (Falco spp.), Black-browed Albatross (Diomedea melanophris), Mourning Dove (Zenaida macroura) and White-tailed Eagle (Haliaeetus albicilla). To our knowledge this is the first published report of definitive laboratory diagnosis of avian poxvirus in a hummingbird. Our results advance the science of disease ecology in hummingbirds, providing management information for banders, wildlife rehabilitators, and avian biologists.

Chylothorax in congenital diaphragmatic hernia.

PURPOSE: Following surgical repair of congenital diaphragmatic hernia (CDH), chylothorax can be present in 7-28% of the cases. It has been associated with prenatal diagnosis, the use of ECMO and prosthetic patches during reparatory surgery. The objective is to present a neonatal unit experience in handling this complication and the search for predictive factors for its appearance in our patients. METHODS: A retrospective study was carried out between 2003 and 2009. RESULTS: We found 65 patients with CDH, of which 7 (10.8%) developed a chylothorax, 5 responded to drainage and diet restriction. Octreotide (OCT) was used in two cases that did not respond to the usual treatment. OCT was successful with one patient, while surgical resolution of the chylothorax was necessary in the other. Two patients died, none of them during treatment of chylothorax. We did not find a significant association between chylothorax and the variables studied in these patients. CONCLUSIONS: Chylothorax is a common complication following CDH repair. We have a low rate of this complication in our institution. Conservative management is an appropriate approach for all patients; OCT could be an alternative to avoid surgery. We did not find any predictive factors for chylothorax in our series.

Improvement of survival in infants with congenital diaphragmatic hernia in recent years: effect of ECMO availability and associated factors.

BACKGROUND/PURPOSE: Survival of patients with congenital diaphragmatic hernia (CDH) depends both on non-modifiable congenital conditions and on modifiable pre and postnatal management. ECMO improves survival up to 80% in neonates with CDH in the best ECMO centers worldwide. The first Neonatal ECMO Program in Chile was started in our University in 2003. Our objective is to determine the impact of a Neonatal ECMO Program in a level III NICU on newborns with CDH. METHODS: Data of all newborns with CDH admitted to our NICU was separated into two groups: pre ECMO (1996-2003) and ECMO (2003-2007). Crude and adjusted odds ratios for 24 months survival were estimated by logistic regression. RESULTS: Data of 46 newborns with CDH was analysed, 20 in the pre ECMO and 26 in the ECMO period. Patient characteristics were similar in both groups; however, 24-month survival increased significantly from 25% (5/20) in the pre ECMO period to 77% (20/26) in the ECMO period (P = 0.001). Adjusted odds ratios for 24-month survival were 26.98 for OI or= 7 and 17.5 for ECMO availability. CONCLUSIONS: The establishment of an ECMO program was associated with a significant increase in long-term survival for infants with CDH.

[Cancer pharmacogenetics: study of genetically determined variations on cancer susceptibility due to xenobiotic exposure]. / Famacogénica del cáncer: estudio de variaciones genéticamente determinadas en la susceptibilidad a cáncer por exposición a xenobióticos.

Pharmacogenetics is the study of genetically determined variations in the response to drugs and toxic agents, and their implications on disease. Recently, the discipline has acquired great relevancy due to the development of non-invasive molecular techniques that identify genetic variants in human beings. There is also a need to explain the individual differences in susceptibility to drug actions and disease risk. Genetic variants can modify the magnitude of a pharmacologic effect, toxicity threshold, secondary effects and drug interactions. There are approximately thirty families of drug-metabolizing enzymes with genetic variants that cause functional alterations and variations in pharmacologic activity. We summarize the general knowledge about genetic variants of biotransformation enzymes, their relationship with cancer risk and the role of ethnicity. Cancer pharmacogenetics is another promising and exciting research area that will explain why people with an almost identical group of genes, have a different susceptibility to cancer, whose etiology has genetic and environmental components.

Famacogénica del cáncer: Estudio de variaciones genéticamente determinadas en la susceptibilidad a cáncer por exposición a xenobióticos / Cancer pharmacogenetics: Study of genetically determined variations on cancer susceptibility due to xenobiotic exposure

Pharmacogenetics is the study of genetically determined variations in the response to drugs and toxic agents, and their implications on disease. Recently, the discipline has acquired great relevancy due to the development of non-invasive molecular techniques that identify genetic variants in human beings. There is also a need to explain the individual differences in susceptibility to drug actions and disease risk. Genetic variants can modify the magnitude of a pharmacologic effect, toxicity threshold, secondary effects and drug interactions. There are approximately thirty families of drug-metabolizing enzymes with genetic variants that cause functional alterations and variations in pharmacologic activity. We summarize the general knowledge about genetic variants of biotransformation enzymes, their relationship with cancer risk and the role of ethnicity. Cancer pharmacogenetics is another promising and exciting research area that will explain why people with an almost identical group of genes, have a different susceptibility to cancer, whose etiology has genetic and environmental components.

Exposición subcutánea a lindano: reporte de caso / Subcutaneous exposure to lindane: case report

El lindano es un insecticida organoclorado perteneciente a la familia de los hexaclorociclohexanos. A pesar de su toxicidad, es usado frecuentemente para el tratamiento de la pediculosis y sarna en humanos, por su bajo costo y amplia disponibilidad. En los principales efectos clínicos de la exposición aguda a lindano, se encuentran: excitación, convulsiones, cefalea, hipertemia, disnea, depresión respiratoria, hipotensión, arritmias, mareos, náuseas, vómitos, entre otras [1]. Se han descrito diferentes vías de absorción del lindano, siendo la más frecuente la exposición dérmica [2], y luego la ingestión e inhalación. Sin embargo, hasta el momento no ha habido reportes de exposición por vía subcutánea. Este reporte presenta un caso en que la exposición se produjo vía subcutánea.