Setting up regional diagnostic reference levels for pediatric computed tomography in Latin America: preliminary results, challenges and the work ahead.

We established a framework for collecting radiation doses for head, chest and abdomen-pelvis computed tomography (CT) in children scanned at multiple imaging sites across Latin America with an aim towards establishing diagnostic reference levels (DRLs) and achievable doses (ADs) in pediatric CT in Latin America. Our study included 12 Latin American sites (in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Honduras and Panama) contributing data on the four most common pediatric CT examinations (non-contrast head, non-contrast chest, post-contrast chest and post-contrast abdomen-pelvis). Sites contributed data on patients' age, sex and weight, scan factors (tube current and potential), volume CT dose index (CTDIvol) and dose length product (DLP). Data were verified, leading to the exclusion of two sites with missing or incorrect data entries. We estimated overall and site-specific 50th (AD) and 75th (diagnostic reference level [DRL]) percentile CTDIvol and DLP for each CT protocol. Non-normal data were compared using the Kruskal-Wallis test. Sites contributed data from 3,934 children (1,834 females) for different CT exams (head CT 1,568/3,934, 40%; non-contrast chest CT 945/3,934, 24%; post-contrast chest CT 581/3,934, 15%; abdomen-pelvis CT 840/3,934, 21%). There were significant statistical differences in 50th and 75th percentile CTDIvol and DLP values across the participating sites (P<0.001). The 50th and 75th percentile doses for most CT protocols were substantially higher than the corresponding doses reported from the United States of America. Our study demonstrates substantial disparities and variations in pediatric CT examinations performed in multiple sites in Latin America. We will use the collected data to improve scan protocols and perform a follow-up CT study to establish DRLs and ADs based on clinical indications.

Pulmonary imaging in coronavirus disease 2019 (COVID-19): a series of 140 Latin American children.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which resulted in the worldwide coronavirus disease 2019 (COVID-19) pandemic of 2020, has particularly affected Latin America. OBJECTIVE: The purpose of the study was to analyze the imaging findings of pulmonary COVID-19 in a large pediatric series. MATERIALS AND METHODS: Children with SARS-CoV-2 infection confirmed by either quantitative reverse transcription-polymerase chain reaction from nasopharyngeal swabs or presence of circulating immunoglobulin M (IgM) antibodies and who underwent chest radiograph or CT or both were included in this retrospective multicenter study. Three pediatric radiologists independently reviewed radiographs and CTs to identify the presence, localization, distribution and extension of pulmonary lesions. RESULTS: We included 140 children (71 female; median age 6.3 years, interquartile range 1.6-12.1 years) in the study. Peribronchial thickening (93%), ground-glass opacities (79%) and vascular engorgement (63%) were the most frequent findings on 131 radiographs. Ground-glass opacities (91%), vascular engorgement (84%) and peribronchial thickening (72%) were the most frequent findings on 32 CTs. Peribronchial thickening (100%), ground-glass opacities (83%) and pulmonary vascular engorgement (79%) were common radiograph findings in asymptomatic children (n=25). Ground-glass opacity and consolidation were significantly higher in children who needed intensive care admission or died (92% and 48%), in contrast with children with a favorable outcome (71% and 24%, respectively; P<0.05). CONCLUSION: Asymptomatic children and those with mild symptoms of COVID-19 showed mainly peribronchial thickening, ground-glass opacities and pulmonary vascular engorgement on radiographs. Ground-glass opacity and consolidation were more common in children who required intensive care admission or died.

Manejo clínico de hemorragia subaracnoidea por aneurisma intracraneal en una mujer embarazada en Quito, Ecuador: reporte de caso / Clinical management of subarachnoid haemorrhage due to intracranial aneurysm in a pregnant woman in Quito, Ecuador: Case report

RESUMEN Objetivo: describir el diagnóstico y manejo de la hemorragia subaracnoidea secundaria a un aneurisma arterial cerebral accidentado en la primera mitad del embarazo. Materiales y métodos: se presenta el caso de una mujer de 26 años en su segundo embarazo, sin abortos previos y con una cesárea anterior, que fue atendida en un centro de referencia de atención materno perinatal ubicado en Quito, Ecuador, por diagnóstico de hemorragia subaracnoidea durante la decimoséptima semana de gestación. En la panangiografía cerebral se observó un aneurisma cerebral de cuello ancho en la arteria temporal anterior con sangrado. Resultados: se realizó un tratamiento con prótesis endovascular y microespirales, con control de la hemorragia. Posteriormente, la paciente requirió doble antiagregación plaquetaria con clopidogrel y ácido acetilsalicílico que se mantuvo hasta una semana antes del parto. A la paciente se le realizó una cesárea electiva en la que nació un niño sano de 37,2 semanas. Conclusión: el tratamiento endovascular con la colocación de microespirales, asociado al uso de antiagregantes plaquetarios, es una alternativa por considerar en gestantes en la primera mitad del embarazo. Se requieren más estudios clínicos para establecer conductas terapéuticas bien fundamentadas en el manejo de estos casos.

ABSTRACT Objective: To describe the diagnosis and management of a case of subarachnoid haemorrhage secondary to arterial cerebral aneurysm during the first half of gestation. Materials and methods: A 26-year-old woman during a second pregnancy, with no prior miscarriages, and one previous cesarean section seen at a maternal and perinatal care referral centre located in Quito, Ecuador, with a diagnosis of subarachnoid haemorrhage at seventeen weeks of pregnancy. Cerebral pan-angiography showed a wide-neck cerebral aneurysm of the anterior temporal artery with bleeding. Results: Treatment was performed using endovascular stenting and coiling. Later, the patient required dual anti-platelet therapy with clopidogrel and acetylsalicylic acid, maintained up to a week before delivery. Elective cesarean section was performed and the patient was delivered of a healthy baby at 37.2 weeks of gestation. Conclusion: Endovascular treatment with the use of micro-coils, associated with anti-platelet aggregation therapy is an option to consider in pregnant women during the first half of gestation. Further clinical studies are needed in order to identify more fundamental therapeutic approaches for the management of these cases.

[Fusarium graminearum presence in wheat samples for human consumption]. / Presencia de Fusarium graminearum en muestras de trigo destinado al consumo humano.

One of the most important diseases in cereal crops is Fusarium head blight, being Fusarium graminearum the main etiological agent. This fungus has the ability to produce a wide spectrum and quantity of toxins, especially deoxynivalenol (DON). During the last crop season (2012-2013) the climatic conditions favored Fusarium colonization. The objective of this work was to determine the presence of this fungus as well as the DON content in 50 wheat grain samples. Our results showed that 80% of the samples were contaminated with Fusarium graminearum. Twenty four percent (24%) of the samples contained ≥ 1µg/g DON, 26% ranged from 0,5 and 0,99µg/g, and the remaining 50% had values lower than 0,5µg/g. Correlation was found between the presence of Fusarium graminearum and DON. It is necessary to establish DON limit values in wheat grains for human consumption.

Presencia de Fusarium graminearum en muestras de trigo destinado al consumo humano / Fusarium graminearum presence in wheat samples for human consumption

La fusariosis es una de las enfermedades más importantes de los cereales, Fusarium graminearum es su principal agente etiológico. Este hongo posee la capacidad de producir distintos tipos y niveles de toxinas, en especial deoxinivalenol (DON). En la campaña 2012-2013 se dieron condiciones ambientales predisponentes para el desarrollo de esta enfermedad. El objetivo de este trabajo fue evaluar la presencia del hongo y el contenido de DON en 50 muestras de trigo. Los resultados demostraron la presencia de Fusarium graminearum en el 80 % de las muestras analizadas. El 24 % de las muestras presentó valores de DON ≥ 1µg/g, el 26 % varió entre 0,5 y 0,99µg/g, mientras que el 50 % restante mostró valores inferiores a 0,5µg/g. Se observó correlación entre la presencia de Fusarium graminearum y de DON. Es necesario establecer valores límites de DON en granos de trigo destinados al consumo humano

One of the most important diseases in cereal crops is Fusarium head blight, being Fusarium graminearum the main etiological agent. This fungus has the ability to produce a wide spectrum and quantity of toxins, especially deoxynivalenol (DON). During the last crop season (2012-2013) the climatic conditions favored Fusarium colonization. The objective of this work was to determine the presence of this fungus as well as the DON content in 50 wheat grain samples. Our results showed that 80% of the samples were contaminated with Fusarium graminearum. Twenty four percent (24%) of the samples contained ≥ 1µg/g DON, 26% ranged from 0,5 and 0,99µg/g, and the remaining 50% had values lower than 0,5µg/g. Correlation was found between the presence of Fusarium graminearum and DON. It is necessary to establish DON limit values in wheat grains for human consumption

Presencia de Fusarium graminearum en muestras de trigo destinado al consumo humano. / [Fusarium graminearum presence in wheat samples for human consumption].

One of the most important diseases in cereal crops is Fusarium head blight, being Fusarium graminearum the main etiological agent. This fungus has the ability to produce a wide spectrum and quantity of toxins, especially deoxynivalenol (DON). During the last crop season (2012-2013) the climatic conditions favored Fusarium colonization. The objective of this work was to determine the presence of this fungus as well as the DON content in 50 wheat grain samples. Our results showed that 80

of the samples were contaminated with Fusarium graminearum. Twenty four percent (24

) of the samples contained  1Ag/g DON, 26

ranged from 0,5 and 0,99Ag/g, and the remaining 50

had values lower than 0,5Ag/g. Correlation was found between the presence of Fusarium graminearum and DON. It is necessary to establish DON limit values in wheat grains for human consumption.

Aborto y planificación de la familia / sss

El presente documento Aborto y Planificación Familiar plantea que se debe evitar y se debe disminuir la mortalidad infantil, se debe evitar la multiplicación de los "niños de la calle", que sufren hambre y no reciben instrucción. Todo esto se debe solucionar limitando el número de hijos "no deseados", no por medio del aborto, sino por una planificación familiar pero con métodos ciéntificos, que no afecten la moral, los principios religiosos.