Prevalence and duration of SARS-CoV-2 fecal shedding in breastfeeding dyads following maternal COVID-19 diagnosis.

Background: There is a paucity of data on the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in feces of lactating women with coronavirus disease 2019 (COVID-19) and their breastfed infants as well as associations between fecal shedding and symptomatology. Objective: We examined whether and to what extent SARS-CoV-2 is detectable in the feces of lactating women and their breastfed infants following maternal COVID-19 diagnosis. Methods: This was a longitudinal study carried out from April 2020 to December 2021 involving 57 breastfeeding maternal-infant dyads: 33 dyads were enrolled within 7 d of maternal COVID-19 diagnosis, and 24 healthy dyads served as controls. Maternal/infant fecal samples were collected by participants, and surveys were administered via telephone over an 8-wk period. Feces were analyzed for SARS-CoV-2 RNA. Results: Signs/symptoms related to ears, eyes, nose, and throat (EENT); general fatigue/malaise; and cardiopulmonary signs/symptoms were commonly reported among mothers with COVID-19. In infants of mothers with COVID-19, EENT, immunologic, and cardiopulmonary signs/symptoms were most common, but prevalence did not differ from that of infants of control mothers. SARS-CoV-2 RNA was detected in feces of 7 (25%) women with COVID-19 and 10 (30%) of their infants. Duration of fecal shedding ranged from 1-4 wk for both mothers and infants. SARS-CoV-2 RNA was sparsely detected in feces of healthy dyads, with only one mother's and two infants' fecal samples testing positive. There was no relationship between frequencies of maternal and infant SARS-CoV-2 fecal shedding (P=0.36), although presence of maternal or infant fever was related to increased likelihood (7-9 times greater, P≤0.04) of fecal shedding in infants of mothers with COVID-19.

SARS-CoV-2 specific antibody trajectories in mothers and infants over two months following maternal infection.

Infants exposed to caregivers infected with SARS-CoV-2 may have heightened infection risks relative to older children due to their more intensive care and feeding needs. However, there has been limited research on COVID-19 outcomes in exposed infants beyond the neonatal period. Between June 2020 - March 2021, we conducted interviews and collected capillary dried blood spots from 46 SARS-CoV-2 infected mothers and their infants (aged 1-36 months) for up to two months following maternal infection onset (COVID+ group, 87% breastfeeding). Comparative data were also collected from 26 breastfeeding mothers with no known SARS-CoV-2 infection or exposures (breastfeeding control group), and 11 mothers who tested SARS-CoV-2 negative after experiencing symptoms or close contact exposure (COVID- group, 73% breastfeeding). Dried blood spots were assayed for anti-SARS-CoV-2 S-RBD IgG and IgA positivity and anti-SARS-CoV-2 S1 + S2 IgG concentrations. Within the COVID+ group, the mean probability of seropositivity among infant samples was lower than that of corresponding maternal samples (0.54 and 0.87, respectively, for IgG; 0.33 and 0.85, respectively, for IgA), with likelihood of infant infection positively associated with the number of maternal symptoms and other household infections reported. COVID+ mothers reported a lower incidence of COVID-19 symptoms among their infants as compared to themselves and other household adults, and infants had similar PCR positivity rates as other household children. No samples returned by COVID- mothers or their infants tested antibody positive. Among the breastfeeding control group, 44% of mothers but none of their infants tested antibody positive in at least one sample. Results support previous research demonstrating minimal risks to infants following maternal COVID-19 infection, including for breastfeeding infants.

Milk From Women Diagnosed With COVID-19 Does Not Contain SARS-CoV-2 RNA but Has Persistent Levels of SARS-CoV-2-Specific IgA Antibodies.

Background: Limited data are available regarding the balance of risks and benefits from human milk and/or breastfeeding during and following maternal infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objective: To investigate whether SARS-CoV-2 can be detected in milk and on the breast after maternal coronavirus disease 2019 (COVID-19) diagnosis; and characterize concentrations of milk immunoglobulin (Ig) A specific to the SARS-CoV-2 spike glycoprotein receptor binding domain (RBD) during the 2 months after onset of symptoms or positive diagnostic test. Methods: Using a longitudinal study design, we collected milk and breast skin swabs one to seven times from 64 lactating women with COVID-19 over a 2-month period, beginning as early as the week of diagnosis. Milk and breast swabs were analyzed for SARS-CoV-2 RNA, and milk was tested for anti-RBD IgA. Results: SARS-CoV-2 was not detected in any milk sample or on 71% of breast swabs. Twenty-seven out of 29 (93%) breast swabs collected after breast washing tested negative for SARS-CoV-2. Detection of SARS-CoV-2 on the breast was associated with maternal coughing and other household COVID-19. Most (75%; 95% CI, 70-79%; n=316) milk samples contained anti-RBD IgA, and concentrations increased (P=.02) during the first two weeks following onset of COVID-19 symptoms or positive test. Milk-borne anti-RBD IgA persisted for at least two months in 77% of women. Conclusion: Milk produced by women with COVID-19 does not contain SARS-CoV-2 and is likely a lasting source of passive immunity via anti-RBD IgA. These results support recommendations encouraging lactating women to continue breastfeeding during and after COVID-19 illness.

Incidencia de la comunicación interventricular en niños de 0-5 años: manifestaciones clínicas y métodos diagnósticos, hospital pediátrico Roberto Gilbert, 2003 / Incidence of interventricular communication in children 0-5 years: clinic manifestations and diagnostic methods, Dr. Roberto Gilbert hospital 2003

Tipo de estudio: retrospectivo, descriptivo, longitudinal y analítico. Objetivo: Determinar las manifestaciones clínicas y métodos diagnósticos de la CIV, eficaces y económicos en niños atendidos en el hospital “Roberto Gilbert“. Metodología: se incluyeron en este estudio 150 pacientes con CIV como defecto único que acudieron a la consulta externa y con edades comprendidas entre 0 - 5 años. Resultados: el grupo de edad en que se diagnosticó la mayoría de los casos fue 0-1 años, 52,6% hombres y 47,4% mujeres. Las manifestaciones clínicas predominantes fueron: soplo cardiaco 100%, taquipnea 66,6% y disnea 50%. El método diagnóstico mas eficaz y efectivo fue el Eco-Doppler, permitiendo conocer el diámetro del defecto: < 0,5 cm (43,3%), 0,5 -1,5 cm (53,3%) y > 1,5 cm (3,3%); la localización: CIV muscular (35,3%) y CIV perimembranosa (64,6%) y el mecanismo de semicierre: restrictiva (espontáneo) 71,3% y corrección quirúrgica 28,6%. Conclusiones: en este grupo de estudio se encontró como principal manifestación clínica de la CIV, soplo cardiaco localizado en el borde esternal inferior izquierdo de intensidad V/VI, y el diagnóstico de certeza se lo obtuvo mediante la combinación de auscultación, radiografía de tórax, EKG y Eco Doppler.

Type of study: retrospective, descriptive, longitudinal and analytic. Objective: to determine clinic manifestation and diagnostic manifestations of CIV, effective and economic in children of the Dr. “Roberto Gilbert” hospital. Methodology: there were included in this study 150 patients with CIV like unique defect that coming at the external consulting and ages between 0 – 5 years old. Results: the age group which was diagnosed the most of cases was 0 – 1 years, 52,6% men and 47,4% women. The clinic manifestations predominant was: cardiac murmur 100%, taquipnea 66,6% and disnea 50%. The diagnostic method more effective and efficient was the Eco-Doppler, allowing to know the diameter of the defect: < 0,5 cm (43,3%), 0,5-1,5 cm (53,3%) y CIV perimembranosa (64,6%) and the semicloses mechanism: restrictive (spontaneous) 71,3% and surgical correction 28,6%. Conclusions: in this group, it found like principal clinic manifestations of CIV, cardiac murmur located in the right lower costal margin, of intensity V/VI, and the right diagnostic is combination of auscultation, X-ray of thorax, EKG and Eco Doppler

Toxoplasmosis en pacientes con VIH / HIV patients with toxoplasmosis

El siguiente trabajo esta enfocado en la toxoplasmosis como una de las enfermedades que más frecuentemente afecta a los pacientes con VIH y a la complicación más grave, la infección del SNC.Tipo de estudio: longitudinal, retrospectivo, descriptivo y analítico.El objetivo del estudio es determinar el número de pacientes que desarrollaron toxoplasmosis, teniendo como patología de base el VIH.Metodología: Se escogieron 40 pacientes en el lapso de 3 años según las siguientes variables; edad, género, CD4 y carga viral.Resultados del estudio: El rango de los pacientes con VIH/SIDA y que además presentaron infección por toxoplasma gondii fue entre los 18 – 49 años y predominó significativamente en el sexo masculino (71,4%); además el 21,4% del total de pacientes presentaron infección del SNC.De lo observado tenemos que el 64,29% de los pacientes tenían un contaje de linfocitos CD4 < 200 células/mm3 y una carga viral alta. Esto concluyó que a menor número de linfocitos CD4, mayor probabilidad de desarrollar toxoplasmosis, y por ende complicaciones graves del SNC.

The following work is focused in toxoplasmosis, the illness that more frequently affects the patients with HIV/AIDS and to the most serious complication, the infection of the CNS. Type of Study design is longitudinal, retrospective, descriptive and analytic. Objectives The study was to asses the number of patients who develop toxoplasmosis, when also as basics concurrent disease they have HIV/AIDS. Methodology: 40 patients were chosen in a period of 3 years by the following variables: age, gender, CD4 counting a viral loading.Results from the study: were the following: The range of age of patients with HIV/AIDS and that also develop toxoplasma gondii infection was between 18 – 49 years old and it was more frequent in male sex (71,4%), also 21,4% of the total of patients develop CNS infection.It was observed also that 64,29% of the patients had a count of lymphocytes CD4 < 200 cells/mm3 and a high viral load. This concludes that to minor number of CD4 lymphocytes, higher the probability of developing toxoplasmosis and so serious complications of the CNS.

Etica en genética médica: actitud frente a dilemas en el asesoramiento genético / Ethics in genetics

Objetivo: Determinar la actitud de especialistas frente a dilemas éticos en relación al asesoramiento genético. Para realizar un anáisis de las actitudes frente a dilemas éticos que surgen en el asesoramiento genético, en los profesionales de la salud, principalmente gineco-obstetras, pediatras y genetistas de la ciudad Santafé de Bogotá; se realizó la averiguación entre profesionales que costó de un formulario que contenía preguntas y relatos de casos del asesoramiento genético. Los datos fueron recolectados desde Febrero de 1993 hasta Mayo de 1994. Se recolectaron 224 encuestas diligenciadas, correspondientes al 44.9 por ciento del total de repartidas. En la encuesta se preguntó respecto a la frecuencia con la que se interrogaba acerca de los antecedentes genéticos, la frecuencia con la que realizaban asesoramiento genético y la actitud ante dilemas presentados en seis casos, acerca: Confidencialidad ante paternidad imputada, Realización de procedimientos riesgosos, Situaciones que desvíen el motivo de consulta, Uso de medicamentos a los cuales no se le ha demostrado teratogenicidad aunque haya sospecha de ésta. El 45 por ciento de los encuestados envían a una paciente a una institución en donde realicen el asesoramiento, mientras que el 50 por ciento realiza el asesoramiento dependiendo del caso, el restante 4 por ciento siempre realiza el asesoramiento. Las respuestas a los dilemas fueron diversas y se encontraron respuestas diferentes en relación a los dilemas planteados en trabajos similares realizados en otros países como Brasil y Estados Unidos. No se observaron diferencias estadísticas importantes.