Gravedad y complicaciones en lactantes con infección por el virus respiratorio sincitial posterior a la pandemia por SARS-CoV-2 / Severity and complications in infants with respiratory syncytial virus infection after the SARS-CoV-2 pandemic

Resumen Introducción: Posterior a la pandemia por SARS-CoV-2 se ha observado un incremento en la hospitalización por virus respiratorio sincitial (VRS), con mayores complicaciones. Se han encontrado alteraciones extrapulmonares asociadas, disfunción biventricular y lesión renal aguda, entre otras. El objetivo de este estudio fue analizar la evolución y las complicaciones en niños hospitalizados con enfermedad respiratoria de vías bajas secundaria a infección por VRS tras la pandemia de COVID-19. Métodos: Se incluyeron todos los menores de 2 años que ingresaron al servicio de urgencias con infección por VRS. Se analizaron las características clínicas, la necesidad de oxígeno suplementario, el uso de aminas, el índice de angina renal y el requerimiento de terapia de sustitución renal. Se realizó ecografía pulmonar al ingreso. En el análisis estadístico, para las variables cuantitativas se determinaron la media y la desviación estándar, y para las variables cualitativas la frecuencia y el porcentaje. Se evaluaron las diferencias de la distribución con la prueba exacta de Fisher. Resultados: Hubo 45 pacientes con infección por VRS. El 26.7% requirieron ventilación mecánica invasiva y el 11.1% diálisis peritoneal. La letalidad fue de cuatro casos, tres de ellos menores de 12 meses con puntuación de LUS > 7; esto contrasta con el 90.2% de los sobrevivientes con puntaje < 7 (p = 0.0004). Conclusiones: Se observó un aumento en la incidencia de bronquiolitis tras la pandemia, en más de la mitad de los casos con cuadros de moderados a graves, y todos requirieron oxígeno suplementario al ingreso. La lesión renal aguda fue la manifestación extrapulmonar más frecuente.

Abstract Background: After the SARS-CoV-2 pandemic, there has been an increase in hospitalization for lower respiratory infection secondary to respiratory syncytial virus (RSV), with greater complications. Associated extrapulmonary alterations, biventricular dysfunction, acute kidney injury, among others, have been found. The objective of this study was to analize the evolution and complications in hospitalized children with lower respiratory infection secondary to RSV after COVID-19 pandemic. Methods: All pediatric patients under 2 years of age admitted to the emergency department with RSV infection were included. Clinical characteristics, need for supplemental oxygen, use of amines, renal angina index, and requirement for renal replacement therapy were analyzed. Lung ultrasound was performed upon admission. Statistical analysis was carried out for the quantitative variables by means of mean and standard deviation, and qualitative variables by frequency and percentage. Differences in the distribution were evaluated with Fisher’s exact distribution. Results: 45 patients with RSV infection were identified, 26.7% required invasive mechanical ventilation and 11.1% requiered peritoneal dialysis. Fatality was observed in four cases, three of these younger than 12 months with a LUS score > 7; contrasts with 90.2% of survivors with a score < 7 (p = 0.0004). Conclusions: An increase in the incidence of bronchiolitis after pandemic was observed, with more than half having moderate to severe symptoms and requiring supplemental oxygen support in all patients upon admission. Acute kidney injury is the most common extrapulmonary manifestation.

Usefulness of lung ultrasound in the evaluation of children with lower respiratory tract infection in the emergency room / Utilidad de ecografía pulmonar en la valoración de niños con infección respiratoria baja en urgencias

Abstract Background: Lung ultrasound is a bedside tool that allows the evaluation of pulmonary parenchymal involvement in pediatric patients through the lung ultrasound score (LUS). We aimed to evaluate a group of patients under 3 years of age with lower respiratory tract infections using LUS at the Hospital Infantil del Estado de Sonora. Methods: We included patients younger than 3 years admitted to the emergency department with lower respiratory tract infections. A lung ultrasound was performed within the first 24 h of admission to the emergency department and evaluated using LUS. We analyzed age, sex, etiology of infection, days of stay, use of mechanical ventilation, Downes scale, failure of mechanical ventilation on admission, and mortality. Descriptive analysis was performed with frequencies and percentages for qualitative variables and medians and interquartile intervals for quantitative variables. Differences in the distribution of LUS variables were evaluated with the Fishers´ exact test and Student´s t-test. Results: We included a total of 19 patients with lower respiratory tract infections, 73.7% with bronchiolitis. Fifty percent of the cases scored 7 on the LUS, 91.7% were admitted to the pediatric intensive care unit, and 53.8% required invasive mechanical ventilation. Conclusions: The use of LUS in lower respiratory tract infections can predict the need for PICU admission, the use of invasive ventilatory support, and prolonged hospital stay.

Resumen Introducción: El ultrasonido pulmonar es una herramienta a pie de cama que permite evaluar la afectación del parénquima pulmonar en pacientes pediátricos por medio de la escala de LUS (lung ultrasound score, por sus siglas en inglés). El objetivo del estudio fue evaluar a niños menores de 3 años con infección respiratoria baja mediante la escala de LUS, en el Hospital Infantil del Estado de Sonora. Métodos: Se incluyeron pacientes menores de 3 años que ingresaron al Servicio de Urgencias con infección respiratoria baja. Se realizó ecografía pulmonar en las primeras 24 horas de ingreso a urgencias y se evaluó mediante la escala de LUS. Se analizó, edad, sexo, etiología de la infección, días de estancia, uso de terapia ventilatoria, escala de Downes, fracaso a la terapia ventilatoria de ingreso y mortalidad. Se realizó un análisis descriptivo por medio de frecuencia y porcentaje para las variables cualitativas y para las cuantitativas con mediana e intervalo intercuartil. Las diferencias en la distribución de las variables por la escala de LUS con la prueba exacta de Fisher y la t de Student. Resultados: Se identificaron 19 pacientes con infección pulmonar aguda, de los cuales el 73.7% presentó bronquiolitis. El 50% de los casos obtuvo 7 puntos de la escala de LUS, el 91.7% ingresó a UCIP y el 53.8% requirió ventilación mecánica asistida. Conclusiones: El uso de la escala LUS en infección respiratoria baja puede predecir la necesidad de ingreso a Unidad de Cuidados Intensivos Pediátricos, así como la utilización de soporte ventilatorio invasivo y una estancia hospitalaria prolongada.

A 6-year retrospective study of fine needle aspiration cytology pattern of otorhinolaryngological cases of patients referred to national ear care centre Kaduna (2013-2018)

Background: This study was carried out to obtain the retrospective study of FNAC cases referred to NECC; and review occurrences of ortorhinolaryngological swellings and demographic studies of patients for a period of 6 years (2013-2018). Records of FNAC were obtained from the laboratory department’s unit’s register alongside the biodata of patients for demographic studies. Methods: FNAC samples were treated for diagnosis according to the unit’s standard operating procedure for cytology. A total of three hundred and fifty-three 353 cases were reported and tables were then plotted to present the study cases using simple descriptive statistics. Results: Highest age distribution was between thirty to thirty-nine (30-39) years with a total of ninety-five cases 95(26.9%) followed by the range of forty to forty-nine (40-49) years with a value of eighty 80(22.6%). Females had the highest frequency of one hundred and thirty-three 133 (62.3%) compared to their male patient counterpart with a value of two hundred and twenty 220 (37.6%). The site of sample collection had ANS with the highest value of eighty-one 81 (42.4%) compared to other sites. The year 2016 had the highest number of FNAC cases and finally ninety 6 cases 96 (27.2%) of cases were inflammatory, two hundred and thirty-two 232 (65.7%) were benign while twenty five 25 (7.1%) were malignant. Conclusions: In conclusion; FNAC plays a vital role in managing otorhinolaryngology conditions and gives a way forward for effective treatment to patients and often at times is therapeutic as some patients come with fluid field swelling that get relieved after the procedure.

A 6-year retrospective study of fine needle aspiration cytology pattern of otorhinolaryngological cases of patients referred to national ear care centre Kaduna (2013-2018)

Background: This study was carried out to obtain the retrospective study of FNAC cases referred to NECC; and review occurrences of ortorhinolaryngological swellings and demographic studies of patients for a period of 6 years (2013-2018). Records of FNAC were obtained from the laboratory department’s unit’s register alongside the biodata of patients for demographic studies. Methods: FNAC samples were treated for diagnosis according to the unit’s standard operating procedure for cytology. A total of three hundred and fifty-three 353 cases were reported and tables were then plotted to present the study cases using simple descriptive statistics. Results: Highest age distribution was between thirty to thirty-nine (30-39) years with a total of ninety-five cases 95(26.9%) followed by the range of forty to forty-nine (40-49) years with a value of eighty 80(22.6%). Females had the highest frequency of one hundred and thirty-three 133 (62.3%) compared to their male patient counterpart with a value of two hundred and twenty 220 (37.6%). The site of sample collection had ANS with the highest value of eighty-one 81 (42.4%) compared to other sites. The year 2016 had the highest number of FNAC cases and finally ninety 6 cases 96 (27.2%) of cases were inflammatory, two hundred and thirty-two 232 (65.7%) were benign while twenty five 25 (7.1%) were malignant. Conclusions: In conclusion; FNAC plays a vital role in managing otorhinolaryngology conditions and gives a way forward for effective treatment to patients and often at times is therapeutic as some patients come with fluid field swelling that get relieved after the procedure.

Nigeria Centre for Disease Control awareness creation and risk communication of Covid-19 pandemic amongst non-literate population in south-west Nigeria: lessons for future health campaign

Background: Risk communication of Covid-19 pandemic in Nigeria appeared to be urban-centred with the dominant use of social media, print communication and other controlled media. In such times of public health emergencies, non-literate population could be vulnerable as a result of their limited understanding of the nature of such health risk. Objective: Therefore, the study seeks to investigate the extent to which NCDC communicated the risk of Covid-19 disease to non-literates population in its public health campaign during the pandemic in South-West Nigeria. Methods: The study adopts risk communication theory which advances the approach communication should take during public health emergencies. Using the concurrent mixed method research design, a sample of 420 respondents were purposively selected from 6 towns in the rural areas of Lagos, Oyo and Osun states to examine the level of awareness on Covid-19 pandemic among non-literates. In addition, NCDC risk communication on Covid-19 for non-literates population were analysed from 3 Jingles in Yoruba language as well as 9 flyers designed for Covid-19 disease from NCDC websites. Results: Results showed that NCDC awareness creation on Covid-19 disease for non-literates in Southwest achieved significant success as a result of the medium used in creating awareness. Specifically, radio was highly rated among majority of the respondents (60.4%) followed by Health workers (19.8%) as channels that created understandable message on Covid-19 safety protocols. Further findings on Jingles content revealed that all Covid-19 safety protocols were communicated in Yoruba language for Southwest populace. However, NCDC fall short in communicating Covid-19 risk effectively for non-literates in Southwest as jingles only buttressed the Covid-19 safety protocols and symptoms as well as the need to comply, without educating the masses on the dreadful nature of the disease and its dynamics. Though flyers designed by the NCDC communicated risk to an extent, nevertheless, graphics and symbols on Covid-19 disease were complimented by words in English language only, which could be difficult for non-literates to decipher. Conclusion: Based on the findings, the study recommends that public health agencies need to educate non-literate population about the nature of a disease more than creating awareness about the outbreak of a disease.

Substance use among adolescents in sub-Saharan Africa: a systematic review and meta-analysis

Background. In sub-Saharan Africa, substance use among adolescents has continued to be a major public health concern, albeit poorly documented across many settings. Objective. To estimate the prevalence of substance use among adolescents in sub-Saharan Africa. Methods. We searched Pubmed, EMBASE, AJOL and Google Scholar for population-based studies on adolescents (age 10 - 19 years) and reporting on the prevalence of substance use across sub-Saharan Africa. Search dates were from January 2000 to December 2016. A random effects meta-analysis was conducted with pooled prevalence rates (and 95% confidence interval (95% CI)) of estimated substance abuse among adolescents in sub-Saharan Africa. Results. Twenty-seven studies across sub-Saharan Africa including 143 201 adolescents (mean age 15.6 years) were selected. The overall prevalence of 'any substance use' in sub-Saharan Africa was 41.6%, with the highest rate in Central Africa at 55.5%. The use of caffeine-containing products (including coffee or kola nut) was most predominant at 41.2% (95% CI 24.3 - 58.1) but limited to West Africa. These were followed by alcohol at 32.8% (95% CI 26.0 - 39.5), tobacco products 23.5% (95% CI 17.7 - 29.3), khat 22.0% (95% CI 12.5 - 31.5) and cannabis 15.9% (95% CI 12.2 - 19.1). Other abused substances included depressants at 11.3% (95% CI 6.5 - 16.1), amphetamines 9.4% (95% CI 6.0 - 12.9), heroin 4.0% (95% CI 3.5 - 4.5) and cocaine 3.9% (95% CI 1.4 - 6.5). Conclusion. Our study reflects a high use of psychoactive substances and drugs among adolescents in sub-Saharan Africa. It is important that interventions and rehabilitation programmes are comprehensive and targeted at adolescents and parents in these settings

Mesenteric hypoperfusion and inflammation induced by brain death are not affected by inhibition of the autonomic storm in rats

OBJECTIVES: Brain death is typically followed by autonomic changes that lead to hemodynamic instability, which is likely associated with microcirculatory dysfunction and inflammation. We evaluated the role of the microcirculation in the hemodynamic and inflammatory events that occur after brain death and the effects of autonomic storm inhibition via thoracic epidural blockade on mesenteric microcirculatory changes and inflammatory responses. METHODS: Male Wistar rats were anesthetized and mechanically ventilated. Brain death was induced via intracranial balloon inflation. Bupivacaine (brain death-thoracic epidural blockade group) or saline (brain death group) infusion via an epidural catheter was initiated immediately before brain death induction. Sham-operated animals were used as controls (SH group). The mesenteric microcirculation was analyzed via intravital microscopy, and the expression of adhesion molecules was evaluated via immunohistochemistry 180 min after brain death induction. RESULTS: A significant difference in mean arterial pressure behavior was observed between the brain death-thoracic epidural blockade group and the other groups, indicating that the former group experienced autonomic storm inhibition. However, the proportion of perfused small vessels in the brain death-thoracic epidural blockade group was similar to or lower than that in the brain death and SH groups, respectively. The expression of intercellular adhesion molecule 1 was similar between the brain death-thoracic epidural blockade and brain death groups but was significantly lower in the SH group than in the other two groups. The number of migrating leukocytes in the perivascular tissue followed the same trend for all groups. CONCLUSIONS: Although thoracic epidural blockade effectively inhibited the autonomic storm, it did not affect mesenteric hypoperfusion or inflammation induced by brain death. .

Seroprevalence of Human Cytomegalovirus and Rubella Virus Antibodies among Anti-retroviral Naive HIV Patients in Lagos.

Background/Aims: Opportunistic infections such as Cytomegalovirus (CMV) and Rubella virus that pose no threat to healthy individuals can be life threatening in those with impaired immune systems. The aim of this study was to determine the sero-prevalence of human Cytomegalovirus (CMV) and Rubella Immunoglobulin M and G (IgM and IgG) antibodies among anti-retroviral naive patients in Lagos. Study Design: This is a cross sectional study. Place and Duration of Study: AIDS Prevention Initiative in Nigeria (APIN) clinic in Lagos University Teaching Hospital (LUTH) between April 2011 and May 2012. Methodology: The study was carried out among 80 (28 males and 52 females) HIV infected adults attending the AIDS Prevention Initiative in Nigeria (APIN) clinic in Lagos University Teaching Hospital and the patients were aged between 18 and 60 years. IgG and IgM assay were performed using ELISA reagents (produced by Biotec laboratories, United Kingdom). Also, CD4+ cell counts were evaluated. Pearson’s Chi-squared test was used for the analytic assessment. Results: From our findings, twenty (25%) patients were positive for CMV IgM and sixty (75%) patients were positive for CMV IgG. Also, 59 (73.75%) patients were positive for Rubella IgG and only one (1.25%) patient was positive for rubella IgM. There was no significant statistical difference in seroprevalences of CMV-IgM, CMV- IgG, and rubella IgG with respect to sex, age, and CD4+ cell counts. Conclusion: This study showed that the sero-prevalence of CMV and Rubella virus is high among anti-retroviral naive HIV patients in Lagos, Nigeria.

Three invasive species occurring in the diets of fishes in a Neotropical floodplain / Ocorrência de três espécies invasoras nas dietas de peixes em uma planície de inundação Neotropical

The composition of the diets of 66 species of fishes was investigated from September 2009 to June 2010 in three subsystems of the Upper Paraná River floodplain (Brazil), following invasion by the two mollusk species Limnoperna fortunei (Dunker, 1857) and Corbicula fluminea (Müller, 1774), and the macrophyte Hydrilla verticillata (L.f.) Royle. Limnoperna fortunei was consumed in all three subsystems and occurred in the diet of 15 fish species, with a high proportion in the diet of Leporinus obtusidens. Corbicula fluminea was present in the diet of Pterodoras granulosus caught in the Paraná and Ivinheima subsystems. Hydrilla verticillata occurred in the diet of Schizodon nasutus caught in the Ivinheima and Paraná subsystems. It is not yet possible to evaluate the potential of these species to control invasive mollusks in the study area or the impact of these species on the structure of the food chain. Omnivorous and herbivorous fishes in the study area may have little impact on the population of H. verticillata.

A composição da dieta de 66 espécies de peixes foi investigada de setembro de 2009 a junho de 2010, em três subsistemas da planície de inundação do alto rio Paraná (Brasil), após a invasão das espécies de molusco Limnoperna fortunei (Dunker, 1857) e Corbicula fluminea (Müller, 1774), e da macrófita Hydrilla verticillata (L.f.) Royle. Limnoperna fortunei foi consumida em todos os subsistemas amostrados e ocorreu na dieta de 15 espécies de peixes, com grande participação na dieta de Leporinus obtusidens. Corbicula fluminea esteve presente na dieta de Pterodoras granulosus coletados nos subsistemas Paraná e Ivinheima. Hydrilla verticillata ocorreu na dieta de Schizodon nasutus, capturados nos subsistemas Ivinheima e Paraná. Até o momento não é possível avaliar o potencial destas espécies para controlar moluscos invasores na área de estudo ou o impacto destas espécies sobre a estrutura das cadeias alimentares. Peixes omnívoros e herbívoros da área de estudo podem ter pouco impacto sobre a população de H. verticillata.

Three invasive species occurring in the diets of fishes in a Neotropical floodplain

The composition of the diets of 66 species of fishes was investigated from September 2009 to June 2010 in three subsystems of the Upper Paraná River floodplain (Brazil), following invasion by the two mollusk species Limnoperna fortunei (Dunker, 1857) and Corbicula fluminea (Müller, 1774), and the macrophyte Hydrilla verticillata (L.f.) Royle. Limnoperna fortunei was consumed in all three subsystems and occurred in the diet of 15 fish species, with a high proportion in the diet of Leporinus obtusidens. Corbicula flumineawas present in the diet of Pterodoras granulosus caught in the Paraná and Ivinheima subsystems. Hydrilla verticillataoccurred in the diet of Schizodon nasutus caught in the Ivinheima and Paraná subsystems. It is not yet possible to evaluate the potential of these species to control invasive mollusks in the study area or the impact of these species on the structure of the food chain. Omnivorous and herbivorous fishes in the study area may have little impact on the population of H. verticillata.

A composição da dieta de 66 espécies de peixes foi investigada de setembro de 2009 a junho de 2010, em três subsistemas da planície de inundação do alto rio Paraná (Brasil), após a invasão das espécies de molusco Limnoperna fortunei (Dunker, 1857) e Corbicula fluminea (Müller, 1774), e da macrófita Hydrilla verticillata (L.f.) Royle. Limnoperna fortunei foi consumida em todos os subsistemas amostrados e ocorreu na dieta de 15 espécies de peixes, com grande participação na dieta de Leporinus obtusidens. Corbicula fluminea esteve presente na dieta de Pterodoras granulosus coletados nos subsistemas Paraná e Ivinheima. Hydrilla verticillata ocorreu na dieta de Schizodon nasutus, capturados nos subsistemas Ivinheima e Paraná. Até o momento não é possível avaliar o potencial destas espécies para controlar moluscos invasores na área de estudo ou o impacto destas espécies sobre a estrutura das cadeias alimentares. Peixes omnívoros e herbívoros da área de estudo podem ter pouco impacto sobre a população de H. verticillata.

Endoparasite infracommunities of Hemisorubim platyrhynchos (Valenciennes, 1840) (Pisces: Pimelodidae) of the Baía River, upper Paraná River floodplain, Brazil: specific composition and ecological aspects

Parasites of 136 specimens of Hemisorubim platyrhynchos, popularly called jurupoca, were analyzed. Fourteen parasite species were recorded: four digeneans (Crocodilicola pseudostoma, one Gorgoderidae species, Sanguinicola platyrhynchi, and Sphincterodiplostomum sp.); three cestodes (Goezeella paranaensis, Spatulifer maringaensis, and Mariauxiella piscatorum); five nematodes (Contracaecum Type 1 larvae of Moravec, Kohn, & Fernandes, 1993; Contracaecum Type 2 larvae of Moravec, Kohn, & Fernandes, 1993; Cucullanus (Cucullanus) zungaro; Eustrongylides ignotus; and Goezia sp.); one acanthocephalan (Quadrigyrus machadoi), and one pentastomid (Sebekia sp.). Most of the helminth specimens were found in larval stages, confirming that H. platyrhynchos is a significant source of their transmission. No dominance was reported. With the exception of Contracaecum Type 2 (featuring random dispersion), the species had a clumped pattern of dispersion in the host sample. Evidence of competition among parasite species was not reported. Several species of parasites were correlated with host size and sex. This fact may be explained by increase in food content and possible behavioral modifications of male and female hosts. Infracommunity diversity was not related to host size or sex

Sanguinicola platyrhynchi n. sp. (Digenea: Sanguinicolidae) parasite of visceral cavity of Hemisorubim platyrhynchos (Valenciennes, 1840) (Pisces: Pimelodidae) from the floodplain of the upper Paraná River, Brazil

A new species is of the genus Sanguinicola Plehn, 1905 described, Sanguinicola platyrhynchi n. sp., digenetic parasite of visceral cavity of Hemisorubim platyrhynchos (Valenciennes, 1840) from the floodplain of the upper Paraná River, Brazil. The species has been thus included because of the presence of separate dorsal genital pores, while differing from other species of the same genus mainly in digestive apparatus features, genital pore position, and infection site. Emendation of generic diagnosis is included

Sanguinicola platyrhynchi n. sp. (Digenea: Sanguinicolidae) parasite of visceral cavity of Hemisorubim platyrhynchos (Valenciennes, 1840) (Pisces: Pimelodidae) from the floodplain of the upper Paraná River, Brazil

A new species is of the genus Sanguinicola Plehn, 1905 described, Sanguinicola platyrhynchi n. sp., digenetic parasite of visceral cavity of Hemisorubim platyrhynchos (Valenciennes, 1840) from the floodplain of the upper Paraná River, Brazil. The species has been thus included because of the presence of separate dorsal genital pores, while differing from other species of the same genus mainly in digestive apparatus features, genital pore position, and infection site. Emendation of generic diagnosis is included.

É descrita uma nova espécie do gênero Sanguinicola Plehn, 1905, Sanguinicola platyrhynchi n. sp., digenético parasita da cavidade visceral de Hemisorubim platyrhynchos (Valenciennes, 1840), da planície de inundação do alto rio Paraná, Brasil. A nova espécie foi incluída neste gênero por possuir poros genitais separados e dorsais e diferir de outras espécies do mesmo gênero, principalmente pelas características do sistema digestório, da posição dos poros genitais e do local de infecção. É realizada uma emenda da diagnose genérica.

Immunotherapeutic modulation of intraperitoneal adhesions by Asparagus racemosus.

The hypothesis that macrophages appear to play a pivotal role in the development of intraperitoneal adhesions and that modulation of macrophage activity, therefore, is likely to provide a tool for prevention of adhesions, was tested in the present study. Effect of Asparagus racemosus, an indigenous agent with immunostimulant properties, was evaluated in an animal model of intraperitoneal adhesions induced by caecal rubbing. Animals were sacrificed 15 days following surgery. The peritoneal macrophages were collected to assess their activity. At the same time, peritoneal cavity was examined for the presence of adhesions, which were graded. A significant decrease was observed in the adhesion scores attained by animals receiving Asparagus racemosus. This was associated with significant increase in the activity of macrophages (70.1 +/- 2.52), compared to that in surgical controls (53.77 +/- 10.8). These findings support our hypothesis and provide a novel approach for the prevention and management of post-operative adhesions.