Long-term facial symmetry after pediatric mandibular reconstruction using the vascularized fibula free flap: A photogrammetric analysis.

BACKGROUND: The fibula free flap is the standard of care in the reconstruction of large mandibular defects in pediatric patients, enabling adequate restoration of the facial contour. However, the unpredictable growth potential of the reconstructed mandible could influence the preservation of the initially restored symmetry over time. Being mindful of the importance of facial appearance during developmental stages, this study aimed to evaluate the long-term facial symmetry after mandible reconstruction using this technique in growing patients. PATIENTS AND METHODS: A photogrammetric analysis of facial symmetry using the "Asymmetry Index" (AI) was performed from preoperative and postoperative frontal photographs in 17 pediatric patients (9 males and 8 females) who underwent mandibular reconstruction with the vascularized fibula free flap and had a minimum follow-up of 5 years. Comparisons between preoperative and postoperative measurements-as well as postoperative comparisons between condyle-reconstructed and condyle-preserved patients-were conducted. RESULTS: The mean follow-up was 76.9 (± 19.0) months (range, 60-120). The average age at intervention was 9.23 (± 3.8) years. Mean AI was 15.31 (± 1.81) preoperatively and 3.59 (± 0.97) postoperatively. Differences between preoperative and postoperative measurements were statistically significant in all the assessed parameters (p<0.001). Postoperative differences between the condyle-reconstructed and the condyle-preserved groups were not significant (p>0.05). No secondary procedures were required to enhance symmetry in the late postoperative period. CONCLUSIONS: Mandibular reconstruction using the vascularized fibula free flap provides adequate restoration of facial symmetry that could be predictably maintained throughout the developmental period in children and adolescents, regardless of the need for condylar reconstruction.

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.

Demanda hospitalaria pediátrica en tiempos de COVID-19 / Pediatric hospital demand in the COVID-19 pandemic

RESUMEN La pandemia del COVID-19 en el Perú está causando una presión inusual a nuestros recursos hospitalarios y de cuidados críticos. A medida que la infección progresa en la población, esperamos ver un alza en los casos severos y en la demanda de unidad de cuidados intensivos (UCI) donde la capacidad de camas puede ser excedida. A pesar de que usualmente el COVID-19 causa una enfermedad poco grave en los niños, debemos estar preparados para que el numero de casos pediátricos ocasionen una sobrecarga en la capacidad de recursos hospitalarios. En un escenario de un 25% de proporción de infección acumulada en la población, podremos ver aproximadamente 891 niños críticamente enfermos que requieren hospitalización en UCI. Proponemos algunas estrategias para enfrentar la escasez de recursos de cuidados intensivos que permitan asegurar la atención de niños vulnerables con condiciones agudas y condiciones complejas que siguen incidiendo en los tiempos de pandemia.

ABSTRACT The COVID-19 pandemic in Perú is causing an unusual pressure in our sanitarian and critic care resources. As the pandemics have progressed in the population, an increasing of several cases and intensive care units (ICU) demand will be expected, because of that, the hospitals capacities would be exceeded in a short place. Despite the low severity of COVID-19 cases in children, we expect that the projected number of pediatric cases could overwhelm the available pediatric capacity. Under a 25% cumulative infection rate scenario, there would be approximately 891 critically ill children requiring ICU admission. We propose several strategies to handle the concerns about shortfalls in our ability to provide pediatric ventilation and critical care support during the epidemic in Perú.

Pediatric hospital demand in COVID-19 times in Perú / Demanda hospitalaria pediátrica en tiempos de COVID-19 en Perú

COVID-19 pandemic in Perú is causing strain on critical care and hospital resources across the nation. As the infection progress into the population we expect a surge in severe cases and on the intensive care unit (ICU) demand. As the peak of the COVID-19 outbreak approaches, the capacity for hospital and ICU beds will probably be exceeded. Despite the low severity of COVID-19 in children, we expect that the projected number of pediatric cases could overwhelm the available pediatric capacity as the outbreak progress in our country. Under a 25% cumulative infection rate scenario, there would be approximately 891 critically ill children requiring ICU admission. We propose several strategies to handle the concerns about shortfalls in our ability to provide pediatric ventilation and critical care support during the epidemic in Perú.

La pandemia del COVID-19 en el Perú está causando una presión inusual a nuestros recursos hospitalarios y de cuidados críticos. A medida que la infección progresa en la población, esperamos ver un alza en los casos severos y en la demanda de unidad de cuidados intensivos (UCI) donde la capacidad de camas puede ser excedida. A pesar de que usualmente el COVID-19 causa una enfermedad poco grave en los niños, debemos estar preparados para que el numero de casos pediátricos ocasionen una sobrecarga en la capacidad de recursos hospitalarios. En un escenario de un 25% de proporción de infección acumulada en la población, podremos ver aproximadamente 891 niños críticamente enfermos que requieren hospitalización en UCI. Proponemos algunas estrategias para enfrentar la escasez de recursos de cuidados intensivos que permitan asegurar la atención de niños vulnerables con condiciones agudas y condiciones complejas que siguen incidiendo en los tiempos de pandemia.

Cryopreservation modulates the detection of regulatory T cell markers.

BACKGROUND: Regulatory T cells (Tregs) modulate the host response in infectious diseases and are key mediators of peripheral tolerance. Cryopreservation of peripheral blood mononuclear cells (PBMCs) is commonly used in immunological field studies where access to complex laboratory tests is not feasible. Our objective is to assess the effects of cryopreservation on the flow cytometric detection of surface and intracellular markers of Tregs. METHODS: Heparinized venous blood was obtained from 36 healthy individuals and 15 HIV-1 infected subjects. PBMCs were isolated and stained for surface and intracellular markers of Tregs. PBMCs from each subject were cryopreserved in liquid nitrogen with DMSO; these cells were thawed and stained at a later date. All samples were analyzed by flow cytometry. The proportion of Tregs was compared using Wilcoxon signed-rank test. RESULTS: Cryopreservation decreased the proportion of Tregs identified by surface and intracellular markers in healthy individuals and in HIV-1 patients. The proportion of CD4+CD25+FoxP3+ was decreased from 3.13 to 2.16% (P < 0.001) for non-HIV subjects and from 2.68 to 0.94% (P < 0.001) for HIV subjects, compared to fresh samples. Significant reduction was also observed for CD4+CD25+CD127lo-neg. However, the effect varied considerably between samples. The effect was similar among HIV and non-HIV patients (P = 0.38). CONCLUSIONS: Cryopreservation modulates the detection of surface and intracellular markers of Tregs. These results confirm that research on Tregs, including studies of HIV-1 infected patients, should be carried out prospectively on fresh samples in order to obtain unbiased conclusions. Results using cryopreserved cells should be regarded as only preliminary.

Evidence-based medicine training in a resource-poor country, the importance of leveraging personal and institutional relationships.

RATIONALE, AIMS AND OBJECTIVES: Efforts to implement evidence-based medicine (EBM) training in developing countries are limited. We describe the results of an international effort to improve research capacity in a developing country; we conducted a course aimed at improving basic EBM attitudes and identified challenges. METHOD: Between 2005 and 2009, we conducted an annual 3-day course in Perú consisting of interactive lectures and case-based workshops. We assessed self-reported competence and importance in EBM using a Likert scale (1 = low, 5 = high). RESULTS: Totally 220 clinicians participated. For phase I (2005-2007), self-reported EBM competence increased from a median of 2 to 3 (P < 0.001) and the perceived importance of EBM did not change (median = 5). For phase II (2008-2009), before the course, 8-72% graded their competence very low (score of 1-2). After the course, 67-92% of subjects graded their increase in knowledge very high (score of 4-5). The challenges included limited availability of studies relevant to the local reality written in Spanish, participants' limited time and lack of long-term follow-up on practice change. Informal discussion and written evaluation from participants were universally in agreement that more training in EBM is needed. CONCLUSIONS: In an EBM course in a resource-poor country, the baseline self-reported competence and experience on EBM were low, and the course had measurable improvements of self-reported competence, perceived utility and readiness to incorporate EBM into their practices. Similar to developed countries, translational research and building the research capacity in developing countries is critical for translating best available evidence into practice.