Neonatal brain injury influences structural connectivity and childhood functional outcomes.

Neonatal brain injury may impact brain development and lead to lifelong functional impairments. Hypoxic-ischemic encephalopathy (HIE) and congenital heart disease (CHD) are two common causes of neonatal brain injury differing in timing and mechanism. Maturation of whole-brain neural networks can be quantified during development using diffusion magnetic resonance imaging (dMRI) in combination with graph theory metrics. DMRI of 35 subjects with CHD and 62 subjects with HIE were compared to understand differences in the effects of HIE and CHD on the development of network topological parameters and functional outcomes. CHD newborns had worse 12-18 month language (P<0.01) and 30 month cognitive (P<0.01), language (P = 0.05), motor outcomes (P = 0.01). Global efficiency, a metric of brain integration, was lower in CHD (P = 0.03) than in HIE, but transitivity, modularity and small-worldness were similar. After controlling for clinical factors known to affect neurodevelopmental outcomes, we observed that global efficiency was highly associated with 30 month motor outcomes (P = 0.02) in both groups. To explore neural correlates of adverse language outcomes in CHD, we used hypothesis-based and data-driven approaches to identify pathways with altered structural connectivity. We found that connectivity strength in the superior longitudinal fasciculus (SLF) tract 2 was inversely associated with expressive language. After false discovery rate correction, a whole connectome edge analysis identified 18 pathways that were hypoconnected in the CHD cohort as compared to HIE. In sum, our study shows that neonatal structural connectivity predicts early motor development after HIE or in subjects with CHD, and regional SLF connectivity is associated with language outcomes. Further research is needed to determine if and how brain networks change over time and whether those changes represent recovery or ongoing dysfunction. This knowledge will directly inform strategies to optimize neurologic functional outcomes after neonatal brain injury.

Myocarditis in children after COVID-19 vaccine.

Three healthy adolescents presented with myocarditis confirmed on cardiac magnetic resonance imaging after receiving Pfizer-BioNTech COVID-19 vaccine. All patients were hemodynamically stable and had good short-term outcomes. Long-term outcomes are yet to be determined. Larger studies are needed to determine whether an association between Pfizer-BioNTech COVID-19 vaccine and myocarditis exists.

Índice de comorbilidad de Charlson aplicado a pacientes de Medicina Interna: estudio multicéntrico

RESUMEN Introducción: la comorbilidad es la presencia de enfermedades coexistentes o adicionales en relación al diagnóstico inicial o enfermedad guía. Es más frecuente en ancianos y contribuye a la aparición de eventos adversos de salud como mayor duración de la internación y mortalidad hospitalaria. Objetivo: determinar el efecto de las comorbilidades en la duración de la internación y en la mortalidad intrahospitalaria de los pacientes ingresados en el Servicio de Clínica Médica del Hospital Nacional (Itauguá, Paraguay) y del Hospital Militar Central (Asunción, Paraguay) entre marzo y julio del 2019. Materiales y métodos: se aplicó diseño de cohortes prospectivas en base al índice de comorbilidad de Charlson con punto de corte en 3 puntos. Ingresaron al estudio todos los varones y mujeres, mayores de 16 años, ingresados al Servicio de Clínica Médica del Hospital Nacional (Itauguá, Paraguay) y del Hospital Militar Central (Asunción, Paraguay) entre marzo y julio 2019. Se aplicó muestreo no probabilístico de casos consecutivos. Se midieron dos variables dependientes: duración de la hospitalización y mortalidad intrahospitalaria. Se calculó RR (IC 95%) y se consideró significativa toda p<0,05. El estudio respetó las normas éticas. Resultados: se incluyeron 543 sujetos, con predominio del sexo masculino (56%). La edad media fue 52±20 años. La mediana del índice de Charlson fue 2 puntos. No se detectó asociación estadísticamente significativa entre la severidad de este índice y la duración de la internación pero la mortalidad intrahospitalaria fue mayor con índice de Charlson ≥4: 6,5% vs 14,5% (p 0,005). Conclusiones: la mediana del índice de Charlson en dos Servicios de Clínica Médica fue 2. Se halló asociación estadísticamente significativa entre este índice y la mortalidad hospitalaria.

ABSTRACT Introduction: Comorbidity is the presence of coexisting or additional diseases in relation to the initial diagnosis or guiding disease. It is more frequent in the elderly and contributes to the occurrence of adverse health events such as longer hospitalization and hospital mortality. Objective: To determine the effect of comorbidities on the length of hospitalization and in-hospital mortality of patients admitted to the Medical Clinic Services of the National Hospital (Itauguá, Paraguay) and the Central Military Hospital (Asunción, Paraguay) between March and July 2019 Materials and methods: Prospective cohort design was applied based on the Charlson comorbidity index with a 3-point cut-off point. All men and women, older than 16 years who were admitted to the Medical Clinic Services of the National Hospital (Itauguá, Paraguay) and the Central Military Hospital (Asunción, Paraguay) between March and July 2019, entered into the study. Non-probabilistic sampling of consecutive cases was applied. Two dependent variables were measured: length of hospitalization and in-hospital mortality. RR (95% CI) was calculated and all p<0.05 was considered significant. The study respected ethical standards. Results: Five hundred forty-three subjects were included, and there was male predominance (56%). The mean age was 52 ± 20 years. The median Charlson index was 2 points. No statistically significant association was detected between the severity of this index and the length of hospitalization, but in-hospital mortality was higher with a Charlson index ≥4: 6.5% vs. 14.5% (p 0.005). Conclusion: The median Charlson index in two Medical Clinic Services was 2. A statistically significant association was found between this index and in-hospital mortality.