Prevalence of malnutrition, anemia, and soil-transmitted helminthiasis in preschool-age children living in peri-urban populations in the Peruvian Amazon.

Stunting, anemia, and soil-transmitted helminth (STH) infections are major health concerns for children in extremely poor regions of the world, especially rural and periurban ones. This study aimed to determine the prevalence of these three cooccurring conditions in preschool-age children in an extremely poor district on the outskirts of Iquitos, in the Peruvian Amazon, to inform public health actions. Malnutrition was assessed by standard World Health Organization-recommended metrics; anemia, by hemoglobin levels; and STH, by the Kato-Katz technique. Logistic regression analyses were performed to identify the risk factors for our three outcomes of interest. A total of 572 children aged 6-59 months were recruited in March 2019. We found a 31.3% stunting, 47.2% anemia, and 34.1% STH prevalence. Stunting and anemia figures exceeded both regional and national estimates for 2019. Having more children was a risk factor for stunting, whereas married mothers were associated with a lower risk. Risk factors for anemia included younger age and the male sex, whereas those for STH, older age, incomplete vaccination, and a lower socioeconomic status. Mothers' employment outside the home was also associated with a lower STH risk. This recent evidence highlights the need for prompt and integrated clinical attention and public health actions to address both short- and long-term health consequences in this vulnerable child age group. The integration of a monitoring and evaluation framework is important to effectively manage these conditions, optimize resources and accountability, and show their impact.

Screening Protocol and Prevalence of Venous Thromboembolic Disease in Hospitalized Patients With COVID-19.

BACKGROUND: SARS-CoV-2 disease (COVID-19) induces endothelial damage and sustained hypoxia and facilitates immobilization as factors of hypercoagulability. OBJECTIVES: The objective of our study was to assess the prevalence of venous thromboembolic disease (VTD) in COVID-19 patients and the usefulness of VTD screening based on age-adjusted D-dimer and point-of-care ultrasound (POCUS). PATIENTS/METHODS: We conducted a single cohort, prospective observational study in 102 consecutive hospitalized patients. RESULTS: A total of 102 POCUS and 39 pulmonary computed tomography angiography (PCTA) were performed diagnosing 27 VTD (26.5%): 17 deep vein thrombosis (DVT) (16.6% positive POCUS) and 18 pulmonary embolism (PE) (46.2% positive PCTA). COVID-19 patients with VTD were older (P < .030), had higher D-dimer (P < .001), higher International Society on Thrombosis and Hemostasis score (P < .001), and higher mortality (P = .025). However, there were no differences in inflammatory laboratory parameters neither in the cytokine storm syndrome (CSS) development. The ROC curve for D-dimer showed an AUC of 0.91. We have evidenced that patients with D-dimer between 2000 and 6000 ng/mL could benefit from a screening strategy with POCUS given the high sensitivity and specificity of the test. Furthermore, patients with D-dimer ≥6000 ng/mL should undergo POCUS and PCTA to rule out DVT and PE, respectively. CONCLUSIONS: In our cohort, 26.5% of the patients presented VTD. Screening strategy based on age-adjusted D-dimer and POCUS proved high sensitivity and specificity. Future trials focused on screening strategies are necessary to early detect the presence of DVT and PE and determine thromboprophylaxis strategies in patients with COVID-19.

Prevalence of malnutrition, anemia, and soil-transmitted helminthiasis in preschool-age children living in peri-urban populations in the Peruvian Amazon / Prevalencia de desnutrición, anemia y helmintiasis transmitida por el contacto con el suelo en niños de edad preescolar que viven en poblaciones periurbanas de la Amazonía peruana / Prevalência de desnutrição, anemia e helmintíase transmitida pelo solo em crianças em idade pré-escolar que vivem em populações periurbanas na Amazônia peruana

Stunting, anemia, and soil-transmitted helminth (STH) infections are major health concerns for children in extremely poor regions of the world, especially rural and periurban ones. This study aimed to determine the prevalence of these three cooccurring conditions in preschool-age children in an extremely poor district on the outskirts of Iquitos, in the Peruvian Amazon, to inform public health actions. Malnutrition was assessed by standard World Health Organization-recommended metrics; anemia, by hemoglobin levels; and STH, by the Kato-Katz technique. Logistic regression analyses were performed to identify the risk factors for our three outcomes of interest. A total of 572 children aged 6-59 months were recruited in March 2019. We found a 31.3% stunting, 47.2% anemia, and 34.1% STH prevalence. Stunting and anemia figures exceeded both regional and national estimates for 2019. Having more children was a risk factor for stunting, whereas married mothers were associated with a lower risk. Risk factors for anemia included younger age and the male sex, whereas those for STH, older age, incomplete vaccination, and a lower socioeconomic status. Mothers' employment outside the home was also associated with a lower STH risk. This recent evidence highlights the need for prompt and integrated clinical attention and public health actions to address both short- and long-term health consequences in this vulnerable child age group. The integration of a monitoring and evaluation framework is important to effectively manage these conditions, optimize resources and accountability, and show their impact.

El retraso en el crecimiento, la anemia y la infección por helmintos transmitidos por el contacto con el suelo (STH) son los principales problemas de salud de la infancia en las regiones del mundo caracterizadas por la extrema pobreza, especialmente en las zonas rurales y periurbanas. Este estudio se llevó a cabo para determinar la prevalencia de estas tres condiciones concurrentes en niños de edad preescolar en un distrito de extrema pobreza en las afueras de Iquitos, en la Amazonía peruana, con el fin último de informar la acción de salud pública. La malnutrición se evaluó mediante las mediciones estándar recomendadas por la Organización Mundial de la Salud (OMS), la anemia mediante los niveles de hemoglobina y la STH mediante la técnica de Kato-Katz. Se realizaron análisis de regresión logística para identificar los factores de riesgo de los tres resultados de interés. Un total de 572 niños de entre 6 y 59 meses fueron reclutados en marzo de 2019. Se determinó que la prevalencia de retraso en el crecimiento era del 31,3%, la anemia del 47,2% y el STH del 34,1%. Las cifras de retraso en el crecimiento y anemia superaron las estimaciones regionales y nacionales para 2019. Tener más hijos fue un factor de riesgo para el retraso del crecimiento, mientras que el hecho de que la madre estuviera casada se asoció con un riesgo menor. Los factores de riesgo para la anemia fueron la edad más joven y el sexo masculino, mientras que los factores de riesgo para el STH fueron la edad más avanzada, las vacunas incompletas y el nivel socioeconómico más bajo. El empleo de las madres fuera del hogar también se asoció a un menor riesgo de STH. Estos datos recientes ponen de manifiesto la necesidad de una atención clínica y una acción de salud pública rápidas e integradas para abordar las consecuencias sanitarias a corto y largo plazo en este grupo de edad infantil vulnerable. La integración de un marco de seguimiento y evaluación sería importante para una gestión eficaz, la optimización de los recursos y la rendición de cuentas, y para demostrar el impacto.

Desnutrição, anemia e infecção por helmintos transmitidos pelo solo (HTS) são as principais preocupações da saúde infantil em regiões do mundo caracterizadas pela extrema pobreza, especialmente em áreas rurais e periurbanas. Realizou-se este estudo para determinar a prevalência dessas três condições coocorrentes em crianças em idade pré-escolar num distrito de extrema pobreza nos arredores de Iquitos, na Amazônia peruana, com a visão final de informar a ação da saúde pública. A desnutrição foi avaliada utilizando métricas padrão recomendadas pela Organização Mundial da Saúde (OMS); a anemia, utilizando níveis de hemoglobina e a HTS, utilizando a técnica Kato-Katz. Realizaram-se análises de regressão logística para identificar fatores de risco para os três desfechos de interesse. Em março de 2019, foram recrutadas 572 crianças de 6 a 59 meses. A prevalência de desnutrição foi determinada em 31,3%, anemia em 47,2% e HTS em 34,1%. Os números de desnutrição e anemia superaram as estimativas regionais e nacionais para 2019. Ter mais filhos foi um fator de risco para a desnutrição, enquanto a mãe ser casada foi associado a um menor risco. Os fatores de risco para anemia foram idade mais jovem e sexo masculino, enquanto os fatores de risco para HTS foram idade mais avançada, vacinação incompleta e menor nível socioeconômico. O emprego das mães fora de casa também foi associado a um menor risco de HTS. Esta evidência recente destaca a necessidade de atenção clínica rápida e integrada e ações da saúde pública para enfrentar as consequências a curto e longo prazo para a saúde nessa faixa etária infantil vulnerável. A integração de um quadro de monitoramento e avaliação seria importante para uma gestão eficaz, otimização de recursos e prestação de contas, e para demonstrar impacto.

Multidrug-resistant tuberculosis imported into low-incidence countries-a GeoSentinel analysis, 2008-2020.

BACKGROUND: Early detection of imported multidrug-resistant tuberculosis (MDR-TB) is crucial, but knowledge gaps remain about migration- and travel-associated MDR-TB epidemiology. The aim was to describe epidemiologic characteristics among international travellers and migrants with MDR-TB. METHODS: Clinician-determined and microbiologically confirmed MDR-TB diagnoses deemed to be related to travel or migration were extracted from GeoSentinel, a global surveillance network of travel and tropical medicine clinics, from January 2008 through December 2020. MDR-TB was defined as resistance to both isoniazid and rifampicin. Additional resistance to either a fluoroquinolone or a second-line injectable drug was categorized as pre-extensively drug-resistant (pre-XDR) TB, and as extensively drug-resistant (XDR) TB when resistance was detected for both. Sub-analyses were performed based on degree of resistance and country of origin. RESULTS: Of 201 patients, 136 had MDR-TB (67.7%), 25 had XDR-TB (12.4%), 23 had pre-XDR TB (11.4%) and 17 had unspecified MDR- or XDR-TB (8.5%); 196 (97.5%) were immigrants, of which 92 (45.8%) originated from the former Soviet Union. The median interval from arrival to presentation was 154 days (interquartile range [IQR]: 10-751 days); 34.3% of patients presented within 1 month after immigration, 30.9% between 1 and 12 months and 34.9% after ≥1 year. Pre-XDR- and XDR-TB patients from the former Soviet Union other than Georgia presented earlier than those with MDR-TB (26 days [IQR: 8-522] vs. 369 days [IQR: 84-827]), while patients from Georgia presented very early, irrespective of the level of resistance (8 days [IQR: 2-18] vs. 2 days [IQR: 1-17]). CONCLUSIONS: MDR-TB is uncommon in traditional travellers. Purposeful medical migration may partly explain differences in time to presentation among different groups. Public health resources are needed to better understand factors contributing to cross-border MDR-TB spread and to develop strategies to optimize care of TB-infected patients in their home countries before migration.

Case Report: COVID-19 with Bilateral Adrenal Hemorrhage.

A 70-year-old Dominican Republic man presented with lower back pain for 10 days. Fifteen days before pain onset, he had low-grade fever, chills, and asthenia, and 4 days before admission, he had constipation, malaise, generalized weakness, anorexia, nausea, and vomiting. On admission, the patient was afebrile and hypotensive, with a heart rate of 105 and an oxyhemoglobin saturation on room air of 95%. Hyponatremia, lymphopenia, elevated C-reactive protein, and ferritin were observed in complementary tests. Computed tomography (CT) scan showed findings consistent with COVID-19 bilateral bronchopneumonia, and an increase in size and blurring (loss of the Y shape) of both adrenals indicative of acute bilateral adrenal hemorrhage. The patient tested negative by reverse transcription polymerase chain reaction (RT-PCR) of nasopharyngeal swab, yet positive for IgG and IgM by ELISA, suggesting COVID-19 diagnosis.