Delayed colonization of Bifidobacterium spp. and low prevalence of B. infantis among infants of Asian ancestry born in Singapore: insights from the GUSTO cohort study.

Background: The loss of ancestral microbes, or the "disappearing microbiota hypothesis" has been proposed to play a critical role in the rise of inflammatory and immune diseases in developed nations. The effect of this loss is most consequential during early-life, as initial colonizers of the newborn gut contribute significantly to the development of the immune system. Methods: In this longitudinal study (day 3, week 3, and month 3 post-birth) of infants of Asian ancestry born in Singapore, we studied how generational immigration status and common perinatal factors affect bifidobacteria and Bifidobacterium longum subsp. infantis (B. infantis) colonization. Cohort registry identifier: NCT01174875. Results: Our findings show that first-generation migratory status, perinatal antibiotics usage, and cesarean section birth, significantly influenced the abundance and acquisition of bifidobacteria in the infant gut. Most importantly, 95.6% of the infants surveyed in this study had undetectable B. infantis, an early and beneficial colonizer of infant gut due to its ability to metabolize the wide variety of human milk oligosaccharides present in breastmilk and its ability to shape the development of a healthy immune system. A comparative analysis of B. infantis in 12 countries by their GDP per capita showed a remarkably low prevalence of this microbe in advanced economies, especially Singapore. Conclusion: This study provides new insights into infant gut microbiota colonization, showing the impact of generational immigration on early-life gut microbiota acquisition. It also warrants the need to closely monitor the declining prevalence of beneficial microbes such as B. infantis in developed nations and its potential link to increasing autoimmune and allergic diseases.

Umbilical Cord Plasma Lysophospholipids and Triacylglycerols Associated with Birthweight Percentiles.

Dysregulated transplacental lipid transfer and fetal-placental lipid metabolism affect birthweight, as does maternal hyperglycemia. As the mechanisms are unclear, we aimed to identify the lipids in umbilical cord plasma that were most associated with birthweight. Seventy-five Chinese women with singleton pregnancies recruited into the GUSTO mother-offspring cohort were selected from across the glycemic range based on a mid-gestation 75 g oral glucose tolerance test, excluding pre-existing diabetes. Cord plasma samples collected at term delivery were analyzed using targeted liquid-chromatography tandem mass-spectrometry to determine the concentrations of 404 lipid species across 17 lipid classes. The birthweights were standardized for sex and gestational age by local references, and regression analyses were adjusted for the maternal age, BMI, parity, mode of delivery, insulin treatment, and fasting/2 h glucose, with a false discovery-corrected p < 0.05 considered significant. Ten lysophosphatidylcholines (LPCs) and two lysophosphatidylethanolamines were positively associated with the birthweight percentiles, while twenty-four triacylglycerols were negatively associated with the birthweight percentiles. The topmost associated lipid was LPC 20:2 [21.28 (95%CI 12.70, 29.87) percentile increase in the standardized birthweight with each SD-unit increase in log10-transformed concentration]. Within these same regression models, maternal glycemia did not significantly associate with the birthweight percentiles. Specific fetal circulating lysophospholipids and triacylglycerols associate with birthweight independently of maternal glycemia, but a causal relationship remains to be established.

Gusto dulce: Percepción, fuentes alimentarias y preferencias

El dulzor es un atributo característico de alimentos y bebidas que contienen azúcares u otros edulcorantes. El uso de azú-cares ha sido reemplazado por otros edulcorantes, a fin de disminuir los efectos nocivos de éstos en diferentes resultados de salud. Sin embargo, se ha sugerido que el gusto dulce, independiente de su origen, podría tener efectos indeseados en la salud. En este artículo se revisan diversos aspectos relacionados con el gusto dulce, desde su percepción, su presencia en alimentos y líquidos, las preferencias innatas y adquiridas por este gusto y los productos que lo aportan. Se analiza además la importancia de estudiar el rol del gusto dulce en la dieta y salud.

Sweetness is a characteristic of foods and beverages that contain sugars or other sweeteners. Sugars have been replaced by other sweeteners to reduce their harmful effects on different health outcomes. However, it has been suggested that the sweet taste, regardless of its origin, could have unwanted effects on health. This article reviews various aspects of sweet taste, from its perception, presence in foods and liquids, innate and acquired preferences for this taste, and the products that provide it. We also analyzed the importance of studying the role of sweet taste in diet and health.

Factores asociados a la anosmia y ageusia en pacientes COVID-19 de una provincia peruana

Objetivo: identificar la presentación clínica y los factores asociados a la anosmia y ageusia en pacientes con la COVID-19 en un centro de salud de una provincia del Perú en el período de 2020-2021. Métodos: estudio transversal analítico a través de los datos del programa COVID-19 del Policlínico Essalud de Jauja - Perú. Se detallaron características sociodemográficas, sintomatología y comorbilidades de los pacientes. A través de un análisis bivariado se identificó los factores asociados a la anosmia y ageusia. Resultados: se identificó a 356 pacientes: 53,1 % fueron mujeres, la edad media fue 48,7 años (±17,8) y 261 (73,3 %) con COVID-19 leve. Del total, el 22,2 % presentó anosmia y 19,9 % ageusia; de los cuales la mayoría fueron menores de 65 años y del sexo femenino. Presentaron síntomas asociados un 86,1 % de los pacientes con anosmia y un 83,1% con ageusia. Los principales factores asociados a la anosmia fueron: la edad menor a 65 años (p=0,027), tos (p<0,001), cefalea (p<0,001), disnea (p<0,001), congestión nasal (p<0,001) y fiebre (p<0,001); y a la ageusia: edad menor a 65 años (p=0,006), tos (p=0,001), cefalea (p<0,001), disnea (p<0,001), congestión nasal (p<0,001) y diarrea (p<0,001). Conclusiones: la anosmia y ageusia son síntomas frecuentes de la COVID-19. La mayoría de pacientes presentaron estos síntomas asociados a los síntomas comunes. Gran parte de los que presentaban anosmia presentaron congestión nasal por lo que es recomendable considerar diferenciarlos al momento de realizar el diagnóstico.

Summary Objective: To identify the clinical presentation and factors associated with anosmia and ageusia in patients with COVID-19 in a health center in a province of Peru for the period 2020-2021. Methods: Cross-sectional analytical study through data from the COVID-19 program of the Essalud Polyclinic in Jauja, Peru. Sociodemographic characteristics, symptoms and comorbidities of the patients were detailed. A bivariate analysis identified the factors associated with anosmia and ageusia. Results: 356 patients were identified: 53.1 % were women, mean age was 48.7 years (±17.8) and 261 (73.3%) with mild COVID-19. Of the total, 22.2% had anosmia and 19.9% ageusia; of which the majority were under 65 and female. Associated symptoms were found in 86.1% of patients with anosmia and 83.1% with ageusia. The main factors associated with anosmia were age younger than 65 years (p=0.027), cough (p<0.001), headache (p<0.001), dyspnea (p<0.001), nasal congestion (p<0.001) and fever (p<0.001); and ageusia: age younger than 65 years (p=0.006), cough (p=0.001), headache (p<0.001), dyspnea (p<0.001), nasal congestion (p<0.001) and diarrhea (p<0.001). Conclusion: Anosmia and ageusia are common symptoms of COVID-19. Most patients had these symptoms associated with common symptoms. Many of those who had anosmia had nasal congestion, so it is advisable to consider differentiating them when making the diagnosis.

Allergic sensitization trajectories to age 8 years in the Singapore GUSTO cohort.

Background: Allergic sensitization is linked to allergy development, with early sensitization often associated with worse outcomes. We aimed to identify if distinct allergic sensitization trajectories existed within a diverse and multi-ethnic Asian cohort. Methods: We administered modified ISAAC questionnaires in the first 8 years and conducted skin prick testing at ages 18 months, 3, 5 and 8 years in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. We used latent class analysis to derive allergic sensitization trajectories, and adjusted odds ratios (AOR) to evaluate predictive risk factors and associations with allergic comorbidities. Results: Among 997 children, three trajectories were identified: early food and mite sensitization (16.2%), late mite sensitization (24.2%) and no/low sensitization (59.6%). Early food and mite sensitization was associated with early eczema by 6 months [AOR (95%CI) 4.67 (1.78-12.28)], increased risk of wheeze by 3-8 years (ARR 1.72-1.99) and eczema in the first 8 years of life (ARR 1.87-2.41). Late mite sensitization was associated with female sex [AOR 0.58 (0.35-0.96)], cesarean section [AOR 0.54 (0.30-0.98)], early eczema by 6 months [AOR 3.40 (1.38-8.42)], and increased risk of eczema by 18 months [ARR 1.47 (1.03-2.08)] and 8 years [ARR 1.35 (1.05-1.73)]. Conclusion: Early onset of eczema and early allergic sensitization were strongly associated. Early sensitization, especially to house dust mites, was associated with increased risks of developing wheeze and eczema, pointing to the importance of developing preventive perinatal interventions and effective therapeutics for sensitized toddlers.

Evaluation of Stool Short Chain Fatty Acids Profiles in the First Year of Life With Childhood Atopy-Related Outcomes.

Introduction: Short chain fatty acids (SCFAs) are the main intestinal intermediate and end products of metabolism of dietary fibers/polyphenols by the gut microbiota. The aim of this study was to evaluate the biological implication of stool SCFA profiles determined in the first year of life on the clinical presentation of allergic outcomes in childhood. Methods: From the Growing Up in Singapore Toward healthy Outcomes (GUSTO) cohort, a sub-cohort of 75 participants was recruited. Scheduled questionnaire data was collected for cumulative prevalence of physician-diagnosed eczema, wheezing with the use of nebuliser, and allergen sensitization till the age of 8 years. Stool samples collected at week 3 and months 3, 6 and 12 were quantitated for 9 SCFAs using LC/MS/MS. SCFA data were grouped into lower (below the 25th) and higher (above the 75th percentiles) categories. Generalized Linear Mixed Models was employed to analyse longitudinal association between SCFAs and atopy-related outcomes. Results: Children with lower stool butyric acid levels (≤25th percentile) over the first 3 time points had higher odds ratio (OR) for wheezing (adjOR = 14.6), eczema (adjOR = 13.2), food sensitization (adjOR = 12.3) and combined outcomes of both wheezing and eczema (adjOR = 22.6) till age 8 years, compared to those with higher levels (≥75 percentile). Additionally, lower longitudinal levels of propionic acid (≤25th percentile) over 4 time points in first year of life was associated with recurrent wheezing (≥2 episodes) till 8 years (adjOR = 7.4) (adj p < 0.05). Conclusion: Our results suggest that relatively low levels of gut SCFAs in early life are associated with increased susceptibility to atopic-related outcomes in childhood.

Subjective assessment of taste and smell disfunction in patients with COVID-19 in Paraguay / Evaluación subjetiva de las alteraciones del sentido del gusto y del olfato en pacientes con COVID-19 en Paraguay

The alteration of the senses of taste and smell in relation to COVID-19 is a widely known phenomenon; however, this alteration has not been exhaustively characterized in the international literature. The following study is proposed with the aim of describing the alterations in the senses of taste and smell in relation to COVID-19 by means of their subjective evaluation. The nature of the study is observational, descriptive and cross-sectional, and was applied to patients who sought medical attention via remote consultations carried out on virtual platforms of the Service of Otorhinolaryngology and Head and Neck Surgery of the Clínicas Hospital, San Lorenzo, between the months of March and October of 2021. We included 440 patients aged 31.3 ± 9.9 years (18 to 60 years), 308 (70%) female, 388 (88%) from urban areas, with evidence of infection by SARS-CoV-2 by RT-PCR in 260 (59%), predominantly without comorbidities 232 (53%), with fever as the most frequently reported symptom 352 (80%), treated more frequently with NSAIDs 208 (47%) and/or Paracetamol 216 (49%). Both taste and smell alterations in patients who have had COVID-19 have been shown to appear more frequently 1 to 7 days after the onset of symptoms (207 for smell, 184 for taste), occurring more frequently with a total decrease of both senses (anosmia 302 and ageusia 216), recovering completely in most cases (214 and 216) and within a period of 1 to 4 weeks (140 and 130).

La alteración de los sentidos del gusto y del olfato en relación con el COVID-19 es un fenómeno ampliamente conocido, sin embargo, esta alteración no ha sido caracterizada de forma exhaustiva en la literatura internacional. Se plantea el siguiente estudio con el objetivo de describir las alteraciones del sentido del gusto y del olfato en relación con el COVID-19 a través de la evaluación subjetiva del mismo. El mismo es observacional, descriptivo, de corte transversal, aplicado a pacientes que consultaron a través de teleconsultas realizadas sobre plataformas virtuales de la Cátedra y Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello del Hospital de Clínicas, de San Lorenzo, durante los meses de marzo a octubre del 2021. Fueron incluidos 440 pacientes de 31,3 ± 9,9 años (18 a 60 años), 308 (70%) de sexo femenino, 388 (88%) provenientes de zona urbana, con evidencia de infección por SARS-CoV-2 por RT-PCR en 260 (59%), predominantemente sin comorbilidades 232 (53%), con fiebre como síntoma asociado al COVID-19 más frecuentemente reportado 352 (80%), tratados más frecuentemente con AINES 208 (47%) y/o Paracetamol 216 (49%). Tanto la alteración del gusto como del olfato en pacientes que han cursado con COVID-19 ha demostrado ser aparecer más frecuentemente en 1 a 7 días del inicio del cuadro (207 para el olfato. 184 para el gusto), cursando más frecuentemente con disminución total de ambos sentidos (anosmia 302 y ageusia 216), recuperándose más frecuentemente de forma total (214 y 216) y en un plazo de 1 a 4 semanas (140 y 130).

Trastornos del gusto: actualización y aproximación clínica / Taste disorders: update and clinical approach

Resumen Los trastornos del gusto constituyen un grupo de alteraciones relativamente frecuentes en la práctica clínica. Son de etiología diversa, pudiendo afectar la vía gustativa en distintos niveles, manifestándose, clínicamente, con alteraciones cuantitativas y/o cualitativas de la sensibilidad gustativa. En gran parte de los casos se puede lograr un diagnóstico etiológico con una anamnesis adecuada, examen físico y exploraciones complementarias básicas. No obstante, existe poco entendimiento de su patogénesis, así como limitadas opciones terapéuticas, lo que implica la falta de algoritmos de diagnóstico y tratamiento completamente validados. El objetivo de la presente revisión es otorgar una actualización y un abordaje práctico de los trastornos del gusto.

Abstract Taste disorders represent a group of alterations relatively frequent in clinical practice. They have a diverse etiology, and they can affect the gustatory pathway at different levels, clinically manifesting with quantitative/qualitative alterations on taste sensitivity. In most of cases it is possibly to achieve an etiologically diagnosis with appropriate anamnesis, physical exploration, and basic complementary tests. However, their pathogenesis is not well understood, and they have limited therapeutic options, which determines a lack of well-validated diagnosis and treatment algorithms. The objective of this review is to provide and update and a practical approach to taste disorders.

Características clínicas y epidemiológicas de pacientes con la COVID-19 y trastornos quimiosensoriales

RESUMEN Introducción: Los trastornos quimiosensoriales se han identificado como síntomas típicos de la COVID-19. Objetivo: Caracterizar a pacientes con la COVID-19 y trastornos quimiosensoriales referidos. Métodos: Se incluyeron 152 pacientes hospitalizados, positivos a la COVID-19, con trastornos quimiosensoriales referidos. Se estudiaron variables clínicas y epidemiológicas, marcadores de inflamación, radiografía de tórax y tratamiento empleado. Resultados: La edad promedio fue 40,2 años, el sexo femenino 59,2 % y predominó el antecedente, contacto de caso confirmado (62,5 %), con anosmia (95,7 %), ageusia (93,3 %), sin comorbilidades (53,3 %) y ausencia de síntomas acompañantes (36,8 %). En pacientes con fuente de infección indeterminada, la confirmación fue tardía (3,89 días); no hubo diferencias significativas entre quienes presentaron uno o ambos trastornos (p= 0,053), ni entre quienes presentaron o no síntomas asociados (p= 0,14). En el 2 % el índice de neutrófilos fue mayor de 4; el 3,3 % presentó conteo absoluto de linfocitos inferior a 1500 x 109/L y el 68,4 % no mostró alteración radiológica. Requirió antimicrobianos el 5,9 % e inmunomoduladores, el 5,3 %; el 1,3 % ingresó en cuidados intensivos. La mayoría (95,4 %) egresó de alta clínica y el 1,3 % falleció. Conclusiones: Predomina el sexo femenino, con ageusia o anosmia; quienes no tienen el antecedente epidemiológico, se diagnostican con dilación. No hay diferencias al buscar atención, por uno o ambos trastornos, ni por síntomas acompañantes. Los trastornos quimiosensoriales se refieren más en ausencia de complicaciones y cuadros graves. Quienes los refieren espontáneamente, son generalmente personas saludables y oligosintomáticas.

ABSTRACT Introduction: Chemosensory disorders have been identified as typical symptoms of COVID-19. Objective: To characterize patients with COVID-19 and referred chemosensory disorders. Methods: One hundred and fifty-two hospitalized patients, positive for COVID-19, with referred chemosensory disorders were included. Clinical and epidemiological variables, inflammation markers, chest X-ray and treatment used were studied. Results: The average age was 40.2 years, the female sex 59.2%. The antecedent of confirmed case contact (62.5 %), anosmia (95.7 %), ageusia (93.3 %), and the absence of comorbidities (53.3 %) and accompanying symptoms (36.8 %), prevailed. In patients with an indeterminate source of infection, confirmation was late (3.89 days); there were no significant differences between those who presented one or both disorders (p = 0.053), nor between those who did or did not present associated symptoms (p = 0.14). In 2 % the neutrophil index was greater than 4; 3.3 % had an absolute lymphocyte count lower than 1500x106/L and 68.4 % did not show radiological alteration. Antimicrobials were required in 5.9 % and immunomodulators in 5.3 %; 1.3 % were admitted to intensive care. Most (95.4 %) were discharged from the clinic and 1.3 % died. Conclusions: The female sex predominates, with ageusia or anosmia; those who do not have an epidemiological background are diagnosed with delay. There are no differences in seeking care, for one or both disorders, or for accompanying symptoms. Chemosensory disorders are more referred in the absence of complications and severe disease. Those who refer them spontaneously are generally healthy and oligosymptomatic people.

Genetic Link Determining the Maternal-Fetal Circulation of Vitamin D.

Vitamin D is an essential micronutrient whose demand is heightened during pregnancy to support the growth of the fetus. Furthermore, the fetus does not produce vitamin D and hence relies exclusively on the supply of maternal vitamin D through the placenta. Vitamin D inadequacy is linked with pregnancy complications and adverse infant outcomes. Hence, early predictive markers of vitamin D inadequacy such as genetic vulnerability are important to both mother and offspring. In this multi-ethnic Asian birth cohort study, we report the first genome-wide association analysis (GWAS) of maternal and fetal vitamin D in circulation. For this, 25-hydroxyvitamin D (25OHD) was measured in the antenatal blood of mothers during mid gestation (n=942), and the cord blood of their offspring at birth (n=812). Around ~7 million single nucleotide polymorphisms (SNPs) were regressed against 25OHD concentrations to identify genetic risk variants. About 41% of mothers had inadequate 25OHD (≤75nmol/L) during pregnancy. Antenatal 25OHD was associated with ethnicity [Malay (Β=-22.32nmol/L, p=2.3×10-26); Indian (Β=-21.85, p=3.1×10-21); reference Chinese], age (Β=0.47/year, p=0.0058), and supplement intake (Β=16.47, p=2.4×10-13). Cord blood 25OHD highly correlated with antenatal vitamin D (r=0.75) and was associated with ethnicity [Malay (Β=-4.44, p=2.2×10-7); Indian (Β=-1.99, p=0.038); reference Chinese]. GWAS analysis identified rs4588, a missense variant in the group-specific component (GC) gene encoding vitamin D binding protein (VDBP), and its defining haplotype, as a risk factor for low antenatal (Β=-8.56/T-allele, p=1.0×10-9) and cord blood vitamin D (Β=-3.22/T-allele, p=1.0×10-8) in all three ethnicities. We also discovered a novel association in a SNP downstream of CYP2J2 (rs10789082), a gene involved in 25-hydroxylation of vitamin D, with vitamin D in pregnant women (Β=-7.68/G-allele, p=1.5×10-8), but not their offspring. As the prevention and early detection of suboptimal vitamin D levels are of profound importance to both mother and offspring's health, the genetic risk variants identified in this study allow risk assessment and precision in early intervention of vitamin D deficiency.

Comparative epidemiology of gestational diabetes in ethnic Chinese from Shanghai birth cohort and growing up in Singapore towards healthy outcomes cohort.

BACKGROUND: Gestational diabetes mellitus (GDM) has been associated with adverse health outcomes for mothers and offspring. Prevalence of GDM differs by country/region due to ethnicity, lifestyle and diagnostic criteria. We compared GDM rates and risk factors in two Asian cohorts using the 1999 WHO and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. METHODS: The Shanghai Birth Cohort (SBC) and the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort are prospective birth cohorts. Information on sociodemographic characteristics and medical history were collected from interviewer-administered questionnaires. Participants underwent a 2-h 75-g oral glucose tolerance test at 24-28 weeks gestation. Logistic regressions were performed. RESULTS: Using the 1999 WHO criteria, the prevalence of GDM was higher in GUSTO (20.8%) compared to SBC (16.6%) (p = 0.046). Family history of hypertension and alcohol consumption were associated with higher odds of GDM in SBC than in GUSTO cohort while obesity was associated with higher odds of GDM in GUSTO. Using the IADPSG criteria, the prevalence of GDM was 14.3% in SBC versus 12.0% in GUSTO. A history of GDM was associated with higher odds of GDM in GUSTO than in SBC, while being overweight, alcohol consumption and family history of diabetes were associated with higher odds of GDM in SBC. CONCLUSIONS: We observed several differential risk factors of GDM among ethnic Chinese women living in Shanghai and Singapore. These findings might be due to heterogeneity of GDM reflected in diagnostic criteria as well as in unmeasured genetic, lifestyle and environmental factors.

Prefrontal cortex VAMP1 gene network moderates the effect of the early environment on cognitive flexibility in children.

During development, genetic and environmental factors interact to modify specific phenotypes. Both in humans and in animal models, early adversities influence cognitive flexibility, an important brain function related to behavioral adaptation to variations in the environment. Abnormalities in cognitive functions are related to changes in synaptic connectivity in the prefrontal cortex (PFC), and altered levels of synaptic proteins. We investigated if individual variations in the expression of a network of genes co-expressed with the synaptic protein VAMP1 in the prefrontal cortex moderate the effect of early environmental quality on the performance of children in cognitive flexibility tasks. Genes overexpressed in early childhood and co-expressed with the VAMP1 gene in the PFC were selected for study. SNPs from these genes (post-clumping) were compiled in an expression-based polygenic score (PFC-ePRS-VAMP1). We evaluated cognitive performance of the 4 years-old children in two cohorts using similar cognitive flexibility tasks. In the first cohort (MAVAN) we utilized two CANTAB tasks: (a) the Intra-/Extra-dimensional Set Shift (IED) task, and (b) the Spatial Working Memory (SWM) task. In the second cohort, GUSTO, we used the Dimensional Change Card Sort (DCCS) task. The results show that in 4 years-old children, the PFC-ePRS-VAMP1 network moderates responsiveness to the effects of early adversities on the performance in attentional flexibility tests. The same result was observed for a spatial working memory task. Compared to attentional flexibility, reversal learning showed opposite effects of the environment, as moderated by the ePRS. A parallel ICA analysis was performed to identify relationships between whole-brain voxel based gray matter density and SNPs that comprise the PFC-ePRS-VAMP1. The early environment predicts differences in gray matter content in regions such as prefrontal and temporal cortices, significantly associated with a genetic component related to Wnt signaling pathways. Our data suggest that a network of genes co-expressed with VAMP1 in the PFC moderates the influence of early environment on cognitive function in children.

Prevalencia de trastornos del gusto en niños y adolescentes con infección por coronavirus: revisión sistemática / Prevalence of taste disorders in children and adolescents with coronavirus infection: a systematic review

Objetivo: Determinar la prevalencia de trastornos del gusto en pacientes niños y adolescentes diagnosticados con infección por coronavirus, a través de la evidencia en la literatura científica. Materiales y métodos: Una revisión sistemática de los artículos publicados entre el 19 de diciembre del 2019 y el 20 de diciembre del 2020 en las bases de datos Medline, Lilacs, BVS, Cochrane, SCOPUS y ScienceDirect. La estrategia de búsqueda de información se basó en el diagrama de flujo clásico de PRISMA. Para la evaluación del riesgo de sesgo, se usó la escala Newcastle-Ottawa. Resultados: Se encontraron 443 artículos en seis bases de datos y se incluyó un total de 7 artículos después de la evaluación, según los criterios de selección. Los artículos abordaron la variable de trastornos del gusto en tres formas: ageusia, disgeusia e hipogeusia, y se halló que esta manifestación clínica estaba presente desde los inicios de la infección. Conclusiones: Se ha encontrado una prevalencia de trastornos del gusto en niños y adolescentes diagnosticados con infección por coronavirus desde un 3,3% hasta un 26,9%. (AU)

Aim: To assess the prevalence of taste disorders in children and adolescents diagnosed with coronavirus infection according to the evidence reported in the scientific literature. Materials and Methods: A systematic review of articles published between December 19, 2019, and December 20, 2020 in the Medline, Lilacs, BVS, Cochrane, SCOPUS and ScienceDirect databases. The information search strategy was based on the classic PRISMA flow diagram. The Newcastle-Ottawa scale was used to assess the risk of bias. Results: 443 articles were found in six databases, and a total of 7 articles were included after evaluation according to the selection criteria. The articles addressed the variable of taste disorders in three ways: ageusia, dysgeusia and hypogeusia; finding that this clinical manifestation was present from the beginning of the infection. Conclusions: The prevalence of taste disorders in children and adolescents diagnosed with coronavirus infection is from 3.3% to 26.9%. (AU)

Trajectories of Systolic Blood Pressure in Children: Risk Factors and Cardiometabolic Correlates.

OBJECTIVE: To identify systolic blood pressure (SBP) percentile trajectories in children and to describe the early-life risk factors and cardiometabolic correlates of those trajectories. STUDY DESIGN: Using age-, sex-, and height-specific SBP percentiles based on the American Academy of Pediatrics reference, we examined SBP trajectories using latent class mixed models from ages 3 to 8 years (n = 844) from the Growing Up in Singapore Towards healthy Outcomes-study, a Singaporean mother-offspring cohort study. We analyzed associations between SBP trajectories and early-life risk factors using multinomial logistic regression and differences across trajectories in cardiometabolic outcomes using multiple linear regression. RESULTS: Children were classified into 1 of 4 SBP percentile trajectories: "low increasing" (15%), "high stable" (47%), "high decreasing" (20%), and "low stable" (18%). Maternal hypertension during early pregnancy was a predictor of the "high stable" and "low increasing" SBP trajectories. Rapid child weight gain in the first 2 years of life was only associated with the "high stable" trajectory. Compared with children in the "low stable" trajectory, children in the "high stable" SBP trajectory had greater body mass index z scores, sum of skinfold thicknesses, waist circumference from ages 3 to 8 years, and abdominal adipose tissue (milliliters) at 4.5 years (adjusted mean difference [95% CI]: superficial and deep subcutaneous abdominal adipose tissue: 115.2 [48.1-182.3] and 85.5 [35.2-135.8]). Their fat mass (kilograms) (1.3 [0.6-2.0]), triglyceride levels (mmol/L) (0.10 [0.02-0.18]), and homeostasis model assessment of insulin resistance (0.28 [0.11 0.46]) at age 6 years were also greater but not their arterial thickness and stiffness. CONCLUSIONS: Reducing maternal blood pressure during pregnancy and infant weight gain in the first 2 years of life might help to prevent the development of high SBP.

Children of Asian ethnicity in Australia have higher risk of food allergy and early-onset eczema than those in Singapore.

BACKGROUND: In Western countries, Asian children have higher food allergy risk than Caucasian children. The early-life environmental exposures for this discrepancy are unclear. We aimed to compare prevalence of food allergy and associated risk factors between Asian children in Singapore and Australia. METHODS: We studied children in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort (n = 878) and children of Asian ancestry in the HealthNuts cohort (n = 314). Food allergy was defined as a positive SPT ≥3 mm to egg or peanut AND either a convincing history of IgE-mediated reaction at 18 months (GUSTO) or a positive oral food challenge at 14-18 months (HealthNuts). Eczema was defined as parent-reported doctor diagnosis. RESULTS: Food allergy prevalence was 1.1% in Singapore and 15.0% in Australia (P<0.001). Egg introduction was more often delayed (>10 months) in Singapore (63.5%) than Australia (16.3%; P<0.001). Prevalence of early-onset eczema (<6 months) was lower in Singapore (8.4%) than Australia (30.5%) (P<0.001). Children with early-onset eczema were more likely to have food allergy than those without eczema in Australia [aOR 5.11 (2.34-11.14); P<0.001] and Singapore [aOR4.00 (0.62-25.8); P = 0.145]. CONCLUSIONS: Among Asian children, prevalence of early-onset eczema and food allergy was higher in Australia than Singapore. Further research with larger sample sizes and harmonized definitions of food allergy between cohorts is required to confirm and extend these findings. Research on environmental factors influencing eczema onset in Australia and Singapore may aid understanding of food allergy pathogenesis in different parts of the world.

Dysgeusia and COVID-19: the Importance of the Dentist in the Diagnostic

ABSTRACT: Dysgeusia is understood as changes in the perception of taste in patients infected with COVID-19 and has been frequently observed in the early stages of the disease. Along with the causes of dysgeusia, we can mention the correlation with infectious conditions, being of importance for the differential diagnosis. Dysgeusia can be considered one of the first manifestations of COVID-19, being an important contribution in the search for solutions regarding early diagnosis and treatment, in addition to its hospital and laboratory application.

RESUMEN: La disgeusia se entiende como cambios en la percepción del gusto en pacientes infectados por COVID-19 y se ha observado con frecuencia en las primeras etapas de la enfermedad. Junto a las causas de la disgeusia, podemos mencionar la correlación con patologías infecciosas, siendo de importancia para el diagnóstico diferencial. La disgeusia se puede considerar como una de las primeras manifestaciones del COVID-19, siendo un aporte importante en la búsqueda de soluciones en cuanto al diagnóstico y tratamiento precoces, además de su aplicación hospitalaria y de laboratorio.

Effects of learning and adaptation on population viability.

Cultural adaptation is one means by which conservationists may help populations adapt to threats. A learned behavior may protect an individual from a threat, and the behavior can be transmitted horizontally (within generations) and vertically (between generations), rapidly conferring population-level protection. Although possible in theory, it remains unclear whether such manipulations work in a conservation setting; what conditions are required for them to work; and how they might affect the evolutionary process. We examined models in which a population can adapt through both genetic and cultural mechanisms. Our work was motivated by the invasion of highly toxic cane toads (Rhinella marina) across northern Australia and the resultant declines of endangered northern quolls (Dasyurus hallucatus), which attack and are fatally poisoned by the toxic toads. We examined whether a novel management strategy in which wild quolls are trained to avoid toads can reduce extinction probability. We used a simulation model tailored to quoll life history. Within simulations, individuals were trained and a continuous evolving trait determined innate tendency to attack toads. We applied this model in a population viability setting. The strategy reduced extinction probability only when heritability of innate aversion was low (<20%) and when trained mothers trained >70% of their young to avoid toads. When these conditions were met, genetic adaptation was slower, but rapid cultural adaptation kept the population extant while genetic adaptation was completed. To gain insight into the evolutionary dynamics (in which we saw a transitory peak in cultural adaptation over time), we also developed a simple analytical model of evolutionary dynamics. This model showed that the strength of natural selection declined as the cultural transmission rate increased and that adaptation proceeded only when the rate of cultural transmission was below a critical value determined by the relative levels of protection conferred by genetic versus cultural mechanisms. Together, our models showed that cultural adaptation can play a powerful role in preventing extinction, but that rates of cultural transmission need to be high for this to occur.

La adaptación cultural es un medio mediante el cual los conservacionistas pueden ayudar a las poblaciones a adaptarse a las amenazas. Un comportamiento aprendido puede proteger a un individuo de las amenazas y este comportamiento puede transmitirse horizontalmente (dentro de las generaciones) y verticalmente (entre generaciones), lo que otorga rápidamente una protección a nivel poblacional. Aunque esto es posible en teoría, aún no está claro si dichas manipulaciones funcionan dentro de un escenario de conservación; cuáles son las condiciones requeridas para que funcionen las manipulaciones; y cómo pueden afectar el proceso evolutivo. Examinamos modelos en los cuales una población puede adaptarse tanto con mecanismos genéticos como culturales. Nuestro trabajo estuvo motivado por la invasión de sapos altamente tóxicos (Rhinella marina) en todo el norte de Australia y las declinaciones resultantes de cuoles norteños (Dasyurus hallucatus), los cuales atacan y mueren envenenados por los sapos tóxicos. Analizamos si una estrategia de manejo novedoso en la cual los cuoles silvestres son entrenados para evitar a los sapos puede reducir la probabilidad de extinción. Usamos un modelo de simulación diseñado alrededor de la historia de vida de los cuoles. Dentro de las simulaciones, se entrenó a cuoles individuales y una característica en continua evolución determinó la tendencia innata para atacar a los sapos. Aplicamos este modelo en un escenario de viabilidad poblacional. La estrategia redujo la probabilidad de extinción sólo cuando la heredabilidad de la aversión innata fue baja (<20%) y cuando las madres entrenadas entrenaron a más del 70% de sus crías para evitar a los sapos. Cuando ambas condiciones fueron cumplidas, la adaptación genética fue más lenta pero la adaptación cultural rápida mantuvo a la población vigente mientras se completaba la adaptación genética. Para ganar conocimiento sobre las dinámicas evolutivas (en las cuales vimos un pico transitorio en la adaptación cultural a lo largo del tiempo) también desarrollamos un modelo analítico simple de las dinámicas evolutivas. Este modelo mostró que la fuerza de la selección natural declinó conforme incrementó la tasa de transmisión cultural y que la adaptación procedió solamente cuando la tasa de transmisión cultural estuvo por debajo de un valor crítico determinado por los niveles relativos de protección otorgados por los mecanismos genéticos contra los mecanismos evolutivos. En conjunto, nuestros modelos mostraron que la adaptación cultural puede jugar un papel importante en la prevención de la extinción, pero las tasas de transmisión cultural necesitan ser altas para que esto ocurra.

High Frequency of Smell and Taste Dysfunction in Health Care Professionals With COVID-19 Working in Allergy Departments

Background: Since the early stages of the novel coronavirus 2019 (SARS-CoV-2) outbreak, smell and/or taste dysfunction (STD) has beenreported in 5% to 88% of COVID-19 patients.Objective: We aimed to assess STD in health care professionals (HCPs), mainly allergists, affected by COVID-19. We carried out a survey toevaluate the association between STD and its severity and demographic characteristics, symptoms, comorbidities, and hospital admission.Methods: We designed a 15-item questionnaire comprising various sections, as follows: demographics, diagnostic characteristics, STDpatterns, medication use, and comorbidities. The questionnaire was developed using Google forms. It was distributed to members of theSpanish Society of Allergology and Clinical Immunology (SEAIC) and sent via social media to be completed by HCPs with COVID-19.Results: The survey was completed by HCPs (n=234), of whom 76.5% were aged ≤55 years and 73.5% were female. STD was detected in74.4% of respondents, of whom 95.6% reported moderate-severe impairment. Mean time until recovery of taste dysfunction was 21.6 (24.0)days in HCPs aged ≤55 years and 33.61±26.2 days in those aged >55 years (P=.019). Analysis stratified by severity of STD showed thatmore than a half of COVID-19 patients presented severe loss of smell. Older age (>55 years) was associated with fever, anorexia, lowerfrequency of headache, and longer persistence of taste dysfunction.Conclusion: STD is a common symptom in COVID-19, even as a unique or preceding symptom. HCPs who reported smell dysfunctionwere younger than those not affected with STD. Taste dysfunction may imply more systemic involvement in COVID-19–positive HCPs. (AU)

Antecedentes: Desde el inicio de la pandemia por el nuevo coronavirus (SARS-CoV-2), la afectación del sentido del olfato y del gusto seha descrito entre el 5% y 88% de la población afecta por COVID-19.Objetivo: Evaluar la alteración del gusto y del olfato en profesionales sanitarios afectos por COVID-19, en relación a parámetros degravedad, características demográficas, síntomas, comorbilidades e ingreso hospitalario.Métodos: Se diseñó un cuestionario de 15 elementos, con las siguientes secciones: demografía, características diagnósticas, patronesde alteración de olfato y del gusto, uso de medicación y efectos adversos asociados y comorbilidades. Dicho cuestionario fue difundidopor las redes sociales de la Sociedad Española de Alergología e Inmunología Clínica, dirigido específicamente a profesionales sanitarios.Resultados: 234 profesionales completaron la encuesta (73,5% mujeres). El 76,5% de los encuestados era ≤55 años. Hubo afectacióndel olfato y/o gusto en el 74,4% de los encuestados. La persistencia media de alteración del gusto fue 21,6± 24,0 días en ≤55 años yde 33,6±26,2 días en >55 años (p=0,019). Ser mayor de 55 años se asociaba estadísticamente con fiebre, anorexia, menos cefalea ymayor persistencia de afectación del gusto.Conclusión: Los profesionales sanitarios que declararon haber padecido SD eran más jóvenes que los que no presentaron STD. La afectacióndel olfato y/o del gusto es un síntoma común entre los profesionales sanitarios con COVID-19 y puede ser patente en fases iniciales ocomo único síntoma en pacientes ≤55 años. La afectación del gusto puede implicar más síntomas sistémicos. (AU)

Avaliação da Percepção do Paladar de Pacientes Oncológicos: Relação com Variáveis Pessoais e Clínicas e Comparação com um Grupo Controle / Evaluation of Taste Perception of Oncological Patients: Relationship with Personal and Clinical Variables and Comparison with a Control Group / Evaluación de la Percepción del Sabor de Pacientes Oncológicos: Relación con Variables Personales y Clínicas y Comparación con un Grupo de Control

Introdução: O tratamento antineoplásico pode causar efeitos colaterais que prejudicam a ingestão alimentar e o estado nutricional dos pacientes. Objetivo: Avaliar a percepção do paladar de pacientes em tratamento oncológico, relacioná-la com as variáveis pessoais e clínicas e compará-la com a percepção do paladar de indivíduos sadios. Método: Trata-se de um estudo transversal com 50 indivíduos em tratamento oncológico e outros 50 indivíduos do grupo controle. Para avaliar a percepção do paladar, os participantes receberam amostras de alimentos e foram questionados quanto aos sabores doce, amargo, salgado e azedo. A intensidade do sabor foi avaliada por meio de uma escala de 1 a 5. Resultados: Os pacientes em tratamento oncológico perceberam os sabores dos seguintes alimentos de maneira mais acentuada: doce de leite (4,48±1,0 vs. 3,78±0,9; p<0,05), goiabada (4,10±1,0 vs. 3,52±0,9; p<0,05), suco de limão (4,42±0,9 vs. 2,86±1,0; p<0,05), suco de maracujá (3,76±1,2 vs. 2,56±1,0; p<0,05) e café (4,42±0,8 vs. 3,14±0,9; p<0,05). Já os alimentos: biscoito de polvilho, iogurte natural, rúcula e chicória foram percebidos com menor intensidade quando comparados ao grupo controle. Entre as quatro categorias de sabor avaliadas, os alimentos do grupo salgado foram os que menos se diferenciaram quanto à percepção do paladar e os alimentos azedos e amargos foram percebidos de forma mais distinta entre os grupos. Conclusão: O presente estudo é pioneiro em avaliar a percepção do paladar utilizando alimentos, ao invés de soluções padronizadas; e, por meio dessa técnica, identificaram-se diferenças significativas na intensidade da percepção do paladar dos indivíduos em tratamento oncológico.

Introduction: Antineoplastic treatment can cause side effects that impair the patients' food intake and nutritional status. Objective: To evaluate the taste perception in patients undergoing cancer treatment, to relate it to personal and clinical variables and to compare with taste perception in healthy individuals. Method: Cross-sectional study with 50 individuals undergoing cancer treatment and another 50 individuals in the control group. To assess taste perception, participants received food samples and were asked about sweet, bitter, salty and sour flavors. The intensity of the flavor was assessed using a scale from 1 to 5. Results: Patients undergoing cancer treatment perceived the flavors of the following foods more strongly: dulce de leche (4.48±1.0 vs. 3.78±0.9; p<0.05), guava (4.10±1.0 vs. 3.52±0.9; p<0.05), lemon juice (4.42±0.9 vs. 2.86±1.0; p<0.05), passion fruit juice (3.76±1.2 vs. 2.56±1.0; p<0.05) and coffee (4.42±0.8 vs. 3.14±0.9; p<0.05). The foods: cassava starch, natural yogurt, arugula and chicory were perceived with less intensity when compared to the control group. Among the four flavor categories evaluated, the foods in the salty group were the ones that least differed in terms of the taste perception and sour and bitter foods were perceived more distinctly between the groups. Conclusion: The present study is pioneer in evaluating the taste perception using food, instead of standardized solutions, and through this technique, significant differences were identified in the intensity of taste perception of individuals undergoing cancer treatment.

Introducción: El tratamiento antineoplásico puede causar efectos secundarios que perjudican la ingesta de alimentos y el estado nutricional de los pacientes. Objetivo: Evaluar la percepción del gusto en pacientes sometidos a tratamiento contra el cáncer, relacionarlo con variables personales y clínicas y compararlo con la percepción del gusto en individuos sanos. Método: Este es un estudio transversal con 50 individuos en tratamiento contra el cáncer y otros 50 individuos en el grupo de control. Para evaluar la percepción del sabor, los participantes recibieron las muestras de alimentos y se les preguntó sobre los sabores dulces, amargos, salados y agrios. La intensidad del sabor se evaluó usando una escala del 1 al 5. Resultados: Los pacientes en tratamiento contra el cáncer percibieron los sabores de los siguientes alimentos con más fuerza: dulce de leche (4,48±1,0 vs. 3,78±0,9; p<0,05), guayaba (4,10±1,0 vs. 3,52±0,9; p<0,05), jugo de limón (4,42±0,9 vs. 2,86±1,0; p<0,05), jugo de maracuyá (3,76±1,2 vs. 2,56±1,0; p<0,05) y café (4,42±0,8 vs. 3,14±0,9; p<0,05). Los alimentos: galletas de almidón, yogur, rúcula y achicoria se percibieron con menos intensidad en comparación con el grupo de control. Entre los sabores, los alimentos salados fueron los que menos diferían y los alimentos amargos y amargos se percibieron más claramente entre los grupos. Conclusión: El presente estudio es pionero en evaluar la percepción del gusto utilizando alimentos, en lugar de soluciones estandarizadas, y identificó diferencias significativas en la intensidad de la percepción del gusto en individuos en tratamiento contra el cáncer.

Primeira infância sem açúcar: um direito a ser conquistado / Early childhood without sugar: a right to be ensured / La primera infancia sin azúcar: un derecho que hay que conquistar

Objetivo: promover a reflexão acerca do impacto do consumo de açúcar na primeira infância à luz da garantia de direitos. Metodologia: o trabalho foi realizado a partir de revisão integrativa de literatura na base de dados PubMed com o uso de descritores específicos. Foram selecionados textos completos em inglês, disponíveis online de 2014 a 2019. Também foram utilizados, de forma complementar, documentos oficiais sobre o perfil nutricional da população e o desenvolvimento das doenças crônicas não transmissíveis em crianças. Resultados: a busca no banco de dados PubMed registrou 36 publicações, das quais onze foram selecionadas para a presente revisão. A fim de relacionar o tema do consumo de açúcar ao direito à saúde da criança, foram consultados também nove documentos jurídicos, onze publicações oficiais de órgãos governamentais, além de livros técnicos, o que possibilitou fundamentar a discussão sobre o impacto do açúcar na saúde da criança como um direito a ser conquistado. Conclusão: apesar do moderno aparato de proteção à saúde e à alimentação da primeira infância pautado pela legislação brasileira, persiste o excesso de açúcar livre na alimentação infantil, o que causa impacto negativo comprovado na prevalência de doenças crônicas não transmissíveis. A alimentação sem sacarose pode ser apontada como um direito da primeira infância devido a sua influência na formação de hábitos, na prevenção de doenças e na qualidade de vida a longo prazo.

Objective: to reflect on sugar consumption´s impact on early childhood in children´s rights perspective. Methods: it is an integrative literature review. The authors selected full texts in English by searching articles from 2014 to 2019 in the PubMed database with specific descriptors. To complement the study, it was used official documents on the nutritional profile of the population and the development of chronic non-communicable diseases in children. Results: the PubMed database search recorded 36 publications, of which eleven were selected for this review. To relate the topic of sugar consumption to the right to children's health, nine legal documents, eleven official publications from government agencies, as well as technical books were also consulted, which made it possible to base the discussion on the impact of sugar on children's health as a right to be conquered. Conclusion: despite the modern apparatus for protecting early childhood health and nutrition by Brazilian legislation, there is still an excess of free sugar in children's diet, which has a proven negative impact on the prevalence of chronic non-communicable diseases. Eating without sucrose can be considered as a right of early childhood due to its influence on the formation of habits, in disease prevention, and on long-term quality of life.

Objetivo: promover la reflexión sobre el impacto del consumo de azúcar en la primera infancia a la luz de la garantía de los derechos. Metodología: el trabajo se realizó a partir de una revisión bibliográfica integradora en la base de datos PubMed utilizando descriptores específicos. Se seleccionaron los textos completos en inglés disponibles en línea desde 2014 hasta 2019. También se utilizaron de manera complementaria los documentos oficiales sobre el perfil nutricional de la población y sobre la evolución de las enfermedades crónicas no transmisibles en los niños. Resultados: la búsqueda en la base de datos PubMed registró 36 publicaciones, de las cuales once fueron seleccionadas para este examen. Para relacionar el tema del consumo de azúcar con el derecho a la salud infantil, se consultaron también nueve documentos jurídicos, once publicaciones oficiales de organismos gubernamentales, además de libros técnicos, que permitieron fundamentar la discusión sobre el impacto del azúcar en la salud infantil como un derecho a conquistar. Conclusión: a pesar del moderno aparato de protección de la salud y nutrición de la primera infancia regido por la legislación brasileña, sigue habiendo un exceso de azúcar libre en la dieta de los niños, lo que ha demostrado tener un efecto negativo en la prevalencia de las enfermedades crónicas no transmisibles. La dieta sin sacarosa puede ser señalada como un derecho de la primera infancia por su influencia en la formación de hábitos, en la prevención de enfermedades y en la calidad de vida a largo plazo.