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Background: The true incidence of SARS-CoV-2 infection in Costa Rica was likely much higher than officially reported, because infection is often associated with mild symptoms and testing was limited by official guidelines and socio-economic factors. Methods: Using serology to define natural infection, we developed a statistical model to estimate the true cumulative incidence of SARS-CoV-2 in Costa Rica early in the pandemic. We estimated seroprevalence from 2223 blood samples collected from November 2020 to October 2021 from 1976 population-based controls from the RESPIRA study. Samples were tested for antibodies against SARS-CoV-2 nucleocapsid and the receptor-binding-domain of the spike proteins. Using a generalized linear model, we estimated the ratio of true infections to officially reported cases. Applying these ratios to officially reported totals by age, sex, and geographic area, we estimated the true number of infections in the study area, where 70% of Costa Ricans reside. We adjusted the seroprevalence estimates for antibody decay over time, estimated from 1562 blood samples from 996 PCR-confirmed COVID-19 cases. Findings: The estimated total proportion infected (ETPI) was 4.0 times higher than the officially reported total proportion infected (OTPI). By December 16th, 2021, the ETPI was 47% [42-52] while the OTPI was 12%. In children and adolescents, the ETPI was 11.0 times higher than the OTPI. Interpretation: Our findings suggest that nearly half the population had been infected by the end of 2021. By the end of 2022, it is likely that a large majority of the population had been infected. Funding: This work was sponsored and funded by the National Institute of Allergy and Infectious Diseases through the National Cancer Institute, the Science, Innovation, Technology and Telecommunications Ministry of Costa Rica, and Costa Rican Biomedical Research Agency-Fundacion INCIENSA (grant N/A).
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BACKGROUND: Retinoblastoma survivors in low- and middle-income countries are exposed to high-intensity treatments that potentially place them at higher risk of early subsequent malignant neoplasms (SMNs). METHODS: We followed 714 (403 [56.4%] nonhereditary and 311 [43.5%] hereditary) retinoblastoma survivors diagnosed from August 1987 to December 2016, up to the age of 16 years. We quantified risk of SMNs with cumulative incidence (CI) and standardized incidence ratios (SIR) analysis. Multivariate regression Cox model was used to determine the association of treatments and risk of SMNs. RESULTS: Median follow-up was of 9 years (range: 0.18-16.9) and 24 survivors (3.36%) developed 25 SMNs (n = 22 hereditary, n = 2 nonhereditary). SMNs included sarcomas (osteosarcomas, Ewing sarcomas, rhabdomyosarcomas; n = 12), leukemias (n = 5), and central nervous system tumors (CNS; n = 3). All cases of acute myeloid leukemia (AML) and most of Ewing sarcomas occurred within 5 years of retinoblastoma diagnosis. The type of SMN was the main indicator of mortality (five of five patients with leukemias, six of 12 with sarcomas, and zero of three with CNS tumors died). Compared to the general population, radiation increased the risk of Ewing sarcoma in hereditary survivors by 700-fold (95% CI = 252-2422.6) and chemotherapy increased the risk of AML by 140-fold (95% CI = 45.3-436). The CI of SMNs for hereditary survivors was 13.7% (95% CI = 8.4-22.1) at 15 years. CONCLUSION: Retinoblastoma survivors from Argentina are at higher risk of developing SMNs early in life compared to the general Argentinean population, especially those treated with radiation plus chemotherapy. AML and Ewing sarcoma presented within 5 years of retinoblastoma diagnosis are associated with chemotherapy and radiation exposure.
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Neoplasias Ósseas , Neoplasias da Mama , Neoplasias do Sistema Nervoso Central , Leucemia , Segunda Neoplasia Primária , Neoplasias , Neoplasias da Retina , Retinoblastoma , Sarcoma de Ewing , Sarcoma , Neoplasias Cutâneas , Neoplasias de Tecidos Moles , Adolescente , Argentina/epidemiologia , Neoplasias Ósseas/complicações , Neoplasias da Mama/epidemiologia , Neoplasias do Sistema Nervoso Central/complicações , Criança , Feminino , Humanos , Incidência , Leucemia/complicações , Neoplasias/complicações , Segunda Neoplasia Primária/diagnóstico , Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/etiologia , Neoplasias da Retina/complicações , Neoplasias da Retina/epidemiologia , Neoplasias da Retina/terapia , Retinoblastoma/complicações , Retinoblastoma/epidemiologia , Retinoblastoma/terapia , Medição de Risco , Sarcoma/epidemiologia , Sarcoma/etiologia , Sarcoma/terapia , Sarcoma de Ewing/complicações , Neoplasias Cutâneas/complicações , Neoplasias de Tecidos Moles/complicações , SobreviventesRESUMO
Objective: Temperature during cardiopulmonary bypass (CPB) for cardiac surgery has been controversial. The aim of the current study is to compare the outcomes for patients with mild hypothermia versus normothermic CPB temperatures. Methods: All patients who underwent cardiac surgery with CPB and temperatures ≥32°C from 2011 to 2018 were included, which consisted of mild hypothermia (32°C-35°C) and normothermia (>35°C) cohorts. Propensity matching (1:1) was performed for risk adjustment. Primary outcomes included operative and long-term survival. Secondary outcomes included postoperative complications. Results: A total of 6525 patients comprised 2 cohorts: mild hypothermia (32°C-35°C; n = 3148) versus normothermia (>35°C; n = 3377). Following adjustment for surgeon preference, there were 1601 propensity-matched patients who had similar baseline characteristics (standard mean difference, ≤0.10), including CPB time, crossclamp time, and intra-aortic balloon pump placement. Kaplan-Meier analysis showed no difference in long-term survival (82.6% vs 81.6%; P = .81). Over a median follow-up of 4.4 years, there were no differences in overall mortality (18.1% vs 18.1%; P = 1.1) or readmission (50.3% vs 48.3%; P = .2). Acute renal failure (3.7% vs 2.4%; P = .03) and intensive care unit hours (46.5 vs 45.1; P = .04) were significantly higher with hypothermia. There was no difference between cohorts for postoperative stroke (2.0% vs 2.0%; P = 1.0), reoperation (5.9% vs 6.0%; P = .9), or operative intra-aortic balloon pump placement (1.7% vs 1.8%; P = .9). Conclusions: Patients with mild hypothermia during CPB had increased postoperative renal failure and length of intensive care unit stay. Although there was no difference in long-term survival, mild hypothermia does not appear to offer patients appreciable benefits, compared with normothermia.
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BACKGROUND: There are no large reported series determining the Covid-19 cancer patient's characteristics. We determine whether differences exist in cumulative incidence and mortality of Covid-19 infection between cancer patients and general population in Madrid. MATERIAL AND METHODS: We reviewed 1069 medical records of all cancer patients admitted at Oncology department between Feb 1 and April 7, 2020. We described Covid-19 cumulative incidence, treatment outcome, mortality, and associated risk factors. RESULTS: We detected 45/1069 Covid-19 diagnoses in cancer patients vs 42,450/6,662,000 in total population (p < 0.00001). Mortality rate: 19/45 cancer patients vs 5586/42,450 (p = 0.0001). Mortality was associated with older median age, adjusted by staging and histology (74 vs 63.5 years old, OR 1.06, p = 0.03). Patients who combined hydroxychloroquine and azithromycin presented 3/18 deaths, regardless of age, staging, histology, cancer treatment and comorbidities (OR 0.02, p = 0.03). CONCLUSION: Cancer patients are vulnerable to Covid-19 with an increase in complications. Combined hydroxychloroquine and azithromycin is presented as a good treatment option.
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Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Neoplasias/complicações , Neoplasias/epidemiologia , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Idoso , Azitromicina/uso terapêutico , Betacoronavirus/isolamento & purificação , COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Combinação de Medicamentos , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Fatores de Risco , SARS-CoV-2 , Espanha/epidemiologia , Resultado do TratamentoRESUMO
OBJECTIVE: To investigate the postnatal risk of Kawasaki disease and coronary complications from a nationwide birth cohort in Taiwan, a country with the third-highest incidence of Kawasaki disease worldwide. STUDY DESIGN: We enrolled children born between 2000 and 2009 with complete postnatal medical care records for 2000-2014 in the Taiwan national database. RESULTS: Out of a total of 2 150 590 live births, we identified 6690 (62.6% boys) patients with Kawasaki disease. The onset was mostly (93.9%) within the first 5 years of life (median, 16 months; 38% during infancy), but was rare within the first 3 months of life. The overall cumulative incidence of Kawasaki disease by age 5 years was 2.78 (3.33 for boys and 2.17 for girls; P < .001) and exhibited an increasing trend with birth year (from 2.28 for 2000 to 3.67 for 2009). The incidence ratio was 1.535 in boys and 1.055 in each increasing year. Kawasaki disease recurred more often in younger patients (cumulative incidence, 2.3% in infants vs 1.7% in children aged 1-4 years). Coronary complications occurred in 16.2% of the patients, including 4 cases of acute myocardial infarction (3 occuring during the acute stage and 1 occurring 5 years later). The probability of a major cardiac event (infarction, undergoing percutaneous coronary intervention or coronary artery bypass grafting, or death) by adolescence was 1.9%. CONCLUSIONS: The postnatal risk of Kawasaki disease was 3-4 and increased with every birth year. Patients with Kawasaki disease are at substantial risk for a major cardiac events during childhood.
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Síndrome de Linfonodos Mucocutâneos/epidemiologia , Pré-Escolar , Estudos de Coortes , Doença das Coronárias/epidemiologia , Doença das Coronárias/etiologia , Bases de Dados Factuais , Feminino , Humanos , Incidência , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações , Medição de Risco , TaiwanRESUMO
OBJECTIVE: To examine the relationship between social contextual factors and child and adolescent labor. METHODS: Population-based cohort study carried out with 2,512 families living in 23 subareas of a large urban city in Brazil from 2000 to 2002. A random one-stage cluster sampling was used to select families. Data were obtained through individual household interviews using questionnaires. The annual cumulative incidence of child and adolescent labor was estimated for each district. New child and adolescent labor cases were those who had their first job over the two-year follow-up. The annual cumulative incidence of child and adolescent labor was the response variable and predictors were contextual factors such as lack of social support, social deprivation, unstructured family, perceived violence, poor school quality, poor environment conditions, and poor public services. Pearson's correlation and multiple linear regression were used to assess the associations. RESULTS: There were selected 943 families corresponding to 1,326 non-working children and adolescents aged 8 to 17 years. Lack of social support, social deprivation, perceived violence were all positively and individually associated with the annual cumulative incidence of child and adolescent labor. In the multiple linear regression model, however, only lack of social support and perceived violence in the neighborhood were positively associated to child and adolescent labor. No effect was found for poor school quality, poor environment conditions, poor public services or unstructured family. CONCLUSIONS: Poverty reduction programs can reduce the contextual factors associated with child and adolescent labor. Violence reduction programs and strengthening social support at the community level may contribute to reduce CAL.
OBJETIVO: Analisar a relação entre as variáveis sociocontextuais e o trabalho de crianças e adolescentes. MÉTODOS: Estudo de coorte com 2.512 famílias residentes em 23 áreas urbanas de Salvador, BA, entre 2000 e 2002. A seleção das áreas e a identificação das famílias foram realizadas por amostragem por conglomerados. Entrevistas domiciliares foram realizadas com questionários individuais. A incidência cumulativa anual do trabalho de crianças e adolescentes foi estimada para cada área. Crianças e adolescentes que se tornaram trabalhadores ao longo dos dois anos de seguimento do estudo foram considerados casos novos. A incidência cumulativa anual do trabalho de crianças e adolescentes foi analisada como variável resposta e fatores contextuais foram as preditoras (ausência de apoio social, deprivação social e famílias não-estruturadas, percepção de violência, má qualidade das escolas e dos serviços públicos, e existência de problemas ambientais na vizinhança). Regressão linear múltipla foi utilizada para análise. RESULTADOS: Foram encontradas 943 famílias com 1.326 crianças e adolescentes não trabalhadores de 8 a 17 anos. Ausência de apoio social, deprivação social e percepção de violência na vizinhança associaram-se positivamente ao trabalho de crianças e adolescentes quando analisadas separadamente. Ausência de apoio social e percepção de violência foram positivamente associadas com o desfecho na regressão linear múltipla. Má qualidade da escola e dos serviços públicos urbanos e a existência de problemas ambientais e familiares não apresentaram associação. CONCLUSÕES: Programas que visem à redução da pobreza podem atuar positivamente nos fatores contextuais considerados. Programas de pacificação em áreas violentas, assim como o fortalecimento das redes sociais nas comunidades, podem contribuir para a diminuição do trabalho de crianças e adolescentes.
OBJETIVO: Analizar la relación entre las variables sociocontextuales y el trabajo de niños y adolescentes. MÉTODOS: Estudio de cohorte con 2.512 familias residentes en 23 áreas urbanas de Salvador, Noreste de Brasil, entre 2000 y 2002. La selección de las áreas y la identificación de las familias fueron realizadas por muestreo por conglomerados. Entrevistas domiciliares fueron realizadas con cuestionarios individuales. La incidencia acumulada anual del trabajo de niños y adolescentes fue estimada para cada área. Niños y adolescentes que se tornaron trabajadores a lo largo de dos años de seguimiento del estudio fueron considerados casos nuevos. La incidencia acumulada anual del trabajo de niños y adolescentes fue analizada como variable respuesta y factores contextuales fueron los predictivos (ausencia de apoyo social; privación social y familias no estructuradas, percepción de violencia, mala calidad de las escuelas, de los servicios públicos, y existencia de problemas ambientales en la vecindad). Regresión linear múltiple fue utilizada para análisis. RESULTADOS: Se encontraron 943 familias con 1.326 niños y adolescentes no trabajadores de 8 a 17 años. Ausencia de apoyo social, privación social y percepción de violencia en la vecindad se asociaron positivamente al trabajo de niños y adolescentes al analizarlos separadamente. Ausencia de apoyo social y percepción de violencia fueron positivamente asociados con el resultado en la regresión linear múltiple. Mala calidad de la escuela y de los servicios públicos urbanos y la existencia de problemas ambientales y familiares no presentaron asociación. CONCLUSIONES: Programas que busquen reducir la pobreza pueden actuar positivamente en los factores contextuales considerados. Programas de pacificación en áreas violentas, así como el fortalecimiento de las redes sociales en las comunidades, pueden contribuir para la disminución del trabajo de niños y adolescentes.