We are not ready to use breast milk eye drops for infants with eye discharges

We were interested to read the paper by Sugimura et al, which evaluated the safety and efficacy of breast milk eye drops in infants up to six months of age with eye discharges. The authors reported that they found these as effective as sodium azulene sulphonate hydrate 0.02% and noted that eye discharge improved in 76.8% of patients without any adverse events. Although these results seem to be promising, we believe that there are some issues that warrant further clarification

Balto and Togo during the cold winter of Alaska (1925): the two canine heroes in the fight against diphtheria

In recent years, diphtheria has re-emerged in areas with inadequate vaccination coverage, and Europe has not been spared with several cases among migrants. Diphtheria is a potentially fatal infection caused mainly by toxigenic strains of Corynebacterium diphtheriae. Due to the high mortality rate, especially among young children, the fight against diphtheria is considered one of the first conquests of immunization. In the history of medicine, there is a unique case of an unconventional response to a diphtheria outbreak in which sled dogs were used to overcome the supply difficulties of diphtheria antitoxin. The mass media followed the medical response to the outbreak and raised audience awareness of public health issues. The facts of Nome, Alaska, in 1925 can serve as a catalyst to rethink conventional responses to diphtheria outbreaks in low-income countries today and promote mass media awareness of public health importance

Candidate Biomarkers for the Detection of Serious Infections in Children: A Prospective Clinical Study

Serious bacterial infections (SBI) in children are associated with considerable morbidity and mortality, and their early identification remains challenging. The role of laboratory tests in this setting is still debated, and new biomarkers are needed. This prospective, observational, single-center study aims to evaluate the diagnostic role of blood biomarkers in detecting SBI in children presenting with signs of systemic inflammatory response syndrome (SIRS). A panel of biomarkers was performed, including C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC), absolute neutrophil count (ANC), interleukin (IL)-6, IL-8, IL-10, human terminal complement complex (C5b-9), Plasmalemma-Vesicle-associated protein 1 (PV-1), Intercellular Adhesion Molecule-1 (ICAM-1), and Phospholipase A2 (PLA2). Among 103 patients (median age 2.9 years, 60% males), 39 had a diagnosis of SBI (38%). Significant predictors of SBI were CRP (p = 0.001) and ICAM-1 (p = 0.043). WBC (p = 0.035), ANC (p = 0.012) and ANC/WBC ratio (p = 0.015) were also significantly associated with SBI in children without pre-existing neutropenia. ROC curves, however, revealed suboptimal performance for all variables. Nevertheless, a model that combined CRP and ANC/WBC ratio had more in-depth diagnostic accuracy than either of the two variables. Overall, this study confirms the limited usefulness of blood biomarkers for the early diagnosis of SBI. WBC, ANC, ANC/WBC ratio, CRP, and ICAM-1 showed the best, albeit moderate, diagnostic accuracy

Análisis del uso de las energías alternativas para la evaluación de su impacto en la industrial regional

La energía es esencial para la vida y para el crecimiento económico de la población, además su obtención mediante recursos convencionales tiene un límite y produce un efecto contaminante notable. Por ello se debe pensar en un plan de incorporación de energías alternativas no solo desde la parte social y económica, sino también integrado a un desarrollo sostenible de las mismas y con un mínimo impacto al medio ambiente. La implementación de tecnologías para la generación de energías alternativas tiene un costo de inversión inicial más elevado por MW que aquellas de generación térmica y es fundamental abordar herramientas que permitan evaluar políticas previamente a su implementación. El objetivo de este trabajo es presentar un análisis económico de modelos de consumo energético con el fin de analizar las posibilidades de implementación de energías alternativas en la industria, tomando como referencia los recursos naturales disponibles en la región. En la provincia de Entre Ríos se está proyectando la generación de energía eléctrica a partir de la biomasa obtenida de los residuos de las industrias arroceras y forestales, como combustible. En cuanto a las empresas de la región de Salto Grande se está reemplazando el gas natural y diésel por el uso de biomasa y pellet de madera, como combustibles para la generación de energía eléctrica, calefacción industrial y hogareña. A partir de estos datos y modelos se analizan distintos escenarios energéticos y se evalúan los resultados desde una visión del desarrollo sustentable. Como resultado del trabajo se muestran los beneficios socio-económicos que puede aportar a la industria el uso de estas energías alternativas.Energy is essential for life and for economic growth of the population, and their production by conventional resources is limited and produces a remarkable polluting effect. Therefore you should think of a plan to incorporate alternative energy not only from the social and economic side, but also integrated sustainable development of the same and with minimal impact to the environment. The implementation of technologies for alternative energy generation has an initial investment cost per MW higher than those of thermal generation and is crucial to address tools to evaluate policies prior to implementation. The aim of this paper is to present an economic analysis of energy consumption patterns in order to analyze the possibilities of implementing alternative energy industry, with reference to the natural resources available in the region. In the province of Entre Ríos being projected electricity generation from biomass residues obtained from rice and forestry industries, as fuel. As for the companies in the region of Salto Grande it is replacing natural gas and diesel for the use of biomass and wood pellets as fuel for power generation, industrial and home heating. From these data and models various energy scenarios are analyzed and the results are evaluated from a perspective of sustainable development. As a result of the work the socio-economic benefits it can bring to the industry the use of these alternative energy.Fil: Chezzi, Carlos María. Universidad Tecnológica Nacional. Facultad Regional Concordia; Argentina.Fil: Bordón, César Francisco. Universidad Tecnológica Nacional. Facultad Regional Concordia; Argentina.Fil: Penco, José Jorge. Universidad Tecnológica Nacional. Facultad Regional Concordia; Argentina.Fil: Salvarredi, Mariela. Universidad Tecnológica Nacional. Facultad Regional Concordia; Argentina.Fil: Alvarez, Carlos Arturo. Universidad Tecnológica Nacional. Facultad Regional Concordia; Argentina.Fil: Tymoschuk, Ana Rosa. Universidad Tecnológica Nacional. Facultad Regional Santa Fé; Argentina.Peer Reviewe

Should paediatric endocrinologists consider more carefully when to perform a stimulation test?

Introduction: Pediatric endocrinology rely greatly on hormone stimulation tests which demand time, money and effort. The knowledge of the pattern of pediatric endocrinology stimulation tests is therefore crucial to optimize resources and guide public health interventions. Aim of the study was to investigate the distribution of endocrine stimulation tests and the prevalence of pathological findings over a year and to explore whether single basal hormone concentrations could have saved unnecessary stimulation tests. Methods: Retrospective study with data collection for pediatric endocrine stimulation tests performed in 2019 in a tertiary center. Results: Overall, 278 tests were performed on 206 patients. The most performed test was arginine tolerance test (34%), followed by LHRH test (24%) and standard dose Synachten test (19%), while the higher rate of pathological response was found in insulin tolerance test to detect growth hormone deficiency (81%), LHRH test to detect central precocious puberty (50%) and arginine tolerance test (41%). No cases of non classical-congenital adrenal hyperplasia were diagnosed. While 29% of growth hormone deficient children who performed an insulin tolerance test had a pathological peak cortisol, none of them had central adrenal insufficiency confirmed at low dose Synacthen test. The use of basal hormone determinations could save up to 88% of standard dose Synachten tests, 82% of arginine tolerance + GHRH test, 61% of LHRH test, 12% of tests for adrenal secretion. Conclusion: The use of single basal hormone concentrations could spare up to half of the tests, saving from 32,000 to 79,000 euros in 1 year. Apart from basal cortisol level <108 nmol/L to detect adrenal insufficiency and IGF-1 <-1.5 SDS to detect growth hormone deficiency, all the other cut-off for basal hormone determinations were found valid in order to spare unnecessary stimulation tests

Reduction in pediatric growth hormone deficiency and increase in central precocious puberty diagnoses during COVID 19 pandemics

11noBackground: While several studies have been published so far on the effect of COVID-19 pandemic on health care for non-COVID-19 diseases, to date no study evaluated the impact of the COVID-19 pandemic on the entire field of pediatric endocrinology. This study aimed to evaluate differences in pediatric endocrine stimulation tests after the advent of COVID-19 pandemics. Methods: Retrospective study with data collection for pediatric endocrine stimulation tests performed in 2019 and 2020 in a tertiary center. Results: Overall, 251 tests were performed on 190 patients in 2020, compared to 278 tests on 206 patients in 2019 (-10% tests; -8% children evaluated). A significant reduction was found in tests to diagnose growth hormone deficiency (GHD) (-35%), while LHRH tests increased (+22%). A reduction of 30% in GHD diagnosis was observed. Central precocious puberty (CPP) diagnosis increased by 38% compared to 2019, mainly in females. Conclusion: This study found a significant reduction of tests investigating GHD during COVID-19 pandemics. It also showed a clinically meaningful increase in cases of CPP in girls. These results suggest the need for families and pediatricians to monitor children's growth during isolation and enlighten new perspectives towards conditions associated with lockdown restrictions as increased screen time, social isolation, and children's anxiety as possible triggers of CPP.openopenMartina Peinkhofer; Benedetta Bossini; Arturo Penco; Manuela Giangreco; Maria Chiara Pellegrin; Viviana Vidonis; Giada Vittori; Nicoletta Grassi; Elena Faleschini; Egidio Barbi; Gianluca TornesePeinkhofer, Martina; Bossini, Benedetta; Penco, Arturo; Giangreco, Manuela; Pellegrin, MARIA CHIARA; Vidonis, Viviana; Vittori, Giada; Grassi, Nicoletta; Faleschini, Elena; Barbi, Egidio; Tornese, Gianluc

Impact of the M184V resistance mutation on virological efficacy and durability of lamivudine-based dual antiretroviral regimens as maintenance therapy in individuals with suppressed HIV-1 RNA: A cohort study

Background. Dual therapy (DT) with boosted protease inhibitors (bPIs) plus lamivudine has been shown to be superior to bPI monotherapy in virologically suppressed patients despite previous selection of the lamivudine resistance M184V mutation. We compared the virological efficacy of lamivudine-based DT in patients with and without a history of M184V detection. Methods. We retrospectively analyzed patients with HIV-RNA ≤50 copies/mL switching to DT with at least 1 previous resistance genotype in the ARCA database. Time to virological failure (VF; HIV-RNA ≥200 copies/mL or 2 consecutive HIV-RNA >50 copies/mL) and to treatment discontinuation (TD) was analyzed by survival analysis. Results. Four hundred thirty-six patients switching to lamivudine plus bPIs (70%) or integrase inhibitors (30%) were included. Patients with M184V (n = 87) were older, had lower nadir CD4+ cell count, longer duration of antiretroviral therapy and of virologic suppression, and higher rate of hepatitis C virus infection compared with patients without M184V. The 3-year probability of remaining free from VF was 91.9% (95% confidence interval [CI], 86.6-97.2) without M184V and 87.8% (95% CI, 78.4-97.2) with M184V (P = .323). The time to TD did not differ between groups. Multivariate analysis adjusting for baseline variables differing between groups also did not detect M184V as being associated with VF or TD; however, the 3-year probability of remaining free of viral blips (isolated HIV-RNA 51-199 copies/mL) was 79.8% (95% CI, 67.8%-91.8%) with M184V vs 90.1% (95% CI, 84.0%-96.2%) without M184V (P = .016). Conclusions. Previous selection of M184V did not increase the risk of VF or TD with lamivudine-based DT but was associated with a higher probability of viral blips