Acute pneumonitis after subcutaneous injection of BIO-ALCAMID® in breast

Filling materials are used to correct soft tissue deficits. Local and systemic complications are described when these substances are applied. The polyalkylamide gel (Bio-alcamid) used as filler material has been associated with complications at the facial level, while at the pulmonary level they have not been reported in the literature. We present the case of a patient who consulted due to sudden progressive dyspnea hours after the subcutaneous injection of Bio-alcamid in the breasts. After the clinical evaluation and the result of auxiliary tests, the diagnosis of acute pneumonitis secondary to the injection of this substance is concluded. Follow-up of the case was carried out with favorable evolution and resolution of symptoms after three months. We conclude that Bio-alcamid can generate complications at the pulmonary level, therefore, the intervention of public policies that regulate its use, commercialization and application by non-medical personnel is necessary

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Neumonitis aguda secundaria a la inyección subcutánea de gel de polialquilamida (BIO-ALCAMID) en mamas: Reporte de Caso: Acute pneumonitis after subcutaneous injection of BIO-ALCAMID® in breast: Case report

ABSTRACT: Filling materials are used to correct soft tissue deficits. Local and systemic complications are described when these substances are applied. The polyalkylamide gel (Bio-alcamid) used as filler material has been associated with complications at the facial level, while at the pulmonary level they have not been reported in the literature. We present the case of a patient who consulted due to sudden progressive dyspnea hours after the subcutaneous injection of Bio-alcamid in the breasts. After the clinical evaluation and the result of auxiliary tests, the diagnosis of acute pneumonitis secondary to the injection of this substance is concluded. Follow-up of the case was carried out with favorable evolution and resolution of symptoms after three months. We conclude that Bio-alcamid can generate complications at the pulmonary level, therefore, the intervention of public policies that regulate its use, commercialization and application by non-medical personnel is necessary.RESUMEN: Los materiales de relleno son utilizados para la corrección de déficit de tejido blando. Se describen complicaciones locales y sistémicas cuando se aplican estas sustancias. El gel de polialquilamida (Bio-alcamid) empleado como material de relleno ha sido asociado a complicaciones a nivel facial, mientras que a nivel pulmonar no han sido informadas en la literatura. Presentamos el caso de una paciente que consultó por presentar disnea súbita progresiva horas después de la inyección subcutánea de Bio-alcamid en mamas. Luego de la evaluación clínica y el resultado de exámenes auxiliares se concluye el diagnóstico de neumonitis aguda secundaria a la inyección de esta sustancia. Se realiza seguimiento del caso con evolución favorable y resolución de síntomas a los tres meses.  Concluimos que el Bio-alcamid puede generar complicaciones a nivel pulmonar, por tanto, es necesario la intervención de políticas públicas que regulen su uso, comercialización y la aplicación por personal no médico