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Mechanical bowel preparation (MBP) is largely used worldwide prior to colostomy closure in children, although its benefits are questioned by scientific evidence, and its use can cause adverse reactions. We hypothesized that colostomy closure procedures in children are not associated with increased complications (surgical site infection [SSI] and anastomotic leakage) when performed without MBP. Thus, we conducted a noninferiority trial to compare the safety and efficacy of colostomy takedown with and without MBP.A randomized noninferiority clinical trial was conducted at Hospital Infantil de Mexico in Mexico City from 2015 to 2019, in which the experimental group did not receive MBP prior to colostomy closure. A total of 79 patients were analyzed, and the primary outcomes were safety-related. Data were analyzed using the chi-squared test, Student's t-test, or Mann-Whitney U test as appropriate.The demographics in both groups were comparable. Statistical analysis revealed equivalence in safety outcomes (superficial SSI, 22.5% vs 15.3% p = 0.420; deep SSI, 7.5% vs 0% p = 0.081; reoperation, p = 0.320; intestinal occlusion, p = 0.986); no anastomotic leakage was observed in any group. Secondary outcomes such as fasting time and length of hospital stay after surgery were also similar between the groups. However, patients who received MBP were admitted 2 days before surgery.Our findings indicate that withholding MBP prior to colostomy takedowns in children is not associated with increased complications. Omitting MBP also leads to less discomfort and shortens hospital length of stay, suggesting that it has safer and more effective procedures.Randomized controlled clinical trial with adequate statistical power.

Producción Científica, Input–output tables (IOTs) provide a relevant picture of economic structure as they represent the composition and interindustry relationships of an economy. The technical coefficients matrix (A matrix) is considered to capture the technological status of an economy; so, it is of special relevance for the evaluation of long-term, structural transformations, such as sustainability transitions in integrated assessment models (IAMs). The A matrix has typically been considered either static or exogenous. Endogenous structural change has rarely been applied to models. The objective of this paper is to analyze energy intensity, a widely used variable in IAMs, and its role as a driver of structural change. We therefore identify the most relevant technical coefficients in the IOTs time series and estimate an econometric model based on the energy intensity of five different final end-use energy sources. The results of this analysis show that energy intensity has a significant influence on the evolution of the A matrix and should therefore be taken into consideration when analyzing endogenous structural change in models., Ministerio de Asuntos Económicos y Transformación Digital, project MODESLOW (grant ECO2017-85110-R), European Union’s Horizon 2020 research and innovation program. Project “Low Carbon society: An enhanced modelling tool for the transition to sustainability (LOCOMOTION) grant award H2020-LC-CLA-01-2018, n. 821105

La ignorancia ha sido considerada como un estado negativo para la humanidad. Sin embargo, bajo ciertos contextos puede ser un impulso para el desarrollo del conocimiento no solo porque motiva al investigador sino porque una clasificación de lo que desconocemos hace que la ignorancia tenga relevancias similares a las del conocimiento. En esa medida, los modelos científicos, como representaciones, alcanzan un carácter de ficticios o posibles debido a que exponen algo que se desconoce o se conoce de manera parcial, haciendo evidente una forma de ignorancia específica.&nbsp

In this study, Monte Carlo codes, Geant4 and MCNP6, were used to characterize the fast neutron therapeutic beam produced at iThemba LABS in South Africa. Experimental and simulation results were compared using the latest generation of Silicon on Insulator (SOI) microdosimeters from the Centre for Medical Radiation Physics (CMRP). Geant4 and MCNP6 were able to successfully model the neutron gantry and simulate the expected neutron energy spectrum produced from the reaction by protons bombarding a 9Be target. The neutron beam was simulated in a water phantom and its characteristics recorded by the silicon microdosimeters; bare and covered by a 10B enriched boron carbide converter, at different positions. The microdosimetric quantities calculated using Geant4 and MCNP6 are in agreement with experimental measurements. The thermal neutron sensitivity and production of 10B capture products in the p+ boron-implanted dopant regions of the Bridge microdosimeter is investigated. The obtained results are useful for the future development of dedicated SOI microdosimeters for Boron Neutron Capture Therapy (BNCT). This paper provides a benchmark comparison of Geant4 and MCNP6 capabilities in the context of further applications of these codes for neutron microdosimetry.

Objective To report the frequency of asymptomatic infection with SARS-CoV-2 in pediatric patients undergoing invasive medical procedures in a tertiary pediatric hospital. Methods From June to October 2020, a SARS-CoV-2 real-time reverse-transcription polymerase chain reaction (rRT-PCR) test was performed for all pediatric patients scheduled to undergo an elective invasive procedure. None of the patients was symptomatic. The cycle threshold (Ct) values of the ORF1ab gene were recorded for all patients. Results A total of 700 patients were screened for SARS-CoV-2 infection. The median age was 5.7 y old. In total, 46.6% (n = 326) of the patients were male, and 53.4% (n = 374) were female. The most common underlying diseases were hemato-oncological (25.3%), gastrointestinal (24.9%), and genitourinary (10.3%). The main scheduled surgical–medical procedures were surgical treatment for acquired congenital diseases, biopsy sampling, local therapy administration, organ transplantation, and the placement of central venous catheters, among others. The SARS-CoV-2 rRT-PCR test was positive in 9.4% (66), and the median Ct value was 35.8. None of the patients developed COVID-19. Conclusions The frequency of asymptomatic SARS-CoV-2 infection was detected in less than 10% of pediatric patients scheduled to undergo an elective invasive procedure in a tertiary hospital. This frequency is higher than those in reports from different countries. Supplementary Information The online version contains supplementary material available at 10.1007/s12098-021-03959-3.

CMV remains a frequent complication after liver transplantation. Few studies exist in children reporting the epidemiology and outcomes of CMV after LT with current prevention strategies. Our goal is to report the incidence of CMV infection and disease in pediatric LT recipients under preemptive therapy, identify risk factors, complications, and adverse reactions to treatment.All pediatric LT recipients from a single center (1998-2018) were included. Antigenemia pp65 (1998-2003) and QNAT or both were used to inform preemptive therapy. Cutoff value for starting treatment was Agpp65 10 + cells/200 000 or QNAT1500 copies/ml or any value in high-risk recipients (D+/R-).One hundred eighteen LT were analyzed. CMV infection was detected in 67% of patients, only 44 (37%) required treatment, and 5 (4%) developed CMV disease. All patients responded well to treatment, and no graft or patients were lost to CMV effects. There were no differences in mortality, CMV indirect effects, or other complications between those who required treatment and those who did not. Thirty-two percent of the patients who received antivirals developed an adverse hematological reaction. Risk factors associated with CMV infection requiring treatment were D+/R- (OR 13.9, p = .01) and fulminant hepatitis (OR 4.8, p = .02).Preemptive therapy for CMV in children is safe and effective, yields low CMV infection rates that require treatment, and minimal rates of CMV disease, without increasing CMV-related complications. Using this strategy, 63% of our patients did not receive treatment. Therefore, drug exposure, adverse reactions, and resistance risk were minimized.

BackgroundPediatric inflammatory multisystem syndrome (PIMS) is a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children that resembles Kawasaki syndrome and places them at high risk of cardiorespiratory instability and/or cardiac damage. This study aims to describe the clinical presentation and outcomes of patients with PIMS in Mexico City.MethodsThis was an observational study of children hospitalized for PIMS based on the Centers for Disease Control and Prevention case definition criteria, in a single tertiary care pediatric center in Mexico City between May 1, 2020, and September 30, 2021. Demographic characteristics, epidemiological data, medical history, laboratory tests, cardiologic evaluations, treatment, and clinical outcomes were analyzed.ResultsSeventy-five cases fulfilled the case definition criteria for PIMS [median age: 10.9 years, Interquartile range (IQR): 5.6–15.6]. Fifteen (20%) patients had a severe underlying disease, 48 (64%) were admitted to the intensive care unit, 33 (44%) required invasive mechanical ventilation and 39 (52%) received vasopressor support. The patients were clustered through latent class analysis based on identified symptoms: Cluster 1 had rash or gastrointestinal symptoms (n = 60) and cluster 2 were those with predominantly respiratory manifestations (n = 15). Two patients (2.7%) died, and both had severe underlying conditions. Five patients (6.7%), all from cluster 1, developed coronary aneurysms.ConclusionThere were a high proportion of patients with severe respiratory involvement and positive RT-PCR SARS-CoV-2 and very few cases of coronary aneurysms in our study which suggests that a high proportion of the children had severe acute COVID-19. The clinical manifestations and outcomes are comparable to previously reported international studies.

For the period since 2011, the UK has been bound by European Union (EU) legislation regarding energy reduction targets to 2020. As of 2019, the UK had reduced its final energy use by 18% against a baseline projection to 2020, on track to meet its target of 18%. Whilst the rest of the EU-27 now set their own energy reduction targets to 2030, upon leaving the EU via Brexit, the UK is now free to choose its own energy targets. But what should the energy target be for 2030, and what are the socio-macroeconomic impacts and policy implications? To address this, we use two econometric energy-economy models to assess three different levels of energy reduction target, with 27%, 33% and 40% reduction in 2030 versus the baseline model projections. We find the strictest (40%) energy reduction target could deliver the largest economic and employment benefits. However, careful attention to policies are required, to ensure improvements to overall economy-wide energy efficiency whilst minimising rebound. Demand-side policies of serious scale within an ‘avoid-shift-improve’ framework are required, including massive building retrofits, significant improvements to industrial energy efficiency, switching to low energy transport modes, and moving away from meat-based diets.

Producción Científica, The literature dedicated to the analysis of the different climate agreements has usually focused on the effectiveness of the aims for emissions in the light of the advance in climate change. This article quantifies the variation in emissions that the Intended Nationally Determined Contributions (INDCs) will entail and their financial allocation and policies country-by-country and regionally. The objective is evaluating the Paris Agreement feasibility regarding the INDCs and its economic and environmental constraints. The criteria through which the 161 INDCs are analysed are as follows: i/ socio-economic impact of the transition; ii/ focus on energy management; iii/ substitution of non-renewable sources; iv/ the role of technology; v/ equality of the transition; vi/ compliance with emission reductions. The results obtained show that the Paris Agreement excessively relies on external financial support (41.4%). Moreover, its unilateralist approach, the socio-economic and biophysical constraints could be the underlying cause of the ineffectiveness of the 2 °C objective. This way, each country would emit an average of 37.8% more than in the years 2005–2015. When this is weighted, the figure would be a 19.3% increase, due mainly to the increases in China and India. These figures would lead the temperatures up to 3°–4 °C., European project H2020-LCE-2015-2 (691287)

El desarrollo de enterocolitis necrosante, con la consecuente perforación intestinal, es frecuente en los recién nacidos pretérmino. El tratamiento estándar de la perforación intestinal es quirúrgico. Sin embargo, se sugiere que la inserción de un drenaje en el abdomen puede ser efectivo para tratar esta afección. Se resumen los resultados de una revisión sistemática Cochrane que compara la efectividad del drenaje peritoneal con la de la laparotomía en neonatos con enterocolitis necrosante perforada.Necrotizing enterocolitis is common in preterm newborns, with consequent intestinal perforation. The standard treatment for intestinal perforation is surgery. However, it is suggested that inserting a drain into the abdomen may be effective in treating this condition. This document summarizes the results of a Cochrane systematic review comparing the effectiveness of peritoneal drainage with laparotomy in neonates with perforated necrotizing enterocolitis.

The radiosensitivity of haematopoietic stem and progenitor cells (HSPCs) to neutron radiation remains largely underexplored, notwithstanding their potential role as target cells for radiation-induced leukemogenesis. New insights are required for radiation protection purposes, particularly for aviation, space missions, nuclear accidents and even particle therapy. In this study, HSPCs (CD34+CD38+ cells) were isolated from umbilical cord blood and irradiated with 60Co γ-rays (photons) and high energy p(66)/Be(40) neutrons. At 2 h post-irradiation, a significantly higher number of 1.28 ± 0.12 γ-H2AX foci/cell was observed after 0.5 Gy neutrons compared to 0.84 ± 0.14 foci/cell for photons, but this decreased to similar levels for both radiation qualities after 18 h. However, a significant difference in late apoptosis was observed with Annexin-V+/PI+ assay between photon and neutron irradiation at 18 h, 43.17 ± 6.10% versus 55.55 ± 4.87%, respectively. A significant increase in MN frequency was observed after both 0.5 and 1 Gy neutron irradiation compared to photons illustrating higher levels of neutron-induced cytogenetic damage, while there was no difference in the nuclear division index between both radiation qualities. The results point towards a higher induction of DNA damage after neutron irradiation in HSPCs followed by error-prone DNA repair, which contributes to genomic instability and a higher risk of leukemogenesis.

El desarrollo de enterocolitis necrosante, con la consecuente perforacion intestinal, es frecuente en los recien nacidos pretermino. El tratamiento estandar de la perforacion intestinal es quirurgico. Sin embargo, se sugiere que la insercion de un drenaje en el abdomen puede ser efectivo para tratar esta afeccion. Se resumen los resultados de una revision sistematica Cochrane que compara la efectividad del drenaje peritoneal con la de la laparotomia en neonatos con enterocolitis necrosante perforada. Necrotizing enterocolitis is common in preterm newborns, with consequent intestinal perforation. The standard treatment for intestinal perforation is surgery. However, it is suggested that inserting a drain into the abdomen may be effective in treating this condition. This document summarizes the results of a Cochrane systematic review comparing the effectiveness of peritoneal drainage with laparotomy in neonates with perforated necrotizing enterocolitis.

Currently, there are very few studies in the dairy sheep sector associating milk quality and indicators regarding carbon footprint and their link to grazing levels. For 1 year, monthly milk samples and records related to environmental emissions and management systems were collected through surveys from 17 dairy sheep farms in the region of Castilla y León (Spain), in order to relate this information to the use of natural pastures under free grazing. Indicators were constructed on the collected data and subjected to a multivariate statistical procedure that involved a factor analysis, a cluster analysis and a population canonical analysis. By applying multivariate statistical techniques on milk quality and carbon footprint indicators, it was possible to identify the management system of the farms. From an environmental point of view, farms with a higher grazing level (cluster 4) were more sustainable, as they had the lowest carbon footprint (lower CO2, N2O and CO2 equivalent emissions per sheep and year) and the lowest energy consumption levels, which were gradually lower than those of farms in cluster 3, both indicators were much lower than those of farms in clusters 1 and 2. The milk quality of cluster 1 and 2 farms was significantly lower in terms of total protein and fat content, dry extract, omega-3 fatty acid levels and α-tocopherol content than farms in clusters 3 and 4, which had higher accessibility to grazing resources. In sum, the higher the use of natural resources, the lower the external inputs the farms required and the lower environmental impact and energy costs they have.

A better understanding of the combined impact of different space stressors on human health is urgently warranted, considering the upcoming long-duration missions beyond lower Earth orbit. Therefore, a growing number of particle accelerator facilities implement ground-based set-ups to study the effect of simulated space radiation with simulated psychological or physical stressors. The immune system is highly sensitive to these types of stressors and limited information is currently available on the impact of the complex space radiation environment on the astronauts’ immune function. This pilot study presents a first step in the implementation of a ground-based set-up with neutron irradiation, which is considered to be an important secondary component in space radiation fields. The effect of dose rate on immune alterations was studied using the in vitro cytokine release assay. Whole blood samples (n=8) were exposed to 0.125 or 1Gy of neutron irradiation (fluence-weighted average energy: 29.8 MeV) at a lower dose rate (LDR) of 0.015Gy/min and a higher dose rate (HDR) of 0.400Gy/min. Immediately post-irradiation, blood samples were stimulated with lipopolysaccharide (LPS), heat-killed Listeria monocytogenes (HKLM) or lectin pokeweed mitogen (PWM), and incubated for 24 hours. Cell-mediated immunity was examined by analysing interleukin­-2 (IL­-2), interferon-gamma (IFN­-γ), tumour necrosis factor-alpha (TNF­-α), and interleukin­-10 (IL­-10) plasma levels. Stimulants significantly increased all cytokine levels except IL­-2, where only PWM induced a significant increase. In general, no statically significant changes were observed in IL­-2, IFN­-γ and TNF­-α concentrations at different neutron doses and dose rates when compared to their stimulated, sham-irradiated controls. After PWM-stimulation, IL­-10 levels were significantly increased at 0.125Gy HDR and 1Gy LDR. In a pooled analysis, the HDR significantly increased IL­-2 titres (under PWM-stimulation) and IFN­-γ titres (with all stimulants), but significantly decreased TNF­-α secretion in unstimulated cultures. Due to the limited sample number, no strong conclusions could be made in this pilot study on the effect of neutron radiation as a single stressor on cytokine secretion in response to different stimuli. However, some interesting trends and dose rate effects were observed, which pave the way for future investigations on the synergistic effects of multiple space stressors on immune cell function.

OBJECTIVE To assess the effect of Fetal Endoscopic Tracheal Occlusion (FETO) on neonatal survival in fetuses with left congenital diaphragmatic hernia (CDH) and moderate lung hypoplasia. STUDY DESIGN CDH fetuses with moderate pulmonary hypoplasia (observed/expected lung area to head ratio between 26% and 35%, or between 36% and 45% with liver herniation) were prospectively recruited. Included patients were matched to a control group who were ineligible for FETO. Primary outcomes were survival at 28 days, at discharge, and at 6 months of age, respectively. RESULTS 58 cases were recruited, 29 treated with FETO and 29 matched controls. Median gestational age (GA) at balloon placement and removal were 29.6 and 33.6 weeks, respectively. FETO group showed significantly lower GA at delivery (35.2 vs. 37.1 weeks, respectively, p

Severe coronavirus disease 2019 (COVID-19) is infrequent in children and shows a mortality rate of around 0.08%. This study aims to explore international differences in the pediatric mortality rate.We analyzed several countries with populations over 5 million that report disaggregated data of COVID-19 deaths by quinquennial or decennial age groups. Data were extracted from COVID-19 cases and deaths by age database, National Ministeries of Health, and the World Health Organization.We included 23 countries in the analysis. Pediatric mortality varied from 0 to 12.1 deaths per million children of the corresponding age group, with the highest rate in Peru. In most countries, deaths were more frequent in the 0-4-year-old age group, except for Brazil. The pediatric/general COVID-19 mortality showed a great variation and ranged from 0% (Republic of Korea) to 10.4% (India). Pediatric and pediatric/general COVID mortality correlates strongly with 2018 neonatal mortality (r = 0.77, p0.001; and r = 0.88, p0.001, respectively), while shows a moderate or no correlation (r = 0.47, p = 0.02; and r = 0.19, p = 0.38, respectively) with COVID-19 mortality in the general population.International heterogeneity in pediatric COVID-19 mortality importantly parallels historical neonatal mortality. Neonatal mortality is a well-known index of the quality of a country's health system, which points to the importance of social determinants of health in pediatric COVID-19 mortality disparities. This issue should be further explored.La COVID-19 grave es poco frecuente en la infancia. El objetivo de este estudio fue explorar las diferencias en la tasa de mortalidad internacional por COVID-19 en la población pediátrica.Se analizaron países con poblaciones superiores a 5 millones de habitantes que reporten muertes por COVID-19 con datos desglosados por grupos de edad quinquenales o decenales. Los datos se extrajeron de la base de datos COVerAge-DBs, de los ministerios nacionales de salud y de la Organización Mundial de la Salud.Se incluyeron 23 países. La mortalidad pediátrica varió de 0 a 12.1 muertes por millón de personas del grupo de edad correspondiente, con la tasa más alta en Perú. En la mayoría de los países, las muertes fueron más frecuentes en el grupo de 0 a 4 años, excepto en Brasil. La mortalidad pediátrica/general por COVID-19 mostró una gran variación entre países y osciló entre el 0% (República de Corea) y el 10.4% (India). La mortalidad pediátrica y pediátrica/general por COVID-19 se correlaciona fuertemente con la mortalidad neonatal de 2018, mientras que tiene una moderada o nula correlación con la mortalidad por COVID-19 en la población general.Existe una importante heterogeneidad internacional en la mortalidad pediátrica por COVID-19, que es paralela a la mortalidad neonatal histórica, la cual es un indicador de la calidad de los sistemas de salud y señala la importancia de los determinantes sociales de la salud en las disparidades de mortalidad pediátrica por COVID-19. Este tema debe explorarse a fondo.

BACKGROUND: The new evere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterized by its high capacity to transmit. Health-care personnel is highly susceptible to becoming infected. This study aimed to determine the characteristics and known risk factors for contagion and severe outcomes of SARS-CoV-2 disease in health-care personnel of a pediatric coronavirus disease (COVID) center in Mexico City. METHODS: In the last week of March 2020 (at the beginning of phase 2 of the Ministry of Health's national campaign in Mexico), a study was conducted on healthcare workers of a pediatric COVID hospital in Mexico City. Using a virtual interview, we evaluated comorbidities, mobility, areas and functions where they carry out the activities, protection measures, contact history, and vaccination. According to their activities, healthcare workers were classified into the following areas: medical, nursing, other health-care personnel (researchers, nutritionists, rehabilitation, imaging, and laboratory), administrative, and other services. We compared the variables between the groups of healthcare workers with the X2 test. RESULTS: We included 812 participants. The mean age was 41 ± 11 years, and 33% were overweight or obese, 18% were over 60 years old, and 19% had high blood pressure. Medical and nursing personnel presented a higher proportion in the use of standard protection measures. CONCLUSIONS: Among healthcare workers, there are risk conditions for the development of complications in case of SARS-CoV-2 infection. Most medical and nursing personnel use standard protective measures.

Producción Científica, Integrated Assessment Models provide a framework to study sustainability transitions and their economic impacts. Models seldom consider energy constraints, taking supply availability for granted and thus suggesting a mere change in the energy mix from non-renewables to renewables. In order to address these limitations, a macro-economic module within a broader system dynamics model (MEDEAS) has been developed. The model has been run for the whole world from 1995 to 2050 under three different scenarios: Business as Usual (BAU), considering no further transition policies and keeping current trends; Green Growth (GG), undertaking the low-carbon transition according to the Paris Agreement set of policies and with high GDP growth standards; and Post-Growth (PG), testing the sustainability transition under a GDP non-growth/degrowth approach. The results reveal the conflict between economic growth, climate policy and the sustainability of resources. Whereas a BAU approach would not even be an option to achieve climate goals, a GG view would not only face the downsizing of economic output, but neither would it be able to achieve the 2 °C objective. The success of the PG approach in meeting emissions objectives suggests a redirection from economic growth policies to an industrial policy that incorporates efficiency and redistribution., European project H2020-LCE-2015-2 (691287), Ministerio de Economía, Industria y Competitividad (Project ECO2017-85110-R)

Esophageal atresia (EA) is the most frequent congenital anomaly of the esophagus. According to Gross Classification, type-C esophageal atresia is the most common type. The Atlas of Esophageal Atresia by Kluth describes multiple variations of defects in EA. We present a female baby of 36 weeks’ gestation, with IIIb13 esophageal atresia, an extremely rare subtype of type-C EA. During pre-surgical bronchoscopy, we observed the presence of a double fistula, which was confirmed in the surgery. The first fistula between trachea and esophagus, and the second fistula between right main bronchus and esophagus, both in the distal esophagus. We made an esophageal anastomosis preserving the total length of the distal esophagus. This is the first report in over 20 years, and the third in the literature. The patient had a satisfactory evolution. After five months of follow-up the patient eats by suction only, with adequate weight gain, without suggestion of stenosis or gastroesophageal reflux.

Overview of the pandemic In December 2019, a new virus named SARS-CoV-2 was reported in Wuhan province, China. The first case of COVID-19 in Mexico was confirmed on February 28, 2020, and the World Health Organization declared the pandemic on March 11.