Asthma deaths following ergometrine and syntometrineWilliam FS SellersThe 2017 to 2019 maternal mortality report (MBRRACE-UK) described a death of an asthmatic possibly from air embolism at Caesarean section. What kind of uterine constrictor drug, or if one was used is not described, and because reports are confidential this information is unavailable. Ergometrine was reported to have caused bronchospasm in an asthmatic after delivery by Caesarean section1 and this stimulated a case report from Anaesthetist Professor Selwyn Crawford of a death of an asthmatic patient after receiving ergometrine, although at the time this cause had not been considered.2 To find if ergometrine and syntometrine were involved in any other maternal deaths, the Royal College of Obstetricians and Gynaecology library’s complete collection of triennial reports from 1952 to 2019 was studied. The 1976-1978 Report page 80 describes the death reported by Selwyn Crawford. The 1988-1990 Report has two asthma deaths. Page 71 reports a death of a patient who had concealed her asthma and died following a legal termination at seven weeks gestation from sudden and severe bronchospasm. Whether a uterine constrictor was used is not mentioned. Page 89 describes an asthmatic patient who died after a legal termination at six weeks under general anaesthesia and an injection of 1ml of syntometrine, after which she developed difficulty in breathing and became cyanosed. A tracheal tube was passed but manual ventilation was impossible because of severe bronchospasm. The report goes on to state: “The cause of the acute bronchospasm is not clear.” Ergometrine and syntometrine constrict vascular, uterine, and bronchial smooth muscle and should be avoided in pregnant asthmatics.References.Sellers WFS, Long DR. Bronchospasm following ergometrine, Anaesthesia 1979;34:909 doi/pdf/10.1111/j.1365-2044.1979.tb08556.xCrawford JS. Bronchospasm following ergometrine, Anaesthesia 1980;35:397-8 doi: 10.1111/j.1365-2044.1980.tb05138.x.

Key PointsPrevious studies have linked recurrent or persistent BPPV to age, anxiety or/and depression and medical comorbidityFactors such as the socioeconomical status have not been assessed.In our retrospective powered cohort we showed that there is a positive correlation between recurrent or persistent BPPV and ageWe found no correlation with the presence of underlying anxiety/depression and recurrent or persistent BPPV and age.While one would have expected that the socioeconomical and educational status would have had an impact on recurrent/persistent BPPV, using the Scottish Index of Multiple Deprivation, we did not identify such link.

Urban overheating, driven by global climate change and urban development, is a major contemporary challenge which substantially impacts urban livability and sustainability. Overheating represents a multi-faceted threat to well-being, performance, and health of individuals as well as the energy efficiency and economy of cities, and it is influenced by complex interactions between building, city, and global scale climates. In recent decades, extensive discipline-specific research has characterized urban heat and assessed its implications on human life, including ongoing efforts to bridge neighboring disciplines. The research horizon now encompasses complex problems involving a wide range of disciplines, and therefore comprehensive and integrated assessments are needed that address such interdisciplinarity. Here, the objective is to go beyond a review of existing literature and provide a broad overview and future outlook for integrated assessments of urban overheating, defining holistic pathways for addressing the impacts on human life. We (i) detail the characterization of heat exposure across different scales and in various disciplines, (ii) identify individual sensitivities to urban overheating that increase vulnerability and cause adverse impacts in different populations, (iii) elaborate on adaptive capacities that individuals and cities can adopt, (iv) document the impacts of urban overheating on health and energy, and (v) discuss frontiers of theoretical and applied urban climatology, built environment design, and governance toward reduction of heat exposure and vulnerability at various scales. The most critical challenges in future research and application are identified, targeting both the gaps and the need for greater integration in overheating assessments.

Background: Existing research focuses primarily on common adverse events (AEs) in adults using Vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKI), systematic reports from real-world settings and safety research on off-label use in children are lacking. Therefore, we aimed to investigate the safety profiles of VEGFR-TKIs via the FAERS. Method: Data regarding VEGFR-TKIs were extracted from the FAERS between 2004Q1 to 2022Q2. Reporting odds ratio (ROR) was performed to identify risk signals associations of VEGFR-TKIs with AEs. A reported AE would be defined as a potential risk signal if it simultaneously met the report cases ≥ 3, ROR ≥ 2, the lower limit of 95% CI ≥1, and χ2 ≥ 4. and categorized by the MedDRA terms. Results: A total of 51,841 reports containing 536 children were identified from May 18, 2005, to June 30, 2022. Despite some differences, 7 VEGFR-TKIs had similar safety profiles in the general population. The most significant ROR was PPES and the most frequent SOC was gastrointestinal disorders. In pediatrics, results varied in these agents, and the most frequent AE with significant ROR were PPES, followed by pneumothorax. Furthermore, blood and lymphatic system disorders and investigation abnormalities were both the most common SOCs. Conclusion: Disproportionality analysis based on the FAERS database is an effective path to recognize VEGFR-TKI-related AEs. Findings of the general population were largely consistent with real-world setting studies, and the widely recorded data in FAERS also made it possible to retrieve the safety of these agents in pediatrics.

Wastewater catchment area data are essential for wastewater treatment capacity planning and have recently become critical for operationalising wastewater-based epidemiology (WBE) for COVID-19. Owing to the privatised nature of the water industry in the United Kingdom, the required catchment area datasets are not readily available to researchers. Here, we present a consolidated dataset of 7,537 catchment areas from ten sewerage service providers in the Great Britain, covering more than 96% of the population of England and Wales. We develop a geospatial method for estimating the population resident within each catchment from small area population estimates generated by the Office for National Statistics. The method is more widely applicable to matching electronic health records to wastewater infrastructure. Population estimates are highly predictive of population equivalent treatment loads reported under the European Urban Wastewater Treatment Directive. We highlight challenges associated with using geospatial data for wastewater-based epidemiology.

A new database of the Entomological Inoculation Rate (EIR) is used to directly link the risk of infectious mosquito bites to climate in Sub-Saharan Africa. Applying a statistical mixed model framework to high-quality monthly EIR measurements collected from field campaigns in Sub-Saharan Africa, we analyzed the impact of rainfall and temperature seasonality on EIR seasonality and determined important climate drivers of malaria seasonality across varied climate settings in the region. We observed that seasonal malaria transmission requires a temperature window of 15-40 degrees Celsius and is sustained if average temperature is well above the minimum or below the maximum temperature threshold. Our study also observed that monthly maximum rainfall for seasonal malaria transmission should not exceed 600 mm in west Central Africa, and 400 mm in the Sahel, Guinea Savannah and East Africa. Based on a multi-regression model approach, rainfall and temperature seasonality were significantly associated with malaria seasonality in most parts of Sub-Saharan Africa except in west Central Africa. However, areas characterized by significant elevations such as East Africa, topography has a significant influence on which climate variable is an important determinant of malaria seasonality. Malaria seasonality lags behind rainfall seasonality only at markedly seasonal rainfall areas such as Sahel and East Africa; elsewhere, malaria transmission is year-round. The study’s outcome is important for the improvement and validation of weather-driven dynamical malaria models that directly simulate EIR. It can contribute to the development of malaria models fit-for-purpose to support health decision-making towards malaria control or elimination in Sub-Saharan Africa.

Background: Previous inconsistent evidence on effects of green space on the development of allergic rhinitis could be explained by the season of exposure. We explored whether the season and timing of exposure to green space play a role in the development of allergic rhinitis during the first 27 years of life. Methods: In a longitudinal study of 2568 participants from the Espoo Cohort Study, green space was assessed using the mean Normalized Difference Vegetation Index (NDVI) within 300 m of the participant’s residence during pregnancy and the first two years after birth during spring and summer seasons. We applied Cox proportional hazards regression to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CI) for the associations between cumulative exposure to NDVI (1-unit increase) and allergic rhinitis. Results: Early-life exposure to abundant vegetation during the spring was associated with an increased risk of allergic rhinitis at 12 years of age [aHR (95% CI) = 1.726 (1.078; 2.765)] and 27 years of age [1.703 (1.139; 2.545)]. However, abundant vegetation during the summer was associated with a decreased risk of allergic rhinitis at 12 years of age [0.754 (0.585; 0.972)] and 27 years of age [0.801 (0.649; 0.989)]. Perinatal exposure to green spaces had no effect on allergic rhinitis. Conclusions: Green space has opposite effects on the development of allergic rhinitis in the spring and summer: early-life exposure to green spaces during the spring increases the risk of developing allergic rhinitis, whereas exposure to greenness in the summer decreases this risk.

Mosquitoes are known vectors for disease transmission that cause over one million deaths globally each year. The majority of natural mosquito habitats are areas containing standing water such as ponds, lakes, and marshes. These habitats are challenging to detect using conventional ground-based technology on a macro scale. Contemporary approaches, such as drones, UAVs, and other aerial imaging technology are costly when implemented. Multispectral imaging technology such as Lidar is most accurate on a finer spatial scale whereas the proposed convolutional neural network(CNN) approach can be applied for disease risk mapping and further guide preventative efforts on a more global scale. By assessing the performance of autonomous mosquito habitat detection technology, the transmission of mosquito borne diseases can be prevented in a cost-effective manner. This approach aims to identify the spatiotemporal distribution of mosquito habitats in extensive areas that are difficult to survey using ground-based technology by employing computer vision on satellite imagery. The research presents an evaluation and the results of 3 different CNN models to determine their accuracy of predicting large-scale mosquito habitats. For this approach, a dataset was constructed utilizing Google Earth satellite imagery containing a variety of geographical features in residential neighborhoods as well as cities across the world. Larger land cover variables such as ponds/lakes, inlets, and rivers were utilized to classify mosquito habitats while minute sites such as puddles, footprints, and additional human-produced mosquito habitats were omitted for higher accuracy on a larger scale. Using the dataset, multiple CNN networks were trained and evaluated for accuracy of habitat prediction. Utilizing a CNN-based approach on readily available satellite imagery is cost-effective and scalable, unlike most aerial imaging technology. Testing revealed that YOLOv4 obtained greater accuracy in mosquito habitat detection than YOLOR or YOLOv5 for identifying large-scale mosquito habitats. YOLOv4 is found to be a viable method for global mosquito habitat detection and surveillance.

Machine-learning algorithms are becoming popular techniques to predict ambient air PM2.5 concentrations at high spatial resolutions (1x1 km) using satellite-based aerosol optical depth (AOD). Most machine-learning models have aimed to predict 24h-averaged PM2.5 concentrations (mean PM2.5). Over Mexico, none has been developed to predict subdaily peak levels, such as the maximum daily one-hour concentration (max PM2.5). We present a new modeling approach based on extreme gradient boosting (XGBoost) and inverse-distance weighting that uses AOD data, meteorology, and land-use variables to predict mean and max PM2.5 in Central Mexico (including the Mexico City Metropolitan Area) from 2004 through 2019. Our models for mean and max PM2.5 exhibited good performance, with overall cross-validated mean absolute errors (MAE) of 3.68 and 9.21 μg/m3 , respectively, compared to mean absolute deviations from the median (MAD) of 8.55 and 15.64 μg/m3. We also investigated applications of our mean PM2.5 predictions that can aid local authorities in air-quality management and public-health surveillance, such as the co-occurrence of high PM2.5 and heat, compliance with local air-quality standards, and the relationship of PM2.5 exposure with social marginalization.

Wildfires result in human fatalities not only due to the direct exposure to flames, but also indirectly through smoke inhalation. The Mediterranean basin with its hot and dry summers is a hotspot for such devastating events. The situation has further been aggravated in recent years by climate change as well as a growing and aging population in the region. To assess the health impacts due to short-term exposure to air pollution created by the 2021 summer wildfires in the eastern and central Mediterranean basin, we used a regional-scale chemistry transport model to simulate concentrations of major air pollutants such as fine particulate matter with a diameter less than 2.5 μm (PM2.5), SO2, NO2, and O3 - in a fire and a no-fire scenario. Elevated short-term exposure of the population to air pollutants are associated with excess all-cause mortality using relative risks for individual pollutants from previously published meta-analyses. Our estimates indicate that the short-term exposure to wildfire-caused changes in O3 accounted for 741 (95% CI:556-940) excess deaths in total over the entire region of investigation during the wildfire season between mid-July to early October 2021. This is followed by 270 (95% CI:177-370) excess deaths due to elevated PM2.5 exposure, rendering the health effect of increased O3 from wildfires larger than the effect of increased PM2.5. We show this to be attributed largely to the spatially more widespread impact of wildfires on O3. Our study concludes with a discussion on uncertainties associated with the health impact assessment based on different air pollutants.

OBJECTIVE To assess the relationship between allostatic load in early pregnancy and CVD, 2 to 7 years postpartum, and potential pathways contributing to racial disparities in CVDs. DESIGN Secondary analysis of an observational cohort study. SETTING nuMom2b Heart Health Study. POPULATION Pregnant individuals. METHODS Our primary exposure was dichotomous high allostatic load in the first trimester, defined as four or more out of 12 biomarkers in the “worst” quartile. The primary outcome was new diagnosis of composite CVD, consisting of HTN and or MD (fasting glucose greater than 100 mg/dL or medication for diabetes). Each outcome and allostatic load component was analyzed secondarily. Multivariable logistic regression was used to test the association between high allostatic load and CVD adjusted for potential confounders. Mediation and moderation analyses assessed the role of high allostatic load in racial disparities of CVD. MAIN OUTCOME MEASURE Composite CVD. RESULTS Among 4,022 individuals, CVD was identified in 1,462 (36.4%); 26.6% had HTN, and had 15.4% MD. High allostatic load was present in 33.0%. After adjustment for covariates, high allostatic load was associated with CVD (aOR 2.0, 1.8-2.3), HTN (2.1, 1.8-2.4), and MD (1.7, 1.5-2.1). There was a reduction in the magnitude of the relationship between race and CVD with the addition of allostatic load. Self-reported race did not significantly moderate the relationship between allostatic load and CVD. CONCLUSION High allostatic load is associated with CVD. Allostatic load was a partial mediator between race and CVD. Race did not moderate the relationship between allostatic load and CVD.

Objective To examine the association of placental and fetal DNA copy number variants (CNVs) with fetal structural malformations (FSMs) in stillborn fetuses. Design A secondary analysis of stillbirth cases in the Stillbirth Collaborative Research Network (SCRN) study. Setting Multicenter, 59 hospitals in 5 geographic regions in the USA. Population 384 stillbirth cases of the SCRN study (2006-2008). Methods FSMs were grouped by anatomic system and specific malformation type (e.g., central nervous system, thoracic, cardiac, gastrointestinal, skeletal, umbilical cord and craniofacial defects). Single-nucleotide polymorphism array detected CNVs of at least 500kb. CNVs were classified into two groups: normal, defined as no CNVs>500kb or benign CNVs, and abnormal, defined as pathogenic or variants of unknown clinical significance. Main outcome measures The proportions of abnormal CNVs and normal CNVs were compared between stillbirth cases with and without FSMs using the Wald Chi-squared test. Results The proportion of stillbirth cases with any FSMs was higher among those with abnormal CNVs compared with those with normal CNVs (46.7% vs. 19.6%; p-value<0.001). The most common organ system-specific FSMs associated with abnormal CNVs were cardiac defects, followed by craniofacial and skeletal defects. A pathogenic deletion of 1q21.1 involving 46 genes (e.g., CHD1L) and a duplication of 21q22.13 involving 4 genes (SIM2, CLDN14, CHAF1B, HLCS) were associated with a skeletal and cardiac defect, respectively. Conclusion Specific CNVs involving several genes were associated with FSMs in stillborn fetuses. The findings warrant further investigation and may inform counseling and care surrounding pregnancies affected by FSMs at risk for stillbirth.

Exposure to fine particulate matter (PM2.5) air pollution is associated with large-scale health consequences, but the uncertainties in estimates of PM2.5-related global premature mortality remain understudied. Using four observation-based PM2.5 datasets and six Coupled Model Intercomparison Project Phase 6 (CMIP6) climate models, we compare uncertainties in current PM2.5-related mortality estimates to the impacts of emissions reductions on global health. Although estimates of current mortality are sensitive to the PM2.5 dataset (6.54 to 8.27 million/year using the Global Exposure Mortality Model), the projected near-term and long-term benefits of emissions reductions for reduced mortality are much more certain. Specifically, uncertainties in projected avoided deaths are consistently less than half the magnitude of uncertainties in recent mortality estimates. Under a low-emissions scenario, avoided cumulative deaths would exceed a quarter-billion by 2100.

Objective To investigate the relationship between maternal supplementation with folic acid/ multiple micronutrients containing folic acid (MM-FA) and gestational diabetes mellitus (GDM) risk. Design Prospective cohort study. Setting Haidian Maternal and Child Health Hospital, Beijing, China. Population 3,458 pregnant women and 653 cases of GDM were approached between October 2017 and December 2020. Methods Sociodemographic characteristics, lifestyle data, and information on folic acid supplementation were obtained from a structured questionnaire. GDM was diagnosed according to IADPSG criteria (2010). After adjusting for confounding variables, associations between folic acid/MM-FA supplementation and GDM risk were estimated using binary logistic regression analysis. Main outcome measures Incident GDM. Results Taking MM-FA periconceptionally was associated with a higher GDM risk (aOR 1.33; 95% CI 1.05–1.69) compared to exclusive folic acid supplementation. And this association was observed exclusively in women with a pre-pregnancy BMI < 24kg/m2 (aOR 1.39; 95% CI 1.06–1.82). In separate analysis of pre-conception supplementation, women without folic acid supplementation before conception were more likely to develop GDM than those taking folic acid alone (aOR 1.40; 95% CI 1.01–1.96). Conclusions Maternal MM-FA supplementation may enhance the risk for GDM. These findings indicated that pregnant women should to be mindful of the risk of iron and other micronutrients over-supplementation when using folic acid supplements. It’s recommended that women take pure folic acid in preference and begin taking them from pre-conception in accordance with the recommended guidelines. Key words Folic acid; Multiple micronutrients; Gestational diabetes mellitus; Cohort

Objective To evaluate the epidemiological trends and patterns of cervical cancer, uterine cancer and ovarian cancer in China in 1990 and 2019. Design Systematical and updated worldwide epidemiological study. Setting Global Burden of Disease (GBD) Study 2019. Population or Sample. Chinese population was obtained from World Health Organization (WHO) World Standard Population Distribution (2000-2025) and the United Nations World Population Prospects 2019 Revision. Methods Data were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. GBD methodology was used to estimate the burden of gynecological malignancies in China, including cervical cancer, uterine cancer and ovarian cancer. Main Outcome Measures The incidence, mortality, disability-adjusted life-years (DALYs), and estimated annual percentage change (EAPC) were systematically analyzed. We additionally predicted the incidence and mortality of gynecological malignancies from 2020 to 2030. Results From 1990 to 2019, the numbers of incidence cases, deaths and DALYs of cervical cancer, uterine cancer and ovarian cancer all significantly increased. The EAPCs in age-standardized incidence rate (ASIR) of three cancers were 1.61 (95% CI: 1.35, 1.88), 1.26 (95% CI: 0.58, 1.94) and 1.88 (95% CI: 1.79, 1.98). From 2020 to 2030, the predicted numbers of incident cases and deaths of gynecological malignancies should continue to increase, and the incidences of uterine cancer would expect to exceed cervical cancer in 2030. Conclusions In China, the numbers of new cases and deaths of gynecological malignancies will continue to increase in the next ten years. Reducing the prevalence of gynecological malignancies should be prioritized in future work.

Background: Sub-Saharan African (SSA) countries have high stillbirth rates compared to high-income countries, yet research on risk factors for stillbirth in SSA remain scant. Objectives: To identify the modifiable risk factors of stillbirths in SSA and investigate their strength of association using a systematic review. Search Strategy: EMBASE, MEDLINE, Global Health, and CINAHL Plus databases were searched for literature. Selection Criteria: Observational population- and facility-level studies exploring stillbirth risk factors, published between 2013-2019 were included. Data Collection and Analysis: Narrative synthesis of data was undertaken and the potential risk factors were classified into sub-groups. Main Results: Thirty-seven studies were included, encompassing 20,264 stillbirths. The risk factors were categorized as maternal antepartum (0-4 antenatal care visits, multiple gestations, hypertension, birth interval >3 years, history of perinatal death); socioeconomic factors (maternal lower wealth index and basic education, advanced maternal age, grand multiparity (≥5)); intrapartum (direct obstetric complication, non-vaginal delivery); fetal (low birthweight and gestational age <37weeks) and health systems (poor ANC quality, emergency referrals, ill-equipped facility). The proportion of unexplained stillbirths remained very high. No association was found between stillbirths and HIV, BMI, diabetes, and distance from the facility. Conclusion: The overall quality of evidence was low as many studies were facility-based and did not adjust for confounders. This review identified preventable risk factors for stillbirth. Focused programmatic strategies should be developed to improve antenatal care, emergency obstetric care, maternal perinatal education, referral and outreach systems, and birth attendant training. More population-based high-quality research is needed. Funding: Not externally funded

Background Progressive transformation of germinal centers (PTGC) is a rare diagnosis characterized by asymptomatic lymph node enlargement. It has previously been associated with lymphoma, autoimmune conditions, and lymphoproliferative diseases in small pediatric case series. Procedures We conducted a single-center retrospective review of pediatric cases of PTGC diagnosed at our institution by hematopathologists from 2000 - 2020. Results We identified 57 primary cases and 3 recurrent cases of PTGC. There was a male predominance in cases (32/57), with median age at diagnosis of 11 years. Head and neck lymph nodes were the most commonly involved and biopsied sites. Laboratory and imaging evaluations were obtained inconsistently. Only 16% of patients saw a pediatric hematology/oncology (PHO) specialist prior to diagnosis and 37% had follow-up with PHO after diagnosis. Six patients (10%) had a preceding or concurrent diagnosis of lymphoma and 5% of patients returned with recurrent PTGC. Conclusions Patients with PTGC had similar characteristics to those from previous case series. Fewer patients underwent recurrent lymph node biopsy than previously described. PTGC has been linked to certain types of lymphoma, although never definitively associated with lymphoma. Follow-up with a PHO provider is indicated to ensure that close surveillance is performed.

Introduction: Monoclonal gammopathies are a group of disorders associated with monoclonal proliferation of plasma cells that produces a monoclonal protein. To describe the epidemiological and immunochemical characteristics of monoclonal gammopathies diagnosed during a nineteen-year period in a Moroccan teaching hospital was the main objective of this study. Methods: This study was performed from January 2000 to August 2019. It was a retrospective study that included of 545 Moroccan patients with monoclonal gammopathy. Results: The patients who participated in the study, 374 (68.6%) were male and 171(31.4%) were female, with a mean ±SD age of 62.24±13.14 years. The most frequent reasons for admission were bone pain (41,60%), renal failure (19.08%), alteration of the general condition (12.21%) and anemia (10.69). Plasma cell proliferative disorders in our study were as follow, multiple myeloma (MM) (45.65%), Monoclonal gammopathies of undetermined significance (MGUS) (39.05%), Waldenstrom’s macroglobulinemia(5.58%), Lymphoma (2.27%+1.2%), Chronic Lymphocytic Leukemia (2.48%), Plasma cell leukemia (1.86%), Plasmacytoma (0.62%), POEMS syndrome (0.41%), and Amyloidosis (0.84%). The most frequent isotypes in MM were the IgGκ (62) 36.5%, IgGλ(52)30.6%, IgAκ(27)15.9% and the IgAλ (19)11.2%. It is also worthy of note, that Free light chain MM represents 20% of all cases of MM. Conclusions: This is the largest Moroccan cohort, it included 545 patients. The results of this study point to the need for an early diagnosis of monoclonal gammopathies in the Moroccan population

Objective: SARS-COV-2 pandemic had a profound impact on acute bronchiolitis epidemiology, especially in RSV diffusion and the burden of disease with implications on the management of prophylaxis and health resources. We aimed to compare clinical and epidemiological characteristics of bronchiolitis before and during the SARS-CoV-2 pandemic.   Methods: We conducted an observational study involving children aged 0-2 years with bronchiolitis admitted to a tertiary children’s hospital during the last 5 years. Demographic, clinical, microbiological, and outcome data were collected. Comparison between pre- and post-pandemic period, RSV positive versus non-RSV patients, and SARS-CoV-2 positive vs negative patients were carried out.    Results: A total of 647 patients admitted for bronchiolitis were included (264 female,40.8%, median age 78 days). Molecular diagnostic tests were performed in 617 patients (95.4%) with RSV detected in 62.5% of patients. SARS-CoV-2 was found in 3.9% of hospitalized bronchiolitis (3.9%). We observed a progressive increase in bronchiolitis admissions and a statistically significant increase over the years in the need for respiratory support. Conversely, this was not true for mechanical ventilation, duration of respiratory support, ICU admission, and length of stay. During the pandemic period children with prematurity increased, although only 1 child had an indication for prophylaxis. Discussion: We confirm the stronger impact of bronchiolitis in the 2021-22 season, which is likely explained by the higher prevalence of RSV and the immunity debt theory. However, our findings were conflicting in terms of worsening clinical severity. The increase of children with prematurity and the inter-seasonal spread of RSV highlight the importance of epidemiological surveillance systems that monitor RSV circulation.

The World Health Organisation has set a target for elimination of cervical cancer within the next century and increasing screening uptake is important. An audit of vaginal swabs, a less invasive sample received for HPV testing outwith screening programme showed that the main clinical indications for these requests were inability to take a standard cervical smear sample for cytology or inability to visualise the cervix followed by women's unwillingness or inability to tolerate speculum due to pain or previous trauma. Offering vaginal swabs where there is clinical justification can provide a means of HPV based screening for cervical cancer.

Background: In 2001, Dr. Sardjito Hospital initiated a systematic hospital-based registry, Yogyakarta Pediatric Cancer Registry (YPCR). This study aims to present an epidemiological profile of childhood malignancies diagnosed in Dr. Sardjito General Hospital and compare it with the previous study 1 Methods: Childhood cancer was diagnosed in children aged 0-18 years, from January 2009 to December 2018, and analyzed. Childhood malignancies were categorized based on age, sex, and disease group according to the International Classification of Childhood Cancer (ICCC-3). An estimated annual average incidence rate (AAIR) of childhood cancer was calculated. We visualized the number of patients and their regions of origin by geographic mapping. Result: There were 1,788 new cases registered in YPCR during the study period. Of these, 58% were male, with a male-to-female.4:1.0. The mean age at diagnosis was 6.3 years old, the median age was 5 years and 56% of cancers were diagnosed in the age group of 0-5 years old. The most common diagnosis category was leukemia (ICCC-3 Category I), which accounted for 60% of all childhood malignancies. The three most common diagnoses included: ALL (44%), AML (13%), and retinoblastoma (6%). Of the 1,077 patients diagnosed with leukemia, 58% were males, most often diagnosed at 0-5 years old (53%). There were 679 patients registered with solid tumors mostly diagnosed at 0-5 years old (57%). The AAIR of leukemia and solid tumors was 26.8 and 17.5 per million, respectively. Conclusion: There was an increase in the number of childhood malignancies in 2009-2018 compared to the 2000-2009 study. The number of patients referred to our hospital increased, indicating a better referral system to the pediatric cancer center. This study is expected to provide data on the hospital-based pediatric cancer registry in Indonesia and promote systematic pediatric cancer registries in other centers.

A three way categorisation of the health effects of climate change on health is not uniqueTo the EditorA review article in your journal published in January 2022 describes a three-way categorisation of the health effects of climate change.1 These effects are summarised as “direct (such as heat waves)” and “indirect (such as vector-borne disease incidence)”. In addition, however, this review presents as “unique” a discussion that “expands on these issues to address a third category of potential longer-term impacts on global health: famine, population dislocation, and environmental justice and education.”Although most published literature on the topic of climate change and health categorises effects as “direct” and “indirect”, there is widespread recognition of elements of this third category. Indeed, elements of this category appear in each of three papers that were published about climate change and health in 1989, at the dawn of this literature.2An editorial in The Lancet , published in April that year, while avoiding the word “famine” states that global warming (sic) “may reduce crop production, with potentially devastating effects on world food supplies.” It also warned that “armed conflicts would be more likely as countries compete for a dwindling supply of natural resources”.3 The second paper (published June 1989) does use the word “famine”.4 The final paper published in that year (in December) avoids the word “famine” but warns of “starvation” “especially in poor countries that are already only marginally self-sufficient with respect to food”.5To my knowledge, the first deliberate use of a three-way framework to describe the health effects of climate change was read to the section on occupational medicine, at the Royal Society of Medicine (London), in February 1992.6 An article describing this presentation was published in the following year.6 It uses the word “primary” as a synonym for and in addition to the word “direct”, mainly to describe the impact of heat on health, such as from heatwaves and reduced winter cold. Instead of “indirect” the paper warns of “secondary” effects including changes in the distribution of arboviruses, malaria and respiratory and allergic diseases.However, this paper also devotes approximately one third of its total length to a description of what it calls “tertiary” effects, including impacts on the “availability of food and water”, “refugees”, and on the “probability of conflict and on political and economic systems.” In the same month (December) a second paper was published (with the same lead author), which uses an almost identical three-way framework.7 This paper also mentions famine, refugees and conflict in the “tertiary” category.The terms “primary”, “secondary” and “tertiary”, in the context of climate change and health, were then absent from the literature for over 16 years, although brief hints of elements of the third category occasionally surfaced.2 In 2010 these terms were revived, using conflict as an example of a “tertiary” effect.8 This paper also stated that there “is a high probability that the current trajectory of climate change, resource depletion and ecological loss will undermine our own civilisation.” In response, the authors argued, this “should motivate intense preventive activity.”In 2014, this three-way framework was used as the basis of an edited book, with three chapters in the tertiary section; one on famine, one on population dislocation and the third on conflict.9Mental health effects were conceptualised as “cross cutting” as it was reasoned that psychological distress can arise from the experience or effects of any of the main three effect categories. For example, a person displaced by a super-typhoon, aggravated by warmer sea temperature and a rising sea level, may not starve, may not be displaced, nor be a participant or victim in subsequent conflict; however he or she may still be psychologically traumatised (see figure).Similarly, issues such as social justice and education are more fairly considered as cross-cutting. To imply that these issues only apply to the third category, as the abstract in the review suggests, is to inappropriately restrict the scope of these very important issues.1

Objective: To study the incidence of sinonasal mucormycosis in active and post COVID-19 patients in a district-level hospital in India. Study Design: A prospective, interventional cohort study conducted from April 2021 to January 2022. Setting: A district-level/secondary level hospital in North India. Methods: Inclusion Criteria: All COVID-19 positive patients with diabetes mellitus as co-morbidity and with at least one of the following:received steroid therapy and/or on high flow oxygen therapy and/or had prolonged hospital stay (>7 days). Exclusion Criteria: Patients already immunocompromised/having malignancy/organ transplant recipients. Clinical workup: History, examination, imaging (CECT/MRI nose and paranasal sinuses if indicated), diagnostic nasal endoscopy + Nasal scrapings for KOH mount to detect fungal elements. Results: Fourteen out of 250 patients tested positive for Mucormycosis (incidence 5.6%). Out of these 13 were symptomatic and only one patient was asymptomatic and detected on screening. No significant difference was found in mucormycosis vs. non-mucormycosis group with respect to HbA1c status, vaccination status or steroid + oxygen treatment (p>0.05 in all scenarios). Patients were treated with intravenous Liposomal Amphotericin B and surgical debridement when indicated. Two succumbed to disease (survival 85.7%). A clinical screening protocol was thus developed which can be used as an effective tool even at far-flung and remote healthcare facilities for diagnosis and timely referral of patients. Conclusion: Mucormycosis is a potentially lethal disease which needs rapid diagnosis and timely action to decrease morbidity and mortality.

Objective Tracheostomy is performed for various indications ranging from prolonged ventilation to airway obstruction. Many factors may play a role in the incidence of complications in the immediate post-operative period including patient-related factors. The relationship between obstructive pulmonary diseases and acute post-tracheostomy complications has been incompletely studied. Chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), and asthma are some of the most common pulmonary pathologies in the United States and given the clinical utility of tracheostomies among these patients, it is important to characterize the risk of acute post-operative complications. Design A retrospective chart review identified tracheostomy patients from January 2017 through December 2018 at an academic cancer center. Medical records were reviewed for the technique used, complications, and contributing patient factors. Post-operative complications were defined as any tracheostomy-related adverse event occurring within 14 days. Patient factors examined included demographics, comorbidities, and body mass index (BMI). Results The most common indication for tracheostomy among the 321 patients that met inclusion criteria was airway obstruction or a head and neck cancer surgical procedure. Obstructive pulmonary pathology (COPD, OSA, asthma) was moderately associated with acute complications in bivariate analysis (13.4% complications, p = 0.039). Among the secondary outcomes measured, radiation was associated with early complications occurring in post-operative days 0-6 (1.1%, p = 0.029). Conclusion Obstructive pulmonary patients may have a higher risk of acute post-tracheostomy complications which is clinically significant when considering the utility of ventilation and tracheostomy in the management of acute respiratory failure secondary to these conditions.