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Classic dyskeratosis congenita (DC) is an inherited disease characterized by the triad of abnormal skin pigmentation, nail dystrophy and mucosal leucoplakia ( Zinsser, 1906; Engman, 1926; Cole et al, 1930 ). A variety of non-cutaneous (dental, gastrointestinal, genitourinary, neurological, ophthalmic, pulmonary and skeletal) abnormalities have also been reported ( Sirinavin & Trowbridge, 1975; Drachtman & Alter, 1995; Dokal, 1996a; Knight et al, 1998a ). Bone marrow (BM) failure is the principal cause of early mortality with an additional predisposition to malignancy and fatal pulmonary complications. X-linked recessive, autosomal dominant and autosomal recessive forms of the disease are recognized. Since the annotation ( Dokal, 1996a), there have been significant advances in DC. These have been facilitated by the dyskeratosis congenita registry (DCR), established at the Hammersmith Hospital (London) in 1995. By November 1999, 92 DC families (Argentina, one; Australia, two; Austria, one; Belgium, two; Brazil, eight; Canada, two; Egypt, one; France, 11, Germany, three; Holland, two; Hong Kong, two; India, two; Ireland, five; Italy, four; New Zealand, one; Spain, two; Turkey, three; United Arab Emirates, two; UK, 14; and USA, 24) had been recruited. These 92 families from 20 different countries collectively comprised 148 (127 male and 21 female) patients. As well as confirming previous observations, the DCR has identified new features of DC and has been pivotal in the identification of the DKC1 gene which is mutated in X-linked DC. In 76 out of the 92 families, there were only males affected and these collectively comprised 118 patients. In 25 of these 76 families, there were two or more affected males with lack of male-to-male transmission, consistent with an X-linked recessive pattern of inheritance. In the 51 families with affected sporadic males, it is likely that many of these also represent the X-linked form of the disease, although some may represent autosomal forms of DC. Overall, out of the 148 patients, 127 (86%) were male and this confirms previous reports that the major form of DC is X linked. In 16 families out of the total of 92, there was one or more affected female. In 4 of these 16, the cases were sporadic with a history of parental consanguinity in two; in eight families, there were two affected members in the same generation with a history of parental consanguinity in two; in three families, there were affected cases in two different generations; finally, in one out of the 16 families, the two cases were first maternal cousins. Thus, collectively they are likely to represent different genetic subtypes. Some of these are likely to represent autosomal recessive forms of the disease and others autosomal dominant. These families therefore provide further evidence for autosomal recessive and dominant forms of the disease in addition to those published previously ( Sorrow & Hitch, 1963; Sirinavin & Trowbridge, 1975; Tchou & Kohn, 1982; Ling et al, 1985 ; Juneja et al, 1987 ; Pai et al, 1989a ; Drachtman & Alter, 1992; Joshi et al, 1994 ; Knight et al, 1998a ; Elliott et al, 1999 ). Somatic abnormalities A wide range of somatic abnormalities were seen as listed in Table I. DC may therefore be regarded as an inherited multisystem syndrome. In general, the abnormalities were not neonatal in manifestation, but developed progressively at a variable rate. The mucocutaneous features (skin pigmentation, nail dystrophy and leucoplakia; Fig 1) usually appeared between the ages of 5 and 10 years. The median ages of onset for abnormal skin pigmentation, nail dystrophy and leucoplakia were 8 years (range 0·5–21 years), 6 years (range 1–17 years) and 7 years (range 1–26 years) respectively. There was a wide age range over which these features developed and there were also significant qualitative differences in the skin pigmentation and the nail dystrophy; for example, some patients had a very florid rash involving most of the skin, others only had a localized rash and some patients had minimal nail changes, whereas some developed complete nail loss. In families with two or more affected members, the phenotypes among the different individuals tended to be similar. However, in some instances there was significant variability in the severity of the clinical phenotype in different members of the same family. This suggests that the phenotype may be modified by other genetic and/or environmental factors. Photographs of DC patients showing abnormal skin pigmentation (A, B, C and D), nail dystrophy of finger nails (E) and toe nails (F and G) and leucoplakia of tongue (H). A subset (20·3%) of patients developed pulmonary complications (Table I) with reduced diffusion capacity and/or restrictive defect. It has been possible to study some of these patients at several time points. For example, in one patient (aged 36 years) the diffusion capacity (TLCO) fell from 73% to 59% over a period of 6 months, suggesting that pulmonary abnormalities also progress with age and highlighting the need for regular monitoring. Postmortem studies on two patients who died suddenly from acute respiratory disease showed abnormal levels of pulmonary fibrosis and abnormalities in the pulmonary microvasculature. These histological changes correlate with the abnormalities in fibroblasts ( Scappaticci et al, 1989 ; Dokal et al, 1992 ; Kehrer & Krone, 1992; Kehrer et al, 1992 ) observed in DC skin biopsies and the telangiectatic vessels seen at the skin surface clinically. The development of pulmonary abnormalities highlighted by the DCR and previous reports ( Paul et al, 1992 ; Verra et al, 1992 ) may in part explain the high incidence of early and late fatal pulmonary complications after bone marrow transplantation (BMT) ( Berthou et al, 1991 ; Dokal et al, 1992 ; Langston et al, 1996 ; Yabe et al, 1997 ; Rocha et al, 1998 ). Haematological abnormalities Bone marrow failure resulting in peripheral cytopenias appears to be much more frequent than previously thought. As can be seen from Table II, 85·5% of patients had a peripheral cytopenia of one or more lineages, with 76·3% having a cytopenia of two or more lineages; in 80% of the patients who developed pancytopenia, the age of onset was less than 20 years (median 8 years), with 50% developing pancytopenia below the age of 10 years. Accepting that there may be some bias in the patients referred to the DCR, the actual probability of developing BM failure [one or more peripheral cytopenia(s)] is much higher than previously documented, approaching 94% by the age of 40 years ( Fig 2). This is also reflected in the causes of death (see below). It is noteworthy that one patient (aged 29 years) had approximately 10% myeloid blasts in the BM ( Dokal et al, 1992 ) and three others had hypocellular marrows with features of myelodysplasia (MDS). Thus, like Fanconi's anaemia (FA) ( Auerbach et al, 1998 ), although hypoplasia is the main abnormality seen in the BM there is a predisposition to both MDS and acute myeloid leukaemia in patients with DC. of bone marrow failure in dyskeratosis The 16 families and with affected collectively comprised 21 and male of the had features that were to those seen in families with affected males only (see in two families and the of DC in the members was facilitated by the of the affected male The phenotype in the cases In the in the of the sporadic was on the of the mucocutaneous triad with below the age of 10 years. In the was the of a male developed BM failure at the age of 4 years In both developed BM they had than two nails affected and had skin In the died of BM failure 8 was and had the features seen in the male patients (see In the patient had skin pigmentation and of the but had nail dystrophy at the age of years. In published by Elliott et al, 1999 ), the male patient died from BM failure 8 had skin pigmentation, leucoplakia and nail The of these two were first cousins. In the had skin pigmentation, and hypocellular BM but nail dystrophy; had nail dystrophy as well as the other features in In there were two affected and one affected in one generation and were first cousins. In the affected had skin pigmentation, and were first cousins. was an in which there were two affected with early onset of BM failure with and one of died from years. In the affected members were a and the had skin pigmentation and leucoplakia but nail whereas the (aged years) had skin pigmentation, anaemia and a that had been with These two therefore had disease which appeared to be as an autosomal dominant In there were three affected members in two a and and The died years from respiratory had skin pigmentation, pancytopenia and of the had and was and is to have died from The three members in this had mucocutaneous features and appeared to autosomal dominant of the clinical In there was one affected years and were first cousins. had leucoplakia and BM failure at age years. In there were three affected members in one two and had peripheral the also had significant In the two affected members were first cousins. The was a who at age 4 years with BM developed skin pigmentation, and the age of had nail dystrophy and maternal had anaemia which to and had very It can be seen that the clinical features in these families with cases are very In general, in families in which the appears to be autosomal recessive DCR and the phenotype is more than in those in which it appears to be autosomal dominant and This with previous Sorrow & Hitch, 1963; Ling et al, 1985 ; Juneja et al, 1987 ; Pai et al, 1989a ; Drachtman & Alter, 1992; Joshi et al, 1994 ; Elliott et al, 1999 ; autosomal Tchou & Kohn, 1982; et al, 1985 ) and further evidence for autosomal recessive and dominant forms of DC. from the DCR that of from BM failure or from complications of died from pulmonary complications. In a further fatal pulmonary complications were seen in the of a died from malignancy and died of causes to DC and The of were to and these usually the of the of It is from patients on the DCR and from the previous reports that abnormalities reduced or reduced and/or and reduced or to can in a of patients with or BM Some from may be to than as and have been previously reported ( et al, ; & and this with of abnormalities (see Table was by et developed in out of the 148 patients. These cases of myelodysplasia patients with anaemia and two patients with anaemia with one which developed at age one at one at and one at 29 years. There was also one of years) and eight cases of years), years), years), years), years), skin years) and tongue at and one at the three were in patients of MDS and two cases of and the of developed in the or for BM failure in DC As in Fanconi's the can an in in many patients for a variable period of time ( et al, ; to and have also been reported ( et al, ; et al, 1997 ). The main for anaemia is transplantation and there is some of both and has been in eight of the patients on the registry and some of these have been published previously ( Berthou et al, 1991 ; Dokal et al, 1992 ; et al, ; Knight et al, 1998a ; Rocha et al, 1998 ; et al, 1999 ). are three of had at one at 5 and one at 7 years after and the had an years There are also other reports of the of in patients with DC with some ( et al, 1992 ; Langston et al, 1996 ; Yabe et al, 1997 ; et al, 1999 ). of early and late fatal complications after ( Berthou et al, 1991 ; Dokal et al, 1992 ; Langston et al, 1996 ; Yabe et al, 1997 ; Knight et al, Rocha et al, 1998 ), the of have been less than in The of pulmonary disease in a significant of DC patients (Table I) the high incidence of fatal pulmonary complications in the of It also the need to which are with pulmonary as and to pulmonary is for As BM failure is the main cause of death in DC patients and is the only for the BM failure some to be on patients. the for are patients with pulmonary disease and who have appears to be in patients and may be in patients with DC. There is a need to new and for DC patients with studies ( et al, ; et al, 1985 ; et al, 1992; Dokal et al, 1992 ; et al, 1992 ) have reduced of myeloid and with and there is usually a with The to which the are reduced can from patient to patient and they can be reduced the is The appears to with a in the of and a reduced ( et al, 1999 ; The of abnormalities of and in fibroblasts suggests that the BM failure is likely to be a of abnormalities in both ( et al, 1985 ; et al, 1992 ) and DC has many features in with Fanconi's anaemia in which there is a to as C which is a Some have reported in ( or ( Pai et al, ; et al, ; et al, 1992 ), whereas others ( Sirinavin & Trowbridge, 1975; Drachtman & Alter, with the over the of DC to et a range of on previous reports suggesting to which an of in DC over that seen in This study that there was significant in between DC and with or the of and This study DC patients to be from DC skin fibroblasts are abnormal both in and in rate. they in the of ( Scappaticci et al, 1989 ; Dokal et al, 1992 ; Kehrer & Krone, 1992; Kehrer et al, 1992 ). In peripheral and BM from some patients in the of ( Dokal et al, 1992 ; et al, 1997 ). These studies provide evidence for a that DC to developing like may be regarded as a but with a predisposition to than the and seen in ( Dokal & The of suggests that of with a high as the skin and may This in part for the high of BM failure and the abnormalities seen in these patients. have been in of from X-linked DC families by a in the at to be of DC showed complete in in to be on the of genetic also had ( et al, 1997 ; et al, 1997 ; et al, 1997 ). The of the pattern of X in suggests that the gene have a over those the a for in the of families at of DC. In may to an inherited from a in sporadic male DC as well as autosomal from X-linked forms of the This also suggests that X-linked may have a reduced and it be to they are at a of developing BM failure than has been observed in one X-linked on the DCR ( Knight et al, 1998a ) levels were in 7 out of patients to ( Dokal et al, ; This suggests a predisposition to It is noteworthy that of the patients with had abnormalities of pulmonary diffusion capacity the with levels had diffusion capacity with three out of these patients below the age of 10 years. This may identification of patients who are more likely to pulmonary complications. levels have been to be in patients who developed fatal complications after ( Berthou et al, 1991 ). The for this predisposition to is It to a more in with high or the may be the of some as The (86%) of patients with DC on the DCR are male and provide further evidence that the X-linked recessive form of DC the of in one the DKC1 for X-linked was to ( & et al, ). additional families this and a of the was with with ( et al, ). further the of the DKC1 in the families in the DCR have been in DCR families the DKC1 gene to be more a DKC1 was between and in ( Knight et al, 1996 ). the of genetic and this to be to between and ( Knight et al, ). with from this in the of a in one DC patient and of the gene for X-linked dyskeratosis congenita DKC1 ( et al, 1998 ). The DKC1 gene is of ( et al, 1999 ; Knight et al, ; et al, the DKC1 is The is a of with a of It is in that DKC1 is the of the gene the gene and gene ( et al, ; & et al, 1998 ; et al, 1999 ). studies of the and that is a in and/or in and a also in the and of was identified ( et al, 1997 ; et al, 1998 ). the of to in The and have been to ( et al, 1997 ; et al, 1999 ) and is to be a of the with an ( et al, 1999 ) or with ( et al, 1999 ) or with a have to the The different abnormalities with DC are variable from patient to patient both in severity and age of It is possible to of abnormality as a with there also in the of abnormalities in a The severity of the DC phenotype may be by the age of onset of the BM failure and the of somatic those with onset of BM failure below the age of 10 years in with several somatic abnormalities can be regarded as having the whereas those who abnormalities after the age of 20 years have the It is that those with early onset of BM failure early and not to some of the other complications of the Thus, pulmonary myelodysplasia and malignancy are seen in patients who It be to it is possible to of it is that DKC1 may in phenotypes which with but which have been other disease one has been The is a multisystem characterized by of and anaemia ( et al, ; et al, ; et al, 1994 ; et al, ; et al, 1997 ; et al, 1997 ). The that had been reported only in and the of in these patients the that may be to in was to the DKC1 gene was in two families, one of which was the by et In one a at in 5 to an of at in was in both affected in the other a at in to an of at in was in the affected The of these two in two families with the features of that is a of X-linked DC ( Knight et al, ). It also that in DKC1 can to a much more clinical phenotype than previously hypoplasia and and which have not previously been regarded as an part of the DC The and hypoplasia in families an of in The that is a of X-linked DC suggests that DKC1 may to a very wide clinical of patients. This may not have been previously clinical to in DKC1 that in death fatal of below the age of 10 years not have been as DC or as these patients not to the mucocutaneous features of DC or have the features of This suggests that with clinical phenotypes who have some features of DC or or but who lack the skin and nail changes, be for in the DKC1 on the previous the DCR and the that is a of X-linked it is possible to the in Fig In this dyskeratosis congenita has been X-linked and autosomal it is possible to X-linked and autosomal forms of a with two patients who had the clinical features of have been reported ( et al, 1998 ) and are of other cases of one can that there are likely to be patients who not DC or but clinical features are to in DKC1 or in for autosomal is likely to be some patients. It is noteworthy that in of the DCR families male members have died of the age of 8 years and the of DC was only of the to the mucocutaneous of these families has been published previously ( et al, ) There are also other reports in the in which patients were to have bone marrow and developed features of DC ( et al, ; et al, 1992 ; et al, ). of clinical and genetic between dyskeratosis congenita (DC) and syndrome. The DC phenotype is in autosomal and X-linked The phenotype is in which is also autosomal and X-linked The disease by in the DKC1 gene is by The for additional clinical by in DKC1 which not DC or is in The wide range of abnormalities seen in patients with and DC that has a in many and this is by the of the DKC1 gene ( et al, 1998 ). It is of that the affected (skin and have a high This clinical with the abnormalities of of reduced and the in suggests that the DC gene may have a in having the on with a high The of DKC1 in the and in this gene to the clinical the BM is As highlighted that is a in and/or It is that a have on with a high need to be to this for have identified DKC1 in of the DCR The of ( Fig identified have been ( et al, 1998 ; Knight et al, ; et al, et al, ). DKC1 have been suggesting that may be In and have been to be It different in the same gene can to clinical studies are to the of and different It is noteworthy that the in 5 in one of the families, which can be regarded as the most phenotype ( Knight et al, ), the first DKC1 the ( Fig which on studies on the is to have a in in ( et al, 1998 ; et al, 1998 ; et al, 1999 ). It is that this is with a in the of than the in the DKC1 This is a of the of the DKC1 gene with the and The with is a which has been in different The were in patients with the syndrome. In addition to the two C a G) and a are also of showing the of some possible The is the of which is with and the ( et al, The ( and is a ( & the and the two It is also likely that has other in addition to in It is noteworthy that the has a and that some studies ( Scappaticci et al, 1989 ; Dokal et al, 1992 ; Kehrer & Krone, 1992; Kehrer et al, 1992 ; Dokal & et al, 1997 ) have and in DC This suggests that may have a in of it suggests a possible of may be in with abnormalities in of or of abnormal and/or of at reduced may be for the predisposition to malignancy in DC. a of with This the of as This is by a of the ( et al, 1997 ). In the form a with a of and of which is the ( et al, 1998 ; et al, 1998 ; et al, 1998 ). The and both the and of the and have been to be This therefore be for It also suggests that some of the in DC may from to other In this it is of that the of the ( et al, ). may to a in resulting in a of et have that DC from two families have a of levels of and have than have from 36 DC patients from different families and have that they also have than A in explain some of the clinical features of DC as to a in may the capacity of somatic ( & in the and It also that different DKC1 very different DKC1 have on the of different of which is one some features of the DC as the abnormalities seen in the are to explain on the of reduced is to the of and and in the The skin pigmentation in DC patients can very and the features of disease after ( Ling et al, 1985 ; et al, ). This suggests that although the in DC is a genetic abnormality inherited & may in part be with abnormalities that are observed in some DC patients ( et al, 1998 ; Knight et al, ). of abnormal or abnormal of of may to the of in may the in may explain the and seen in some patients. The resulting may to those of X-linked DC had clinical features a of pigmentation, and and the clinical phenotype in some patients is less ( Knight et al, 1998a ). This the that some of the patients who have been the autosomal forms of DC may out to have in However, to have not DKC1 in cases This the for autosomal DC for DC patients developing ( Dokal, for the subset of patients who have the are very of a high incidence of fatal pulmonary complications. There is therefore a clinical need to new for patients developing As DC is a gene recessive and the that need to be are DC is a for gene there is evidence from studies and from in DC that with the gene have with the an also be from the of in studies in DC there is of the there is a in the of and a reduced of DKC1 of of DKC1 in of DC in form the of developing a of gene for DC patients. The for these studies on advances in and that are in many In on the of the DKC1 and the of a DC may the development of an gene These may also have for the of patients with the first to be identified that is in the of and have a possible for the be in in which is are which with may out to be in the not only of autosomal but also of some of DC is a multisystem with mortality usually to BM for which forms of are The of patients are showing a X-linked recessive pattern of inheritance. The identification of the DKC1 gene and an that early in patients with features as the patients with anaemia or and who are below the age of 10 years be for DC. The over the years is to the of in the and The DKC1 gene also a to the for autosomal and some of anaemia or As have that has a in this may of not only the with DC but also that in other patients with This in to new for patients who be by to and has been over the 5 years. other and at the Hammersmith who have and to the clinical and of the DC also to for in the dyskeratosis congenita registry and to the and for

No AccessWorld Development Report1 Feb 2013World Development Report 1993Investing in Health, Volume1Authors/Editors: World BankWorld Bankhttps://doi.org/10.1596/0-1952-0890-0AboutView ChaptersPDF (6.2 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:This is the sixteenth in the annual series and examines the interplay between human health, health policy and economic development. Because good health increases the economic productivity of individuals and the economic growth rate of countries, investing in health is one means of accelerating development. More important, good health is a goal in itself. During the past forty years life expectancy in the developing world has risen and child mortality has decreased, sometimes dramatically. But progress is only one side of the picture. The toll from childhood and tropical diseases remains high even as new problems - including AIDS and the diseases of aging populations - appear on the scene. And all countries are struggling with the problems of controlling health expenditures and making health care accessible to the broad population. This report examines the controversial questions surrounding health care and health policy. Its findings are based in large part on innovative research, including estimation of the global burden of disease and the cost-effectiveness of interventions. These assessments can help in setting priorities for health spending. The report advocates a threefold approach to health policy for governments in developing countries and in the formerly socialist countries. First, to foster an economic environment that will enable households to improve their own health. Policies for economic growth that ensure income gains for the poor are essential. So, too, is expanded investment in schooling, particulary for girls. Second, redirect government spending away from specialized care and toward such low-cost and highly effective activities such as immunization, programs to combat micronutrient deficiencies, and control and treatment of infectious diseases. By adopting the packages of public health measures and essential clinical care dsecribed in the report, developing countries could reduce their burden of disease by 25 percent. Third, encourage greater diversity and competition in the provision of health services by decentralizing government services, promoting competitive procurement practices, fostering greater involvement by nongovernmental and other private organizations, and regulating insurance markets. These reforms could translate into longer, healthier, and more productive lives for people around the world, and especially for the more than 1 billion poor. 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Cyberpsychology, Behavior, and Social NetworkingVol. 23, No. 7 EditorialConnecting Through Technology During the Coronavirus Disease 2019 Pandemic: Avoiding “Zoom Fatigue”Brenda K. WiederholdBrenda K. WiederholdBrenda K. Wiederhold, Editor-in-Chief Search for more papers by this authorPublished Online:10 Jul 2020https://doi.org/10.1089/cyber.2020.29188.bkwAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail View article"Connecting Through Technology During the Coronavirus Disease 2019 Pandemic: Avoiding “Zoom Fatigue”." 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Ryan Wagner, and Jack Tsai11 July 2022 | Cyberpsychology, Behavior, and Social Networking, Vol. 25, No. 7The Influence of E-Scaffolding Sources in a Mobile Learning Environment on Students’ Design Skills and the Technology Fatigue Associated with a 3D Virtual Environment11 July 2022 | Electronics, Vol. 11, No. 14INVESTIGATION OF PARENTS’ VIEWS ON THE DISTANCE EDUCATION PROCESS DURING THE PANDEMIC22 June 2022 | Journal of Advanced Education Studies, Vol. 4, No. 1DATA COLLECTION BY ONLINE IN-DEPTH INTERVIEW IN QUALITATIVE RESEARCH: A POSTGRADUATE THESIS EXAMPLE14 June 2022 | Pamukkale University Journal of Social Sciences InstituteTwelve tips to enhance student engagement in synchronous online teaching and learning20 April 2021 | Medical Teacher, Vol. 44, No. 6Current and future influences of COVID-19 on the knowledge management function of conventions and exhibitions15 March 2022 | Service Business, Vol. 16, No. 2Robust Institutional Support and Collaboration Between Summer Training Programs in Cancer and Biomedicine Drive the Pivot to a Virtual Format in Response to the COVID January 2022 | Journal of Cancer Education, Vol. 37, No. of a Social Virtual Reality into the Vol. 29, No. Work Meetings During the COVID-19 Pandemic: The and May 2021 | Group Research, Vol. No. of in in the for New in for Use by May 2022 | Journal of Cognitive and Vol. 16, No. Online during COVID-19 Is Scientific February 2022 | Vol. 13, No. the Is and to It and K. 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and Psychology of the Pandemic November Through the October 2021 | Education, Vol. No. Practice During COVID-19 to and of November 2021 | Vol. 36, No. as the of Exploring and Perspectives of of Telehealth by a Australian Service during COVID-19 October 2021 | International Journal of Environmental Research and Public Health, Vol. 18, No. with The of technology and consumer July 2021 | International Journal of Consumer Studies, Vol. 45, No. of June 2021 | Annals of Surgery, Vol. No. and of Virtual in Video and Effects on of the ACM on Human-Computer Interaction, Vol. 5, No. How a Virtual Network during the COVID-19 of the ACM on Human-Computer Interaction, Vol. 5, No. May 2021 | American Journal of Clinical Vol. No. to and Education in the of December 2021 | Journal of Education, Vol. No. between social communication and during the early of September 2021 | Journal of Social and Vol. No. September 2021 | Vol. 11, No. Bir September 2021 | Vol. 5, No. of During the COVID-19 Pandemic by the of Medical of A Survey September 2021 | Frontiers in Medicine, Vol. student under remote learning using digital A June 2021 | Education and Information Vol. No. of the COVID-19 Pandemic on Higher Education: the

No AccessWorld Bank Annual Report1 Feb 2013The World Bank Annual Report 2009Year in ReviewAuthors/Editors: World BankWorld Bankhttps://doi.org/10.1596/978-0-8213-7946-2SectionsAboutPDF (10.7 MB)Other FormatsePUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:The World Bank Annual Report 2009, Year in Review, explores the impact of the global financial and economic crisis in developing countries, and fast-track funding and programs that can help member countries withstand the debacle. In addition, new and ongoing programs and projects in health, climate change, infrastructure, and several other areas are highlighted. A new feature this year is personal-impact stories for each region, relaying the positive effects of World Bank assistance on individuals. 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April 2014References23 January 2015A Critical Reflection on Irish Industrial Policy: A Strategic Choice ApproachInternational Journal of the Economics of Business, Vol.22, No.119 January 2015Piketty and Friends: Capitalism, Inequality, Development, TerritorialismThe AAG Review of Books, Vol.3, No.13 February 2015Internal Migration Data Around the World: Assessing Contemporary PracticePopulation, Space and Place, Vol.21, No.112 March 2014A Paradigm Shift in Urban Water Management: An Imperative to Achieve SustainabilityBuilding the Globalizing City With or Without Slums?—Exploring the Contrast Between City Models in São Paulo and Beijing13 February 2015Regional Development Policies in the Philippines: From Diffusion to IntegrationIntegrating Climate Change in City Planning: Framework and Case StudiesDecomposing regional patenting rates: how the composition factor confounds the rate factorRegional Studies, Regional Science, Vol.2, No.113 November 2015Space-neutral and place-based 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No AccessHealth, Nutrition, and Population1 Feb 2013Better Health Systems for India's PoorFindings, Analysis, and OptionsAuthors/Editors: David H. Peters, Abdo S. Yazbeck, Rashmi R. Sharma, G. N. V. Ramana, Lant H. Pritchett, Adam WagstaffDavid H. Peters, Abdo S. Yazbeck, Rashmi R. Sharma, G. N. V. Ramana, Lant H. Pritchett, Adam Wagstaffhttps://doi.org/10.1596/0-8213-5029-3SectionsAboutPDF (1.3 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:This report focuses on four areas of the health system in which reforms, and innovations would make the most difference to the future of the Indian health system: oversight, public health service delivery, ambulatory curative care, and inpatient care (together with health insurance). Part 1 of the report contains four chapters that discuss current conditions, and policy options. Part 2 presents the theory, and evidence to support the policy choices. The general reader may be most interested in the overview chapter, and in the highlights found at the beginning of each of the chapters in part 2. These highlights outline the empirical findings, and the main policy challenges discussed in the chapter. The report does not set out to prescribe detailed answers for India ' s future health system. It does however, have a goal: to support informed debate, and consensus building, and to help shape a health system that continually strives to be more effective, equitable, efficient, and accountable to the Indian people, and particularly to the poor. Previous bookNext book FiguresreferencesRecommendeddetailsCited byWomen's Perceived Barriers to Accessing Post-Abortion Care Services in Selected Districts in KwaZulu Natal Province, South Africa: A Qualitative StudyAnnals of Global Health, Vol.88, No.1Breast reconstruction following mastectomy in Indian women: a neglected entityBMJ Case Reports, Vol.15, No.721 July 2022Bibliometric analysis of scientific publications on health care insurance in India from 2000 to 2021International Journal of Healthcare Management, Vol.3011 June 2022Decrease of glycated hemoglobin based on evaluation of diabetes intervention programs in low-and middle-income countries: A systematic reviewDiabetes Epidemiology and Management, Vol.6Persistent Inequalities in Health-Contextualising the Neglect of Ambedkar's Contribution18 August 2022Measuring Income Elasticity of Healthcare-Seeking Behavior in India: A Conditional Quantile Regression ApproachJournal of Quantitative Economics, Vol.19, No.430 July 2021"Demand Side" Health Insurance in India: The Price of ObfuscationMedical Anthropology, Vol.40, No.528 May 2021Going Granular: Equity of Health Financing at the District and Facility Level in IndiaHealth Systems & Reform, Vol.7, No.217 August 2021Out-of-Pocket Payments for Delivery Care in India: Do Households face Hardship Financing?Journal of Health Management, Vol.23, No.215 June 2021Utilization of health care services in public and private healthcare in India: Causes and determinantsInternational Journal of Healthcare Management, Vol.14, No.211 October 2019Facilities are substantially more influential than care providers in the quality of delivery care received: a variance decomposition and clustering analysis in Kenya, Malawi and IndiaBMJ Global Health, Vol.5, No.819 August 2020Does Credit Utilization Pattern Promote Poverty Alleviation? 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No AccessJournal of Urology1 Apr 1967Distal Tunnel Ureteral Reimplantation James F. Glenn and E. Everett Anderson James F. GlennJames F. Glenn More articles by this author and E. Everett AndersonE. Everett Anderson More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)63089-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1967 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited by Nishi M, Eura R, Hayashi C, Gohbara A and Yamazaki Y (2023) Vesicoscopic ureteral reimplantation with a modified Glenn-Anderson technique for vesicoureteral refluxJournal of Pediatric Urology, 10.1016/j.jpurol.2023.02.018, Online publication date: 1-Feb-2023. 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Ellsworth P and Merguerian P (1995) Detrusorrhaphy for the repair of vesicoureteral reflux: Comparison with the Leadbetter-Politano ureteroneocystostomyJournal of Pediatric Surgery, 10.1016/0022-3468(95)90141-8, VOL. 30, NO. 4, (600-603), Online publication date: 1-Apr-1995. THOMSON A, DABHOIWALA N, VERBEEK F and LAMERS W (1994) The functional anatomy of the ureterovesical junctionBritish Journal of Urology, 10.1111/j.1464-410X.1994.tb07520.x, VOL. 73, NO. 3, (284-291), Online publication date: 1-Mar-1994. Ortenberg J and Winters J (1994) Vesicoureteral Ruflux Radiology of the Lower Urinary Tract, 10.1007/978-3-642-84431-7_7, (149-165), . Brandell R and Brock J (1993) Ureteral reimplantation: Postoperative management without cathetersUrology, 10.1016/0090-4295(93)90539-M, VOL. 42, NO. 6, (705-707), Online publication date: 1-Dec-1993. Gerber G and Schoenberg H (2018) Female Urinary Tract FistulasJournal of Urology, VOL. 149, NO. 2, (229-236), Online publication date: 1-Feb-1993.Houle A, McLorie G, Heritz D, McKenna P, Churchill B and Khoury A (2018) Extravesical Nondismembered Ureteroplasty with Detrusorrhaphy: A Renewed Technique to Correct Vesicoureteral Reflux in ChildrenJournal of Urology, VOL. 148, NO. 2 Part 2, (704-707), Online publication date: 1-Aug-1992.Wacksman J, Gilbert A and Sheldon C (2018) Results of the Renewed Extra Vesical Reimplant for Surgical Correction of Vesicoureteral RefluxJournal of Urology, VOL. 148, NO. 2 Part 1, (359-361), Online publication date: 1-Aug-1992. Tanagho E (1992) Vesikoureteraler Reflux Smiths Urologie, 10.1007/978-3-642-76107-2_12, (207-224), . Castejón R, Gamallo C and Jaureguizar E (1992) Histomorphometric study of experimental extramucosal ureteroureterostomyMicrosurgery, 10.1002/micr.1920130103, VOL. 13, NO. 1, (2-6), . Burbige K (2018) Ureteral Reimplantation: A Comparison of Results with the Cross-Trigonal and Politano-Leadbetter Techniques in 120 PatientsJournal of Urology, VOL. 146, NO. 5, (1352-1353), Online publication date: 1-Nov-1991. Fornarola V, Voce S, Montanari F, Arnone S and Dragoni E (2018) Plastica Antireflusso Secondo Gil-Vernet: Esperienza Personale E Variante TecnicaUrologia Journal, 10.1177/039156039105800532, VOL. 58, NO. 5, (612-616), Online publication date: 1-Oct-1991. De Gennaro M, Appetito C, Lais A, Talamo M, Capozza N and Caione P (2018) Effectiveness of Trigonoplasty to Treat Primary Vesicoureteral RefluxJournal of Urology, VOL. 146, NO. 2 Part 2, (636-638), Online publication date: 1-Aug-1991.Guthman D, Malek R, Neves R and Svensson J (2018) Vesicoureteral Reflux in the Adult. V. Unilateral DiseaseJournal of Urology, VOL. 146, NO. 1, (21-23), Online publication date: 1-Jul-1991. STEFANOVlČ K, BUKUROV N and MARINKOVlČ J (1991) Non-antireflux versus Antireflux Ureteroneocystostomy in AdultsBritish Journal of Urology, 10.1111/j.1464-410X.1991.tb15131.x, VOL. 67, NO. 3, (263-266), Online publication date: 1-Mar-1991. Kliment J, Fetisov I and Svitač J (1990) Surgical management of vesicoureteral reflux by modified Gil-Vernet methodInternational Urology and Nephrology, 10.1007/BF02549741, VOL. 22, NO. 6, (531-535), Online publication date: 1-Nov-1990. Brown S (2018) Open Versus Endoscopic Surgery in the Treatment of Vesicoureteral RefluxJournal of Urology, VOL. 142, NO. 2 Part 2, (499-500), Online publication date: 1-Aug-1989. McMullin N (1988) URINARY TRACT RECONSTRUCTION IN CHILDRENANZ Journal of Surgery, 10.1111/j.1445-2197.1988.tb07572.x, VOL. 58, NO. 8, (619-629), Online publication date: 1-Aug-1988. 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Glenn J and Anderson E (2018) Technical Considerations in Distal Tunnel Ureteral ReimplantationJournal of Urology, VOL. 119, NO. 2, (194-198), Online publication date: 1-Feb-1978. JONES P (1977) Ureteric Advancement in the Treatment of RefluxBritish Journal of Urology, 10.1111/j.1464-410X.1977.tb04543.x, VOL. 49, NO. 7, (629-632), Online publication date: 1-Dec-1977. Hampel N, Richter-Levin D and Gersh I (2018) Extra Vesical Repair of Primary Vesicoureteral Reflux in ChildrenJournal of Urology, VOL. 117, NO. 3, (355-357), Online publication date: 1-Mar-1977. Kontturi M and Koskela E (2010) Active Surgical Management of Primary Vesicoureteral Reflux in AdultsScandinavian Journal of Urology and Nephrology, 10.3109/00365597709179958, VOL. 11, NO. 3, (239-244), Online publication date: 1-Jan-1977. 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Breastfeeding MedicineVol. 15, No. 5 CorrespondenceFree AccessManaging COVID-19-Positive Maternal–Infant Dyads: An Italian ExperienceGuglielmo Salvatori, Domenico Umberto De Rose, Carlo Concato, Dario Alario, Nicole Olivini, Andrea Dotta, and Andrea CampanaGuglielmo SalvatoriNeonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this author, Domenico Umberto De RoseAddress correspondence to: Domenico Umberto De Rose, MD, Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS "Bambino Gesù" Children's Hospital, Piazza S. Onofrio 4, Rome 00165, Italy E-mail Address: [email protected]Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this author, Carlo ConcatoVirology Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this author, Dario AlarioPediatrics Unit, "San Paolo" Hospital, Civitavecchia (Rome), Italy.Search for more papers by this author, Nicole OliviniDepartment of Pediatrics, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this author, Andrea DottaNeonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this author, and Andrea CampanaDepartment of Pediatrics, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this authorPublished Online:8 May 2020https://doi.org/10.1089/bfm.2020.0095AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail Dear Editor:We report our experience in Italy during COVID-19 viral outbreak. At time of writing, on April 13, 2020, the number of confirmed cases was 1,699,595 worldwide, with 106,138 deaths, resulting in a crude fatality rate of 6.2%.1Although children seem to have a milder disease than adults, newborns and infants could be more at risk than other pediatric categories; thus, they deserve special attention because of insidious and nonspecific symptoms.2Although there is currently no evidence showing a vertical transmission of SARS-CoV-2 infection in fetuses of women developing COVID-19 pneumonia in late pregnancy,3 a major concern involves the possible transmission of the infection to their fragile infants, in particular after delivery. The virus can be detected by real-time polymerase chain reaction (RT-PCR) in different biological fluids (bronchoalveolar-lavage fluid, sputum, saliva, nasopharyngeal swabs, and feces) but no positive breast milk samples have been found in different reported cohorts for a total number of 32 dyads.2Therefore, for COVID-19-positive new mothers, whenever possible, it is advisable to plan a joint management of the mother with her infant, to promote the beginning of breastfeeding, while assessing on a case-by-case basis if eventual drugs administered to infected mothers could be harmful to the infant. According to the indications of the Italian Society of Neonatology,4 if a mother previously identified as COVID-19 positive is asymptomatic or paucisymptomatic, rooming-in is a reasonable management and direct breastfeeding is prudent, ensuring strict measures of infection control (washing often mother's hands before touching the infant and wearing a face mask). In most cases, a hospital stay of ∼1 week is preferred.Herein we describe our experience in our children's hospital, which is a referral care center in Rome (Italy) for ill out born neonates, who are transferred from other institutions. We report the first two maternal–infant dyads presenting to our emergency department because of a positive nasopharyngeal swab for SARS-CoV-2 both in the mother and in the child; clinical characteristics are summarized in Table 1. They were probably infected by a third person at the same time. Neither the mothers nor the infants needed intensive care unit admission; therefore, newborns were prudently isolated from their paucisymptomatic mothers.Table 1. Clinical Features of Newborns with Postnatal Confirmed SARS-CoV-2 Infection and Their Mothers Mother 1/newborn 1Mother 2/newborn 2Maternal age, years3626Maternal symptomsAnosmia and dysgeusiaBack and thoracic painMaternal ICU admissionNoNoMaternal nasopharyngeal swabPositivePositivePositive breast milk samplesNoNoExclusive breast milkYesYesFeeding: breastfeeding or feeding bottleBreastfeedingBreastfeedingNeonatal nasopharyngeal swab on admissionPositivePositiveGestational age, weeks41 + 239Birth weight, g4,4403,120Neonatal genderMaleFemaleNeonatal age on admission, days1810Neonatal weight on admission, g5,2003,200Neonatal symptoms and complicationsNoCoughDiarrheaPoor feedingNeonatal body temperature on admission36°C36.7°CNeonatal SatO2 on admission99%100%Neonatal oxygen supportNoNoNeonatal ICU admissionNoNoNeonatal recoveryAsymptomatic patientNo more diarrhea and need of intravenous fluids on day 5ICU, intensive care unit.We analyzed expressed breast milk samples of both mothers, and SARS-CoV-2 was not detected by RT-PCR, as already described.2 Virus detection analysis after pasteurization was not performed because the virus was not found already in expressed milk.To the best of our knowledge, these are the first data on postnatal horizontal COVID-19 infection in newborns and breast milk analysis in Italy. We confirm that SARS-CoV-2 seems to spare breast milk and horizontal transmission from mother to neonate could occur through respiratory droplets rather than through milk. Therefore, when SARS-CoV-2 is identified both in the mother and in the child, there are no reason to stop breastfeeding and separate them. Whenever direct breastfeeding is not possible, the use of expressed mother's milk should be considered and promoted to take advantage of its unquestionable benefits.In conclusion, we agree that medical staff and nurses should not only focus on care of COVID-19 mothers and infants, but also protect, promote, and support breastfeeding. Breastfeeding creates a unique relationship between mother and child, thus reducing the length of hospital stay and the negative effects linked to quarantine and stress because of this pandemic viral outbreak.Authors' ContributionsAll authors participated in the conception and design of the study, acquisition and interpretation of data, and drafting the article. All authors read and approved the final version.Ethical StatementThe authors declare that they have followed the protocols of their work center on the publication of patients' data and Helsinki Declaration: no patient is recognizable with data appearing in this article. An informed consensus was obtained before enrolling patients, records were anonymized and deidentified before analysis, and all data were fully anonymized before any access by the authors.Disclosure StatementNo competing financial interests exist.Funding InformationNo funding was received for this article.References1. World Health Organization. WHO: Novel Coronavirus (COVID-19) Situation Reports. https://who.sprinklr.com/ (accessed on April 13, 2020). Google Scholar2. De Rose DU, Piersigilli F, Ronchetti MP, et al. Novel coronavirus disease (COVID-19) in newborns and infants: what we know so far. Ital J Pediatr 2020 (in press). Google Scholar3. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020;395:809–815. Crossref, Medline, Google Scholar4. Davanzo R, Moro G, Sandri F, et al. Breastfeeding and coronavirus disease-2019. Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Matern Child Nutr 2020:e13010. 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Systematic ReviewArchives of Medical Research, Vol. 53, No. 3The course of new coronavirus infection in newborn infantsRussian Pediatric Journal, Vol. 25, No. 1Revisión de nuevas evidencias acerca de la posible transmisión vertical de la COVID-19Gaceta Sanitaria, Vol. 36, No. 2Safety of breast/chest-feeding by those infected by SARS-CoV-228 December 2021 | Current Opinion in Clinical Nutrition & Metabolic Care, Vol. 25, No. 2Italian neonatologists and SARS-CoV-2: lessons learned to face coming new waves7 April 2021 | Pediatric Research, Vol. 91, No. 3Maternal Transmission of SARS-CoV-2: Safety of Breastfeeding in Infants Born to Infected Mothers9 December 2021 | Frontiers in Pediatrics, Vol. 9Study of perinatal transmission of SARS-CoV-2 in a Mexican public hospitalInternational Journal of Infectious Diseases, Vol. 113COVID-19 during pregnancy should we really worry from vertical transmission or rather from fetal hypoxia and placental insufficiency? A systematic review12 April 2021 | Egyptian Pediatric Association Gazette, Vol. 69, No. 1Breastfeeding Experiences During the COVID-19 Lockdown in the United Kingdom: An Exploratory Study Into Maternal Opinions and Emotional States9 September 2021 | Journal of Human Lactation, Vol. 37, No. 4The Benefits of Breastfeeding Still Outweigh the Risks of COVID-19 Transmission8 September 2021 | Frontiers in Medicine, Vol. 8COVID-19: Relationship and Impact on Breastfeeding—A Systematic Review26 August 2021 | Nutrients, Vol. 13, No. 9Clinical Features and Outcome of SARS-CoV-2 Infection in Neonates: A Systematic Review28 August 2020 | Journal of Tropical Pediatrics, Vol. 67, No. 3ISIDOG Consensus Guidelines on COVID-19 Vaccination for Women before, during and after Pregnancy29 June 2021 | Journal of Clinical Medicine, Vol. 10, No. 13Reshaping neonatal intensive care units (NICUs) to avoid the spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) to high-risk infants24 June 2020 | Infection Control & Hospital Epidemiology, Vol. 42, No. 5Coronavirus infection in neonates: a systematic review17 September 2020 | Archives of Disease in Childhood - Fetal and Neonatal Edition, Vol. 106, No. 3Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis16 February 2021 | Archives of Disease in Childhood, Vol. 106, No. 5A Case Study Supporting Lack of SARS-CoV-2 Spread to a 3-Month Old Infant Through Exclusive Breastfeeding13 February 2021 | Journal of Human Lactation, Vol. 37, No. 2Neonatal SARS-CoV-2 Infection: Practical Tips17 May 2021 | Pathogens, Vol. 10, No. 5Clinical implications of coronavirus disease 2019 in neonatesClinical and Experimental Pediatrics, Vol. 64, No. 4Breastfeeding and COVID-19: From Nutrition to Immunity7 April 2021 | Frontiers in Immunology, Vol. 12Perinatal COVID-19: review of current evidence and practical approach towards prevention and management12 November 2020 | European Journal of Pediatrics, Vol. 180, No. 4Should COVID-19 Mother Breastfeed her Newborn Child? A Literature Review on the Safety of Breastfeeding for Pregnant Women with COVID-194 January 2021 | Current Nutrition Reports, Vol. 10, No. 1Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerationsJornal de Pediatria, Vol. 97, No. 2COVID-19 in pregnancy and the puerperium: A review for emergency physiciansThe American Journal of Emergency Medicine, Vol. 40Universal Screening for SARS-CoV-2 of all Human Milk Bank Samples22 September 2020 | Journal of Human Lactation, Vol. 37, No. 1Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Positive Newborns of COVID-19 Mothers After Dyad-Care: A Case SeriesCureusMaternal and perinatal outcomes in pregnant women infected by SARS-CoV-2: A meta-analysisEuropean Journal of Obstetrics & Gynecology and Reproductive Biology, Vol. 256Risk transmission through breastfeeding and antibody in COVID-19 motherGaceta Sanitaria, Vol. 35Community-Onset Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Young Infants: A Systematic ReviewThe Journal of Pediatrics, Vol. 228Transmission of SARS‐CoV‐2 through breast milk and breastfeeding: a living systematic review28 August 2020 | Annals of the New York Academy of Sciences, Vol. 1484, No. 1Synthesis and systematic review of reported neonatal SARS-CoV-2 infections15 October 2020 | Nature Communications, Vol. 11, No. 1Breastfeeding mothers with COVID-19 infection: a case series8 August 2020 | International Breastfeeding Journal, Vol. 15, No. 1Coronavirus global pandemic: An overview of current findings among pediatric patients7 October 2020 | Pediatric Pulmonology, Vol. 55, No. 12Maternal, Perinatal and Neonatal Outcomes With COVID-19: A Multicenter Study of 242 Pregnancies and Their 248 Infant Newborns During Their First Month of Life11 September 2020 | Pediatric Infectious Disease Journal, Vol. 39, No. 12Impact of Maternal Severe Acute Respiratory Syndrome Coronavirus 2 Detection on Breastfeeding Due to Infant Separation at BirthThe Journal of Pediatrics, Vol. 226A study of breastfeeding practices, SARS-CoV-2 and its antibodies in the breast milk of mothers confirmed with COVID-19The Lancet Regional Health - Western Pacific, Vol. 4Breastfeeding in COVID-19: A Pragmatic Approach8 September 2020 | American Journal of Perinatology, Vol. 37, No. 13Implications of the COVID-19 Pandemic Response for Breastfeeding, Maternal Caregiving Capacity and Infant Mental Health6 August 2020 | Journal of Human Lactation, Vol. 36, No. 4Lack of viral transmission to preterm newborn from a COVID‐19 positive breastfeeding mother at 11 days postpartum2 June 2020 | Journal of Medical Virology, Vol. 92, No. 11The clinical course of SARS-CoV-2 positive neonates6 July 2020 | Journal of Perinatology, Vol. 40, No. 10Covid-19 and breastfeeding: what's the risk?13 July 2020 | Journal of Perinatology, Vol. 40, No. 10SARS‐CoV‐2 and human milk: What is the evidence?30 May 2020 | Maternal & Child Nutrition, Vol. 16, No. 4Covid-19 in pregnant women and babies: What pediatricians need to knowPaediatric Respiratory Reviews, Vol. 35Vertical Transmission of SARS-CoV-2 (COVID-19): Are Hypotheses More than Evidences?5 August 2020 | American Journal of Perinatology, Vol. 37, No. S 02Management and Nutrition of Neonates during the COVID-19 Pandemic: A Review of the Existing Guidelines and Recommendations8 September 2020 | American Journal of Perinatology, Vol. 37, No. S 02Negative Transmission of SARS-CoV-2 to Hand-Expressed Colostrum from SARS-CoV-2–Positive Mothers Miguel Ángel Marín Gabriel, Ana María Malalana Martínez, María Eugenia Marín Martínez, and Jorge Anel Pedroche6 August 2020 | Breastfeeding Medicine, Vol. 15, No. 8Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic24 June 2020 | BMJ Global Health, Vol. 5, No. 6Coronavirus disease-2019 (COVID-19) infection in a 3-month-old infant: Clinical features, treatment and probable route of transmissionIDCases, Vol. 22 Volume 15Issue 5May 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Guglielmo Salvatori, Domenico Umberto De Rose, Carlo Concato, Dario Alario, Nicole Olivini, Andrea Dotta, and Andrea Campana.Managing COVID-19-Positive Maternal–Infant Dyads: An Italian Experience.Breastfeeding Medicine.May 2020.347-348.http://doi.org/10.1089/bfm.2020.0095Published in Volume: 15 Issue 5: May 8, 2020Online Ahead of Print:April 21, 2020 TopicsCOVID-19 PDF download

HomeCirculationVol. 142, No. 1Obesity Is a Risk Factor for Severe COVID-19 Infection Free AccessArticle CommentaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessArticle CommentaryPDF/EPUBObesity Is a Risk Factor for Severe COVID-19 InfectionMultiple Potential Mechanisms Naveed Sattar, Iain B. McInnes and John J.V. McMurray Naveed SattarNaveed Sattar Naveed Sattar, MD, Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, United Kingdom. Email E-mail Address: [email protected] https://orcid.org/0000-0002-1604-2593 Institute of Cardiovascular and Medical Sciences (N.S., J.J.V.M.), University of Glasgow, United Kingdom. , Iain B. McInnesIain B. McInnes Institute of Infection, Immunity and Inflammation (I.B.M.), University of Glasgow, United Kingdom. and John J.V. McMurrayJohn J.V. McMurray Institute of Cardiovascular and Medical Sciences (N.S., J.J.V.M.), University of Glasgow, United Kingdom. Originally published22 Apr 2020https://doi.org/10.1161/CIRCULATIONAHA.120.047659Circulation. 2020;142:4–6Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: April 22, 2020: Ahead of Print The coronavirus disease 2019 (COVID-19) pandemic has led to worldwide research efforts to identify people at greatest risk of developing critical illness and dying. Initial data pointed toward older individuals being particularly vulnerable, as well as those with diabetes mellitus or cardiovascular (including hypertension), respiratory, or kidney disease. These problems are often concentrated in certain racial groups (eg, African Americans and Asians), which also appear to be more prone to worse COVID-19 outcomes.1 Increasing numbers of reports have linked obesity to more severe COVID-19 illness and death.1–3 In a French study, the risk for invasive mechanical ventilation in patients with COVID-19 infection admitted to the intensive treatment unit was more than 7-fold higher for those with body mass index (BMI) >35 compared with BMI <25 kg/m2.2 Among individuals with COVID-19 who were <60 years of age in New York City, those with a BMI between 30 to 34 kg/m2 and >35 kg/m2 were 1.8 times and 3.6 times more likely to be admitted to critical care, respectively, than individuals with a BMI <30 kg/m2.3We suggest obesity or excess ectopic fat deposition may be a unifying risk factor for severe COVID-19 infection, reducing protective cardiorespiratory reserve as well as potentiating the immune dysregulation that appears, at least in part, to mediate the progression to critical illness and organ failure in a proportion of patients with COVID-19 (Figure). Whether obesity is an independent risk factor for susceptibility to infection requires further research.Download figureDownload PowerPointFigure. Pathways potentially linking obesity or excess ectopic fat to more severe coronavirus disease 2019 (COVID-19) illness. There are multiple pathways by which obesity (or excess ectopic fat) may increase the effect of COVID-19 infection. These include underlying impairments in cardiovascular, respiratory, metabolic, and thrombotic pathways in relation to obesity, all of which reduce reserve and ability to cope with COVID-19 infection and the secondary immune reaction to it. At the same time, there are several reasons why obese individuals may have amplified or dysregulated immune response, linked both to greater viral exposure, as well as the possibility that excess adipose tissue potentiates the immune response. BP indicates blood pressure; COVID-19, coronavirus disease 2019; CV, cardiovascular; FEV1, forced expiratory volume; FVC, forced vital capacity; and SES, socioeconomic status.From a cardiovascular perspective, trial and genetic evidence conclusively show that obesity (and excess fat mass) are causally related to hypertension, diabetes mellitus, coronary heart disease, stroke, atrial fibrillation, renal disease, and heart failure. Obesity potentiates multiple cardiovascular risk factors, the premature development of cardiovascular disease, and adverse cardiorenal outcomes. There is also a metabolic concern. In individuals with diabetes mellitus, or at high risk of diabetes mellitus, obesity and excess ectopic fat lead to impairment of insulin resistance and reduced β-cell function. Both the latter limit ability to evoke an appropriate metabolic response on immunologic challenge, leading some patients with diabetes mellitus to require substantial amounts of insulin during severe infections. Overall, the integrated regulation of metabolism required for the complex cellular interactions, and for effective host defense, is lost, leading to functional immunologic deficit. COVID-19 may also directly disrupt pancreatic β-cell function through an interaction with angiotensin-converting enzyme 2. Furthermore, obesity enhances thrombosis, which is relevant given the association between severe COVID-19 and prothrombotic disseminated intravascular coagulation and high rates of venous thromboembolism.Beyond cardiometabolic and thrombotic consequences, obesity has detrimental effects on lung function, diminishing forced expiratory volume and forced vital capacity (Figure). Higher relative fat mass is also linked to such adverse changes, perhaps relevant to emerging reports of greater critical illness from COVID-19 in certain ethnicities, eg, Asians.1 Asians often display lower cardiorespiratory fitness and carry proportionally more fat tissue at lower BMIs. With extreme obesity (eg, BMI >40 kg/m2), care for individuals admitted to intensive therapy units is often impeded as these patients are more difficult to image, ventilate, nurse, and rehabilitate.With respect to the immune response, there is a clear association between obesity and basal inflammatory status characterized by higher circulating interleukin 6 and C-reactive protein levels. Adipose tissue in obesity is "proinflammatory," with increased expression of cytokines and particularly adipokines. There is also dysregulated tissue leukocyte expression, and inflammatory macrophage (and innate lymphoid) subsets replace tissue regulatory (M2) phenotypic cells. Obesity per se is an independent and causal risk factor for the development of immune-mediated disease, eg, psoriasis,4 suggesting that such adipose state may have systemic immune consequence on additional environmental provocation. In terms of host defense, obesity impairs adaptive immune responses to influenza virus5 and conceivably could do so in COVID-19. Obese individuals may exhibit greater viral shedding, suggesting potential for great viral exposure, especially if several family members are overweight. This may be aggravated in overcrowded multigenerational households, which are more common in the socioeconomically deprived communities in which obesity is prevalent. All these observations point toward a potential for obesity to give rise to a more adverse virus versus host immune response relationship in COVID-19. Poorer nutritional status and hyperglycemia may further aggravate the situation in some obese individuals.Much of the focus of COVID-19 has been on older people. However, it is important to remember that weight and muscle mass start to decline at advanced age but relative fat mass increases, particularly in those with comorbid diseases such as cardiovascular and respiratory conditions. Older age is also associated with more hypertension and diabetes mellitus because of stiffer vessels and impaired metabolic efficiency, respectively. People who are older (eg, >70 years of age), similar to younger obese individuals, have less cardiorespiratory reserve to cope with COVID-19 infection. Immune senescence is well recognized, as is the concept of inflammaging, and both may influence virus–host dynamics in the elderly and infection outcomes.What are the implications of these emerging observations for future research and public health messaging? With respect to research, predictive instruments for those most at risk of severe outcomes should consider BMI. Mechanistic understanding of the relationship between obesity and COVID-19 may suggest therapeutic interventions (eg, proven weight loss drugs, low-calorie diets) to potentially reduce the risk of developing severe COVID-19 illness. With respect to public health, it is important to communicate risks without causing anxiety. People worldwide should be encouraged to improve their lifestyle to lessen risk both in the current and subsequent waves of COVID-19. In addition to increasing activity levels, there should be improved messaging on better diet, focusing on simpler advice to help people adopt sustainable changes. This is particularly challenging with current stay-at-home rules limiting activity levels—the lockdown cost of weight gain. Even more worrying is that the resultant economic downturn may worsen obesity, especially in the most vulnerable individuals, a risk that governments need to address after the current pandemic. Indeed, this pandemic has highlighted that more—not less—must be done to tackle and prevent obesity in societies for the prevention of chronic disease and greater adverse reactions to viral pandemics.AcknowledgmentsThe authors thank Liz Coyle from the University of Glasgow for her excellent technical assistance in the preparation of this article.Sources of FundingThe work in this study is supported by the British Heart Foundation Center of Research Excellence Grant RE/18/6/34217.DisclosuresDr Sattar reports personal fees from Amgen, AstraZeneca, Eli Lilly, Novo Nordisk, Pfizer, and Sanofi and personal fees and research grants from Boehringer Ingelheim outside the submitted work. Drs McInnes and McMurray report no conflicts.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.https://www.ahajournals.org/journal/circNaveed Sattar, MD, Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, United Kingdom. Email naveed.sattar@glasgow.ac.ukReferences1. Petrilli CM, Jones SA, Yang J, Rajagopalan H, O'Donnell LF, Chernyak Y, Tobin K, Cerfolio RJ, Francois F, Horwitz LI. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study.BMJ2020; 369:m1966. doi: 10.1136/bmj.m1966CrossrefMedlineGoogle Scholar2. Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, Labreuche J, Mathieu D, Pattou F, Jourdain M, Lille Intensive Care COVID-19 and Obesity Study Group. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation [published online April 9, 2020].Obesity (Silver Spring). doi: 10.1002/oby.22831. https://onlinelibrary.wiley.com/doi/10.1002/oby.22831Google Scholar3. Lighter J, Phillips M, Hochman S, Sterling S, Johnson D, Francois F, Stachel A. Obesity in patients younger than 60 years is a risk factor for COVID-19 hospital admission [published online April 9, 2020].Clin Infect Dis. 2020. doi:10.1093/cid/ciaa415. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa415/5818333CrossrefGoogle Scholar4. Budu-Aggrey A, Brumpton B, Tyrrell J, Watkins S, Modalsli EH, Celis-Morales C, Ferguson LD, Vie GÅ, Palmer T, Fritsche LG, et al. Evidence of a causal relationship between body mass index and psoriasis: a mendelian randomization study.PLoS Med. 2019; 16:e1002739. doi: 10.1371/journal.pmed.1002739CrossrefMedlineGoogle Scholar5. Green WD, Beck MA. Obesity impairs the adaptive immune response to influenza virus.Ann Am Thorac Soc. 2017; 14(suppl 5):S406–S409. doi: 10.1513/AnnalsATS.201706-447AWCrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. 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Ramos T and Adhikary D (2024) Genome Designing for Nutritional Quality in Amaranthus Compendium of Crop Genome Designing for Nutraceuticals, 10.1007/978-981-19-3627-2_56-2, (1-33), . Aktiz Bıçak E and Oğlak S (2023) Clinical characterisation and management outcome of obstetric patients following intensive care unit admission for COVID-19 pneumonia, Journal of Obstetrics and Gynaecology, 10.1080/01443615.2023.2218915, 43:2, Online publication date: 8-Dec-2023. Nganabashaka J, Niyibizi J, Umwali G, Rulisa S, M. Bavuma C, Byiringiro J, Ntawuyirushintege S, Niyomugabo P, Izerimana L, Tumusiime D and Keetile M (2023) The effects of COVID-19 mitigation measures on physical activity (PA) participation among adults in Rwanda: An online cross-sectional survey, PLOS ONE, 10.1371/journal.pone.0293231, 18:11, (e0293231) Moll-Bernardes R, Ferreira J, Sousa A, Tortelly M, Pimentel A, Figueiredo A, Schaustz E, Secco J, Sales A, Terzi F, Xavier de Brito A, Sarmento R, Noya-Rabelo M, Fortier S, Matos e Silva F, Vera N, Conde L, Cabral-Castro M, Albuquerque D, Rosado de-Castro P, Camargo G, Pinheiro M, Souza O, Bozza F, Luiz R and Medei E (2023) Impact of the immune profiles of hypertensive patients with and without obesity on COVID-19 severity, International Journal of Obesity, 10.1038/s41366-023-01407-0 Onyango T, Zhou F, Bredholt G, Brokstad K, Lartey S, Mohn K, Özgümüs T, Kittang B, Linchausen D, Shafiani S, Elyanow R, Blomberg B, Langeland N and Cox R (2023) SARS-CoV-2 specific immune responses in overweight and obese COVID-19 patients, Frontiers in Immunology, 10.3389/fimmu.2023.1287388, 14 Chenchula S, Sharma S, Tripathi M, Chavan M, Misra A and Rangari G (2023) Prevalence of overweight and obesity and their effect on COVID‐19 severity and hospitalization among younger than 50 years versus older than 50 years population: A systematic review and meta‐analysis, Obesity Reviews, 10.1111/obr.13616, 24:11, Online publication date: 1-Nov-2023. Boutari C, Kokkorakis M, Stefanakis K, Valenzuela-Vallejo L, Axarloglou E, Volčanšek Š, Chakhtoura M and Mantzoros C (2023) Recent research advances in metabolism, clinical and experimental, Metabolism, 10.1016/j.metabol.2023.155722, (155722), Online publication date: 1-Nov-2023. 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The Journal of Bone and Joint Surgery. British volumeVol. 70-B, No. 2 ArticlesFree AccessLaminectomy versus laminoplasty for cervical myelopathy: brief reportS Hukuda, M Ogata, T Mochizuki, K ShichikawaS HukudaSearch for more papers by this author, M OgataSearch for more papers by this author, T MochizukiSearch for more papers by this author, K ShichikawaSearch for more papers by this authorPublished Online:1 Mar 1988https://doi.org/10.1302/0301-620X.70B2.3346317AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byOutcomes after Cervical Duraplasty for Monomelic Amyotrophy (Hirayama Disease): Results of a Case–Control Study of 60 Patients22 September 2021 | Journal of Neurosciences in Rural Practice, Vol. 12, No. 04Surgical treatment and outcomes of intramedullary tumors by minimally invasive approachJournal of Clinical Neuroscience, Vol. 86Vertebral plate and ligament composite laminoplasty in spinal 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for the treatment of spondylotic cervical myelopathy: short-term follow-up23 August 2016 | European Spine Journal, Vol. 26, No. 1Prognostic Factors in Cervical Spondylotic MyelopathyNeurosurgery Quarterly, Vol. 25, No. 1Cervical Laminoplasty: The History and the FutureNeurologia medico-chirurgica, Vol. 55, No. 7Novel Surgical Approach in the Management of Longitudinal Pathologies Within the Spinal Canal: The Split Laminotomy and “Archbone” Technique: Alternative to Multilevel Laminectomy or Laminotomy11 November 2013Box-Shape Cervical Expansive Laminoplasty: Clinical and Radiological OutcomesKorean Journal of Spine, Vol. 11, No. 3Effectiveness of the Microsurgical Cervical Laminectomy for the Patients with Cervical Spondylosis : Investigation of Postoperative InstabilityJapanese Journal of Neurosurgery, Vol. 23, No. 10Laminoplasty versus laminectomy for multi-level cervical spondylotic myelopathy: a systematic review of the literature1 December 2013 | Journal of Orthopaedic Surgery and Research, Vol. 8, No. 1Ultrasonic BoneScalpel for Osteoplastic Laminoplasty in the Resection of Intradural Spinal PathologyOperative Neurosurgery, Vol. 73A less-invasive cervical laminoplasty for spondylotic myelopathy that preserves the semispinalis cervicis muscles and nuchal ligamentJournal of Neurosurgery: Spine, Vol. 18, No. 6Symmetrically Medial Bony Gutters for Open-door LaminoplastyJournal of Spinal Disorders & Techniques, Vol. 26, No. 3A Prospective, Randomized Trial Comparing Expansile Cervical Laminoplasty and Cervical Laminectomy and Fusion for Multilevel Cervical Myelopathy2 August 2011 | Neurosurgery, Vol. 70, No. 2Cervical Expansive Laminoplasty with 90° Box-Shape Double Door MethodKorean Journal of Spine, Vol. 9, No. 3Cervical Spondylosis–Spinal StenosisThe Biomechanical Effect of Transverse Connectors Use in a Pre- and Postlaminectomy Model of the Posterior Cervical SpineSpine, Vol. 36, No. 26Complications associated with the treatment for spinal 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Following Cervical Laminoplasty: A Computer-Simulated Comparison Between Single and Double-Door TechniquesSpine, Vol. 31, No. 24Double-Door Laminoplasty Using Autologous Spinous Process for the Management of Cervical MyelopathyThe Kurume Medical Journal, Vol. 53, No. 1/2Laminoplastia expansiva: uma alternativa no tratamento da mielopatia espondilótica cervicalArquivos de Neuro-Psiquiatria, Vol. 63, No. 4Is Posterior Spinal Cord Shifting by Extensive Posterior Decompression Clinically Significant for Multisegmental Cervical Spondylotic Myelopathy?Spine, Vol. 30, No. 21Technical Improvements and Results of Open-door Expansive Laminoplasty with Hydroxyapatite Implants for Cervical MyelopathyOperative Neurosurgery, Vol. 57, No. suppl_4En bloc laminoplasty without dissection of paraspinal musclesJournal of Neurosurgery: Spine, Vol. 3, No. 1Postoperative Spinal DeformitiesManagement of Ossification of Posterior Longitudinal LigamentA Critical Review of Cervical LaminoplastyNeurosurgery Quarterly, Vol. 14, No. 1Results of Skip Laminectomy—Minimum 2-Year Follow-up Study Compared With Open-Door LaminoplastySpine, Vol. 28, No. 24The role of laminaplasty in treating cervical myelopathyOperative Techniques in Orthopaedics, Vol. 13, No. 3Laminectomy and Posterior Cervical Plating for Multilevel Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament: Effects on Cervical Alignment, Spinal Cord Compression, and Neurological OutcomeNeurosurgery, Vol. 52, No. 5Laminectomy and Posterior Cervical Plating for Multilevel Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament: Effects on Cervical Alignment, Spinal Cord Compression, and Neurological OutcomeNeurosurgery, Vol. 52, No. 5Cervical laminoplasty: a critical reviewJournal of Neurosurgery: Spine, Vol. 98, No. 3Biomechanical Evaluation of Cervical Double-Door Laminoplasty Using Hydroxyapatite SpacerSpine, Vol. 28, No. 3The Biomechanical Effects of Multilevel Posterior Foraminotomy and Foraminotomy with Double-Door LaminoplastyJournal of Spinal Disorders & Techniques, Vol. 15, No. 6Skip laminectomy—a new treatment for cervical spondylotic myelopathy, preserving bilateral muscular attachments to the spinous processesThe Spine Journal, Vol. 2, No. 2Laminoplasty with Preservation of Posterior Cervical Elements: Surgical TechniqueNeurosurgery, Vol. 50, No. 1Bilateral open-door cervical expansive laminoplasty with hydroxyapatite spacers and titanium screwsJournal of Neurosurgery: Spine, Vol. 96, No. 1A new technique for exposure of the cervical spine laminaeJournal of Neurosurgery: Spine, Vol. 96, No. 1Laminoplasty with Preservation of Posterior Cervical Elements: Surgical TechniqueNeurosurgery, Vol. 50, No. 1Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathyJournal of Neurosurgery: Spine, Vol. 93, No. 2Microsurgical Posterior Approaches to the Cervical SpineClinicoradiologic Study of Cervical Laminoplasty With Posterolateral Fusion or Bone GraftSpine, Vol. 25, No. 2Evaluation of Cervical Laminectomy and LaminoplastySpine, Vol. 24, No. 13Modified open-door laminoplasty for treatment of neurological deficits in younger patients with congenital spinal stenosis: analysis of clinical and radiographic dataJournal of Neurosurgery: Spine, Vol. 90, No. 2New method for measuring area of spinal canal after double-door laminoplastyJournal of Orthopaedic Science, Vol. 4, No. 2Cervical Spondylotic MyelopathyClinical Orthopaedics and Related Research, Vol. 359Spinal Deformity and Instability After Multilevel Cervical Laminectomy for Spondylotic MyelopathySpine, Vol. 23, No. 4Vascularized Pedicled LaminoplastySurgical Neurology, Vol. 48, No. 5Ossification of the Posterior Longitudinal Ligament in EvolutionPosterior Cervical Laminaplasty for Myeloradiculopathy: North American ExperienceLong-term follow-up review of suspension laminotomy for cervical compression myelopathyJournal of Neurosurgery, Vol. 85, No. 5A Novel Technique for Laminoplasty Augmentation of Spinal Canal Area Using Titanium Miniplate StabilizationSpine, Vol. 21, No. 4Lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy: A magnetic resonance imaging studyJournal of Neurology, Vol. 243, No. 9Cervical laminoplasty for cervical myeloradiculopathyOperative Techniques in Orthopaedics, Vol. 6, No. 1Laminoplasty With Foraminotomy for Coexisting Cervical Myelopathy and Unilateral RadiculopathySpine, Vol. 21, No. 2T-laminoplasty ? a surgical approach for cervical spondylotic myelopathyActa Neurochirurgica, Vol. 132, No. 1-3Evaluation and Management of Cervical Spondylotic MyelopathyThe Journal of Bone & Joint Surgery, Vol. 76, No. 9Cervical spondylotic myelopathy.The Journal of Bone & Joint Surgery, Vol. 75, No. 1Microsurgical Posterior Approaches to the Cervical Spine Vol. 70-B, No. 2 Metrics History Published online 1 March 1988 Published in print 1 March 1988 InformationCopyright © 1988, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

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