Effects of Air Pollutants on Mortality of Chronic Kidney Disease Patients with Green Spaces Exposure: A Large Observational Study

With increasing air pollution, the association between green space exposure and health outcomes is a global health concern. The relationship between air pollution and the survival of patients with chronic kidney disease (CKD) who are exposed to residential greenness is yet to be elucidated. This study aimed to determine this relationship in Seoul between 2002 and 2015. A time-varying survival analysis was conducted to investigate the association between long-term exposure to air pollutants and mortality in 29,602 patients with CKD living in residential environments with small and large green infrastructure. The low and high index groups were defined using continuous and percentile thresholds of the satellite data—the derived average Normalized Difference Vegetation Index within 250 m and 1,250 m of residence, respectively. During the observation, 3,863 (14%) deaths occurred. The effect of air pollution exposure on mortality was worse in the low index group than in the high index group. Particularly, exposure to SO2 was associated with increased mortality risk, regardless of the greenness threshold. Consistent results were observed in co-pollutant models. High greenery exposure significantly reduced the risk of air pollution related mortality. Our results emphasize the need for creating environmental infrastructures that include green spaces.

Urticarial eruption in COVID-19-positive children: A report of two cases

Recent literature has reported a variety of dermatological manifestations in children and adults associated with COVID-19. Herein, we report urticarial eruptions in two COVID-19-positive children. In the first case, urticaria with angioedema preceded a febrile episode and only partially responded to conventional doses of antihistamines. In the second case, urticaria followed the appearance of fever and upper respiratory symptoms. Both cases recovered completely within two weeks of diagnosis. These cases demonstrate that urticaria and angioedema, precedent or following a febrile illness, with or without respiratory symptoms, may be a presenting symptom of COVID-19 infection in children. A high index of suspicion in such cases helps the early administration of treatment and isolation of the patients to limit the spread of the virus.

Extrapulmonary tuberculosis: risk factors

Objective. To identify the main demographic and clinical risk factors for the development of extrapulmonary tuberculosis (EPTB).Materials and methods. A retrospective study of tuberculosis cases registered from 2016 to 2020 in the Gomel region was conducted (330 patients with EPTB and 2,505 patients with pulmonary tuberculosis). The odds ratios were calculated to assess the risk factors for the development of EPTB.Results. The prevalence of EPTB was studied over the course of five years. The most significant risk factors for the development of tuberculosis in extrapulmonary localizations have been identified.Conclusion. The risk factors for the development of EPTB are age (EPTB often develops in children and older persons), females, and in those who have had an episode of tuberculosis previously. Awareness of the predisposing factors may help physicians maintain a high index of suspicion regarding the development of EPTB.

Neonatal chikungunya encephalitis

Chikungunya is a tropical viral disease and can present in the new born with perinatal transmission. Presentation usually mimics sepsis and high index of suspicion is needed for diagnosis specially at times of outbreak. Characteristic skin rash and perioral blotchy hyperpigmentation can point to diagnosis along with laboratory confirmation with RTPCR.