Background
Hemophagocytic lymphohistiocytosis (HLH) is an exaggerated inflammatory reaction secondary to a host’s inadequate immune response causing a self-perpetuating loop of altered regulation. Signs and symptoms of HLH are compatible with other common diseases and are nonspecific. Underdiagnosis makes it difficult to estimate the real incidence of HLH, especially in developing countries.
Methods
Retrospective, descriptive study of pediatric patients admitted to a high-complexity institution in Cali, Colombia between 2012 and 2019 with HLH diagnosis. Medical history review to complete an electronic database and a secondary, descriptive analysis was carried out. The study was approved by the Institutional Ethics Committee.
Results
Twenty-one patients were included. 52.4 % of the population was male with a median age of 9.3 years [IQR (3.0-13.7 years)]. More than half of patients (66.6 %) had viral disease at diagnosis, the most frequent being Epstein-Barr Virus (EBV) (52.3 %) and dengue (14.3 %). Three patients had confirmed gene mutations (G6PC3, XIAP, and UNC13D). 95 % of the patients were treated with the HLH 2004 protocol, half of them received incomplete protocol with intravenous immunoglobulin (IVIG) and/or systemic steroids, while the other half received the complete protocol including etoposide and cyclosporine. More than three-fourths (76.2 %) required admission to an ICU with a median stay of 14 days [IQR (11–37 days)] and a median hospital stay of 30 days [IQR (18–93 days)]. 14.3 % (n = 3) of patients died.
Conclusions
HLH is a complex disease that requires multidisciplinary management with secondary HLH due to EBV infection being a common cause. There is increasing awareness of HLH diagnosis in developing countries such as Colombia which can offer earlier treatment options and better outcomes.
In a previous article, growth and survival of Argentine and Peruvian Prosopis were measured in a greenhouse hydroponic system in which the salinities were increased from 10 to 45 dS m À1 . Twenty-one of the Prosopis alba seedlings that grew at the 45 dS m À1 salinity were propagated by rooting cuttings and a seed orchard= long-term evaluation trial established. To develop predictors and=or correlations between seedling and performance in mature field trials, this study characterized the seedlings for growth, leaf, and thorn morphology and ease in asexual propagation by rooting of cuttings. The percentage rooting of all clones varied from 40 to 100%, the roots per cutting from 0.60 to 67, and the length of the longest root from 1.63 to 6.70 cm. The parent trees were selected from P. alba specimens in a highly saline area of Argentina where P. ruscifolia Griseb (which has larger leaves and 15 cm long spines) was the dominant species. Some progeny were intermediate in spine and morphological characters between P. alba and P. ruscifolia and were locally known as vinalillo (P. vinalillo Stuck). The thorn length varied from 7.7 mm to 53.3 mm for the vinalillo ''species'' and from 0 thorns to 28 mm for P. alba. There was no correlation between leaf=thorn characters and salinity tolerance. The overwhelmingly greater abundance of spiny P. ruscifolia over P. alba may be due to livestock palatability rather than salinity tolerance. The increasing demand for the high-quality Prosopis lumber for furniture may make recuperation of moderately saline soils (<30 dS m À1 ) economically attractive.
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