Background Seasonal influenza virus is a common cause of acute lower respiratory infection (ALRI) in young children. In 2008, we estimated that 20 million influenza-virus-associated ALRI and 1 million influenza-virus-associated severe ALRI occurred in children under 5 years globally. Despite this substantial burden, only a few low-income and middleincome countries have adopted routine influenza vaccination policies for children and, where present, these have achieved only low or unknown levels of vaccine uptake. Moreover, the influenza burden might have changed due to the emergence and circulation of influenza A/H1N1pdm09. We aimed to incorporate new data to update estimates of the global number of cases, hospital admissions, and mortality from influenza-virus-associated respiratory infections in children under 5 years in 2018.Methods We estimated the regional and global burden of influenza-associated respiratory infections in children under 5 years from a systematic review of 100 studies published between Jan 1, 1995, and Dec 31, 2018, and a further 57 high-quality unpublished studies. We adapted the Newcastle-Ottawa Scale to assess the risk of bias. We estimated incidence and hospitalisation rates of influenza-virus-associated respiratory infections by severity, case ascertainment, region, and age. We estimated in-hospital deaths from influenza virus ALRI by combining hospital admissions and in-hospital case-fatality ratios of influenza virus ALRI. We estimated the upper bound of influenza virus-associated ALRI deaths based on the number of in-hospital deaths, US paediatric influenza-associated death data, and populationbased childhood all-cause pneumonia mortality data in six sites in low-income and lower-middle-income countries.Findings In 2018, among children under 5 years globally, there were an estimated 109•5 million influenza virus episodes (uncertainty range [UR] 63•1-190•6), 10•1 million influenza-virus-associated ALRI cases (6•8-15•1); 870 000 influenza-virus-associated ALRI hospital admissions (543 000-1 415 000), 15 300 in-hospital deaths (5800-43 800), and up to 34 800 (13 200-97 200) overall influenza-virus-associated ALRI deaths. Influenza virus accounted for 7% of ALRI cases, 5% of ALRI hospital admissions, and 4% of ALRI deaths in children under 5 years. About 23% of the hospital admissions and 36% of the in-hospital deaths were in infants under 6 months. About 82% of the in-hospital deaths occurred in low-income and lower-middle-income countries.Interpretation A large proportion of the influenza-associated burden occurs among young infants and in low-income and lower middle-income countries. Our findings provide new and important evidence for maternal and paediatric influenza immunisation, and should inform future immunisation policy particularly in low-income and middleincome countries.Funding WHO; Bill & Melinda Gates Foundation.

Background:The current COVID-19 pandemic has put all health units in crisis. The easy transmissibility facilitated the fast spread to all countries, and Guatemala was not the exception. By May 2020 almost 229 thousand cases were reported, with 3.2% of case fatality. Among the principal mortality risks factors there are: advance age, diabetes mellitus, cardiovascular disease, etc. Due to the systemic injury associated with moderate to severe SARS-CoV2, the clinic presentation is not limited to fever and lung lesion, but neurological, renal, and liver damage have been reported. Some studies have linked liver injury and mortality, so we decided to recollect data with our patients seeking for this association. Material and Methods: Data were recollected from over 18-year-old patients admitted to the COVID-19 service at Roosevelt Hospital, looking for epidemiological and laboratory data, making correlation with mortality during April -September 2020. Then logistic regression was made looking for the best variables to predict mortality. Results: The main results were mean age 48.26 and 59.2 years old for alive and deceased cases respectively, no differences in transaminases, albumin, INR nor alkaline phosphatase. The best sensibility and specificity predicting mortality were obtained with lactate dehydrogenase > 400 and bilirubin > 0.58. Conclusions: According with our data the best predictors for COVID-19 mortality were lactate dehydrogenase > 400 and Bilirubin > 0.58.