Joubert syndrome: a case report of neonatal presentation and early diagnosis / Síndrome de Joubert: reporte de caso de presentación neonatal y diagnóstico temprano

Abstract Background: Joubert syndrome is a rare genetic condition with a prevalence of 1:80,000-1:100,000. In most cases, it shows an autosomal autosomal recessive hereditary pattern, although X-linked and autosomal dominant cases have been described. The distinctive characteristic of this syndrome is the malformation at cerebral and cerebellar levels, known as the "molar tooth sign," hypotonia, and delayed neurodevelopment. Case report: We describe the case of a newborn with transient tachypnea. However, during hospital stay, he showed other clinical signs not corresponding to the admission diagnosis, such as bradycardia, apneas, hypotonia, and alteration in swallowing mechanics. To rule out etiologies of central origin, we conducted a magnetic resonance of the brain and identified the "molar tooth sign," where the pathognomonic sign of Joubert syndrome. Conclusions: Rare genetic diseases may manifest as early as the neonatal period with non-specific signs. The early diagnosis of Joubert syndrome is reflected in better pediatric follow-up, which impacts its prognosis and the possibility of improving the patient's quality of life with a multidisciplinary management and genetic counseling.

Resumen Introducción: El síndrome de Joubert es una rara condición genética con una prevalencia de 1:80,000 a 1:100,000. En la mayoría de los casos se presenta con un patrón de herencia autosómica recesiva, aunque se han reporatdo casos ligados al cromosoma X y autosómicos dominantes. La característica distintiva de este síndrome es la malformación a nivel cerebral y del cerebelo conocido como el "signo del molar", hipotonía y retraso en el neurodesarrollo. Caso clínico: Se describe el caso de un recién nacido con taquipnea transitoria del recién nacido; sin embargo, durante su estancia manifestó otros signos que no correspondían con el diagnóstico de ingreso, como bradicardia, apneas, hipotonía y alteración en la mecánica de la deglución. Para descartar etiologías de origen central, se realizó una resonancia magnética cerebral en la que se detectó el "signo del molar", patognomónico del síndrome de Joubert. Conclusiones: Las enfermedades genéticas raras pueden manifestarse desde el periodo neonatal con signos muy inespecíficos. El diagnóstico precoz del Síndrome de Joubert permite un mejor seguimiento pediátrico que impacta en su pronóstico y en la posibilidad de mejorar la calidad de vida del paciente con un manejo multidisciplinario, así como brindar asesoramiento genético.

Taquipnea persistente como manifestación inicial de hiperplasia de células neuroendocrinas: reporte de un caso clínico / Persistent tachypnea as initial manifestation of hyperplasia of neuroendocrine cells: case report

Se realiza revisión de la literatura y presentación de un caso clínico de Hiperplasia de Células Neuroendocrinas en paciente lactante masculino que inicia su padecimiento a los 3 meses de vida con dificultad respiratoria caracterizada por retracciones subcostales y taquipnea persistente, posterior-mente a los 8 meses de edad se agrega hipoxemia respirando aire ambiente que requiere uso de oxígeno suplementario continuo. Tiene antecedente de tres hospitalizaciones, con diagnóstico de Bronquiolitis y Neumonía atípica, realizándose panel viral respiratorio con reporte negativo. El paciente persiste con sintomatología respiratoria a pesar de tratamientos médicos, por lo que se deriva a neumología pediátrica, unidad de enfermedad pulmonar intersticial del lactante, iniciando protocolo de estudio, se realiza tomografía tórax de alta resolución, que evidencia imágenes en vidrio despulido en lóbulo medio y región lingular, además de atrapamiento aéreo. Se concluye el diagnóstico de Hiperplasia de Células neuroendocrinas con base a la clínica y hallazgos tomográficos. La Hiperplasia de Células Neuroendocrinas es una patología pulmonar intersticial poco frecuente, cuyo diagnóstico es clínico y radiológico, en la minoría de los casos se requiere biopsia pulmonar para confirmación. Puede ser fácilmente confundida con otras enfermedades respiratorias comunes, por lo que es importante sospecharla para realizar un diagnóstico precoz. La mayor parte de los casos evolucionan con declinación de los síntomas, mejorando espontáneamente en los primeros años de vida.

A review of the literature and presentation of a clinical case of Neuroendocrine Cell Hyperplasia in a male infant patient who begins his condition at 3 months of age with respiratory distress characterized by subcostal retractions and persistent tachypnea is presented. After 8 months of age hypoxemia is added requiring continuous oxygen therapy. He has a history of three hospitalizations, with a diagnosis of bronchiolitis and atypical pneumonia, respiratory viral panel has a negative report. The patient persists with respiratory symptoms despite medical treatments, so it is referred to pediatric pulmonology, initiating study protocol for interstitial lung disease of the infant. A high resolution chest tomography is performed, which evidences images in polished glass in the middle lobe and lingular region, in addition to air entrapment. The diagnosis of neuroendocrine cell hyperplasia is concluded based on clinical and tomographic findings. Neuroendocrine Cell Hyperplasia is a rare interstitial pulmonary pathology, whose diagnosis is clinical and radiological. Lung biopsy is required only in the minority of cases for confirming diagnosis. It can be easily confused with other common respiratory diseases, so it is important to suspect it to make an early diagnosis. Most cases evolve with decline in symptoms, improving spontaneously in the first years of life.

Neonato de 39 semanas de gestación con taquipnea transitoria, criptorquidia e hidrocele, con el modelo de Dorothea E. Orem / Neonate 39 weeks gestation with transient tachypnea, cryptorchidism and hidrocele, with the model of Dorothea E. Orem

Introducción: a nivel mundial la taquipnea transitoria del recién nacido se presenta entre el 0.3 y 0.5 % de todos los recién nacidos, aunque existen algunas series mexicanas que reportan hasta el 2 % de todos los recién nacidos vivos. Comprende entre el 35 y 50 % de todos los casos de dificultad respiratoria no infecciosa que ingresan a los cuneros patológicos o unidades de cuidado intensivo neonatal.1 Mientras que las tasas de criptorquidia e hidrocele son más altas en los niños nacidos por cesárea (3.3 y 4.7 %, respectivamente), en comparación con los obtenidos por vía vaginal (1.7 y 1.6 %).2 Descripción del caso: neonato de 39 semanas de gestación con taquipnea transitoria del recién nacido, criptorquidia e hidrocele atendido en el servicio de atención al recién nacido de un hospital de segundo nivel de atención. Objetivo: proporcionar cuidados especializados, utilizando el proceso de atención de enfermería basado en los conceptos teóricos del modelo de autocuidado de Dorothea E. Orem. Método: estudio de caso, dado que en este diseño se observan los fenómenos en su contexto natural, el cual se realizó en la tercera semana de mayo 2021. Consideraciones éticas: se tomaron en cuenta aspectos bioéticos para la investigación clínica basada en evidencia científica, como la ley de Helsinki y el código de Nuremberg. Resultado: se logró que el neonato y su cuidador primario alcanzaran las metas propuestas al inicio del ingreso hospitalario, mediante la continua capacitación sobre los cuidados generales del recién nacido. Conclusión: la taquipnea transitoria, criptorquidia e hidrocele son alteraciones que pueden ser detectadas al momento de la exploración al neonato.

Introduction: worldwide, transient tachypnea of the newborn occurs in 0.3 to 0.5% of all newborns, although there are some Mexican series that report up to 2% of all live newborns. It comprises 35-50% of all cases of noninfectious respiratory distress admitted to pathological nurseries or neonatal intensive care units.1 While the rates of cryptorchidism and hydrocele are higher in infants born by cesarean section (3.3% and 4.7%, respectively), compared to those obtained vaginally (1.7% and 1.6%).2 Case description: the case study was conducted on a 39-week gestational neonate with Transient Tachypnea of Newborn, Cryptorchidism and Hydrocele seen in the Newborn Care service of a second-level care hospital. Objective: to provide specialized care, using the nursing care process based on the theoretical concepts of Dorothea E. Orem's Self-Care Model. Orem. Method: is a case study, given that in this design the phenomena are observed in their natural context, which was carried out in the third week of May 2021. Ethical considerations: bioethical aspects for clinical research based on scientific evidence, such as the Helsinki law and the Nuremberg code, were taken into account. Result: the neonate and his primary caregiver were able to achieve the goals proposed at the beginning of hospital admission, through continuous training on general newborn care. Conclusion: transient tachypnea, cryptorchidism and hydrocele are alterations that can be detected at the time of examination of the newborn.

Exercise causes oxygen desaturation and hypercapnia in stable chronic obstructive pulmonary disease patients

Background: Assessment of severity of chronic obstructive pulmonary disease (COPD) is the cornerstone of therapy. Spirometric measurements have traditionally remained as the popular diagnostic tool of choice. Oxygenation and carbon dioxide removal cannot be assessed by Spirometry alone, especially during exercise. Therefore, we studied whether desaturation and hypercapnea occur in response to exercise in COPD patients. Aims and Objectives: To know whether bicycle pedaling as an exercise can unravel the gas exchange abnormalities and airflow limitation that might be precipitated by physical activity. This is done by estimating the changes in Oxygen saturation by pulse oximetry, and by estimating the changes in Blood CO2 levels by capnography. Materials and Methods: Thirty stable COPD patients and controls were included for the study. Here we measured the change in oxygen saturation from rest to submaximal exercise (done using bicycle ergometry). Concomitantly, we measured the change in carbon dioxide levels of expired air from rest to submaximal exercise. Results: We found that COPD patients experience oxygen desaturation. ?SaO2 (difference between resting and exercise SaO2) was only 1% in controls whereas 8.86% in COPD. Hypercapnia occurred in response to a submaximal exercise in COPD patients (End tidal carbon dioxide of 48.87 mmHg). We also found that they become tachypneic and show greater degree of exhaustion. Conclusion: Our study points out that exercise-induced desaturation and hypercapnia are a definite occurrence in COPD patients. It is a marker of progressive disease. It can be used as a form of stress test for the pulmonary system.

Diagnostic accuracy of lung ultrasound for transient tachypnea: a meta-analysis

Abstract Objective: The objective of this meta-analysis was to study the diagnostic value of lung ultrasound (LUS) for transient tachypnea of the newborn (TTN). Methods: Embase, Cochrane Library, PubMed, Web of Science, and Google Scholar were searched, and the last search date was October 31, 2020. Studies on the diagnostic accuracy of pulmonary ultrasound for transient tachypnea were included. The quality assessment of the included study was assessed using the Diagnostic Accuracy Studies-2 tool. A meta-analysis was performed using Meta-Disc 1.4. A random-effects model was used and subgroup analysis was carried out to identify possible sources of heterogeneity. Results: A total of 378 articles were retrieved and nine studies with 3239 patients were included in the present meta-analysis. The overall quality of the included studies was moderate to high. The result of threshold analysis shows that there was no threshold effect. However, there was a significant heterogeneity caused by non-threshold effects in the included studies. A random-effects model was used. The pooled sensitivity, specificity, PLR and NLR were 0.55 (95% CI: 0.51-0.58), 0.98 (95% CI: 0.98-0.99), 58.30 (95% CI: 14.05-241.88) and 0.28 (95% CI: 0.18-0.43). The pooled DOR and AUC were 689.12 (95% CI: 68.71 to 6911.79) and 0.994. The results of subgroup analysis showed that the LUS diagnostic criteria and gold standard might be responsible for heterogeneity. Choosing "DLP combined with B line" as the diagnostic standard of LUS and choosing CXR as the gold standard could significantly improve the diagnostic performance of LUS. Conclusion: LUS is a promising method to diagnose TTN. Only DLP is not enough to diagnose TTN, while DLP combined with B-line has good diagnostic performance.

¿Polipnea o taquipnea? Esa es la cuestión / Compliance with the recommendations for physical activity set by the WHO by public bicycle users in a Spanish municipality

RESUMEN Introducción: Polipnea y taquipnea tienen significados diferentes en diversos textos y los estudiantes de Medicina se desorientan al estudiar la Semiología de la disnea. Objetivo: Elucidar la disparidad semántica entre polipnea y taquipnea. Material y Métodos: Se realizó una revisión bibliográfica utilizando los descriptores en ciencias de la salud taquipnea y polipnea. Se realizó una búsqueda en quince textos de Semiología Médica y en otros libros y revistas, impresos y electrónicos, entre ellos, la Revista Española de Cardiología (enero 1997 a diciembre 2020) en Archivos de Bronconeumología(diciembre 1964 a diciembre 2020); y se hizo el análisis etimológico de las palabras estudiadas, en Medigraphic (2012-21). Resultados: Seis de quince textos de Semiología consideran sinónimos polipnea y taquipnea; cuatro, solo emplean polipnea; y dos, taquipnea. Tres distinguen taquipnea como aumento de la frecuencia respiratoria; de polipnea, respiración superficial y rápida; dos definen taquipnea como aumento de la frecuencia respiratoria simple o con disminución de la amplitud (respiración superficial) y polipnea o hiperpnea, como aumento de la profundidad respiratoria con incremento de la frecuencia. En revistas científicas, taquipnea apareció en 192 artículos como respiración rápida y superficial; con igual significado se encontró polipnea, en 27. Según origen, taquipnea significa aceleración del ritmo respiratorio; polipnea, respiración muy frecuente y superficial, sin relación con polýpnóoos: "que sopla con fuerza" e hiperpnea significa incremento de la velocidad y amplitud de los movimientos respiratorios. Conclusiones: Polipnea y taquipnea deben considerarse equivalentes de respiración rápida y superficial; taquipnea simple, si la amplitud respiratoria es normal; e hiperpnea denomina la respiración muy frecuente y profunda.

ABSTRACT Introduction: Polypnea and tachypnea have different meanings in several texts, and medical studentsmay get confusedwith just the study of the semiology of dyspnea. Objective: Toelucidatethe semantic gap between polypnea and tachypnea. Material and Methods: A bibliographic review was conducted usinghealth science descriptors such as tachypnea and polypnea; a search was performed in 15 texts of Medical Semiology and other printed or electronic books and journals, among them, theRevista Española de Cardiología(fromJanuary 1997 to December 2020) andArchivos de Bronconeumología (from December 1964 toDecember 2020); in addition, the etymological analysis of these words was carried out in Medigraphic (2012-2021). Results: Six out of fifteen texts on semiology consider that the termspolypnea and tachypnea are synonymous; fourtexts only use polypnea; and two use the term tachypnea. Three texts distinguish tachypnea as increased respiratory rate, andpolypnea as arapid, shallow breathing; two texts define tachypnea as a simple increase in the respiratory rateor a decrease in the respiratory amplitude (shallow breathing); and polypnea or hyperpnea as the increasein depth and rate of breathing.In scientific journals, the term tachypnea was usedin 192 papersto refer to rapid, shallow breathing; andpolypnea had the same meaning in 27 articles. According to its origin, tachypnea means rapid respiratory rate; Polypnea is presented as very frequent and shallow breathing, unrelated to polýpnoos: "that blows forcefully"; while hyperpneameans an increase in the speed and amplitude of respiratory movements. Conclusions: Polypnea and tachypnea should be considered as equivalents of rapid andshallow breathing; simple tachypneaif the respiratory amplitude is normal; and hyperpnea designs a very frequent and deep breathing.

Taquipnea persistente de la infancia: hiperplasia de células neuroendocrinas, una revisión / Persistent tachypnea of infancy: neuroendocrine cell hyperplasia, a review

La hiperplasia de células neuroendocrinas de la infancia (HCNEI) constituye una de las enfermedades intersticiales más frecuentes en pediatría. Tanto su etiología como los mecanismos fisiopatológicos involucrados son inciertos. Suele presentarse en pacientes por lo demás sanos, durante los primeros meses de vida con taquipnea, retracciones costales, rales e hipoxemia. En la tomografía axial computada de tórax de alta resolución (TACAR) presenta imágenes características en vidrio esmerilado de distribución central y zonas de atrapamiento aéreo. Para el diagnóstico, además de la clínica y la TACAR, podemos recurrir a la biopsia en casos atípicos. Los hallazgos histológicos reflejan una arquitectura pulmonar normal y un aumento en el número de células neuroendocrinas. El manejo global es con medidas de sostén, ya que no se cuenta con un tratamiento específico. La sintomatología suele mejorar con la edad y el pronóstico es favorable.

Neuroendocrine cell hyperplasia of infancy (NEHI) is one of the most common interstitial lung diseases of childhood. The etiology and pathophysiological mechanisms involved are uncertain. It usually presents in otherwise healthy patients during the first months of life with tachypnea, rib retractions, crackles, and hypoxemia. High-resolution chest computed tomography (HRCT) shows ground-glass opacities of central distribution and areas of air trapping. For diagnosis purposes, in addition to clinical and HRCT features, a lung biopsy is indicated for atypical cases. Histological findings reflect normal architecture and an increased number of neuroendocrine cells. The management consists of supportive and preventive care, since there is no specific treatment. Symptoms usually improve with age and the prognosis is favorable.

Hiperplasia de células neuroendocrinas: reporte de caso / Neuroendocrine cell hyperplasia: case report

A clinical case of Neuroendocrine Cell Hyperplasia is presented with a bibliographic review. An infant patient with respiratory distress syndrome, characterized by nasal flaring, retractions, and tachypnea with temporary resolution with the use of bronchodilators. However, the patient requires oxygen. With complementary examinations (negative viral panel twice) and epidemiology it is classified as a viral Bronchiolitis. Without improvement, extrapulmonar pathologies were suspected, discarding hearth disease, epilepsy, pathological gastroesophageal reflux. New tests were performed to rule out other pathologies, including immunological disorders. Those results were normal, so a high-resolution chest tomography was done which allowed the diagnosis of Neuroendocrine Cell Hyperplasia. During the follow up the child had improved and required oxygen until he was two years old. Neuroendocrine Cell Hyperplasia belongs to a huge group of less common interstitial disorders, which diagnosis is clinical and radiological. It can easily be confused with common respiratory disorders. For this reason, it is important to know about this disease to make an early diagnosis. Most of the cases had a gradual (months to years) improvement.

Se presenta un caso clínico de Hiperplasia de Células Neuroendocrinas y la revisión de la literatura. Paciente lactante menor con cuadro de dificultad respiratoria, caracterizado por aleteo nasal, retracciones y taquipnea persistente acompañada de desaturación. Sin adecuada respuesta al uso de broncodilatadores. Por exámenes complementarios, panel viral negativo en dos ocasiones y epidemiología, se le diagnostica una bronquiolitis viral. Por no presentar mejoría se completan estudios, descartándose neumonía atípica, cardiopatía, epilepsia, reflujo gastroesofágico patológico y compromiso inmunológico. El diagnóstico fue determinado en base a la clínica, junto con imágenes en vidrio esmerilado característicos en lóbulo medio y língula. En su seguimiento mejora paulatinamente, requiriendo soporte de oxígeno hasta los dos años. La Hiperplasia de Células Neuroendocrinas es una patología intersticial pulmonar poco frecuente, cuyo diagnóstico es clínico y radiológico. Puede ser fácilmente confundida con desórdenes respiratorios comunes, por lo que es importante sospecharla para realizar un diagnóstico precoz. La mayor parte de los casos evolucionan con declinación de los síntomas, mejorando espontáneamente en meses o en los primeros años de vida.

Acute Illness Observation Scale in community acquired pneumonia in children aged 2 months to 59 months

Background: Pediatric respiratory disease remains an important cause of morbidity in both the developing and the developed world. Aim of the study is to validate Acute Illness Observation Scale (AIOS) in predicting illness severity and clinical outcome of community acquired pneumonia.Methods: This was a descriptive study done in a cohort of 248 children at the Department of Paediatrics, at a tertiary care hospital in Chennai. Children between 2 months - 59 months coming to outpatient department with suspected pneumonia, if satisfying the inclusion criteria were enrolled into the study. AIOS scoring is done on each subject on day 1, day 2, day 5 by two persons simultaneously in a reasonably quite state. Respiratory parameters, vital signs and pulseoximeter reading of each patient as in data collection form are documented.Results: Children scoring abnormally on AIOS (>10) had significantly higher frequency of severe tachypnea (p=0.001), marked chest retraction (p=0.001), grunting, cyanosis (p=0.01), lethargy, inability to drink and so on except incidence of convulsion and wheeze which didn't have any statistical significance. Severe hypoxemia associated with cyanosis (SpO2<85) was observed in 14 children of which 92.9% (13) scored a high value on AIOS (AIOS>15). Complications were absent in those who scored <10, while maximum complications were seen in those who scored >15.Conclusions: AIOS can be used as a tool to decide on therapeutic modalities and prognosticating a child with pneumonia admitted to the hospital by a physician.

The neonatal outcomes of Dexamethasone administration before scheduled cesarean delivery at term: a randomized clinical trial

Background: Caesarean delivery (CD) rates in developing countries are rising beyond the recommended rates of World health organization. Objective of this study was to evaluate whether Dexamethasone injections reduce neonatal incubation admissions when given before scheduled caesarean delivery (CD) at term or not.Methods: A double blinded, two armed, randomized clinical trial was conducted at Tanta University hospitals in the period from October 2017 to March 2019. Four hundred pregnant women admitted for scheduled CD with gestational age ≥37 weeks were included. Patients were randomized into study group and control group. The study group was given 3 dexamethasone doses, 8 mg each while control group was given saline injections simultaneously as a placebo drug. The primary outcome was the neonatal incubatory admissions.Results: Demographic data in both groups were comparable. Transient tachypnea of newborn (TTN) was 15.47% in study group versus 20.33% in control group with p=0.227. The respiratory distress (RDS) in study group was 6.63% versus 9.89% in control group with p=0.260. The incubation admissions were nasal oxygen 12.71% versus 15.38%, continuous positive airway pressure ventilation (CPAP) 5.52% versus 8.24% and mechanical ventilation was 3.87% versus 6.59% in the study and control groups respectively.Conclusions: Although Dexamethasone administration before scheduled CD at term reduced both respiratory morbidity and incubation admissions, the differences between study and control groups were not significant.

Prophylactic antenatal corticosteroid before elective cesarean delivery at or near term: a retrospective study

Background: While the role of antenatal steroids administration to mother is proved in reducing neonatal morbidity and mortality in preterm gestation secondary to respiratory distress and hyaline membrane disease its role in patients undergoing elective cesarean deliveries at or near term appears to be controversial.Methods: This was a retrospective observational study in which women who have undergone elective cesarean delivery between 34-37 weeks of gestation were included. Those women who received two intramuscular injections of 12 mg betamethasone 24 h apart were included in group S whereas the women who didn’t receive such injections were included in group B. Outcome measures were incidence of transient tachypnea of the newborn, hyaline membrane disease and NICU admissions due to respiratory distress.Results: Neonates in the treatment group had a statistically significant lower overall incidence of transient tachypnea of newborn, respiratory distress syndrome and NICU admissions. The incidence of transient tachypnea of newborn and respiratory distress in Group S was 5% and 8.33% respectively where as TTN and respiratory distress was seen in 18.33% and 28.33% neonates in the group N. The over NICU admission rates, due to respiratory distress in group S and Group N were found to be 8.33% and 28.33% respectively.Conclusions: Antenatal administration of corticosteroids to women at or near term (34-37 weeks) is found to have a beneficial effect in reducing neonatal morbidity and NICU admissions secondary to respiratory distress in women undergoing elective CS.

Mecanismos fisiopatológicos de taquipnea / Physiopathological mechanisms of tachypnea

Tachypnea is a common symptom in respiratory diseases, generally triggered for metabolic compensation purposes. Its presence results from integrated complex mechanisms, both physiological and pathological; for a good clinical approach, it is indispensable to know these mechanisms.

La taquipnea es la manifestación más común de las enfermedades respiratorias y obedece generalmente a una respuesta de compensación metabólica. Su presencia resulta de mecanismos de integración complejos tanto fisiológicos como patológicos que es necesario conocer para el mejor abordaje clínico de un paciente.

Severity factors of Acquired Pneumonia Community in a children's hospital in the Colombian Caribbean / Factores de severidad de Neumonía Adquirida en la Comunidad en un hospital infantil del Caribe colombiano

Abstract Objective: To identify predisposing factors to developing severe pneumonia in hospitalized children diagnosed with community-acquired pneumonia hospitalized in Cartagena's Napoleón Franco Pareja children's Hospital. Methods: Analytical observational cross-sectional study performed in patients under 18 years. Data from surveys and records were analyzed. Univariate and bivariate analysis was performed. The variables are grouped according to the presence or absence of complications and analyzed by jisquare test. We calculated OR of each of the dummy variables to evaluate their association with complications. A P < 0.05 was considered statistically significant for all analyses. Results: 301 patients with severe pneumonia were included. Riskfactors related to severity: age less than 3 months (OR: 4.86; CI 95%: 1,5 -14.3; p = 0.004); exclusive breastfeeding for less than 6 months (CI:95% 7,7-1,4; p = 0.0019); heart disease (OR: 5.37; CI 95%: 1,28-19,88, p = 0.010); prematurity (OR: 1.62, CI 95%: 0.93- 6.69, p = 0.034); Incomplete vaccination (OR: 2.32; CI: 95% 1.07 - 5.10; p = 0.015). Conclusions: It was found increased severity risk, statistically significant, in patients less than 6 months breastfeeding, prematurity, heart disease, incomplete vaccination scheme, and positive blood culture with Sp. pneumonia

Resumen Objetivo: Identificar factores predisponentes a desarrollar neumonía severa en niños hospitalizados con diagnóstico de NAC en el Hospital Infantil Napoleón Franco Pareja de Cartagena Colombia. Materiales y métodos: Estudio observacional transversal analítico en pacientes menores de 18 años hospitalizados con neumonía adquirida en la comunidad. Se analizaron datos obtenidos de encuestas y registros clínicos. Se realizó un análisis descriptivo univariado y bivariado. Las variables se agruparon según la presencia o no de complicación y se analizaron a través de la prueba ji cuadrado. Se realizó el cálculo de OR de cada una de las variables dicotómicas para evaluar su asociación a complicaciones. Una P<0,05 fue considerada como estadísticamente significativa para todos los análisis. Resultados: Se incluyeron 301 pacientes con neumonía grave. Los factores de riesgo más relacionados con severidad fueron: edad menor de 3 meses (OR: 4,86; IC 95%: 1,5-14,3; p 0,004); la lactancia materna exclusiva menor a 6 meses (IC 95%: 1,4- 7,7; p 0,0019); cardiopatía (OR: 5,37; IC 95%: 1,28-19,88; p: 0,010); prematurez (OR: 1,62; IC: 0,93-6,69; p: 0,034); esquema incompleto de vacunación (OR: 2,32; IC 95%: 1,07-5,10: p: 0,015). Conclusiones: Se encontró aumento de riesgo de severidad en pacientes con lactancia materna menor de 6 meses, prematurez, cardiopatía, esquema de vacunación incompleto, y hemocultivo con Sp. Neumoniae positivo.

Doenças respiratórias agudas em crianças brasileiras: os cuidadores são capazes de detectar os primeiros sinais de alerta? / Acute respiratory diseases in brazilian children: are caregivers able to detect early warning signs?

RESUMO Objetivo: Avaliar o nível de conhecimento do cuidador em relação aos sinais e sintomas respiratórios de Infecções Respiratórias Agudas (IRA) e a percepção dos mesmos em relação às crianças que necessitam de assistência médica. Métodos: Estudo prospectivo e transversal, no qual um questionário padronizado com itens relacionados à percepção da gravidade dos sinais e sintomas de IRA foi administrado a cuidadores de pacientes pediátricos admitidos no serviço de emergência de um hospital universitário no período de agosto de 2011 a maio de 2012. A análise estatística foi realizada com os testes do qui-quadrado e t-Student para determinar quais variáveis contribuíram para o reconhecimento pelos cuidadores da gravidade das doenças respiratórias agudas. Resultados: Foram entrevistados 499 cuidadores. As causas de IRA mais citadas foram Síndrome gripal (78,6%), Resfriado comum (73,9%), Faringites (64,1%) e Pneumonia (54,5%). Febre (34,1%) e Tosse (15,8%) foram as principais razões para a procura de atendimento. Os sinais de gravidade mais citados pelos cuidadores foram: febre (99,6%), dispneia (91,4%), sibilância (86,4%), adinamia (80,2%), tosse (79,8%) e taquipneia (78,6%). O histórico de doença respiratória anterior do paciente (p=0,002), a idade (p=0,010) e o estado civil do cuidador (p=0,014) foram as variáveis significativamente associadas com taquipneia, o sintoma mais grave de IRA. Conclusões: Embora cuidadores pediátricos possam perceber os principais sinais de IRA, eles não são capazes de reconhecer a gravidade destes, o que pode atrasar os cuidados médicos e impedir o tratamento precoce.

ABSTRACT Objective: To assess the level of caregiver knowledge about respiratory signs and symptoms of acute respiratory infection (ARI) as well as their ability to detect the early warning signs and need for medical assistance in children referred to an emergency service. Methods: This is a prospective, cross-sectional study. A standardized questionnaire with questions on the perception of the severity of ARI signs and symptoms was applied to caregivers of pediatric patients assisted in the emergency room of a university hospital from August 2011 to May 2012. Chi-square and Student's t-tests were used to determine which variables contributed with caregivers' recognition of severity of acute respiratory diseases. Results: 499 caregivers were interviewed. The most cited causes of ARI were flu syndrome (78.6%), common cold (73.9%), pharyngitis (64.1%), and pneumonia (54.5%). Fever (34.1%) and cough (15.8%) were major reasons for referral to hospital. The most cited signs of severity recognized by caregivers were fever (99.6%), dyspnea (91.4%), wheezing (86.4%), adynamia (80.2%), coughing (79.8%), and tachypnea (78.6%). Children's history of respiratory diseases (p=0.002), caregiver's age (p=0.010) and marital status (p=0.014) were significantly associated with tachypnea, the most severe ARI symptom. Conclusions: Although caregivers of children can recognize ARI most important signs and symptoms, they are unable to judge severity, which may delay medical care and early treatment.

Eclampsia y síndrome HELLP en los Andes del Perú: complicaciones perinatales / Eclampsia and HELLP syndrome in the Peruvian Andes: perinatal complications

Resumen OBJETIVO: Comparar las complicaciones perinatales en pacientes con eclampsia, síndrome HELLP y su asociación. MATERIALES Y MÉTODOS: Estudio transversal y comparativo efectuado en mujeres con eclampsia, síndrome HELLP, o ambos, y sus neonatos atendidas en el Hospital Regional Docente de Cajamarca, Perú, entre el 1 de enero y el 31 de diciembre de 2015. La información se procesó con el programa Epi Info versión 7. Se usó la ANOVA y χ2 no paramétrica con Kruskal-Wallis para comparar grupos, y se consideró significativo un valor de p < 0.05. RESULTADOS: Se registraron 3411 nacimientos; 71 pacientes tuvieron eclampsia o síndrome HELLP. Las complicaciones perinatales de prematurez, menor peso y talla al nacer y Apgar más bajo fueron significativamente mayores en mujeres con síndrome HELLP que con eclampsia. En cuanto a prematurez hubo 30 (66.6%) casos de madres con síndrome HELLP, 14 (70%) con eclampsia asociada con síndrome HELLP y ninguno con eclampsia (p = 0.01). El peso promedio al nacimiento fue 2133.5 ± 66.7 g en síndrome HELLP y 3083.1 ± 67.8 g en eclampsia (p = 0.001). Hubo Apgar más bajo al minuto y a los cinco minutos en la combinación eclampsia y síndrome HELLP que en solo eclampsia (p = 0.002). No hubo diferencias significativas en la mortalidad, restricción del crecimiento fetal, asfixia neonatal, taquipnea transitoria, enfermedad de membranas hialinas, enterocolitis necrotizante, policitemia, ictericia patológica o sepsis. La tasa de cesáreas en síndrome HELLP fue 41 (91.1%) y en eclampsia 4 (66.6%) (p = 0.03). CONCLUSIONES: Las complicaciones perinatales son mayores pacientes con síndrome HELLP que con eclampsia.

Abstract OBJECTIVES: To compare perinatal complications in patients with eclampsia, HELLP syndrome and association. MATERIALS AND METHODS: a cross-sectional, comparative study conducted in women with eclampsia and / or HELLP syndrome and their perinates in Hospital Regional Docente de Cajamarca , Peru. Data obtained from 01/01/2015 to 12/31/15. Information processing was carried out with the Epi Info program version 7. The ANOVA and non-parametric χ2 with Kruskal-Wallis were used to compare groups, and a value of P <0.05 was considered significant. RESULTS: 71 women had eclampsia and / or HELLP syndrome of 3411 births. Perinatal complications such as prematurity, lower weight and height at birth and lower Apgar were significantly higher in HELLP syndrome than in eclampsia. Regarding prematurity, there were 30 (66.6%) in HELLP syndrome, 14 (70%) in eclampsia associated with HELLP syndrome and none in eclampsia (p = 0.01). Birth weight was 2133.5 ± 66.7 g in HELLP syndrome and 3083.1 ± 67.8 g in eclampsia (p = 0.001). Apgar was lower at minute and at 5 minutes in the combination eclampsia and HELLP syndrome than in eclampsia alone (p = 0.002). There were no significant differences in mortality, IUGR, neonatal asphyxia, transient tachypnea, hyaline membrane disease, necrotizing enterocolitis, polycythemia, pathological jaundice or sepsis. The rate of cesareans in HELLP syndrome was 41 (91.1%) and in eclampsia 4 (66.6%) (p = 0.03). CONCLUSIONS: Perinatal complications are greater in HELLP syndrome than in eclampsia.

Diagnostic efficacy of lung ultrasound and X-ray for neonatal respiratory distress syndrome and transient tachypnea / 中国医学影像技术

Objective To compare the efficacy of lung ultrasound and chest X-ray for diagnosis of neonatal transient respiration syndrome (TTN) and respiratory distress syndrome (RDS).Methods Totally 120 infants with respiratory distress underwent lung ultrasound and chest X-ray within 6 h after birth.Taking clinical diagnosis as the standard,the sensitivity,specificity and accuracy of lung ultrasound and X-ray for diagnosis of TTN and RDS were calculated.Results According to clinical diagnosis,there were 75 infants of TTN and 34 of RDS.The sensitivity,specificity and accuracy of lung ultrasound in diagnosis of TTN was 96.00％ (72/75),88.89％ (40/45) and 93.33％ (112/120),respectively,higher than those of chest X-ray (85.33％ [64/75],84.44％ [38/45] and 85.00％ [102/120]).Lung ultrasound showed 85.29％ (29/34) of sensitivity,95.35％ (82/86) of specificity and 92.50％ (111/120) of accuracy for diagnosis of RDS,whereas chest X-ray showed 88.23％ (30/34) of sensitivity,89.53％ (77/86) of specificity and 89.17％ (107/120) of accuracy.Conclusion Lung ultrasound is accurate for the diagnosis of TTN and RDS.

Taquipnea transitoria del recién nacido asociada a cesárea con y sin labor de parto / Transient tachypnea of ​​the newborn associated with caesarean section with and without labor

Contexto: la taquipnea transitoria del recién nacido (TTRN) es una entidad frecuente en neonatos nacidos por cesárea. Objetivo: identificar factores de riesgo potencialmente modificables que contribuyan a la disminución de la patología respiratoria neonatal derivada de un parto por cesárea Sujetos y métodos: se presenta un estudio observacional retrospectivo de cohorte analítico que identifico expedientes clínicos de recién nacidos por cesárea, atendidos en el Hospital de la Policía Quito N°1 en el periodo enero de 2001 a diciembre de 2015; el estudio incorporó neonatos entre 35 y 41 semanas de gestación, a quienes se clasificaron en 2 grupos: con y sin labor de parto previo a la cesárea. Resultados: la frecuencia de recién nacidos con taquipnea transitoria que se determinó en el presente estudio fue 25,6%, 29,4% y 44,8% en los respectivos grupos de edad gestacional determinándose una proporción es 5,1:1; 1,9:1 y 0,5:1 para cada grupo por lo que la relación entre un pretérmino leve frente a RN a término es 10 veces mayor para el grupo que desarrolla TTRN. Existe una mayor frecuencia de TTRN en neonatos de cesáreas sin labor de parto previa comparado con el grupo de neonatos nacidos por cesárea con labor de parto previa; esta diferencia es estadísticamente significativa con un OR de 5,8. Conclusión: se determinó que la labor de parto previa a la cesárea, constituyo un factor protector para taquipnea transitoria del recién nacido en neonatos entre 35 y 38 semanas. La labor de parto previa a la cesárea no fue un factor de protección frente al riesgo de desarrollar taquipnea transitoria del recién nacido en neonatos de 39 o más semana de gestación.(AU)

Context: transient tachypnea of the newborn (TTRN) is a frequent entity in neonates born by caesarean section, Objective: identify potentially modifiable risk factors that contribute to the reduction of neonatal respiratory pathology derived from a cesarean delivery Subjects and methods: We present a retrospective observational study of an analytical cohort that identified clinical records of newborns by caesarean section, attended at Quito Police Hospital No. 1 in the period January 2001 to December 2015; The study included neonates between 35 and 41 weeks of gestation, who were classified into 2 groups: with and without labor prior to cesarean section. Results: the frequency of newborns with transient tachypnea that was determined in the present study was 25.6%, 29.4% and 44.8% in the respective gestational age groups determining a proportion is 5.1: 1; 1.9: 1 and 0.5: 1 for each group, so that the relationship between a preterm mild versus a term BN is 10 times higher for the group that develops TTRN. There is a greater frequency of TTRN in neonates of caesarean sections without previous labor compared with the group of neonates born by caesarean section with previous labor; this difference is statistically significant with an OR of 5.8. Conclusion: labor prior to caesarean section constitutes a protective factor for transient tachypnea of thnewborn in neonates between 35 and 38 weeks. Labor prior to cesarean section is not a protective factor againsthe risk of developing transient tachypnea of the newborn in infants of 39 or more weeks of gestation.(AU)

Estudio Descriptivo: Neumonía y Complicaciones en Niños en el Hospital de Especialidades José Carrasco Arteaga. Enero - Diciembre 2015 / Desciptive Research: Pneumonia and Complications in Children at José Carrasco Arteaga Specialty Hospital. January - December 2015

INTRODUCCIÓN: La neumonía es la primera causa de morbi ­ mortalidad en los países en desarrollo, según la Organización Mundial de la Salud representa aproximadamente el 19 % de todas las muertes en menores de 5 años. El objetivo del presente estudio fue determinar las características clínicas y complicaciones de niños con neumonía en un Hospital de Especialidades en la zona sur de Ecuador. MÉTODOS: El presente estudio es descriptivo retrospectivo de corte trasversal con recolección de información obtenida de historias clínicas de los pacientes hospitalizados por neumonía de Enero a Diciembre de 2015 en el Hospital de Especialidades José Carrasco Arteaga de la ciudad de Cuenca-Ecuador. Se analizaron las variables demográficas de la población estudiada y sus complicaciones. Se presentan datos en frecuencias y porcentajes. RESULTADOS: En los 6 meses de estudio se revisaron 573 historias clínicas de los cuales 142 casos se registraron como neumonía (24.78 %). La edad media fue 4 a 3.57 años, y es el sexo femenino el más afectado (53.53 %). La tos (91.55 %), alza térmica (87.32 %), taquipnea (70.42 %), estertores (47.18 %), fueron las características clínicas más comunes. La neumonía bacteriana típica (62.68 %), es el tipo de neumonía más frecuente y la que mayor complicación presenta como: derrame pleural (7.04 %), sepsis (6.34 %), fallecimiento (6.34 %), empiema (4.23 %), absceso pulmonar (2.11 %), fistula broncopulmonar (2.11 %). CONCLUSIONES: La neumonía es una patología frecuente de hospitalización en pediatría, la edad más afectada fue de 1 a 3 años, las características clínicas como tos, alza térmica, y taquipnea fueron las más comunes. La neumonía bacteriana típica, es el tipo más grave y las complicaciones que presentaron fueron: derrame pleural, empiema, sepsis, con mortalidad de 5.63 %. (AU)

BACKGROUND: Pneumonia is the leading cause of morbidity and mortality in developing countries, according to the World Health Organization, accounting for approximately 19 % of all deaths in children under 5 years of age. The aim of the present study was to determine the clinical characteristics and complications of children with pneumonia at a Specialty Hospital in the southern area of Ecuador. METHODS: The present study is a descriptive retrospective cross-sectional study with data collection from clinical records of patients hospitalized for pneumonia from January to December 2015 at the José Carrasco Arteaga Specialty Hospital in the city of Cuenca, Ecuador. We analyzed the demographic variables of the studied population and their complications. Data are presented in frequencies and percentages. RESULTS: In the 6-month study, 573 medical records were reviewed, of which 142 cases were recorded as pneumonia (24.78 %). The mean age was 4 a 3.57 years, and the female sex was the most affected (53.53 %). Cough (91.55 %), thermal rise (87.32 %), tachypnea (70.42 %), rales (47.18 %) were the most common clinical features. The most common type of pneumonia is pneumonia (62.68 %), which presents as pleural effusion (7.04 %), sepsis (6.34 %), death (6.34 %), empyema (4.23 %), abscess pulmonary (2.11 %), bronchopulmonary fistula (2.11 %) CONCLUSIONS: The Pneumonia is a pathology frequent pediatrics of hospitalization; the most affected age was 1 to 3 years and clinical characteristics most common such as: cough, fever, and tachypnea. Typical bacterial pneumonia is the most severe type for disease children's and the complications frequents presented were pleural effusion, empyema, and sepsis, with mortality of 5.63 %.(AU)

Comparação entre o método Reequilíbrio Toracoabdominal e a fisioterapia respiratória convencional em recém-nascidos com taquipneia transitória: um ensaio clínico randomizado / Comparison between Thoracic-abdominal Rebalance Method and conventional respiratory physiotherapy in neonates with transient tachypnea: a randomized clinical trial

Introdução: Recém-nascidos acometidos pela taquipneia transitória do recém-nascido (TTRN) cursam com desequilíbrio da biomecânica toracoabdominal e desconforto respiratório e necessitam de cuidados especiais. A fisioterapia respiratória convencional em recém-nascidos tem efeitos adversos, podendo ser o método reequilíbrio toracoabdominal (RTA) uma alternativa terapêutica. Objetivo: Comparar a fisioterapia respiratória convencional com o método RTA em recém-nascidos com TTRN. Métodos: Ensaio clínico intervencional, comparativo e randomizado. 49 recém-nascidos foram divididos em dois grupos: fisioterapia respiratória convencional (n=20) e RTA (n=29). Parâmetros fisiológicos (frequência respiratória, frequência cardíaca, saturação de pulso de oxigênio, temperatura axila), dor, estado comportamental, desconforto respiratório e desequilíbrio da biomecânica respiratória foram avaliados antes e após os manuseios. Resultados: A mediana da idade gestacional foi 38 semanas e a do peso de nascimento 2.940 g. Após os manuseios, não houve diferença entre os grupos quanto à dor (p=0,63), o estado comportamental (p=0,11) e os parâmetros fisiológicos (frequência respiratória, p=0,18; frequência cardíaca, p=0,82; SpO2, p=0,74; temperatura axila, p=0,29). O método RTA mostrou-se superior a fisioterapia respiratória convencional na melhora da biomecânica respiratória (elevação do esterno, p=0,01; elevação dos ombros, p=0,02) e do desconforto respiratório (p=0,009). Conclusão: O método RTA mostrou-se seguro e superior à fisioterapia respiratória convencional em recém-nascidos com TTRN. (AU)

Introduction: Newborn infants who are affected by transient tachypnea of the newborn (TTNB) have an imbalance of thoracoabdominal biomechanics and respiratory distress and so, require special care. The conventional respiratory physiotherapy in newborns has adverse effects, and the Thoracic-Abdominal Rebalance (TAR) method may be a therapeutic alternative. Objective: To compare conventional respiratory physiotherapy and TAR method in newborns with TTNB. Methods: Randomized, comparative, interventional clinical trial. 49 newborn infants divided into two groups: conventional respiratory physiotherapy (n=20) and TAR method (n=29). Physiological parameters (respiratory rate, heart rate, pulse oxygen saturation (SpO2), axilla temperature), pain, behavioral status, respiratory discomfort, and imbalance of respiratory biomechanics were evaluated before and after handling. Results: The median of gestational age of 38 weeks, and birthweight was 2,940 g. After the interventions, we did not observe difference between the groups regarding pain (p=0.63), behavioral status (p=0.11) and physiological parameters (respiratory rate, p=0.18; heart rate, p=0.82; SpO2, p=0.74 and axilla temperature, p=0.29). The TAR method was better than conventional respiratory physiotherapy in improvement of respiratory biomechanics (sternum elevation, p=0.01, elevation of the shoulders, p=0.02) and respiratory distress (p=0.009). Conclusion: The TAR method proved to be safe and superior to conventional respiratory physiotherapy in newborn infants with TTNB. (AU)

Predictores clínicos de eventos adversos serios en el adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad / Clinical predictors of serious adverse events in immunocompetent adult patients hospitalized with community-acquired pneumonia

Introducción: La neumonía adquirida en la comunidad (NAC) ocasiona morbilidad y mortalidad significativa en la población adulta. Objetivos: Examinar las variables clínicas y de laboratorio medidas en la admisión al hospital que permiten predecir los eventos adversos clínicamente relevantes en pacientes adultos hospitalizados por neumonía comunitaria. Métodos: Evaluamos las variables clínicas y de laboratorio asociadas a eventos adversos serios en una cohorte de adultos hospitalizados por NAC. Los eventos adversos examinados fueron la admisión a UCI, necesidad de ventilación mecánica, shock séptico, complicaciones cardiovasculares y generales y estadía prolongada en el hospital y mortalidad a 30 días. Las variables predictoras fueron sometidas a análisis univariado y multivariado en un modelo de regresión logística. Resultados: Se evaluaron 659 pacientes, edad: 67 ± 18 años, 52% varones, 77% tenía comorbilidad, 23% fueron admitidos a la UCI, 12% requirieron ventilación mecánica, 31% presentaron complicaciones en el hospital, la estadía media en el hospital fue 9 días y 9,9% fallecieron en el seguimiento a 30 días. Las comorbilidades, inestabilidad hemodinámica y disfunción renal se asociaron con la admisión a UCI, riesgo de complicaciones y estadía prolongada en el hospital. El uso de ventilación mecánica y shock séptico fue más frecuente en pacientes con inestabilidad hemodinámica y disfunción renal. La edad avanzada, enfermedades cardiovasculares y respiratorias crónicas, sospecha de aspiración, taquipnea y disfunción renal se asociaron al riesgo de eventos cardiovasculares en el hospital. Conclusión: Las variables clínicas y de laboratorio medidas en la admisión al hospital permiten predecir el riesgo de eventos adversos serios en el adulto hospitalizado por neumonía.

Introduction: Community-acquired pneumonia (CAP) causes significant morbidity and mortality in adult population. Objectives: To assess clinical and laboratory variables measured at hospital admission associated to clinically relevant adverse outcomes in patients hospitalized with community-acquired pneumonia. Methods: We prospectively assessed clinical and laboratory variables associated to serious adverse events in a cohort of CAP hospitalized adult patients. Major adverse outcomes were admission to ICU, need for mechanical ventilation, septic shock, prolonged hospital stay, cardiovascular and in-hospital complications and 30-day mortality. The clinical and laboratory variables measured at hospital admission associated to serious adverse events were assessed by univariate and multivariate analysis using logistic regression models. Results: 659 CAP hospitalized immunocompetent adult patients were assessed, mean age: 67 years, 52% were male, 77% had comorbidities, 23% were admitted to the intensive care unit (ICU), 12% needed mechanical ventilation, 31% had hospital complication, mean hospital length of stay was 9 days and 9.9% died at 30-days follow up. Comorbidities, hemodynamic instability and renal dysfunction were associated with ICU admission, risk of complications, and prolonged hospital stay. Mechanical ventilation requirement and septic shock were more frequent in patients with hemodynamic instability and renal dysfunction. Advanced age, chronic cardiovascular and respiratory diseases, aspiration pneumonia, tachypnea, and renal dysfunction were associated with high risk of cardiovascular events in the hospital. Conclusion: The clinical and laboratory variables measured at hospital admission allow us to predict the risk of serious adverse events in CAP hospitalized adult patients.