Caracterización de una cohorte durante cinco años después de un episodio de bronquiolitis que requiere hospitalización en una clínica de tercer nivel de Bogotá, Colombia / Characterization of a cohort five years after an episode of bronchiolitis that required hospitalization in a third level clinic of Bogotá, Colombia

Introducción. La Bronquiolitis secundaria al Virus Sincitial Respiratorio, se han asociado con episodios sibilantes recurrentes y desarrollo de asma, incluso en la adultez. Sin embargo, la relación entre estas patologías es controvertida, y aun no se conoce el comportamiento de este fenómeno en Colombia. El objetivo de este estudio fue describir la evolución clínica a cinco años, de los niños con antecedente de bronquiolitis que requirieron hospitalización Materiales y métodos. Estudio descriptivo de cohorte retrospectiva de menores de dos años, con diagnóstico de Bronquiolitis atendidos en la Clínica Universitaria Colombia en los años 2008 a 2011 con seguimiento de hospitalizaciones por patologías respiratorias hasta el año 2016. Se revisaron 306 historias clínicas de pacientes y se analizaron características socio- demográficas, aislamientos virales y manejo farmacológico. Resultados. Los años con mayor número de hospitalizaciones por episodios sibilantes posterior al episodio bronquiolitis fueron el 2009 y 2011 con una incidencia acumulada de 15,6% y 9,9%. La edad promedio de hospitalización fue 6 meses y más frecuente en hombres. El virus sincital fue aislado con mayor frecuencia en los años de seguimiento, y la mayoría de los casos requirió manejo antibiótico; la ampicilina sulbactam (28,5%) y la ampicilina (22,6%).

Introduction. Bronchiolitis secondary to Respiratory Syncytial Virus, have been associated with recurrent wheezing episodes and development of asthma, even in adulthood. However, the relationship between these pathologies is controversial, and the behavior of this phenomenon in Colombia is not yet known. The aim of this study was to describe the five-year clinical course of children with a history of bronchiolitis who required hospitalization Materials and methods. Descriptive study of a retrospective cohort of children under two years of age, with a diagnosis of Bronchiolitis attended at the University Clinic Colombia in the years 2008 to 2011 with follow-up of hospitalizations for respiratory pathologies up to 2016. 306 patient clinical histories were reviewed and characteristics were analyzed. socio-demographic, viral isolates and pharmacological management. Results. The years with the highest number of hospitalizations for wheezing episodes after the bronchiolitis episode were 2009 and 2011 with an accumulated incidence of 15.6% and 9.9%. The average age of hospitalization was 6 months and more frequent in men. The syncytial virus was isolated more frequently in the years of follow-up, and most of the cases required antibiotic management; ampicillin sulbactam (28.5%) and ampicillin (22.6%).

Primary transcatheter closure of post-myocardial infarction ventricular septal rupture using amplatzer atrial septal occlusion device: A study from tertiary care in South India

Objective The study investigated effectiveness of transcatheter closure of post-myocardial infarction (MI) ventricular septal rupture (VSR) using atrial septal device (ASD) occluder in a cohort of patients admitted at our institute. Method This was a retrospective, observational and single center study, which included patients who were treated with transcatheter closure for post-MI VSR at our tertiary care center between May 2000 and August 2014 depending upon inclusion and exclusion criteria. Primary outcome was all-cause mortality at 30-days follow-up. The MELD-XI (Model for End Stage Liver Disease) score was used as a predictor for poor outcome in these patients. Results A total of 21 patients (mean age 66.4 ± 5.9 years) were included in the study. Study cohort predominantly included male patients (n = 15; 71.4%) and patients with single vessel disease (n = 15; 71.4%). Revascularization of the culprit lesion, before VSR closure, was attempted in 6 patients. Except one patient (treated with Cera® occluder), all patients were treated with Amplatzer® ASD occluders. Average diameter of VSR was 20.8 ± 6.9 mm. Diameter of the device used in the study ranged from 10 mm to 30 mm. Residual defect was detected in 13 patients (62%). All-cause mortality at 30-day follow-up was observed in 9 (42.9%) patients. Time to VSR closure, diameter of VSR, and serum creatinine levels were significantly related to the 30-day mortality. MELD-XI score was found to be strongly associated with increased risk of mortality. Conclusion Primary transcatheter VSR closure using ASD occluders is a feasible approach which can provide reasonable survival outcomes along with equitable mortality rates.

Heliox delivered by high flow nasal cannula improves oxygenation in infants with respiratory syncytial virus acute bronchiolitis / Heliox administrado por cânula nasal de alto fluxo melhora a oxigenação em crianças com bronquiolite aguda por vírus sincicial respiratório

Abstract Objective: The objective of this study is to evaluate the hypothesis that use of heliox would result in improvement of gas exchange when used with high flow nasal cannula in infants with RSV acute bronchiolitis. Methods: All patients that met the inclusion criteria were randomized to either heliox (70:30) or air-oxygen mixture 30% via high flow nasal cannula at 8 L/min for a continuous 24 h. Measurements were taken at baseline, after 2 h, and at the end of the 24 h. Results: This prospective study included 48 patients. After 2 h of treatment with heliox, the oxygen saturation and PaO2 significantly improved when compared with the air-oxygen group, 98.3% vs. 92.9%, 62.0 mmHg vs. 43.6 mmHg (p = 0.04 and 0.01), respectively. Furthermore, PaO2/FiO2 ratio was significantly higher in the heliox group when compared with the air-oxygen group, 206.7 vs. 145.3. Nevertheless, CO2 showed better elimination when heliox was used, without significance. MWCA score dropped significantly in the heliox group, 2.2 points vs. 4.0 points in air-oxygen (p = 0.04), 2 h after starting the therapy. Conclusion: Transient improvement of oxygenation in infants with RSV acute bronchiolitis during the initial phase of the therapy is associated with heliox when provided with HFNC, may provide a precious time for other therapeutic agents to work or for the disease to resolve naturally, avoiding other aggressive interventions.

Resumo Objetivo: Avaliar a hipótese de que o uso da mistura heliox resultaria em melhoria da troca gasosa quando usado com cânula nasal de alto fluxo em crianças com bronquiolite aguda por VSR. Métodos: Todos os pacientes que atenderam aos critérios de inclusão foram randomizados para receber a mistura heliox (70:30) ou a mistura ar/oxigênio a 30% por meio da cânula nasal de alto fluxo a 8 L/min por 24 horas contínuas. As medições foram feitas no início, depois de duas horas e ao fim de 24 horas. Resultados: Fizemos um estudo prospectivo em que foram incluídos 48 pacientes. Após duas horas de tratamento com a mistura heliox, a saturação de oxigênio e a PaO2 apresentaram melhoria significativa em comparação com o grupo da mistura ar/oxigênio: 98,3% em comparação com 92,9%, 62,0 mmHg em comparação com 43,6 mmHg (p = 0,04 e 0,01), respectivamente. Além disso, a relação PaO2/FiO2 era significativamente mais alta no grupo da mistura heliox do que no grupo da mistura ar/oxigênio, 2.067 em comparação com 1.453. Contudo, o CO2 apresentou melhor eliminação quando a mistura heliox foi usada, sem relevância. O Escore MWCA caiu significativamente no grupo da mistura heliox, 2,2 pontos em comparação com 4,0 pontos da mistura ar/oxigênio (p = 0,04) duas horas após o início da terapia. Conclusão: A breve melhoria da oxigenação em crianças com bronquiolite aguda por VSR na fase inicial da terapia está associada à mistura heliox quando administrada pela CNAF e poderá fornecer um tempo precioso para outros agentes terapêuticos funcionarem ou para a própria doença se curar naturalmente e evitar outras intervenções agressivas.

Rapid antigen detection test for respiratory syncytial virus diagnosis as a diagnostic tool / Teste rápido de detecção de antígenos para o diagnóstico do Vírus Sincicial Respiratório como ferramenta de diagnóstico

Abstract Objective: The aim of this study was to evaluate the QuickVue® RSV Test Kit (QUIDEL Corp, CA, USA) as a screening tool for respiratory syncytial virus in children with acute respiratory disease in comparison with the indirect immunofluorescence assay as gold standard. In Brazil, rapid antigen detection tests for respiratory syncytial virus are not routinely utilized as a diagnostic tool, except for the diagnosis of dengue and influenza. Methods: The authors retrospectively analyzed 486 nasopharyngeal aspirate samples from children under age 5 with acute respiratory infection, between December 2013 and August 2014, the samples were analyzed by indirect immunofluorescence assay and QuickVue® RSV Test kit. Samples with discordant results were analyzed by real time PCR and nucleotide sequencing. Results: From 313 positive samples by immunofluorescence assays, 282 (90%) were also positive by the rapid antigen detection test, two were positive only by rapid antigen detection test, 33 were positive only by immunofluorescence assays, and 171 were positive by both methods. The 35 samples with discordant results were analyzed by real time PCR; the two samples positive only by rapid antigen detection test and the five positive only by immunofluorescence assays were also positive by real time PCR. There was no relation between the negativity by QuickVue® RSV Test and viral load or specific strain. The QuickVue® RSV Test showed sensitivity of 90%, specificity of 98.8%, predictive positive value of 99.3%, and negative predictive value of 94.6%, with accuracy of 93.2% and agreement κ index of 0.85 in comparison to immunofluorescence assay. Conclusions: This study demonstrated that the QuickVue® RSV Test Kit can be effective in early detection of Respiratory syncytial virus in nasopharyngeal aspirate and is reliable for use as a diagnostic tool in pediatrics.

Resumo Objetivo: Avaliar o teste QuickVue® RSV Test Kit (QUIDEL Corp, CA, EUA) para o diagnóstico rápido do vírus sincicial respiratório em crianças com doença respiratória aguda, comparandoo com a imunofluorescência indireta como padrão ouro. Visto que, no Brasil, testes rápidos para detecção de antígenos para vírus sincicial respiratório não são rotineiramente utilizados como ferramenta de diagnóstico, exceto para Dengue e Influenza. Métodos: Um total de 486 amostras de aspirado de nasofaringe de crianças menores de 5 anos com doença respiratória aguda, coletadas entre dezembro de 2013 e agosto de 2014, foram analisadas por imunofluorescência e pelo teste QuickVue®. Amostras com resultados discordantes entre os métodos foram submetidas a PCR em tempo real e sequenciamento. Resultados: Das 313 amostras positivas por IFI, 282 foram positivas no teste rápido (90%), 2 amostras foram positivas apenas no teste rápido (0.6%), 33 apenas na imunofluorescência (10.5%) e 171 foram negativas em ambos os métodos. As 35 amostras com resultados discordantes foram testadas por PCR em tempo real, sendo que duas que foram positivas apenas no teste rápido e 5 apenas na imunofluorescência confirmaram-se positivas. Não houve relação entre a ausência de positividade no teste QuickVue® com a carga ou com a cepa viral. O teste QuickVue® mostrou sensibilidade de 90.1%, especificidade 98.9%, valor preditivo positivo 99.3%, valor preditivo negativo de 94.6%, acurácia de 93.2% e índice de concordância de 0.85 em comparação à imunofluorescência. Conclusões: Nosso estudo demonstrou que o teste QuickVue® RSV pode ser efetivo na detecção precoce do vírus sincicial respiratório em amostras de aspirado de nasofaringe e é confiável como uma ferramenta de diagnósticos em pediatria.

Factores de riesgo para infección por Virus Sincicial Respiratorio en Venezuela: Reunión de expertos. Octubre 2013 / Risk factors for Infecction by Respiratory Sincitial Virus in Venezuela: Experts meeting. October 2013

El Virus Sincicial Respiratorio (VSR) es uno de los agentes causales más frecuentes de Infecciones respiratorias en niños menores de 2 años. La forma clínica más frecuente es la bronquiolitis. Dentro de esta población vulnerable son más susceptibles los lactantes que nacieron antes de las 32 semanas de gestación y aquellos portadores de displasia broncopulmonar en tratamiento o cardiopatía congénita cianógena, con insuficiencia cardiaca o hipertensión pulmonar; considerándose también susceptibles los lactantes con anomalías pulmonares, enfermedades neuromusculares, fibrosis quística o inmunosupresión severa. El VSR produce cambios inflamatorios crónicos que implican secuelas a corto, mediano y largo plazo. La prevención ha demostrado ser la mejor medida para reducir las complicaciones y costos de la enfermedad y, en este sentido, la profilaxis con Palivizumab es efectiva en los lactantes de riesgo para infección severa por VSR. El siguiente artículo tiene como finalidad establecer los criterios para la profilaxis con Palivizumab.

Respiratory syncytial virus (RSV) is one of the most common causative agents of respiratory infections in children under 2 years of age. The most common clinical form is bronchiolitis. Within this vulnerable population, infants born before 32 weeks gestation and those with bronchopulmonary dysplasia or with cyanotic congenital heart disease, heart failure or pulmonary hypertension are more susceptible; infants with lung anomalies, neuromuscular diseases, cystic fibrosis or severe immunosuppression are also at risk. RSV causes chronic inflammatory changes that lead to short, medium and long term sequelae. Prevention has proven to be the best measure to reduce complications and costs and palivizumab prophylaxis has been effective in infants at risk. The following article aims to review the risk factors involved in infection by respiratory syncytial virus and establish the criteria for prophylaxis with palivizumab.

Comparison of modifications of intra-abdominal fat between low calorie diet alon and low calorie diet with exercise in Korean women

BACKGROUND: Obesity and its complicatians are increasing as social ecanamic standard of living is improving and life style has been changing in Korea. There is growing evidence that the visceral/subcutaneous adipose tissue area ratio (VSR) on computed tomography (CI) is closely related to the obesity camplications. Therefore, it is important to determine whether the VSR reduction is praduced during weight loss. The purpose of this study was to observe and campare the amount of reduction of intraabdaminal fat between low calorie diet (LCD) alane and LCD with exercise. METHODS: Sixty obese females were randomly prescribed a LCD alone or a LCD with exercise. Thirty obese females were treated with a LCD of 1,000kcal/d for 8 weeks (group A). Another thirty obese females were treated with a LCD of 1,000kcal/d combined with supervised aerobic exercise for 8 weeks (group B). Weight, height, BMI, and body fat distribution were measured in all subjects immediately before and after 8 weeks of this study. The body fat distribution was assessed by CT, by which the total abdaminal adipose tissue area (AT), subcutaneous abdominal adipose tissue (SAT), intra-abdominal adipose tissue (VAT), and visceral/subcutaneous adipose tissue area ratio (VSR) were measured at the level of the umbilicus. A venous blood sample was taken after an overnight fast to determine lipid, glucose, and insulin concentrations in all subjects before and after 8 weeks of this study. RESULTS: Body weight, BMI, CI' measurement of total (AT), visceral (VAT), and subcutaneous (SAT) fat were found to be decreased significantly in the two groups. The VSR of the group A did not change after weight loss. In contrast, the VSR of the group B decreased significantly (P<0.05) during weight loss. Fasting plasma glucose and total cholesterol levels significantly decreased in the both groups (P<0.001). Fasting plasma insulin and triglyceride levels significantly decreased in the group B, but not in group A. CONCLUSIONS: This study shows that the VSR decreased significantly in group B, but not in group A. Fasting plasma insulin and triglyceride levels decreased significantly in group B, but not in group A. These results suggest that the LCD with exercise is more effective in reducing expected complications of obesity than LCD alone.