Juvenile polyposis syndrome: A case report.

INTRODUCTION: Juvenile polyposis syndrome it is an uncommon autosomal dominant inherited condition. Hamartomatous polyps can affect the entire gastrointestinal tract but usually predominates in the colon. We introduce a case of juvenile polyposis syndrome presented with massive gastric polyposis that requires a total gastrectomy. CASE PRESENTATION: A 22-year-old man presented symptoms of chronic upper gastrointestinal bleeding. Gastroscopy showed massive gastric polyposis. Initially endoscopic polypectomy was performed, but due to the progressive symptoms, a total gastrectomy was then performed. Histology confirmed massive gastric juvenile polyposis. CONCLUSION: Massive gastric polyposis it is an uncommon manifestation of juvenile polyposis syndrome.

Microgeographic variation in recruitment under adult trees: arrival of new genotypes or perpetuation of the existing ones?

Investigating spatial variation in the relative importance of sexual reproduction and clonal propagation is critical to obtain more accurate estimates of future effective population sizes and genetic diversity, as well as to identify ecological correlates of clonality. We combined a stratified sampling scheme with microsatellite genetic analyses to estimate variation in the proportion of sexual versus clonal recruits among saplings in five populations of the tree Pyrus bourgaeana. Using a likelihood framework, we identified clones among the genotypes analysed and examined variation among populations regarding the proportion of saplings coming from clonal propagation. We also examined the relationship between the relative abundance of clonal shoots across the studied populations and their herbivory levels. Our results revealed that one third of the saplings examined (N = 225 saplings) had a probability above 0.9 of being clones of nearby (<10 m) trees, with the ratio between clonal propagation and sexual recruitment varying up to eight-fold among populations. A small portion of these putative clonal shoots reached sexual maturity. Relative abundance of clonal shoots did not significantly relate to the herbivory by ungulates. Our results call into question optimistic expectations of previous studies reporting sufficient levels of recruitment under parental trees without animal seed dispersal services. Nevertheless, given that some of these clonal shoots reach sexual maturity, clonal propagation can ultimately facilitate the long-term persistence of populations during adverse periods (e.g. environmental stress, impoverished pollinator communities, seed dispersal limitation).

The landscape of fear: Why some free-ranging rodents choose repeated live-trapping over predation risk and how it is associated with the physiological stress response.

Live trapping is an essential element of field ecological studies. However, the act of trapping provides two types of conditional benefits (food from the bait when hungry, and refuge from a predator when threatened) against one type of drawback (confinement). Our understanding of how animals assess the two benefits against the lone risk determines how we interpret classic field studies in chemical ecology and wildlife management. Here, we studied wood mice responses to these risks and rewards of field trapping by examining experience through recapture and faecal corticosterone metabolites (FCM) as a physiological response indicator. Wood mice were live-trapped in two different plots subjected to two distinct phases: phase 1, absence of predator cues, and phase 2, in which traps were treated with red fox faeces. During phase 1, the recapture percentage was lower indicating that mice avoided traps while FCM levels in recaptured mice were higher. On the contrary, during phase 2, despite the total number of captures was lower we found an increase in the recapture percentage and FCM levels did not increase in recaptured mice. Our results suggest that under increased risk perception traps could be likely considered as a suitable shelter and thus, for some individuals the benefits of traps may outweigh their risks. In addition, we discovered that the effects of combining two stressors do not result in the addition of the response originated by each factor separately.

[Adult hepatoblastoma. A case report]. / Hepatoblastoma del adulto. Presentación de un caso.

Adult hepatoblastoma is a rare pathology. Its pathogeny is not well understood and prognosis is very bad. We pre-sent a case of adult hepatoblastoma treated in our centre. A 65 year-old male, without previous hepatopathy, who consulted due to right hypochondrial pain with a subacute evolution. The pathological diagnosis was adult epithelial hepatoblastoma, with free surgical margins. The patient recei-ved a second surgical intervention 5 months later due to early recurrence and died 10 months after the diagnosis due to a new massive recurrence. His definitive diagnosis is histological. Radical surgery is the only treatment that increases survival, but recurrence is frequent. There are no well-defined patterns of adjuvant chemotherapy nor is there any trans-plant experience.

Hepatoblastoma del adulto. Presentación de un caso / Adult hepatoblastoma. A case report

El hepatoblastoma del adulto es una patología inusual, de patogenia no bien conocida y de muy mal pronóstico. Presentamos un caso de hepatoblastoma del adulto tratado en nuestro centro. Varón de 65 años, sin hepatopatía previa, que consulta por dolor en hipocondrio derecho de evolución subaguda. El diagnóstico anatomopatológico fue hepatoblastoma epitelial del adulto, con bordes quirúrgicos libres. Fue reintervenido 5 meses después por recidiva precoz y falleció 10 meses después del diagnóstico por nueva recidiva masiva. Su diagnóstico definitivo es histológico. La cirugía radical ofrece el único tratamiento que aumente la supervivencia, pero frecuentemente recidiva. No existen pautas bien definidas de quimioterapia adyuvante, ni experiencia en trasplante (AU)

Adult hepatoblastoma is a rare pathology. Its pathogeny is not well understood and prognosis is very bad. We present a case of adult hepatoblastoma treated in our centre. A 65 year-old male, without previous hepatopathy, who consulted due to right hypochondrial pain with a subacute evolution. The pathological diagnosis was adult epithelial hepatoblastoma, with free surgical margins. The patient received a second surgical intervention 5 months later due to early recurrence and died 10 months after the diagnosis due to a new massive recurrence. His definitive diagnosis is histological. Radical surgery is the only treatment that increases survival, but recurrence is frequent. There are no well-defined patterns of adjuvant chemotherapy nor is there any transplant experience (AU)

[Epithelioid angiosarcoma of the gallbladder. Case report and review of the literature]. / Angiosarcoma epitelioide de vesícula.

Angiosarcoma of the gallbladder is an infrequent pathology but has a high morbidity and mortality. There are only 10 references in the international literature. We present a case treated in our center and we review the cases published since 1956. An 81 year-old male patient with abdominal pain, asthenia and dyspnea. Analytically anemia and leukocytosis. Exploration found a distended abdomen, right hypochondrium pain, with defense. Abdominal echography and a CT were requested with a diagnosis of acute cholecystitis and he was admitted for antibiotic treatment. The patient did not evolve favorably and was subjected to emergency surgery, which found a haemoperitoneum and a gallbladder with a tumoral appearance that could not be totally extirpated. He died 20 days after the operation. The report from pathological anatomy was compatible with epithelioid angiosarcoma of the biliary gallbladder. Gallbladder angiosarcoma is a neoplasia with a bad prognosis, whose clinical presentation can be mistaken for acute cholecystitis. Improving the prognosis of this disease involves carrying out early diagnosis and surgical treatment.

Angiosarcoma epitelioide de vesícula. Presentación de un caso y revisión bibliográfica / Epithelioid angiosarcoma of the gallbladder. Case report and review of the literature

El angiosarcoma de vesícula es una patología poco frecuente pero con una alta morbi-mortalidad del que sólo hay 10 referencias en la literatura internacional. Presentamos un caso tratado en nuestro centro y realizamos una revisión de los casos publicados desde 1956. Paciente varón de 81 años con dolor abdominal, astenia y disnea. Analíticamente anemia y leucocitosis. En la exploración destacaba un abdomen distendido, doloroso en hipocondrio derecho, con defensa. Se solicitó ecografía abdominal y un TC con diagnóstico de colecistitis aguda y se ingresó para tratamiento antibiótico. El paciente no evolucionó favorablemente y se intervino de urgencia hallando un hemoperitoneo y una vesícula de aspecto tumoral que no se pudo extirpar en su totalidad. Falleció a los 20 días de la intervención. El informe de anatomía patológica fue compatible con angiosarcoma epiteloide de vesícula biliar. El angiosarcoma de vesícula es una neoplasia de mal pronóstico, cuya presentación clínica puede confundirse con la colecistitis aguda. Conseguir mejorar el pronóstico de esta enfermedad pasa por realizar un diagnóstico y tratamiento quirúrgico precoces (AU)

Angiosarcoma of the gallbladder is an infrequent pathology but has a high morbidity and mortality. There are only 10 references in the international literature. We present a case treated in our center and we review the cases published since 1956. An 81 year-old male patient with abdominal pain, asthenia and dyspnea. Analytically anemia and leukocytosis. Exploration found a distended abdomen, right hypochondrium pain, with defense. Abdominal echography and a CT were requested with a diagnosis of acute cholecystitis and he was admitted for antibiotic treatment. The patient did not evolve favorably and was subjected to emergency surgery, which found a haemoperitoneum and a gallbladder with a tumoral appearance that could not be totally extirpated. He died 20 days after the operation. The report from pathological anatomy was compatible with epithelioid angiosarcoma of the biliary gallbladder. Gallbladder angiosarcoma is a neoplasia with a bad prognosis, whose clinical presentation can be mistaken for acute cholecystitis. Improving the prognosis of this disease involves carrying out early diagnosis and surgical treatment (AU)

Sex-specific phenotypic selection and geographic variation in gender divergence in a gynodioecious shrub.

In sexually polymorphic plant species the extent of gender divergence in floral morphology and phenology may be influenced by gender-specific selection patterns imposed by pollinators, which may change geographically. Distribution margins are areas where changes in the pollinator fauna, and thus variation in gender divergence of floral traits, are expected. We tested for pollination-driven geographic variation in the gender divergence in floral and phenological traits in the gynodioecious shrub Daphne laureola, in core and marginal areas differing in the identity of the main pollinator. Pollinators selected for longer corolla tubes in hermaphrodite individuals only in core populations, which in turn recorded higher fruit set. Consistent with these phenotypic selection patterns, gender divergence in flower corolla length was higher in core populations. Moreover, pollinators selected towards delayed flowering on hermaphrodite individuals only in marginal populations, where the two sexes differed more in flowering time. Our results support that a shift in main pollinators is able to contribute to geographic variation in the gender divergence of sexually polymorphic plant species.

NKG2C gene deletion in the Mexican population and lack of association to respiratory viral infections.

Expansion of a natural killer (NK) cell population that expresses NKG2C has been associated with cytomegalovirus and other viral infections. It has been suggested that this cell population may play a role in infection control. Deletion of the NKG2C gene (homozygous or heterozygous) has been reported with high prevalence in European and Asian populations. However, the effect of NKG2C genotype on NK cell responses to infection remains poorly defined. We determined the prevalence of the NKG2C deletion in a Mexican population (n = 300) and in a group of patients (n = 131) to assess whether NKG2C genotype affects the incidence of symptomatic viral infections caused by influenza or respiratory syncytial virus. The frequency of the NKG2C deletion haplotype in Mexican mestizos was significantly lower (10.3%) than that reported in other populations (17.5-21.9%). No difference in the prevalence of NKG2C deletion was observed in subjects with viral infections compared with the reference population. In addition, no differences in clinical characteristics and infection outcome were observed between patients with and without the NKG2C gene deletion. Our results indicate that copy number variation in the NKG2C gene has no impact on the severity of respiratory viral infections.

Prolactin fractions from lactating rats elicit effects upon sensory spinal cord cells of male rats.

Recently it has been suggested that the neurohormone prolactin (PRL) could act on the afferent nociceptive neurons. Indeed, PRL sensitizes transient receptor potential vanilloid 1 (TRPV1) channels present in nociceptive C-fibers and consequently reduces the pain threshold in a model of inflammatory pain. Accordingly, high plasma PRL levels in non-lactating females have been associated with several painful conditions (e.g. migraine). Paradoxically, an increase of PRL secretion during lactation induced a reduction in pain sensitivity. This difference could be attributed to the fact that PRL secreted from the adenopituitary (AP) is transformed into several molecular variants by the suckling stimulation. In order to test this hypothesis, the present study set out to investigate whether PRL from AP of suckled (S) or non-suckled (NS) lactating rats affects the activity of the male Wistar wide dynamic range (WDR) neurons. The WDR neurons are located in the dorsal horn of the spinal cord and receive input from the first-order neurons (Ab-, Ad- and C-fibers). Spinal administration of prolactin variant from NS rats (NS-PRL) or prolactin variant from S rats (S-PRL) had no effect on the neuronal activity of non-nociceptive Ab-fibers. However, the activities of nociceptive Ad-fibers and C-fibers were: (i) increased by NS-PRL and (ii) diminished by S-PRL. Either NS-PRL or S-PRL enhanced the post-discharge activity. Taken together, these results suggest that PRL from S or NS lactating rats could either facilitate or depress the nociceptive responses of spinal dorsal horn cells, depending on the physiological state of the rats.

Long-term results of electrical stimulation of the lower esophageal sphincter for the treatment of gastroesophageal reflux disease.

BACKGROUND AND STUDY AIMS: In patients with gastroesophageal reflux disease (GERD), temporary electrical stimulation of the lower esophageal sphincter (LES) increases LES pressure without interference with LES relaxation. The aim of the current study was to investigate the safety and efficacy of long term LES electrical stimulation therapy (LES-EST), using a permanently implanted stimulator for the treatment of GERD. PATIENTS AND METHODS: Patients with GERD who were at least partially responsive to proton pump inhibitors (PPIs) and who had hiatal hernia of ≤ 3 cm and esophagitis of Los Angeles Grade A, B, or C were included in the study. Stimulation electrodes were placed in the LES and a pulse generator (EndoStim LES Stimulation System; EndoStim BV, The Hague, The Netherlands) was implanted laparoscopically. LES stimulation was delivered at 20 Hz, 215 µs, 3 - 8 mA in multiple 30-minute sessions. Patients were evaluated at follow-up using the GERD Health-Related Quality of Life (HRQL) questionnaire, daily symptom and medication diaries, the SF-12 Health Survey, esophageal pH testing, and high resolution manometry. RESULTS: A total of 24 patients (mean age 53 ± 12 years; 14 men) were implanted and 23 completed the 12-month evaluation. No serious implantation or stimulation-related adverse affects or sensations were reported. Median composite GERD-HRQL score at 12 months was 2.0 (interquartile range [IQR] 0 - 3.0), which was significantly better than baseline scores both on PPI therapy (median 9.0, IQR 6.0 - 10.0; P = 0.002) and off PPIs (median 23.5, IQR 21 - 25.75; P < 0.001). The median percentage of the 24-hour period with esophageal pH < 4.0 at baseline was 10.1 % (IQR 7.7 - 15.5), which was reduced to 3.3 % (1.8 - 6.9) at 12 months (P < 0.001), with 69 % of patients showing either normalization or > 50 % improvement in their distal esophageal pH. At 12 months, 96 % of patients (22/23) were completely off PPI medication. CONCLUSION: During the long term follow-up of 12 months, LES - EST was safe and effective for the treatment of GERD. There was a significant and sustained improvement in GERD symptoms, reduction in esophageal acid exposure with elimination of daily PPI usage, and no stimulation-related adverse effects.

Differentiation of mangoes (Magnifera indica L.) conventional and organically cultivated according to their mineral content by using support vector machines.

Mangoes of uniform genetics (Lippens variety) cultivated in the Gomera Island (Canary Islands) by conventional and organic farming were used to analyze the mineral content in order to differentiate crops cultivated in the same geographic area by the cultivation practices. Farming differences as well as soil differences may be reflected in the mineral content of the mangoes cultivated in these extensions. Concentration metal profiles consisting of the content of Ca, Co, Cu, Fe, K, Mg, Mn, Na, Ni and Zn in mangoes were obtained by using atomic absorption spectrometry (AAS). Pattern recognition classification procedures were applied for discriminating purposes. Linear discriminant analysis (LDA) allows to a classification performance of about 73% and support vector machines (SVM) found up to a 93% of prediction ability. The classification success when applying support vector machines techniques is due to their ability for modeling non-linear class boundaries.

Palm tree syrup: nutritional composition of a natural edulcorant.

INTRODUCTION: Palm syrup is a typical product from the Canary Islands, traditionally produced from the sap of the tropical palm tree Phoenix canariensis. Its high caloric content has led to its increasing use as a health food supplement for athletes, children and elderly. Furthermore, demand for this natural syrup is continuously increasing due also to its medicinal uses in homeopathic medicine. OBJECTIVE: Palm Tree syrup samples prepared with palm sap from primary producers in La Gomera island (Canary Islands, Spain) were analyzed for their nutritional composition (moisture, ash, sugars, fat, vitamins and minerals). METHODS: 35 syrup samples from five different producing regions in La Gomera island were analyzed. High-performance liquid chromatography (HPLC) was used to determine sugars and vitamins and Flame Atomic Absorption Spectrophotometry (FAAS) was used to analyze the minerals. RESULTS: Major carbohydrates were sucrose (37.8%), glucose (9.50%) and fructose (4.80%), respectively. The presence of arabinose could not be confirmed. Niacin was the water-soluble vitamin with the highest concentration with an average content of 0.003%. Fat content was found to be under 0.20%. Potassium was the mineral with highest contents (0.45%). CONCLUSIONS: Results suggest that palm tree syrup can play an important role as a sugar and mineral source in human nutrition, suggesting that future applications for this product could be developed.

Palm tree syrup; nutritional composition of a natural edulcorant / Miel de palma; composición nutricional de un edulcorante natural

Introduction: Palm syrup is a typical product from the Canary Islands, traditionally produced from the sap of the tropical palm tree Phoenix canariensis. Its high caloric content has led to its increasing use as a health food supplement for athletes, children and elderly. Furthermore, demand for this natural syrup is continuously increasing due also to its medicinal uses in homeopathic medicine. Objective: Palm Tree syrup samples prepared with palm sap from primary producers in La Gomera island (Canary Islands, Spain) were analyzed for their nutritional composition (moisture, ash, sugars, fat, vitamins and minerals). Methods: 35 syrup samples from five different producing regions in La Gomera island were analyzed. High-performance liquid chromatography (HPLC) was used to determine sugars and vitamins and Flame Atomic Absorption Spectrophotometry (FAAS) was used to analyze the minerals. Results: Major carbohydrates were sucrose (37.8%), glucose (9.50%) and fructose (4.80%), respectively. The presence of arabinose could not be confirmed. Niacin was the water-soluble vitamin with the highest concentration with an average content of 0.003%. Fat content was found to be under 0.20%. Potassium was the mineral with highest contents (0.45%). Conclusions: Results suggest that palm tree syrup can play an important role as a sugar and mineral source in human nutrition, suggesting that future applications for this product could be developed (AU)

Introducción: La miel de palma es un producto típico de las Islas Canarias, tradicionalmente producido a partir de la savia de la palmera Phoenix canariensis. El alto contenido calórico lo convierte en un producto cada vez más utilizado como suplemento alimenticio para atletas, niños y mayores. Además, la demanda de este sirope natural, está en constante crecimiento debido también a sus usos medicinales en la medicina homeopática. Objetivo: Analizar la composición nutricional (humedad, cenizas, azúcares, grasa, vitaminas y minerales) de las muestras de miel de palma preparadas con la savia de las palmeras de los productores de la isla de La Gomera (Islas Canarias, España). Métodos: 35 muestras de miel de palma procedentes de cinco regiones productoras de la isla de La Gomera fueron analizadas. Los azúcares y las vitaminas fueron medidos mediante cromatografía líquida de alta resolución (CLAR) y la espectrofotometría de absorción atómica por llama (FAAS) se usó para determinar los minerales. Resultados: Los hidratos de carbono mayoritarios fueron sacarosa (37,8%), glucosa (9,50%) y fructosa (4,80%), respectivamente. La presencia de arabinosa no pudo ser confirmada. La niacina es la vitamina hidrosoluble con la mayor concentración con un contenido promedio de 0,003%. Los contenidos en grasas se encontraron por debajo de 0,20%. El potasio era el macroelemento con los contenidos más altos (0,45%). Conclusiones: Los resultados sugieren que la miel de palma puede jugar un papel importante como una fuente de azúcar y minerales en la nutrición humana y se pueden desarrollar futuras aplicaciones para este producto (AU)

Genetic structure of the shrub Daphne laureola across the Baetic Ranges, a Mediterranean glacial refugium and biodiversity hotspot.

Distribution margins constitute areas particularly prone to random and/or adaptive intraspecific differentiation in plants. This trend may be particularly marked in species discontinuously distributed across mountain ranges, where sharp geographic isolation gradients and habitat boundaries will enhance genetic isolation among populations. In this study, we analysed the level of neutral genetic differentiation among populations of the long-lived shrub Daphne laureola (Thymelaeaceae) across the Baetic Ranges, a glacial refugium and biodiversity hotspot in the western Mediterranean Basin. Within this area, core and marginal populations of D. laureola were compared with regard to their spatial isolation, size, genetic diversity and differentiation. A spatially explicit analysis conducted on the vast majority of the species' known populations in the study area (N = 111) showed that marginal populations (western and eastern) present larger spatial isolation than core populations, but are not smaller. We compared genetic diversity and differentiation between core and marginal populations using a subsample of 15 populations and 225 amplified fragment length polymorphism (AFLP) markers. Core and marginal populations did not differ in genetic diversity, probably because of the occurrence of large populations on the local margins. Western populations were strongly differentiated from the other populations. In addition, spatial and genetic differentiation among populations was larger on the western margin. Eastern populations constituted a genetically homogeneous group closely related to core populations, despite their greater spatial isolation. Results suggest that studies on phenotypic differentiation between core and marginal populations of D. laureola, and presumably other species having discontinuous distributions across the Baetic ranges, should take into account geographical differences in levels of genetic differentiation between the different distribution borders.

La extrusión del dacron subcutáneo como tratamiento de la infección crónica del orificio de salida del catéter de diálisis peritoneal / No disponible

No disponible

Modelo de unidad de gestión clínica interniveles: Hospital Juan Ramón Jiménez de Huelva / The inter-level clinical management unit: the Hospital Juan Ramón Jiménez de Huelva

Planteamos un nuevo modelo organizativo de rehabilitación en atención primaria, consistente en formar una unidad de gestión clínica interniveles, esto es, agrupando en el mismo ámbito todos los recursos, materiales y humanos, relativos a rehabilitación, tanto de atención primaria como de atención especializada. Presentamos la unidad de gestión clínica interniveles constituida por el Servicio de Rehabilitación del Hospital Juan Ramón Jiménez de Huelva, las salas periféricas de fisioterapia de su área de influencia, correspondientes a los distritos sanitarios de atención primaria Huelva-Costa y Condado-Campiña, y el equipo móvil de rehabilitación domiciliaria. Tras un año de funcionamiento, podemos ofrecer los resultados asistenciales, de consecución de objetivos y de política de calidad de la unidad. La unidad de gestión clínica interniveles de rehabilitación de Huelva, como nuevo modelo organizativo que establece una relación directa entre atención primaria y atención especializada, nos ha aportado beneficios en cuanto a la continuidad asistencial, optimización de recursos y mejora de la calidad de la atención a nuestros pacientes (AU)

We propose a new organizational model for rehabilitation in primary care, consisting of the creation of an interlevel clinical management unit, i.e., grouping all the material and human resources related to rehabilitation in primary and specialized care in the same area. We present the interlevel clinical management unit, which was established by the Rehabilitation Department of the Juan Ramón Jiménez Hospital in Huelva, the peripheral physical therapy areas in its catchment area, corresponding to the distinct primary care health districts in the coastal and inland regions of Huelva, and the mobile home rehabilitation team. The 1-year results on the activity, achievement of goals, and quality policy of the unit are presented. Our interlevel clinical management unit, a new organizational model that establishes a direct relationship between primary and specialized care, provides benefi ts in terms of continuity of care, resource optimization and improved healthcare quality (AU)

Cys mutants in functional regions of Sticholysin I clarify the participation of these residues in pore formation.

Experimental evidence shows that the mechanism of pore formation by actinoporins is a multistep process, involving binding of the water-soluble monomer to the membrane and subsequent oligomerization on the membrane surface, leading to the formation of a functional pore. However, as for other eukaryotic pore-forming toxins, the molecular details of the mechanism of membrane insertion and oligomerization are not clear. In order to obtain further insight with regard to the structure-function relationship in sticholysins, we designed and produced three cysteine mutants of recombinant sticholysin I (rStI) in relevant functional regions for membrane interaction: StI E2C and StI F15C (in the N-terminal region) and StI R52C (in the membrane binding site). The conformational characterization derived from fluorescence and CD spectroscopic studies of StI E2C, StI F15C and StI R52C suggests that replacement of these residues by Cys in rStI did not noticeably change the conformation of the protein. The substitution by Cys of Arg5² in the phosphocholine-binding site, provoked noticeable changes in rStI permeabilizing activity; however, the substitutions in the N-terminal region (Glu², Phe¹5) did not modify the toxin's permeabilizing ability. The presence of a dimerized population stabilized by a disulfide bond in the StI E2C mutant showed higher pore-forming activity than when the protein is in the monomeric state, suggesting that sticholysins pre-ensembled at the N-terminal region could facilitate pore formation.

[Invasive pneumococcal pneumonia in children 0-24 months old: does bacterial resistance affect outcome]. / Neumonía neumocócica invasiva en niños de 0 a 24 meses: influye la resistencia bacteriana en la evolución?

INTRODUCTION: In Uruguay community acquired bacterial pneumonia is a significant cause of morbidity and mortality. S. pneumoniae is the most frequent agent. The disease is more severe in children less than two years old. The relationship between pneumococcal penicillin resistance and outcome is still an unresolved problem. OBJECTIVES: To compare the outcome of children 0 to 24 months old hospitalized in the Hospital Pediátrico-Centro Hospitalario Pereira Rossell, with invasive pneumococcal pneumonia caused by S. pneumoniae susceptible and resistant to penicillin. PATIENTS AND METHODS: Children 0 to 24 months old with invasive pneumococcal pneumonia, admitted between January 1st 1998 and December 31st 2005 were included. Susceptibility to penicillin was defined as a MIC < 0.06 microg/ml, reduced susceptibility was defined as a MIC of 0.1 to 1 microg/ml (intermediate) and as a MIC >or= 2 microg/ml (resistant). Outcome was evaluated with the following criteria: empyema, sepsis, septic shock, mechanical ventilation, and death. Length of hospital stay and outcome were compared in both groups. RESULTS: Inclusion criteria were met by 168 children. S. pneumoniae was susceptible to penicillin in 90 children and with reduced susceptibility in 78. Both groups were similar in age, comorbidity, nutritional status and initial antibiotic treatment. There were no significant differences in outcome and length of hospital stay. CONCLUSIONS: S. pneumoniae resistance to penicillin did not affect the outcome of pneumonia in this group of children.