Evolución de la función pulmonar en niños con asma grave en tratamiento con omalizumab / Lung function evolution in children with severe asthma treated with omalizumab

Introducción: Omalizumab es un anticuerpo monoclonal frente a la inmunoglobulina E utilizado en el tratamiento del asma alérgica grave. El objetivo de este estudio fue describir el efecto de omalizumab sobre los valores de la función pulmonar y la fracción exhalada de óxido nítrico (FeNO) en pacientes pediátricos. Material y métodos: Análisis estadístico de la función pulmonar y de la FeNO en los 13 niños tratados con omalizumab en el servicio de pediatría de un hospital terciario entre los años 2010 y 2016. Resultados: Se observa una mejoría estadísticamente significativa a los 3 meses de tratamiento que se mantiene estable en el tiempo, tanto en valores de función pulmonar (pretratamiento: capacidad vital forzada [FVC] 84,1% y volumen espiratorio forzado en el primer segundo [FEV1] 72%; postratamiento: FVC 101% [p= 0,02] y FEV1 92% (p= 0,01) como en la FeNO (pretratamiento: 82 ppb; postratamiento: 36 ppb). Conclusiones: En nuestros pacientes pediátricos con asma grave, omalizumab es capaz de mejorar y mantener estable en el tiempo la función pulmonar y disminuir el valor de la FeNO

Introduction: Omalizumab is a monoclonal antibody against immunoglobulin E used in the treatment of severe allergic asthma. The aim of this study was to describe, in pediatric patients, the effects of omalizumab in pulmonary function values and in the nitric oxide concentration levels in exhaled breath (FeNO). Material and methods: We performed a statistical analysis of lung function and FeNO evolution in 13 children treated with omalizumab in a pediatric service, between year 2010 and 2016. Results: A statistically significant improvement was observed after 3 months of treatment, which remained stable over time, in lung function values (pre-treatment: forced vital capacity [FVC] 84.1% and forced expiratory volume in the first second [FEV1] 72%; after treatment: FVC 101% [p= 0.02] and FEV1 92% [p= 0.01]). A significant improvement was also detected in the FeNO levels (pre-treatment: 82 ppb; after treatment: 36 ppb). Conclusions: In our pediatric patients with severe asthma, omalizumab was able to improve and maintain stable in time both pulmonary function and FeNO values

Relación entre el consumo de productos lácteos y las enfermedades respiratorias sibilantes en escolares / Relationship between lactic product ingestion and wheezing respiratory diseases in school children

Introducción: Los lácteos son alimentos importantes para el desarrollo, pero muchos padres limitan su consumo para evitar enfermedades respiratorias a pesar de que no existe evidencia científica concluyente al respecto. El objetivo de este estudio es estudiar si el consumo de leche y derivados lácteos se asocia con enfermedades respiratorias sibilantes (asma, síndrome de obstrucción bronquial recurrente, sibi-lancias) en escolares. Material y método: Estudio transversal dentro de la co-horte SENDO. La información sobre el consumo de lácteos se obtuvo mediante cuestionario semicuantitativo de frecuen-cia de consumo de alimentos. Los participantes se dividieron a partir de la mediana de consumo. El diagnóstico de enfer-medades sibilantes referido en los cuestionarios se confirmó mediante revisión de los registros médicos digitalizados. Para estudiar la asociación del consumo de leche, queso, yogur y de los lácteos en conjunto con las enfermedades sibilantes se utilizó un test de regresión logística ajustado por posibles factores de confusión. Resultados: En la muestra de 170 escolares (55,9% niñas, edad media 6,1 años) no se encontró una asociación significativa entre el consumo de lácteos en conjunto y las enfermedades sibilantes estudiadas [OR 0,85; IC 95% (0,44-1,64)]. Al analizar cada alimento por separado (le-che, yogur y queso), se encontró que un mayor consumo de leche se asociaba con un menor riesgo de enfermedades sibilantes. Conclusiones: Los resultados no apoyan la existencia de una asociación directa entre el consumo de leche o derivados lácteos y el riego de enfermedades sibilantes

Background: Milk consumption is important in child development, but some parents are avoiding dairy products as a way to prevent respiratory diseases in their children, even though there is no scientific evidence in this regard. Objective: To examine the association between dairy products consumption and wheezing respiratory diseases (asthma, recurrent wheezing episodes) in school-age chil-dren. Materials and methods: Cross-sectional study within SENDO project. Dairy products consumption was assessed through a semiquantitative food frequency questionnaire (FFQ). Participants were divided based on the median of consumption. Wheezing diseases diagnose referred by pa-rents in the questionnaires was confirmed by medical records review. A logistic regression test, adjusted for possible-con-founding factors was used to study the association between dairy products (milk, cheese, and yoghurt) and wheezing diseases.Results. In the 170 participants included (55.9% girls, mean age 6.1 years), no significant association was found between dairy products consumption and the respiratory di-seases studied [OR 0.85, 95% CI (0.44-1.64)]. When analy-sed separately a higher consumption of milk was associated with a lower risk of wheezing diseases. Conclusions: The results do not support the association between dairy products consumption and an increased risk of wheezing respiratory diseases

[Comparison of clinical features and diagnosis between the A and B subgroups of respiratory syncytial virus.] / Comparación de las características clínicas y diagnósticas de los subgrupos A y B del virus respiratorio sincitial.

BACKGROUND: Lower respiratory tract infection by respiratory syncytial virus (RSV) is the most frequent cause of admission in children under 2 years old. The RSV subgroups A and B may circulate simultaneously. We aimed to determine whether clinical differences exist between RSV subgroups A and B. Additionally, we tested the sensitivity of the rapid antigen detection test (RADT) based on immunochromatography in diagnosing subgroups A and B, taking the polymerase chain reaction assay (RT-PCR) as reference. METHODS: A retrospective observational study was performed in a tertiary hospital from October 2013 to March 2014. Clinical records and analytical variables of all children under 5 admitted with lower respiratory tract infection and RT-PCR positive for RSV in nasal lavage were consulted. Previously, the RADT for RSV had been performed from the same sample. RESULTS: A total of 198 children under 5 were diagnosed with RSV by RT-PCR: 55 (28%) were RSV-A, 132 (67%) RSV-B and 11 (5%) were positive for both subgroups. No differences were observed between subgroups in medical history, symptoms, radiological and analytical findings, and severity. The sensitivity of RADT for RSV was 52%, higher for RSV-A (69%) than for RSV-B (44%, p=0.001). CONCLUSIONS: The two RSV subgroups were indistinguishable in symptoms and prognosis. The sensitivity of RADT compared to RT-PCR was low and limits its usefulness for clinical decision-making. Key words. Respiratory syncytial virus. RSV subgroups. Rapid antigen detection test. Reverse transcription polymerase chain reaction.

Comparación de las características clínicas y diagnósticas de los subgrupos A y B del virus respiratorio sincitial / Comparison of clinical features and diagnosis between the A and B subgroups of respiratory syncytial virus

Fundamento: La infección del tracto respiratorio inferior por virus respiratorio sincitial (VRS) es la causa más frecuente de ingreso en menores de 2 años. Los subgrupos de VRS A y B pueden circular indistintamente. Nuestro objetivo fue determinar si existían diferencias clínicas entre los VRS subgrupo A y B, y si la sensibilidad del test de detección rápida de antígeno del VRS por inmunocromatografía difiere de la técnica de referencia (RT-PCR). Material y métodos: Estudio retrospectivo, observacional realizado en el hospital terciario desde octubre de 2013 a marzo de 2014. Se consultó la historia clínica y las analíticas de los niños menores de 5 años ingresados en por infección respiratoria de vías bajas con RT-PCR positivo a VRS en una muestra de lavado nasal. De la misma muestra previamente se había realizado el test de detección rápida de antígeno de VRS. Resultados: Se confirmaron 198 niños menores de 5 años para VRS mediante RT-PCR: 55 (28%) fueron VRS-A, 132 (67%) VRS-B y 11 (5%) fueron positivos para ambos subgrupos. No encontramos diferencias entre subgrupos en antecedentes, clínica, radiología, analítica y gravedad. La sensibilidad del test de detección rápida fue 52%, mayor para VRS-A (69%) que para VRS-B (44%, p=0,001). Conclusiones: Los dos subgrupos de VRS fueron indistinguibles por su presentación clínica y pronóstico. La sensibilidad del test rápido en comparación con la RT-PCR fue baja, lo que limita su utilidad en la toma de decisiones clínicas (AU)

Background: Lower respiratory tract infection by respiratory syncytial virus (RSV) is the most frequent cause of admission in children under 2 years old. The RSV subgroups A and B may circulate simultaneously. We aimed to determine whether clinical differences exist between RSV subgroups A and B. Additionally, we tested the sensitivity of the rapid antigen detection test (RADT) based on immunochromatography in diagnosing subgroups A and B, taking the polymerase chain reaction assay (RT-PCR) as reference. Methods: A retrospective observational study was performed in a tertiary hospital from October 2013 to March 2014. Clinical records and analytical variables of all children under 5 admitted with lower respiratory tract infection and RT-PCR positive for RSV in nasal lavage were consulted. Previously, the RADT for RSV had been performed from the same sample. Results: A total of 198 children under 5 were diagnosed with RSV by RT-PCR: 55 (28%) were RSV-A, 132 (67%) RSVB and 11 (5%) were positive for both subgroups. No differences were observed between subgroups in medical history, symptoms, radiological and analytical findings, and severity. The sensitivity of RADT for RSV was 52%, higher for RSV-A (69%) than for RSV-B (44%, p=0.001). Conclusions: The two RSV subgroups were indistinguishable in symptoms and prognosis. The sensitivity of RADT compared to RT-PCR was low and limits its usefulness for clinical decision-making (AU)

Effect of pregnancy in myopia progression: the SUN cohort.

PurposePrevious studies have suggested that pregnancy may induce myopia progression. However, no longitudinal study with a large sample size and long-term follow-up has assessed this association. Our objective was to investigate whether pregnancy was related to mid- or long-term myopic refraction changes.Patients and methodsA prospective study was conducted in a Mediterranean cohort. The study included 10 401 women (20-50 years old) from the SUN Project. SUN project is a multipurpose, prospective, and dynamic cohort of university graduates conducted in Spain. The recruitment of participants started in 1999 and it is permanently open. All participants in this cohort had university studies. Participants were followed up for a period of up to 14 years, and pregnancy and refractive changes were assessed through baseline and biennial questionnaires. Pregnancies and myopia were repeatedly assessed in each biennial follow-up questionnaire during a total of 14 years of follow-up.ResultsPregnancy was inversely associated with the risk of myopia development or progression during each of the 2 years periods, with fully adjusted hazard ratio=0.61; (95% confidence interval=0.49-0.75) after adjusting for known potential confounders.ConclusionTo our knowledge this is the first large-longitudinal assessment in young adult women, showing that pregnancy is inversely associated with myopia development or progression. Further studies are needed to confirm these epidemiological findings.

Lactante sano con una pluma en el cuero cabelludo; la explicación más sencilla suele ser la más probable / Healthy infant, with a feather on the scalp; the simplest explanation is usually the most likely

Presentamos las imágenes de un lactante sano que acude a Urgencias traído por sus padres preocupados porque 'le ha salido una pluma en la cabeza'. La exploración física es normal, salvo por una pluma de aproximadamente unos 3-4 mm de longitud en región occipitotemporal derecha. No presenta inflamación local, edema ni eritema en la zona. Tras la limpieza y desinfección, mediante pinzas se extrae entera y sin incidencias. La evolución es buena y la herida cicatriza sin complicaciones. Es posible que pequeñas plumas de los rellenos de edredones o almohadas se fracturen y salgan al exterior, clavándose en el cuerpo del niño o pudiendo ser aspiradas. Las plumas pueden tener extremos afilados que penetran fácilmente en la piel del bebé, pudiendo además provocar infecciones. Este sencillo caso remarca la importancia de aconsejar a los padres sobre el uso de materiales adecuados en la ropa de cama del entorno del bebé (AU)

We present images of a healthy infant who was brought to our emergency department by his worried parents, who consulted concerned because 'a feather has grown in his head'. Physical examination was all normal, except from a small feather of approximately 3-4 mm, located on the right occipital- temporal region. No local inflammation, edema or erythema was appreciated in the area. After cleaning the area, the feather was removed entirely using tweezers. Evolution was good and the small wound healed without complications. It is possible that small feathers from duvets or pillows, may penetrate the baby skin or may be aspirated. Feathers may have sharp edges that easily penetrate the skin and can also cause different infections. This simple case highlights the importance of advising parents about the use of appropriate materials in the environment of the baby bedding (AU)

La importancia de la nutrición y los estilos de vida saludables en la infancia y adolescencia / The importance of nutrition and healthy lifestyles in childhood and adolescence

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Neumonía cavitada versus hernia diafragmática congénita / Cavitary pneumonia versus congenital diaphragmatic hernia

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Nut consumption and 5-y all-cause mortality in a Mediterranean cohort: the SUN project.

OBJECTIVE: The aim of this study was to assess the association between nut consumption and all-cause mortality after 5-y follow-up in a Spanish cohort. METHODS: The SUN (Seguimiento Universidad de Navarra, University of Navarra Follow-up) project is a prospective cohort study, formed by Spanish university graduates. Information is gathered by mailed questionnaires collected biennially. In all, 17 184 participants were followed for up to 5 y. Baseline nut consumption was collected by self-reported data, using a validated 136-item semi-quantitative food frequency questionnaire. Information on mortality was collected by permanent contact with the SUN participants and their families, postal authorities, and the National Death Index. The association between baseline nut consumption and all-cause mortality was assessed using Cox proportional hazards models to adjust for potential confounding. Baseline nut consumption was categorized in two ways. In a first analysis energy-adjusted quintiles of nut consumption (measured in g/d) were used. To adjust for total energy intake the residuals method was used. In a second analysis, participants were categorized into four groups according to pre-established categories of nut consumption (servings/d or servings/wk). Both analyses were adjusted for potential confounding factors. RESULTS: Participants who consumed nuts ≥2/wk had a 56% lower risk for all-cause mortality than those who never or almost never consumed nuts (adjusted hazard ratio, 0.44; 95% confidence intervals, 0.23-0.86). CONCLUSION: Nut consumption was significantly associated with a reduced risk for all-cause mortality after the first 5 y of follow-up in the SUN project.