Rendimiento de dos índices predictores de mortalidad (PSI y CURB-65) en pacientes adultos inmunocompetentes hospitalizados por neumonía adquirida en la comunidad / Yield of two mortality predictors in immunocompetent patients with community acquired pneumonia

Background: The severity of community acquired pneumonia (CAP) can be evaluated by the PSI and CURB-65 scales. However, it is unknown whether their predictive capacity varies according to the etiology of the disease. Aim: To compare the performance of these scales in adults with viral, bacterial, mixed, and no agent detected CAP. Material and Methods: We studied 725 patients hospitalized for CAP aged 18 to 95 years (47% females) Urinary S. pneumoniae and Legionella antigens were detected by immuno-chromatography (Binax®). Respiratory viruses and bacteria were detected by PCR in nasopharyngeal smears. The proportions of deaths, admission to the intensive care unit (ICU), and oxygen therapy were compared between mild and non-severe patients defined by PSI (I/II and I-III) and CURB-65 (1 and 1-2), according to the causative agent. Results: Ten percent of patients died. A causative agent was detected in 65%. The proportion of mild and non-severe patients according to PSI and CURB-65, and of deceased patients, admitted to the ICU and with oxygen therapy was similar in the four categories per agent. There were no deaths among non-severe patients with bacterial CAP. However, 6% of patients with CAP caused by virus or without causative agents, died. No deaths occurred among mild patients with bacterial CAP. In viral CAP, no deaths occurred among patients classified as mild only by PSI. The yields of PSI were greater than those of CURB-65 in non-severe patients who died and were admitted to the ICU with bacterial and viral CAP (5 and 14%; 7 and 12% respectively, p = 0.04). Conclusions: The prognostic performance of PSI in CAP varies according to the causative agent in adults. It is higher in non-severe bacterial cases, and superior to CURB-65.

[Yield of two mortality predictors in immunocompetent patients with community acquired pneumonia]. / Rendimiento de dos índices predictores de mortalidad (PSI y CURB-65) en pacientes adultos inmunocompetentes hospitalizados por neumonía adquirida en la comunidad.

BACKGROUND: The severity of community acquired pneumonia (CAP) can be evaluated by the PSI and CURB-65 scales. However, it is unknown whether their predictive capacity varies according to the etiology of the disease. AIM: To compare the performance of these scales in adults with viral, bacterial, mixed, and no agent detected CAP. MATERIAL AND METHODS: We studied 725 patients hospitalized for CAP aged 18 to 95 years (47% females) Urinary S. pneumoniae and Legionella antigens were detected by immuno-chromatography (Binax®). Respiratory viruses and bacteria were detected by PCR in nasopharyngeal smears. The proportions of deaths, admission to the intensive care unit (ICU), and oxygen therapy were compared between mild and non-severe patients defined by PSI (I/II and I-III) and CURB-65 (1 and 1-2), according to the causative agent. RESULTS: Ten percent of patients died. A causative agent was detected in 65%. The proportion of mild and non-severe patients according to PSI and CURB-65, and of deceased patients, admitted to the ICU and with oxygen therapy was similar in the four categories per agent. There were no deaths among non-severe patients with bacterial CAP. However, 6% of patients with CAP caused by virus or without causative agents, died. No deaths occurred among mild patients with bacterial CAP. In viral CAP, no deaths occurred among patients classified as mild only by PSI. The yields of PSI were greater than those of CURB-65 in non-severe patients who died and were admitted to the ICU with bacterial and viral CAP (5 and 14%; 7 and 12% respectively, p = 0.04). CONCLUSIONS: The prognostic performance of PSI in CAP varies according to the causative agent in adults. It is higher in non-severe bacterial cases, and superior to CURB-65.

[Estimation of the effective reproduction number of measles 2018-2019 in Chile]. / Estimación del número reproductivo efectivo del brote de sarampión 2018-2019 en Chile.

BACKGROUND: Measles cases are reemerging in many countries across the globe. There was an outbreak of imported measles between November 2018 and February 2019 in Chile, raising concern among the public and health authorities. Many were worried about the Chilean measles herd immunity, a factor that relates to the reproductive capacity of the virus (measure of transmissibility of a pathogen). AIM: Here we estimate the effective reproductive number (Re) of this measles outbreak. RESULTS: Although the estimate is highly uncertain due to the low number of cases and the absence of homogeneous mixing of the population, we found Re was approximately 1.5. DISCUSSION AND CONCLUSIONS: Consequently we estimated about 90,3 % had measles immunity, consistent with administrative estimates from the Ministry of Health. These results suggest the Chilean population has established herd immunity against the introduction of imported measles cases, reflecting adequate preventive management of this disease.

Estimación del número reproductivo efectivo del brote de sarampión 2018-2019 en Chile / Estimation of the effective reproduction number of measles 2018-2019 in Chile

Resumen Introducción: Los casos de sarampión están resurgiendo en muchos países del mundo. Hubo un brote de sarampión importado entre noviembre de 2018 y febrero de 2019 en Chile, lo que generó preocupación entre el público y las autoridades sanitarias. Muchos se preocuparon por la tasa de inmunización contra el sarampión de la población, un factor que se relaciona con la capacidad reproductiva del virus (medida de transmisibilidad de un patógeno). Objetivo: Aquí estimamos el número reproductivo efectivo (Re) de este brote de sarampión. Resultados: Aunque la estimación tiene mucha incertidumbre por el bajo número de casos y la ausencia de mezcla homogénea de la población, encontramos que Re fue aproximadamente 1,5. Discusión y Conclusiones: En consecuencia estimamos que aproximadamente 90,3% de la población tiene inmunidad al sarampión, lo que coincide con las estimaciones del Ministerio de Salud. Estos resultados sugieren que la población chilena ha establecido la inmunidad colectiva contra la introducción de casos importados de sarampión, lo que refleja un manejo preventivo adecuado de esta enfermedad.

Abstract Background: Measles cases are reemerging in many countries across the globe. There was an outbreak of imported measles between November 2018 and February 2019 in Chile, raising concern among the public and health authorities. Many were worried about the Chilean measles herd immunity, a factor that relates to the reproductive capacity of the virus (measure of transmissibility of a pathogen). Aim: Here we estimate the effective reproductive number (Re) of this measles outbreak. Results: Although the estimate is highly uncertain due to the low number of cases and the absence of homogeneous mixing of the population, we found Re was approximately 1.5. Discussion and Conclusions: Consequently we estimated about 90,3 % had measles immunity, consistent with administrative estimates from the Ministry of Health. These results suggest the Chilean population has established herd immunity against the introduction of imported measles cases, reflecting adequate preventive management of this disease.

Multiuser communication scheme based on binary phase-shift keying and chaos for telemedicine.

BACKGROUND AND OBJECTIVES: Currently, telemedicine is levered upon the improvement in communication network technology such as Body Area Sensor Networks (BASN) to provided biomedicine solutions. Nevertheless, information security is an important issue since biomedical data is exchanged through insecure channels, which exposes private information that can be intercepted by malicious intruder. Therefore, secure communication protocols for multiuser networks in telemedicine applications are a big challenge. Recent chaos-based encryption works have been conducted in the area of medical secure communications with high security capabilities. However, none of them has considered multiuser network, which is used in several e-health applications. Up to our knowledge, the proposed protocol is the first attempt to consider this service in secure telemedicine. In this paper, we propose a novel scheme based on binary phase-shift key (BPSK) and chaos to provide information security at biosignals in a multiuser network system transmitting data over single channel. METHODS: The proposed scheme uses the two-dimensional Hénon map with enhance pseudorandom sequences and CDMA technique to achieve multiuser encryption process and transmit data over a single channel. We use biosignals such as electrocardiograms (ECG) and blood pressure (PB) signals from PhisioBank ATM data base for simulation results at MatLab software. We evaluate the security and performance by determining the secret key space, secret key sensitivity, resistance against noise attack with quality analysis by using BER, MSE, and PSNR, encryption-decryption time, and throughput. RESULTS: In simulations tests, biosignals of ECG and BP in a BANS network are encrypted and transmitted over shared wireless channels and just authorized medical personal can retrieve such information with corresponding secret key from the cryptogram, that appears as noise to any intruder. The proposed multiuser scheme support high noise and interference attacks efficiently in contrast with classic chaos-based encryption works for telemedicine, where some scenarios are simulated with very low BER, very low MSE, and high PSNR between plain biosignals and recovered biosignals when high AWGN noise is added to encrypted-transmitted signal. In addition, the encryption process presents enough key space and high sensitivity at secret key. A comparative analysis of proposed method and recent existing works was also presented. CONCLUSIONS: Patients can be monitored and diagnosed opportunely remotely and all their medical information is transmitted securely to the correct specialist. Also, it is possible to transmit several electrophysiological signals in a single channel in a secure multiuser network at low cost optimizing the use of available bandwidth for telemedicine applications.

A Double Chaotic Layer Encryption Algorithm for Clinical Signals in Telemedicine.

Recently, telemedicine offers medical services remotely via telecommunications systems and physiological monitoring devices. This scheme provides healthcare delivery services between physicians and patients conveniently, since some patients can not attend the hospital due to any reason. However, transmission of information over an insecure channel such as internet or private data storing generates a security problem. Therefore, authentication, confidentiality, and privacy are important challenges in telemedicine, where only authorized users should have access to medical or clinical records. On the other hand, chaotic systems have been implemented efficiently in cryptographic systems to provide confidential and privacy. In this work, we propose a novel symmetric encryption algorithm based on logistic map with double chaotic layer encryption (DCLE) in diffusion process and just one round of confusion-diffusion for the confidentiality and privacy of clinical information such as electrocardiograms (ECG), electroencephalograms (EEG), and blood pressure (BP) for applications in telemedicine. The clinical signals are acquired from PhysioBank data base for encryption proposes and analysis. In contrast with recent schemes in literature, we present a secure cryptographic algorithm based on chaos validated with the most complete security analysis until this time. In addition, the cryptograms are validated with the most complete pseudorandomness tests based on National Institute of Standards and Technology (NIST) 800-22 suite. All results are at MATLAB simulations and all them show the effectiveness, security, robustness, and the potential use of the proposed scheme in telemedicine.

Artificial cooling as an alternative to increase productivity and welfare of steers under heat stress / Resfriamento artificial como alternativa para aumentar o bem-estar de novilhos sob estresse térmico

The effects of a cooling system on productive efficiency and welfare of Holstein steers were evaluated during the summer. Sixty steers in the finishing phase were randomly allotted to one of two treatment-groups. Animals of control group were only provided with shade (non-cooled group) and a group of animals under a cooling system were installed in the shaded area (cooled group), which were operated daily from 09am to 6pm during the 69d of the study. The averages of environmental temperature and relative humidity were 35.4ºC and 35.3 percent, respectively, with a temperature-humidity index average of 81.4 during the study. Individual body weight was recorded every two weeks, while body surface temperature and respiratory frequency were recorded three times per week. Blood samples were biweekly taken from coccygeal vein for determination of T3 and T4. The average daily gain in the cooled group gain (1.46kg/d) was similar (P=0.21) to non-cooled group (1.37kg/d). Body surface temperature (35.9ºC vs 38.7ºC) and respiratory frequency per minute (77 vs 104) were lower (P<0.01) in the cooled group than in non-cooled group, respectively. Triiodotironine levels were similar (P=0.30) in cooled (0.80ng/mL) and non-cooled (0.87ng/mL) groups, while, tiroxine level was lower (P<0.01) in cooled group (44.0ng/mL) compared to non-cooled group (56.6ng/mL). The cooling system did not improve productive parameters but the welfare in the cooled group was increased.

Avaliou-se um sistema de resfriamento para aumentar a eficiência produtiva e o bem-estar de novilhos durante o verão. Utilizaram-se 60 animais em fase de acabamento, distribuídos aleatoriamente em dois grupos: os do grupo-controle permaneceram somente sob sombra (grupo não resfriado) e os do grupo sob sistema de resfriamento, sob área sombreada, diariamente, das 9 às 18h, durante 69 dias de estudo. As médias registradas de temperatura ambiente e umidade relativa foram 35,4ºC e 35,3ºC, respectivamente, com índice de temperatura-umidade de 81,4 durante o período de estudo. O peso individual foi anotado a cada duas semanas, e a temperatura da superfície corporal e a frequência respiratória foram registrados três vezes por semana. Amostras de sangue foram tomadas da veia coccígea duas vezes por semana para determinação de T3 e T4. O ganho médio diário no grupo sob resfriamento (1,46kg/dia) foi similar (P=0,21) ao do grupo-controle (1,37kg/dia). A temperatura da superfície corporal (35,9ºC versus 38,7ºC) e a frequência respiratória/minuto (77 versus 104) foram mais baixas (P<0,01) no grupo sob resfriamento do que no grupo-controle (P<0,01), respectivamente. Níveis de triiodotironina foram similares (P=0,30) em animais com resfriamento (0,80ng/mL) e sem resfriamento (0,87ng/mL), enquanto o nível de tiroxina foi mais baixo (P<0,01) no grupo com resfriamento (44,0ng/mL versus 56,6ng/mL). O sistema de resfriamento não afetou parâmetros produtivos, porém o bem-estar dos animais do grupo com resfriamento foi melhor.

Effects of biosolids application on nitrogen dynamics and microbial structure in a saline-sodic soil of the former Lake Texcoco (Mexico).

The saline-sodic soil of the former Lake Texcoco, a large area exposed to desertification, is a unique environment, but little is known about its microbial ecology. The objective of this study was to examine bacterial community structure, activity, and function when biosolids were added to microcosms. The application rates were such that 0, 66, 132, or 265 mg total Nk g(-1) were added with the biosolids (total C and N content 158 and 11.5 g kg(-1) dry biosolids, respectively). Approximately 60% of the biosolids were mineralized within 90 days. Microbial respiration and to a lesser extent ammonification and nitrification, increased after biosolids application. The rRNA intergenic spacer analysis (RISA) patterns for the biosolids and unamended soil bacterial communities were different, indicating that the microorganisms in the biosolids were distinct from the native population. It appears that the survival of the allochthonous microorganisms was short, presumably due to the adverse soil conditions.

The relationship of meteorological conditions to the epidemic activity of respiratory syncytial virus.

Our aim was to obtain knowledge of how meteorological conditions affect community epidemics of respiratory syncytial virus (RSV) infection. To this end we recorded year-round RSV activity in nine cities that differ markedly in geographic location and climate. We correlated local weather conditions with weekly or monthly RSV cases. We reviewed similar reports from other areas varying in climate. Weekly RSV activity was related to temperature in a bimodal fashion, with peaks of activity at temperatures above 24-30 degrees C and at 2-6 degrees C. RSV activity was also greatest at 45-65% relative humidity. RSV activity was inversely related to UVB radiance at three sites where this could be tested. At sites with persistently warm temperatures and high humidity, RSV activity was continuous throughout the year, peaking in summer and early autumn. In temperate climates, RSV activity was maximal during winter, correlating with lower temperatures. In areas where temperatures remained colder throughout the year, RSV activity again became nearly continuous. Community activity of RSV is substantial when both ambient temperatures and absolute humidity are very high, perhaps reflecting greater stability of RSV in aerosols. Transmission of RSV in cooler climates is inversely related to temperature possibly as a result of increased stability of the virus in secretions in the colder environment. UVB radiation may inactivate virus in the environment, or influence susceptibility to RSV by altering host resistance.

Metoclopramide response in patients with early diffuse systemic sclerosis. Effects on esophageal motility abnormalities.

OBJECTIVE: To assess the metoclopramide response in patients with early diffuse systemic sclerosis (dSSc) and the acute effects of intravenous (IV) metoclopramide on the lower esophageal sphincter (LES). METHODS: Twenty-one patients with early dSSc (mean age 41.4 +/- 9.8 yrs., mean disease duration 2.47 +/- 0.75 yrs.) were prospectively evaluated. Six patients with late dSSc (mean age 52.6 +/- 9.1 yrs., mean disease duration 9.5 +/- 2.5 yrs.) were used as control group. All underwent solid-state esophageal manometry at rest and 15 minutes later received 10 mg of metoclopramide in an intravenous single bolus. RESULTS: We found that the mean LES pressures measured by the station pull-through technique significantly increased in both early and late dSSc patients after metoclopramide administration (p < 0.05). While early dSSc patients did improve the mean residual pressures (p < 0.05), late dSSc patients did not (p > 0.05). In the esophageal body (EB), the mean contractions amplitude at 18, 13, 8, and 3 cm above the LES was < 20 mm Hg for both groups. However, peristaltic contraction velocitiy was significantly higher in early dSSc patients (< 0.05) than in that with late dSSc (p > 0.05). Our study did not show any major differences when comparing both groups. No side effects were seen. CONCLUSIONS: The results of our study show that metoclopramide may improve LES pressures in patients with early and late dSS. Metoclopramide improve the mean residual pressure in patients with early dSSc, but not in late dSSc patients. Although esophageal contractions amplitude were significantly improved, they did not achieve a pressure > 20 mm Hg. Because metoclopramide can be used orally, it may mitigate both dysphagia and heartburn.

Impacto en salud infantil del invierno 2002: disociación entre factores ambientales y virus respiratorio sincicial, en Santiago / The influence of winter 2002 in pediatric health: dissociation between environmental factors and respiratory syncytial viruses, in Santiago

BACKGROUND: The increase in winter related health pediatric demand is associated with three factors: cold and rainy weather, air pollution and respiratory viral epidemics. During the winter of 2002 there was, successively, heavy rain, air pollution, cold weather and a respiratory syncytial virus (RSV) epidemic in Santiago. AIM: To study the influence of environmental factors and RSV epidemic on pediatric health care demand. PATIENTS AND METHODS: The number of hospital admissions and outpatient consultations for acute lower respiratory infections (ALRI) from April to October 2002 (Autumn to Spring in Chile), were registered in a public pediatric hospital of Santiago. A respiratory virus surveillance (RSV, adenovirus influenza and parainfluenza virus) was carried out among children admitted for ALRI. Climate conditions and air pollution (number of particles of more than 10 microns/mm3) values were provided by local environmental health services. RESULTS: As expected, a rise in winter hospital admissions and outpatient consultations was detected, that peaked in week 29. This rise coincided with the higher RSV detection week. There was heavy rain in weeks 22, 23 and 30, as well as cold weather in June-July (weeks 23, 24, 26, 27 and 30; mid Winter), that did not increase health care demand. Likewise, high air pollution, registered from weeks 24 to 26, did not increase health care demand. CONCLUSIONS: RSV epidemic is the principal factor associated to the increase in health burden during winter in Santiago.

A simple modification of the Baermann method for diagnosis of strongyloidiasis.

The diagnosis of Strongyloides stercoralis infections is routinely made by microscopic observation of larvae in stool samples, a low sensitivity method, or by other, most effective methods, such as the Baermann or agar culture plate methods. We propose in this paper a practical modification of Baermann method. One hundred and six stool samples from alcoholic patients were analyzed using the direct smear test, agar culture plate method, the standard Baermann method, and its proposed modification. For this modification the funnel used in the original version of the method is substituted by a test tube with a rubber stopper, perforated to allow insertion of a pipette tip. The tube with a fecal suspension is inverted over another tube containing 6 ml of saline solution and incubated at 37 degrees C for at least 2 h. The saline solution from the second tube is centrifuged and the pellet is observed microscopically. Larva of S. stercoralis were detected in six samples (5.7%) by the two versions of the Baermann method. Five samples were positive using the agar culture plate method, and only in two samples the larva were observed using direct microscopic observation of fecal smears. Cysts of Endolimax nana and Entamoeba histolytica/dyspar were also detected in the modification of Baermann method. Data obtained by the modified Baermann method suggest that this methodology may helps concentrate larvae of S. stercoralis as efficiently as the original method.

Bacterial and viral etiology of acute otitis media in Chilean children.

BACKGROUND: Acute otitis media (AOM) is a main cause for antimicrobial prescription in Latin America. Pathogen diversity in different geographic regions underscores the need for updated knowledge on AOM microbiology. AIM: To prospectively determine the role of bacteria and viruses in Chilean children with AOM. METHODS: Between July, 1998, and June, 1999, children >3 months with a presumptive diagnosis of AOM were referred to the study ear, nose and throat physician. Middle ear fluid and nasopharyngeal aspirates were obtained from children with confirmed AOM and processed for common bacteria, Mycoplasma pneumoniae, Chlamydia pneumoniae and viruses. Antimicrobial susceptibility patterns and serotypes of Streptococcus pneumoniae strains were determined. RESULTS: An ear, nose and throat physician confirmed diagnoses for 222 (42%) of 529 children referred with diagnosis of AOM, and 170 children met eligibility criteria for the study. One or more pathogens were detected in 140 of 170 (82%) children. Predominant bacteria were S. pneumoniae (37%), Haemophilus influenzae (24%) and Streptococcus pyogenes (13%). M. catarrhalis was detected in 2 children, C. pneumoniae was found in 1 and M. pneumoniae was not detected. Viruses were detected in 22 children (13%) from nasopharyngeal aspirates, and in 6 of them the same virus was detected in middle ear fluid. Penicillin-resistant (intermediate and high) S. pneumoniae represented 40% of isolates and 10% of H. influenzae were beta-lactamase producers. All 10 penicillin-resistant S. pneumoniae strains were resistant to cefuroxime. Eighteen S. pneumoniae serotypes were detected and 19F was associated with high level penicillin resistance. CONCLUSION: This study can impact local management of AOM, and it should encourage continuous surveillance of AOM microbiology in Chile and other developing countries.

Human caliciviruses are a significant pathogen of acute sporadic diarrhea in children of Santiago, Chile.

Human caliciviruses (HuCVs) are increasingly recognized as common pathogens that cause acute sporadic diarrhea in children; however, regional antigenic and genetic diversity complicate detection techniques. Stool samples from children seeking medical attention in 2 outpatient clinics, a large emergency department, and 2 hospital wards were evaluated for HuCVs by reverse transcription-polymerase chain reaction, using primers based on a conserved sequence of the polymerase region of a previously sequenced Chilean strain. HuCVs were detected in 53 (8%) of 684 children 1 month to 5 years of age (mean, 13 months). Detection occurred year-round without a clear seasonal peak, and detection frequency declined from 16% in 1997 to 2% in 1999. The decline may have been due to a change in virus genotype. HuCVs are a significant pathogen of acute sporadic diarrhea in Chilean children, and continuous characterization of genetic diversity will be crucial for appropriate detection.

Hospital-acquired adenovirus 7h infantile respiratory infection in Chile.

BACKGROUND: Adenoviruses are the second most common cause of viral acute lower respiratory tract infection (ALRI) requiring hospitalization in Chile. Little information is available with respect to nosocomial infection rate by adenovirus. This issue is important because of its potential severity and long term sequelae. METHODS: Infants hospitalized for ALRI were studied to determine the rate of nosocomial cross-infection with respiratory adenovirus and its corresponding genome type. The group studied included all cases younger than 2 years of age admitted to a seven crib ward in the Roberto del Rio Children's Hospital (Santiago, Chile) between May, 1995, and October, 1996. Nasopharyngeal aspirates for immunofluorescence assay and viral isolation were obtained on admission and the next day. On identification of a positive case for adenovirus, samples were obtained from contacts for 2 consecutive days and twice weekly thereafter for 2 weeks. RESULTS: Fifteen index positive cases for adenovirus and their 65 contacts were identified. Secondary attack rate for adenoviral cross-infection was 55%, most of which were diagnosed by viral isolation. Mortality occurred in 4 cases; 3 had underlying diseases. Four secondary cases presented mild respiratory infection after acquiring the cross-infection, and 16 patients developed a moderate and severe ALRI. Twelve patients required supplemental oxygen and 4 needed mechanical respiratory support. Genome types for the 10 index cases and 19 contacts were obtained. All of these corresponded to adenovirus 7h. CONCLUSIONS: The high secondary attack rate observed, stresses the importance of adequate isolation of patients and the need for rapid and sensitive viral diagnosis.

Adenovirus surveillance on children hospitalized for acute lower respiratory infections in Chile (1988-1996).

Adenoviruses (Ad) play an important role in the etiology of acute lower respiratory tract infections (ALRI) in young children in Chile. Our aim was to correlate the clinical severity of the infections with the Ad strains isolated during surveillance over 8 years. From 1988 through 1996, nasopharyngeal aspirates (NPA) were obtained for viral isolation and immunofluorescence assay (IFA) from children under 2 years of age hospitalized for ALRI; Ad isolates were further studied by restriction enzyme analysis of genomic DNA. Of 3,097 cases enrolled, the Ad isolation rate was 12.6%. The most common admission diagnoses among Ad-positive cases were pneumonia and wheezing bronchitis (69.8%). Duration of Ad shedding was studied in 74 cases by IFA. Children excreting Ad for 4 or more days had a longer hospital stay than those shedding for 1-3 days (mean: 16.8 and 7.2 days, respectively; P <.01). Viral shedding for more than 3 days was associated with more severe outcomes. Genome typing of 221 out of 390 Ad isolates resulted in 87 subgenus C and 134 subgenus B strains, including 123 Ad genome type 7h (55.6%, P <.01). The IFA from the NPA was more sensitive for the detection of subgenus B (51. 5%) than subgenus C infections (24.1%, P <.01). Children shedding Ad 7h had longer hospital stays (P <.01), a higher frequency of rectal temperatures over 39 degrees C (P <.01), and greater need for additional oxygen (P <.02) than subgenus C cases. Four cases requiring mechanical ventilation were associated with Ad 7h infections. The data presented show that, in children hospitalized for ALRI, the genome type 7h was associated with a more severe clinical outcome.

Differential effects of respiratory syncytial virus and adenovirus on mononuclear cell cytokine responses.

Respiratory syncytial virus (RSV) and adenovirus (Advs) serotype 3 (Adv3) and 7h (Adv7h) are associated with mild to severe respiratory infection and are indistinguishable during the acute phases of the illnesses. However, outcome and long-term prognosis are different with both infections. RSV infection is associated with later development of asthma, and Adv, mainly Adv7h, with severe lung damage, bronchiectasis, and hyperlucent lung. We hypothesized that this difference could be partly due to different immune responses induced by these viruses. To test this hypothesis we quantified TCD4+, TCD8+, and BCD19+ expressing the interleukin-2 receptor-alpha chain (CD25) and interferon-gamma (IFN-gamma), interleukin (IL)-10, and IL-4 in the supernatant of peripheral blood mononuclear cells (PBMC) from school children infected in vitro with and without RSV, Adv7h, and Adv3 and after phytohemagglutinin (PHA) stimulation in the presence or absence of these viruses at a multiplicity of infection (MOI) of 1. PBMC from every child produced more IL-10 (p

Transmisión vertical del virus de la inmunodeficiencia humana: experiencia preliminar con el uso de protocolo ACTG 076 en el Hospital San Juan de Dios / Vertical transmission of HIV: preliminary experience with the use of protocol ACTG 076 at the San Juan de Dios hospital

Durante el período comprendido entre septiembre de 1995 y octubre de 1998, 6 pacientes embarazadas con diagnóstico de VIH, controladas en el Policlínico de VIH dependiente del Servicio de Medicina del Hospital San Juan de Dios, fueron atendidas en el Servicio de Obstetricia y Ginecología de dicho Hospital. Todas ellas recibieron AZT según el protocolo ACTG 076. Se constató un solo parto vía vaginal, el resto se llevó a cabo por cesárea electiva. Todos los recién nacidos recibieron AZT postparto y ninguno fue alimentado con leche materna. Se realizó seguimiento de los niños confirmándose VIH en uno de ellos, 2 estaban sanos y 3 se encontraban en etapa de estudio. Las madres continúan en control en el Policlínico de VIH; 4 de ellas asintomáticas hasta la fecha y 2 etapa C

[Systematic surveillance of influenza, syncytial respiratory, parainfluenza and adenovirus in children with acute respiratory infections]. / Vigilancia sistemática de virus influenza, respiratorio sincicial, parainfluenza y adenovirus, en niños ambulatorios con infecciones respiratorias agudas.

BACKGROUND: The efficacy of influenza vaccination programs depends on the antigenic similitude between vaccine and the influenza virus circulating in the community. Therefore the surveillance of clinical activity and antigenic features of influenza virus is of utmost importance. AIM: To perform a systematic surveillance of clinical activity and antigenic characteristics of influenza virus. MATERIAL AND METHODS: Since 1996 and during the cold months (May to September), 20 samples of upper respiratory secretions per week, were obtained from children with acute respiratory infections consulting to the emergency room of a public hospital. Using indirect immunofluorescence and cellular cultures, the presence of influenza, syncytial respiratory, parainfluenza and adenovirus was assessed. The weekly number of consultations in the emergency room and the number of hospital discharges due to acute respiratory infections, were registered. RESULTS: Influenza and syncytial respiratory were the predominant virus detected since 1996. In 1996 and 1998, the weekly detection of influenza virus followed a single seasonal curve. The maximal weekly positively results reached 85 and 80% of the obtained samples, respectively. During 1997, two curves of influenza virus activity were observed, but none reached more than 50% of weekly positive samples. The demand for outpatient care evolved in parallel to the weekly detection of influenza virus. The hospital discharges due to acute respiratory infections paralleled the syncytial respiratory virus detection rates. CONCLUSIONS: This surveillance model is effective for the detection of influenza and other virus responsible for acute respiratory infections and their relationship with the demand for health care during the cold months.