Infecção por vírus sincicial respiratório como causa de internação na população com menos de 1 ano na Colômbia / Respiratory syncytial virus infection as a cause of hospitalization in population under 1 year in Colombia

OBJETIVO: determinar a frequência, as complicações e a sazonalidade com que a infecção pelo vírus sincicial respiratório (VSR) do trato respiratório inferior causa hospitalização em neonatos com um ano de idade ou menos, em seis cidades da Colômbia. MÉTODOS: estudo observacional prospectivo multicêntrico de um ano que incluiu 717 pacientes, que compareceram ao serviço de emergência com sintomas respiratórios em seis cidades da Colômbia. As crianças hospitalizadas foram testadas para verificar a existência de VSR com teste de imunofluorescência das secreções nasofaríngeas. Foram realizadas análises descritivas e estatísticas da população. RESULTADOS: a população estudada incluiu 717 pacientes com uma idade média de 3,6 meses (DP 3,25), na proporção de 4:3 do sexo masculino para o sexo feminino e uma prevalência de ITRI por VSR de 30% (216 neonatos/cidade, faixa 26-49%). Os fatores de risco para ITRI por VSR foram encontrados em 8,2% da população, dos quais 28,8% foram positivos para VSR. Os grupos positivo e negativo para VSR foram comparados utilizando um teste t bicaudal com IC de 95%, p < 0,05. Não foram constatadas diferenças estatisticamente significativas. Todas as cidades apresentaram trimestres anuais específicos para ocorrência de ITRI por VSR. CONCLUSÕES: o VSR causou uma em três internações de ITRI na população, com uma incidência de 30%. Isso confirma uma circulação contínua do VSR na Colômbia, que varia pela localização geográfica.

OBJECTIVE: to determine the frequency, complications and seasonality at which respiratory syncytial virus (RSV) infection of the lower respiratory tract causes hospitalization in infants of age 1 year or less in 6 cities of Colombia. METHODS: one-year prospective multicentric observational study that included 717 patients presenting to the emergency department with respiratory symptoms in 6 cities of Colombia. Hospitalized children were tested for RSV with an immunofluorescence rapid test in nasopharyngeal secretions. Descriptive and statistical analyses of the population were conducted. RESULTS: the study population included 717 patients with a mean age of 3.6 months (SD 3.25), 4:3 male: female ratio and a positive RSV LRTI prevalence of 30.0% (216 infants/City, range 26.0 - 49.0%). Risk factors for RSV LRTI were found in 8.2% of the population, of which 28.8% were RSV positive. RSV positive and negative groups were compared using a two-tailed t test with 95.0%CI, p < 0.05. No statistically significant differences were found. All cities presented specific year trimesters in the occurrence of RSV LRTI. CONCLUSIONS: the RSV caused 1 in 3 LRTI hospitalizations in the population, with an incidence of 30.0%. This confirms a continuous circulation of RSV in Colombia varying by geographic location.

Respiratory syncytial virus infection as a cause of hospitalization in population under 1 year in Colombia.

OBJECTIVE: to determine the frequency, complications and seasonality at which respiratory syncytial virus (RSV) infection of the lower respiratory tract causes hospitalization in infants of age 1 year or less in 6 cities of Colombia. METHODS: one-year prospective multicentric observational study that included 717 patients presenting to the emergency department with respiratory symptoms in 6 cities of Colombia. Hospitalized children were tested for RSV with an immunofluorescence rapid test in nasopharyngeal secretions. Descriptive and statistical analyses of the population were conducted. RESULTS: the study population included 717 patients with a mean age of 3.6 months (SD 3.25), 4:3 male: female ratio and a positive RSV LRTI prevalence of 30.0% (216 infants/City, range 26.0 - 49.0%). Risk factors for RSV LRTI were found in 8.2% of the population, of which 28.8% were RSV positive. RSV positive and negative groups were compared using a two-tailed t test with 95.0%CI, p < 0.05. No statistically significant differences were found. All cities presented specific year trimesters in the occurrence of RSV LRTI. CONCLUSIONS: the RSV caused 1 in 3 LRTI hospitalizations in the population, with an incidence of 30.0%. This confirms a continuous circulation of RSV in Colombia varying by geographic location.

Prophylactic probiotics to prevent death and nosocomial infection in preterm infants.

BACKGROUND AND OBJECTIVE: It has been suggested that probiotics may decrease infant mortality and nosocomial infections because of their ability to suppress colonization and translocation of bacterial pathogens in the gastrointestinal tract. We designed a large double-blinded placebo-controlled trial using Lactobacillus reuteri to test this hypothesis in preterm infants. METHODS: Eligible infants were randomly assigned during the first 48 hours of life to either daily probiotic administration or placebo. Infants in the intervention group were administered enterally 5 drops of a probiotic preparation containing 10(8) colony-forming units of L reuteri DSM 17938 until death or discharge from the NICU. RESULTS: A total of 750 infants ≤ 2000 g were enrolled. The frequency of the primary outcome, death, or nosocomial infection, was similar in the probiotic and placebo groups (relative risk 0.87; 95% confidence interval: 0.63-1.19; P = .376). There was a trend toward a lower rate of nosocomial pneumonia in the probiotic group (2.4% vs 5.0%; P = .06) and a nonsignificant 40% decrease in necrotizing enterocolitis (2.4% vs 4.0%; P = .23). Episodes of feeding intolerance and duration of hospitalization were lower in infants ≤ 1500 g (9.6% vs 16.8% [P = .04]; 32.5 days vs 37 days [P = .03]). CONCLUSIONS: Although L reuteri did not appear to decrease the rate of the composite outcome, the trends suggest a protective role consistent with what has been observed in the literature. Feeding intolerance and duration of hospitalization were decreased in premature infants ≤ 1500 g.

Very early surfactant without mandatory ventilation in premature infants treated with early continuous positive airway pressure: a randomized, controlled trial.

BACKGROUND: Chronic lung disease is one of the most frequent and serious complications of premature birth. Because mechanical ventilation is a major risk factor for chronic lung disease, the early application of nasal continuous positive airway pressure has been used as a strategy for avoiding mechanical ventilation in premature infants. Surfactant therapy improves the short-term respiratory status of premature infants, but its use is traditionally limited to infants being mechanically ventilated. Administration of very early surfactant during a brief period of intubation to infants treated with nasal continuous positive airway pressure may improve their outcome and further decrease the need for mechanical ventilation. OBJECTIVE: Our goal was to determine if very early surfactant therapy without mandatory ventilation improves outcome and decreases the need for mechanical ventilation when used in very premature infants treated with nasal continuous positive airway pressure soon after birth. DESIGN/METHODS: Eight centers in Colombia participated in this randomized, controlled trial. Infants born between 27 and 31 weeks' gestation with evidence of respiratory distress and treated with supplemental oxygen in the delivery room were randomly assigned within the first hour of life to intubation, very early surfactant, extubation, and nasal continuous positive airway pressure (treatment group) or nasal continuous airway pressure alone (control group). The primary outcome was the need for subsequent mechanical ventilation using predefined criteria. RESULTS: From January 1, 2004, to December 31, 2006, 279 infants were randomly assigned, 141 to the treatment group and 138 to the control group. The need for mechanical ventilation was lower in the treatment group (26%) compared with the control group (39%). Air-leak syndrome occurred less frequently in the treatment group (2%) compared with the control group (9%). The percentage of patients receiving surfactant after the first hour of life was also significantly less in the treatment group (12%) compared with the control group (26%). The incidence of chronic lung disease (oxygen treatment at 36 weeks' postmenstrual age) was 49% in the treatment group compared with 59% in the control group. All other outcomes, including mortality, intraventricular hemorrhage, and periventricular leukomalacia were similar between the groups. CONCLUSIONS: In premature infants treated with nasal continuous positive airway pressure early after birth, the addition of very early surfactant therapy without mandatory ventilation decreased the need for subsequent mechanical ventilation, decreased the incidence of air-leak syndrome, and seemed to be safe. Reduction in the need for mechanical ventilation is an important outcome when medical resources are limited and may result in less chronic lung disease in both developed and developing countries.

Evaluation of passive and active rehabilitation and of tendon repair for partial tendon lacerations after three weeks of healing in canines.

BACKGROUND: Both passive and active rehabilitation have been shown to be superior to immobilization following partial tendon laceration, but few studies have directly compared these two rehabilitation protocols. In addition, controversy still remains over whether a partial tendon laceration should be repaired. METHODS: We evaluated gap formation, adhesions, gliding function and structural properties of repaired and unrepaired tendons following 3 weeks of unrestricted active rehabilitation versus passive mobilization for partial laceration of canine flexor digitorum profundus tendons. An ex vivo radiographic method was used to measure tendon excursion and rotation at each finger joint. The tendon was examined for adhesions, and gapping was measured with calipers. The tendons were tensile tested to failure. FINDINGS: We found no significant differences in tendon excursion, total joint rotation, or adhesions between any groups. Gap size was higher with active mobilization. We found no effect of rehabilitation protocol on the strength or stiffness of healing tendons at 3 weeks. Tendon repair did not affect tendon strength, but did produce higher stiffness in healing tendons at 3 weeks. INTERPRETATION: The results indicate that active rehabilitation appears safe for partial lacerations less than 60 percent. Though repair appears to weaken the tendon in the early stages of healing, it may provide some biomechanical benefit by the middle stages of healing.