Vestibular CCK signaling drives motion sickness-like behavior in mice.

Travel can induce motion sickness (MS) in susceptible individuals. MS is an evolutionary conserved mechanism caused by mismatches between motion-related sensory information and past visual and motion memory, triggering a malaise accompanied by hypolocomotion, hypothermia, hypophagia, and nausea. Vestibular nuclei (VN) are critical for the processing of movement input from the inner ear. Motion-induced activation of VN neurons recapitulates MS-related signs. However, the genetic identity of VN neurons mediating MS-related autonomic and aversive responses remains unknown. Here, we identify a central role of cholecystokinin (CCK)-expressing VN neurons in motion-induced malaise. Moreover, we show that CCK VN inputs onto the parabrachial nucleus activate Calca-expressing neurons and are sufficient to establish avoidance to novel food, which is prevented by CCK-A receptor antagonism. These observations provide greater insight into the neurobiological regulation of MS by identifying the neural substrates of MS and providing potential targets for treatment.

Peritonitis primària per N. meningitidis serogrup B / Peritonitis primaria por N. Meningitidis serogrupo B / Primary peritonitis by serogroup B N. Meningitidis

INTRODUCCIÓ: Neisseria meningitidis és un dels principals causants de sèpsia I meningitis adquirida a la comunitat en pacients pediàtrics. Se'n descriuen presentacions atípiques, com la peritonitis primària. Presentem aquest cas per la seva excepcionalitat: una patologia infreqüent en edat pediàtrica causada per un germen poc habitual. CAS CLÍNIC: Es presenta un lactant de 4 mesos que acut al servei d'Urgències amb els seus pares per febre I lesions cutànies disseminades de 24 hores d'evolució, amb vòmits I diarrea. Davant la sospita de sèpsia, s'inicien maniobres de reanimació inicial, amb càrrega de volum I antibioteràpia, prèvia extracció d'hemocultiu. Tot I la millora clínica inicial, persisteix la palpació dolorosa a l'hipogastri. Es valora juntament amb Cirurgia I es fa una tomografia computada abdominal que mostra hipercaptació de nanses d'intestí prim I líquid intraabdominal compatible amb procés inflamatori peritoneal. Es fa una laparoscòpia exploradora I s'obté abundant líquid purulent; es revisen íntegrament budell I colon sense observar lesions. Es manté a dieta absoluta durant 48 hores després de la cirurgia, amb progressió alimentària posterior sense incidències. S'obtenen resultats microbiològics: hemocultiu positiu per N. meningitidis B I reacció en cadena de la polimerasa N. meningitidis positiva en sang I en líquids cefalorraquidi I peritoneal. COMENTARIS: La peritonitis primària en pacients pediàtrics sans és una entitat de baixa incidència. Entre els gèrmens descrits en la literatura és molt poc freqüent trobar N. meningitidis. És necessari pensar en aquesta entitat davant d'un pacient amb malaltia invasiva per N. meningitidis I exploració abdominal patològica. La base del tractament són la cirurgia I l'antibioteràpia endovenosa

INTRODUCCIÓN: Neisseria meningitidis es una de las principales causas de sepsis y meningitis adquirida en la comunidad en pacientes pediátricos. Se describen presentaciones atípicas entre las cuales consta de forma excepcional la peritonitis primaria. Este caso ha sido seleccionado por su excepcionalidad, pues se trata de una patología poco frecuente en edad pediátrica y causada por un germen poco habitual. CASO CLÍNICO: Se presenta a un lactante de 4 meses que acude al servicio de Urgencias con sus padres por fiebre y lesiones cutáneas diseminadas de 24 horas de evolución, junto con vómitos y diarrea. Ante la sospecha de sepsis se realizan maniobras de reanimación inicial con carga de volumen y antibioterapia, con previa toma de hemocultivo. A pesar de la mejoría clínica inicial, persiste palpación dolorosa en hipogastrio. Se valora junto con Cirugía y se realiza tomografía computarizada abdominal que muestra hipercaptación de asas de intestino delgado, asociado a líquido intra-abdominal compatible con proceso inflamatorio peritoneal. Se realiza laparoscopia exploradora y se obtiene abundante líquido purulento y esfacelos; se revisan de forma íntegra intestino y colon sin observar lesiones. Se mantiene a dieta absoluta durante 48 horas tras la cirugía, con progresión alimentaria posterior y sin incidencias. Se obtienen resultados microbiológicos: hemocultivo positivo para N. meningitidis B sensible y reacción en cadena de la polimerasa N. meningitidis B positiva en sangre y en líquidos cefalorraquídeo y peritoneal. COMENTARIOS: La peritonitis primaria en pacientes pediátricos sanos es una entidad de baja incidencia. Entre los gérmenes descritos en la literatura es muy poco frecuente encontrar N. meningitidis. Es necesario pensar en esta entidad ante un paciente con infección invasiva por N. meningitidis con exploración abdominal patológica. La base de su tratamiento son la cirugía y la antibioterapia endovenosa

INTRODUCTION: Neisseria meningitidis is one of the main causes of community acquired sepsis and meningitis in children. Atypical presentations have been described, one of them is primary peritonitis. CASE REPORT: We present a 4-month-old infant admitted to the emergency department with fever and disseminated petechia of 24 hours of evolution along with vomiting and diarrhea. With the diagnosis of sepsis, resuscitation maneuvers were started with intravenous fluids and antibiotics after a blood culture was obtained. In spite of the initial clinical improvement, painful palpation persisted in hypogastrium. The patient was assessed together with surgery and an abdominal computed tomography was performed, which showed a small intestine loop enlargement, associated with intraabdominal fluid that suggested peritonitis. Exploratory laparoscopy was performed, obtaining abundant purulent fluid and necrotic and inflammatory tissue. The entire bowel and colon were inspected and no lesions were found. The patient remained fasting for 48 hours after surgery. Enteral nutrition was started afterwards with no complications. N. menigitidis B was isolated in blood culture and polymerase chain reaction positive for N. meningitidis B was positive in blood and in cerebrospinal and peritoneal fluids. COMMENTS: Primary peritonitis in healthy pediatric patients is rare. N. meningitidis is very rare causative pathogen. Primary peritonitis should be considered when having a patient with invasive infection by N. meningitidis with abnormal abdominal examination. Treatment includes surgery and intravenous antibiotics

Lung ultrasound findings in pediatric patients with COVID-19.

During the pandemic caused by the novel coronavirus (COVID-19), lung ultrasound has been used to diagnose and monitor respiratory condition. The aim of the study was to describe lung ultrasound findings in children with a COVID-19 infection. Patients younger than 18 years old and positive for COVID-19, admitted to pediatric tertiary referral hospital were included. They were divided into two groups depending on the presence of respiratory symptoms. Lung ultrasound results were categorized into four degrees according to Soldati et al. score (J Ultrasound Med 39:1-7, 2020) and it was also described the presence and type of consolidation. Sixteen patients were recruited. The median age was 11 years old (IQR 2.8-12). Four children (25%) required admission to the intensive care unit. Six patients (37.5%) presented with respiratory symptoms. Most of them showed S.score of 2 and subpleural consolidations were observed in four cases (66.6%). Ten patients (62.5%) presented with non-respiratory symptoms, lung ultrasound showed S.score from 0 to 2. Three (30%) were diagnosed of multisystem inflammatory syndrome and lung ultrasounds showed S.score of 2 with bilateral pleural effusion.Conclusions: Children with COVID-19 and respiratory symptoms mostly showed a S.score of 2 and 3 with subpleural consolidations, upon the lung ultrasound assessment. What is Known: • Lung ultrasound is a useful tool for monitoring patients with respiratory symptoms in both adults and children. Lung ultrasounds are altered in adult patients with COVID-19. What is New: • Lung ultrasound might improve COVID-19 assessment, it could be a useful tool to diagnose and monitor patients throughout the COVID-19 pandemic. Even COVID-19 patients with non-respiratory symptoms have lung alterations that are visible on lung ultrasound.

Neonates With Urinary Tract Infection: Is a Lumbar Puncture Always Indicated?

BACKGROUND: Our objectives were to determine the prevalence of and to identify risk factors for coexisting bacterial meningitis (BM) in neonates with urinary tract infection (UTI). METHODS: A cross-sectional study was conducted at pediatric emergency department of a tertiary teaching hospital from 2001 to 2017. Infants <29 days of age with UTI (≥10,000 colony-forming units/mL of a single pathogen from a catheterized specimen in association with positive urinalysis) were included. Definite BM was defined as growth of a single bacterial pathogen from a cerebrospinal fluid (CSF) sample and probable BM as (1) positive blood culture with CSF pleocytosis and treatment consistent with BM or (2) antibiotic pretreatment before lumbar puncture, CSF pleocytosis and treatment consistent with BM. Univariate testing was used to identify possible risk factors associated with BM. Receiver operating characteristics curves were constructed for the laboratory markers associated with BM. RESULTS: Three hundred seventy-one infants were included. Five [1.3%; 95% confidence interval (CI): 0.6%-3.1%] had BM: 4 definite BM and 1 probable BM. Risk factors detected for BM were classified as not being well-appearing and a procalcitonin value ≥0.35 ng/mL [sensitivity of 100% (95% CI: 56.6%-100%) and negative predictive value of 100% (95% CI: 96.1%-100%)]. CONCLUSIONS: Coexisting BM occurs uncommonly in neonates with UTI. Well-appearing neonates with UTI and procalcitonin value <0.35 ng/mL were at very low risk for BM; avoiding routine lumbar puncture in these patients should be considered.

Lung Ultrasound to Assess the Etiology of Persistent Pulmonary Hypertension of the Newborn (LUPPHYN Study): A Pilot Study.

INTRODUCTION: Persistent pulmonary hypertension of the newborn (PPHN) is a neonatal syndrome associated with significant morbidity and mortality that is caused by the failure of postnatal drop in pulmonary vascular resistance. In extreme cases, patients may require extracorporeal membrane oxygenation therapy (ECMO). The aim of this study was to explore lung ultrasound (LUS) patterns in newborns with PPHN requiring ECMO. PATIENTS AND METHODS: From January 2014 to January 2018, LUS was performed on patients with PPHN admitted for ECMO treatment. PPHN diagnosis was based on clinical and echocardiographic findings. LUS was performed before patients underwent ECMO cannulation. An underlying diagnosis was made taking into account the patient's complete medical history, excluding LUS information. A blinded physician, unaware of the patient's clinical condition, analyzed the stored ultrasound images. Results were then compared with chest x-ray (CXR) diagnoses. RESULTS: Seventeen patients were recruited; 12 were male (70.6%). The median gestational age was 38.7 weeks, with 13 term newborns (76.5%). Twelve were cannulated for VA ECMO, with a median ECMO run of 111.2 h. Six patients (35%) survived. Patients with alveolar capillary dysplasia with misaligned pulmonary veins, fetal ductus arteriosus constriction, or sepsis had normal LUS patterns (A-lines with lung sliding). LUS showed a better sensitivity (88.9%) and specificity (85%) than CXR (55.6 and 77.5%, respectively) in identifying patients with nonparenchymal lung disease. CONCLUSIONS: LUS can provide essential information to help diagnose the underlying cause of PPHN in an earlier and more effective way than CXR. LUS is suitable for routine utilization in the intensive care unit.