Dolor abdominal: guía de supervivencia en la consulta del pediatría / Abdominal pain: Survival guideline in the pediatrician’s office

El dolor abdominal es una patología frecuente en Pediatría, representando del 2 al 4% de las consultas del pediatra de Atención Primaria, y el 7-25% de las consultas de Gastroenterología Infantil. Las causas del dolor abdominal pueden ser múltiples y variadas, y el abordaje de un paciente con dolor abdominal constituye en ocasiones un reto para el pediatra. En esta revisión se pretende ayudar al pediatra a valorar de forma práctica a un paciente con dolor abdominal, revisando las patologías más frecuentes según la localización del dolor, identificando las banderas rojas que orientan a una patología orgánica potencialmente grave, y se aportan estrategias para poder llegar a un diagnóstico y posterior tratamiento del cuadro.(AU)

Abdominal pain is a common pathology in Pediatrics, representing 2 to 4% of Primary Care pediatrician consultations, and 7-25% of Pediatric Gastroenterology consultations. The causes of abdominal pain can be multiple and varied, and addressing a patient with abdominal pain is sometimes a challenge for the pediatrician. This review aims to help the pediatrician to practically evaluate a patient with abdominal pain, reviewing the most frequent pathologies according to the location of the pain, identifying the red flags that indicate a potentially serious organic pathology, and providing strategies to be able to reach a diagnosis and subsequent treatment of the condition.(AU)

Aqueous extract of pomegranate enriched in ellagitannins prevents anxiety-like behavior and metabolic changes induced by cafeteria diet in an animal model of menopause.

Women around menopause are vulnerable to present psychiatric and metabolic disorders; thus, therapies that contribute to treat both pathologies are required. Previous reports showed that an aqueous extract of pomegranate (Punica granatum), enriched in ellagitannins, exerts an antidepressant-like effect in ovariectomized rats. We analyze whether this aqueous extract of P. granatum (AE-PG) prevents the anxiety-like behavior induced by a cafeteria diet (CAF) in middle-aged ovariectomized rats at the same time that it prevents an increase in body weight, glucose, lipids, and the changes on mRNA expression of the peroxisome proliferator-activated receptor-gamma (PPAR-γ) in the liver. Also, the effects of AE-PG on the protein levels of PPAR-γphospho-PPAR-γ, extracellular signal-regulated protein kinase (ERK1/2) and phospho-ERK1/2 were measured in the hippocampus and amygdala. CAF induced anxiety-like behavior, augmented lipids and glucose blood levels, body weight, visceral fat, insulin resistance, and decreased mRNA expression of PPAR-γ in the liver. In rats fed with the CAF, AE-PG prevented the anxiety-like behavior, reduced body weight, lowered lipid levels, reduced insulin resistance, and increased PPAR-γ mRNA expression in the liver. In the hippocampus, ERK1/2 but not PPAR-γ protein levels were decreased by CAF, while AE-PG prevented these effects. In the amygdala, CAF increased the phosphorylation of PPARγ, and AE-PG prevented it. In contrast, AE-PG rescued the decreased ERK1/2 protein level in the hippocampus caused by CAF. In conclusion, AE-PG treatment prevented anxiogenic and metabolic effects induced by CAF, and its effects appear to be mediated by ERK1/2 and PPARγ depending on the brain area studied.

Influence of nutrition education in paediatric coeliac disease: impact of the role of the registered dietitian: a prospective, single-arm intervention study.

BACKGROUND: The diagnosis of coeliac disease (CD) involves a change in the diet of the individual, which may influence their quality of life and nutritional status. The present study aimed to determine whether nutrition education by a registered dietitian is able to improve eating habits and body composition in children with CD. METHODS: Dietary, physical activity and body composition changes were analysed, comparing baseline assessments with those 1 year after receiving education on healthy eating. At both time points, a 3-day dietary survey, a food frequency consumption questionnaire, an adherence to the Mediterranean diet test (Kidmed), duration of activity and an electrical bioimpedance study were conducted. Student's paired t-test and the McNemar test were also employed. RESULTS: Seventy-two subjects (42 girls) with an mean (range) age of 10 (2-16) years were included. Before the intervention, an unbalanced diet was observed, rich in protein and fat, and deficient in complex carbohydrates. Only 14% consumed an adequate Mediterranean diet. After nutrition intervention, a significant increase in the consumption of plant-based foods and a concomitant decrease in meat, dairy and processed food intake (P < 0.001) were observed. Moreover, 92% of the patients (P < 0.001) managed to consume an adequate Mediterranean diet. Similarly, an increase was observed in the duration of physical activity undertaken [mean (SD) 1.02 (1.79) h, P < 0.001] and improvements in body composition were recorded, with a 17% decrease in fat mass percentage (P < 0.001). CONCLUSIONS: Nutrition intervention focused on healthy eating is effective with respect to improving the nutritional status and diet quality in CD patients.

Liver damage in bleomycin-induced pulmonary fibrosis in mice.

Pulmonary fibrosis is an emerging disease with a poor prognosis and high mortality rate that is even surpassing some types of cancer. This disease has been linked to the concomitant appearance of liver cirrhosis. Bleomycin-induced pulmonary fibrosis is a widely used mouse model that mimics the histopathological and biochemical features of human systemic sclerosis, an autoimmune disease that is associated with inflammation and expressed in several corporal systems as fibrosis or other alterations. To determine the effects on proliferation, redox and inflammation protein expression markers were analyzed by immunohistochemistry. Analyses showed a significant increase in protein oxidation levels by lipoperoxidation bio-products and in proliferation and inflammation processes. These phenomena were associated with the induction of the redox status in mice subjected to 100 U/kg bleomycin. These findings clearly show that the bleomycin model induces histopathological alterations in the liver and partially reproduces the complexity of systemic sclerosis. Our results using the bleomycin-induced pulmonary fibrosis model provide a protocol to investigate the mechanism underlying the molecular alteration found in the liver linked to systemic sclerosis.

The furosemide stress test for prediction of worsening acute kidney injury in critically ill patients: A multicenter, prospective, observational study.

PURPOSE: To validate the furosemide stress test (FST) for predicting the progression of acute kidney injury (AKI). MATERIALS AND METHODS: We performed a multicenter, prospective, observational study in patients with stage I or II AKI. The FST (1 mg/kg for loop diuretic naïve patients and 1.5 mg/kg in patients previously exposed to loop diuretics) was administered. Subsequent urinary flow rate (UFR) recorded and predictive ability of urinary output was measured by the area under the curve receiver operatic characteristics (AuROC). Primary outcome was progression to Stage III AKI. Secondary outcomes included in-hospital mortality and adverse events. RESULTS: We studied 92 critically ill patients. 23 patients progressed to stage III AKI and had significantly lower UFR (p < 0.0001). The UFR during the first 2 h was most predictive of progression to stage III AKI (AuROC = 0.87), with an ideal cut-off of less than 200mls, with a sensitivity of 73.9% and specificity of 90.0%. CONCLUSION: In ICU patients without severe CKD with mild AKI, a UFR of less than 200mls in the first 2 h after an FST is predictive of progression to stage III AKI. Future studies should focus on incorporating a FST as part of a clinical decision tool for further management of critically ill patients with AKI.

Características demográficas, clínicas y reacciones adversas de personas con sobrepeso y obesidad: consumidores de orlistat atendidos por centro de atención telefónica (2009 ­ 2017) / Demographic and clinical characteristics, and adverse reactions of people with overweight and obesity consumers of orlistat, attended by a call center (2009 ­ 2017)

Resumen Introducción Las enfermedades crónicas van en ascenso y están asociadas al incremento ponderal. Se requieren estrategias multidisciplinarias para su control. Métodos El diseño es descriptivo, observacional y retrospectivo. Los objetivos de esta comunicación son describir las características demográficas, clínicas y reacciones adversas de personas con sobrepeso y obesidad consumidores de orlistat, atendidos por un centro de atención telefónica durante el periodo 2009 a 2017; e identificar al profesional de la salud más consultado por ellos. La información se obtuvo desde una base de datos existente de un programa de atención a personas con sobrepeso u obesidad, interesadas en usar orlistat (prospectos) o usuarios (pacientes). El estudio se llevó a cabo en México y duró siete años. Las variables estudiadas fueron demográficas, clínicas y reacciones adversas. Resultados Se reunieron 311 913 solicitudes de 126 607 sujetos (104 711 prospectos interesados en consumir orlistat y 21 896 pacientes que ya lo tomaban). Las principales actividades fueron llamadas al sujeto (35,9%). Hubo 104 711 solicitudes: 82 810 (79,1%) prospectos y 21 896 (20,9%) pacientes. El 79,9% fue de sexo femenino. El intervalo de edad predominante fue de 32 a 45 años. Se detectaron 43 reacciones adversas (0,02%); las más comunes fueron dolor abdominal (0,05%) y cefalea (0,03%). Conclusiones La población más interesada en el control ponderal en este estudio es la femenina (79,9%) y el grupo etario de 32 a 45 años. El profesional más consultado fue el nutriólogo. Solo se obtuvo el índice de masa corporal (29,2 kilogramos por metro cuadrado) de los sujetos que desarrollaron 43 reacciones adversas, las más comunes fueron dolor abdominal y cefalea.

Introduction Chronic diseases are on the rise and are associated with weight gain. Multidisciplinary strategies are required for its control. Methods The design was descriptive, observational and retrospective. The objectives of this communication were to describe the demographic and clinical characteristics and adverse reactions of overweight and obese people who were consumers of orlistat, attended by a call center during the period 2009 to 2017; and to identify the healthcare professional most consulted by them. The information was obtained from an existing database of a program of attention to people with overweight or obesity, interested in using orlistat (prospects) or users (patients). The study was carried out in Mexico and lasted seven years. The variables studied were demographic, clinical and adverse reactions. Results A total of 311,913 requests were collected from 126 607 subjects (104 711 prospects interested in consuming orlistat and 21 896 patients who already took it). The main activities were phone calls to the subject (35.9%). There were 104 711 requests: 82 810 (79.1%) prospects and 21 896 (20.9%) patients. 79.9% of all were female. The predominant age interval was 32 to 45 years. 43 adverse reactions (0.02%) were detected; the most common were abdominal pain (0.05%) and headache (0.03%). Conclusions The population most interested in weight control in this study was the female population (79.9%) and the age group from 32 to 45 years. The most consulted healthcare professional was the nutritionist. Only the body mass index (29.2 kilograms per square meter) of the subjects who developed 43 adverse reactions was obtained. There were 43 adverse reactions, the most common being abdominal pain and headache.

Rapid MRSA PCR on respiratory specimens from ventilated patients with suspected pneumonia: a tool to facilitate antimicrobial stewardship.

Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of pneumonia in ventilated patients. Our objective was to evaluate the GeneXpert MRSA/SA SSTI Assay (Xpert MRSA/SA) (Cepheid, Sunnyvale, CA) for use in lower respiratory tract (LRT) specimens for rapid MRSA detection and to determine the potentially saved antibiotic-days if a culture-based identification method was replaced by this assay. Remnant LRT samples from ventilated patients submitted to the microbiology laboratory for routine culture were tested using conventional culture and Xpert MRSA/SA. One hundred of 310 LRT specimens met the inclusion criteria. Ten samples were positive for MRSA by Xpert MRSA/SA, while six were positive by routine culture methods. Xpert MRSA/SA correctly identified 5/6 positive and 89/94 negative MRSA specimens, for a sensitivity of 83.3%, specificity of 94.7%, positive predictive value of 45.6%, and negative predictive value of 98.9%. The assay also correctly detected 3/3 positive and 90/97 negative methicillin-susceptible S. aureus (MSSA) specimens, for a sensitivity of 100%, specificity of 92.8%, positive predictive value of 30%, and negative predictive value of 100%. A total of 748 vancomycin and 305 linezolid antibiotic-days were associated with the enrolled specimens. Vancomycin and linezolid utilization could decrease by 68.4% and 83%, respectively, if discontinued 1 day after negative polymerase chain reaction (PCR) results. The Xpert MRSA/SA SSTI rapid MRSA PCR assay performed well in respiratory samples from ventilated patients with suspected pneumonia and has the potential to facilitate stewardship efforts such as reducing empiric vancomycin and linezolid therapy.

Predictors of community-associated Staphylococcus aureus, methicillin-resistant and methicillin-susceptible Staphylococcus aureus skin and soft tissue infections in primary-care settings.

Skin and soft tissue infections (SSTIs) due to Staphylococcus aureus have become increasingly common in the outpatient setting; however, risk factors for differentiating methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) SSTIs are needed to better inform antibiotic treatment decisions. We performed a case-case-control study within 14 primary-care clinics in South Texas from 2007 to 2015. Overall, 325 patients [S. aureus SSTI cases (case group 1, n = 175); MRSA SSTI cases (case group 2, n = 115); MSSA SSTI cases (case group 3, n = 60); uninfected control group (control, n = 150)] were evaluated. Each case group was compared to the control group, and then qualitatively contrasted to identify unique risk factors associated with S. aureus, MRSA, and MSSA SSTIs. Overall, prior SSTIs [adjusted odds ratio (aOR) 7·60, 95% confidence interval (CI) 3·31-17·45], male gender (aOR 1·74, 95% CI 1·06-2·85), and absence of healthcare occupation status (aOR 0·14, 95% CI 0·03-0·68) were independently associated with S. aureus SSTIs. The only unique risk factor for community-associated (CA)-MRSA SSTIs was a high body weight (⩾110 kg) (aOR 2·03, 95% CI 1·01-4·09).

Una rara causa de dolor abdominal en un niño sano / A rare cause of abdominal pain in a healthy child

No disponible

Eficacia y seguridad de una pauta rush de inducción de tolerancia oral en pacientes con alergia a proteínas de leche de vaca: evolución clínica e inmunológica / Oral rush desensitization for cow milk allergy: Clinical and immunological follow-up

Introducción: Evaluar la seguridad y la eficacia de la inducción de tolerancia oral mediante pauta rush en pacientes con alergia a proteínas de leche de vaca persistente. Material y métodos: Estudio prospectivo realizado en 3 hospitales españoles. Se incluyó a niños mayores de 3 años con alergia IgE-mediada a proteínas de leche de vaca, a los que se administraron dosis crecientes de leche durante 5 días, desde 1 cc al 1% hasta 200 cc de leche pura en régimen de hospital de día. Las reacciones adversas a la administración de leche fueron registradas y se trataron atendiendo a la clasificación de Clark. Se realizó seguimiento clínico durante 2 años. Se determinaron los niveles de IgE específica basales y a los 6, 12 y 24 meses. Resultados: Se incluyó a 18 niños (13 varones) entre 3 y 14 años (media 5,96). De 271 dosis administradas, 55 presentaron algún tipo de reacción. Un 84% de las mismas fueron leves. Al finalizar el protocolo, el 100% presentaba algún grado de tolerancia (39% total). Tras 2 años, el 72% de los pacientes realizaba una dieta sin restricción de productos lácteos. Dos pacientes presentaron pérdida de la tolerancia alcanzada. Se observó un descenso significativo de los niveles de IgE específica a leche de vaca y α-lactoalbúmina a los 24 meses, y de caseína a los 6, 12 y 24 meses respecto de los niveles basales. Conclusiones: La desensibilización mediante pauta rush es una opción terapéutica eficaz y segura a medio plazo para pacientes con alergia persistente a proteínas de leche de vaca (AU)

Objective: The aim of this study was to evaluate the safety and efficacy of oral rush desensitization in children with cow milk allergy. Material and methods: Prospective study. We included IgE-mediated cow milk allergy children over 3 years in 3 Spanish hospitals. Increasing doses of cow milk for 5 days from 1 cc of 1% to 200cc of pure milk were administered. Clinical follow-up was conducted and we compared specific IgE levels at onset, 6, 12 and 24 months after desensitization. Results: We included 18 children (13 males) between 3 and 14 years (mean 5.96). A total of271 doses were administered; there were 55 adverse reactions (84% mild). At the end of the protocol, 100% showed some degree of tolerance (39% total). Full tolerance was achieved in 72%of patients after two years. Two children failed to achieve tolerance. There was a significant decrease in the levels of specific IgE to cow milk and alpha-lactalbumin at 24 months, and to casein at 6, 12 and 24 months, compared to baseline. Conclusions: Oral rush desensitization is a safe and effective therapeutic option for patients with persistent cow milk allergy to medium term (AU)

[Oral rush desensitization for cow milk allergy: Clinical and immunological follow-up]. / Eficacia y seguridad de una pauta rush de inducción de tolerancia oral en pacientes con alergia a proteínas de leche de vaca: evolución clínica e inmunológica.

OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of oral rush desensitization in children with cow milk allergy. MATERIAL AND METHODS: Prospective study. We included IgE-mediated cow milk allergy children over 3 years in 3 Spanish hospitals. Increasing doses of cow milk for 5 days from 1 cc of 1% to 200 cc of pure milk were administered. Clinical follow-up was conducted and we compared specific IgE levels at onset, 6, 12 and 24 months after desensitization. RESULTS: We included 18 children (13 males) between 3 and 14 years (mean 5.96). A total of 271 doses were administered; there were 55 adverse reactions (84% mild). At the end of the protocol, 100% showed some degree of tolerance (39% total). Full tolerance was achieved in 72% of patients after two years. Two children failed to achieve tolerance. There was a significant decrease in the levels of specific IgE to cow milk and alpha-lactalbumin at 24 months, and to casein at 6, 12 and 24 months, compared to baseline. CONCLUSIONS: Oral rush desensitization is a safe and effective therapeutic option for patients with persistent cow milk allergy to medium term.

De la fiebre periódica a los síndromes autoinflamatorios / From periodic fever to self-inflammatory syndromes

En la consulta de Atención Primaria, el pediatra debe enfrentarse con relativa frecuencia con un niño con fiebre recurrente. La mayoría de las veces el diagnóstico es infeccione svirales de repetición, pero detrás de este escenario se nos puede ocultar un síndrome autoinflamatorio. Los síndromes autoinflamatorios son un grupo de enfermedades caracterizado por inflamación recurrente o persistente, sin evidencia de etiología infecciosa o autoinmune. El retraso en el diagnóstico de estos cuadros es habitualmente la norma, y algunos de ellos tienen un regular pronóstico alargo plazo debido a la instauración de amiloidosis secundaria. La incidencia es baja, aunque está probablemente subestimada debido a la dificultad en el diagnóstico. Hay un grupo de síndromes autoinflamatorios en los que el síntoma guía es la fiebre periódica o recurrente, acompañada habitualmente de exantema cutáneo, dolor abdominal, artralgias o artritis y linfadenopatías. En esta revisión se describen estos cuadros, explicando de forma práctica cómo sospecharlos, diagnosticarlos y tratarlos (AU)

In the primary care consult, the pediatrician must face quite frequently with a child with recurrent fever. Most of the times the diagnosis is recurrent viral infections, but behind this scenario an autoinflammatory syndrome might be missed. Autoinflammatory syndromes are a group of diseases characterised by recurrent or persistent inflammation, without an evidence of autoimmune or infectious etiology. The delay in the diagnosis in these diseases is important, and some of them have a poor long term prognosis because of secondary amiloidosis. The incidence is low, but it is probable underestimated because of the difficulty in the diagnosis. There is a group of autoinflammatory syndromes in which the main symptom is periodic or recurrent fever, usually accompanied by skin rash, abdominal pain, arthralgias or arthritis and limphadenopaty. In this paper we describe these entities, and summarize the way we can suspect, diagnose and treat these syndromes in a practical way (AU)

Patología gastrointestinal en niños con parálisis cerebral infantil y otras discapacidades neurológicas / Gastrointestinal disorders in children with cerebral palsy and neurodevelopmental disabilities

A pesar de los constantes avances en la medicina perinatal, la prevalencia de los niños con parálisis cerebral infantil no ha disminuido en los últimos 20 años. La patología gastrointestinal constituye uno de los principales problemas de estos y otros pacientes con discapacidades neurológicas. El manejo multidisciplinar de estos pacientes, por parte de neurólogos, gastroenterólogos, enfermeras, dietistas y otros especialistas, contribuye a una mejora sustancial de su calidad de vida y la de sus cuidadores. En este artículo discutiremos sobre los métodos diagnósticos y las opciones terapéuticas disponibles para los principales problemas nutricionales y gastrointestinales en los pacientes con discapacidades neurológicas: el reflujo gastroesofágico, el estreñimiento y los trastornos de la deglución (AU)

Recent data suggest that, contrary to initial expectations with improvements in perinatal medicine, the prevalence of cerebral palsy has not decreased over the last 20 years. Gastrointestinal disorders are a major chronic problem in most of children with cerebral palsy and in children with neurodevelopmental disabilities. A multidisciplinary approach, with input from neurologists, gastroenterologists, nurses, dieticians and other specialists, can make a major contribution to the medical wellbeing and quality of life of these children and their caregivers. This article focuses on diagnostic methods and therapeutic options available for major nutritional and gastrointestinal problems in patients with neurological disabilities: gastroesophageal reflux, constipation and swallowing disorders (AU)

[Gastrointestinal disorders in children with cerebral palsy and neurodevelopmental disabilities]. / Patología gastrointestinal en niños con parálisis cerebral infantil y otras discapacidades neurológicas.

Recent data suggest that, contrary to initial expectations with improvements in perinatal medicine, the prevalence of cerebral palsy has not decreased over the last 20 years. Gastrointestinal disorders are a major chronic problem in most of children with cerebral palsy and in children with neurodevelopmental disabilities. A multidisciplinary approach, with input from neurologists, gastroenterologists, nurses, dieticians and other specialists, can make a major contribution to the medical wellbeing and quality of life of these children and their caregivers. This article focuses on diagnostic methods and therapeutic options available for major nutritional and gastrointestinal problems in patients with neurological disabilities: gastroesophageal reflux, constipation and swallowing disorders.

Enfermedad de Kawasaki. Experiencia en nuestro hospital / Kawasaki's Disease. Experience in our hospital

Objetivo: Conocer la situación de la enfermedad de Kawasaki en nuestro medio. Pacientes y métodos: Se revisaron de forma retrospectiva, entre 1995 y 2007, a los niños que cumplían los criterios diagnósticos de la enfermedad de Kawasaki en su forma completa o incompleta, en el Hospital Universitario Central de Asturias. Se realizó un análisis descriptivo de los datos. Resultados: Revisamos un total de 19 pacientes. El 84%fueron menores de 3 años y el 57% varones. La incidencia anual fue de 8,4 casos/100.000 niños menores de 5 años. El 31% (todos varones) presentaron alteraciones en la ecocardiografía inicial; sin embargo, todos se normalizaron en controles posteriores. No se registraron aneurismas. El75% presentaron una PCR >5 mg/dl y hasta el 77% una VSG>50 mm/h. Solo 2 niños no respondieron a gammaglobulinai .v., requiriendo una segunda dosis. Conclusiones: La enfermedad de Kawasaki presenta en nuestro medio una incidencia semejante a la comunicada en Europa y Estados Unidos. Las complicaciones coronarias son más frecuentes en varones y en pacientes con fiebre prolongada (AU)

Objective: The aim of this study was to analyze the incidence and clinical spectrum of Kawasaki’s disease in children attended in our hospital. Patients and methods: Retrospective review of all children with Kawasaki’s disease evaluated in the department of Pediatric of Hospital Central (Asturias), between 1995and 2007.Results: Nineteen patients with Kawasaki’s disease were analyzed. 84% were younger than 3 years and 57% men. The annual incidence rate in our health area was estimated at8.4 cases per 100,000 children < 5 years. 31 % (all male)showed abnormalities in the initial echocardiography, none that included coronary aneurysms, all them were normalized in later controls. Blood analysis showed alterations of high ESR (77% of cases) and C-reactive protein (75%). Only2 children did not respond to IV gamma globulin requiring a second dose. Conclusions: The annual incidence rate for Kawasaki’s disease in our area was similar to that in Europe and the United States. Coronary aneurysms were more common in men and in patients with prolonged fever (AU)

Coagulopatía como presentación inicial de un déficit de alfa 1 antitripsina / Coagulopathy as initial presentation of an alpha 1 antitryipsin deficiency

El déficit de alfa-1 antitripsina es una enfermedad genética causada por la alteración del gen de un inhibidor de la proteasa de los neutrófilos localizado en el cromosoma14. Su expresividad clínica es variable: hepatitis colestásicaneo natal, ictericia, hipertransaminasemia o incluso cirrosis juvenil. El diagnóstico de sospecha se basa en la detecciónde niveles disminuidos de alfa-1 antitripsina y se confirma mediante fenotipificación de la proteína (electroforesis)y estudio genético. Presentamos el caso de un lactante de mes y medio que presentó un gran hematoma en la zona de punción de una vacuna. La analítica demostró una alteración de la coagulación asociado a un patrón de hepatitis colestásica. Los niveles de alfa-1 antitripsina fueron de 54 mg/dl y un fenotipo Pi tipo SZ. Se trató con factor VII activado recombinante, suplementos de vitaminas liposolubles y ácido ursodesoxicólico con buena evolución .La ictericia neonatal puede ser signo de colestasis por lo que debe determinarse la bilirrubina total y conjugada en todo neonato con ictericia persistente (AU)

Alpha-1 antitrypsin is an inhibitor of the protease of the neutrophils. Alpha-1 antitrypsin deficiency is a genetic disorder caused by the alteration of the gene in chromosome14 which codifies this protein. Clinical manifestations may vary: neonatal cholestatic hepatitis, jaundice, hypertransaminasemia or even childhood cirrhosis. Diagnosis is based on alpha-1 antitrypsin levels and it is confirmed bythe phenotype of the protein (electrophoresis) and genetic study. We describe the case of a six weeks old infant seen in our emergency department due to a haematoma surrounding avaccine puncture point. Blood analysis revealed a coagulopathy associated to cholestatic hepatitis. The levels ofalpha-1 antitrypsin were 54 mg/dl and the phenotype was Pi SZ. He was treated with recombinant factor VIIa, fat soluble vitamins and ursodeoxicolic acid, with a good evolution. Neonatal jaundice may indicate cholestasis, so in a newborn with persistent jaundice a measurement of the serum total and conjugated bilirub in is mandatory (AU)

Manejo y características de la bronquiolitis en niños ingresados menores de 3 meses en un hospital de tercer nivel / Management and characteristics of bronchiolitis in children under three months of age admitted to a tertiary hospital

Objetivos: Describir la presentación clínica, parámetros analíticos, epidemiología, manejo terapéutico, así como la evolución respiratoria en los 3 meses posteriores, de los lactantes menores de 90 días, ingresados con diagnóstico de bronquiolitis durante el primer semestre del 2006 en el Hospital Universitario Central de Asturias. Material y métodos: Estudio epidemiológico, retrospectivo, realizado en el Departamento de Pediatría del Hospital Universitario Central de Asturias. Se revisaron las historias de los lactantes menores de 90 días ingresados con diagnóstico de bronquiolitis, entre el 1 de enero y 30 de junio de 2006, describiéndose parámetros clínicos, analíticos, epidemiológicos y terapéuticos. Resultados: En dicho periodo se atendieron 15.500urgencias pediátricas, de las que 415 fueron bronquiolitis (2,6% del total), de ellos 88 eran lactantes de menos de 3meses de edad (21,2% de la muestra). De todas las bronquiolitis ingresaron 129 (31% de la muestra), de estos ingresados54 pacientes tenían menos de 90 días (61% de los lactantes menores a 3 meses, edad media de 47 días). La media de duración del ingreso fue de 8 ± 11,57 días (mediana: 8días); la del score de Wood-Downes-Ferrés fue 4. El cultivo de exudado nasal fue positivo en el 50% para virus sincitial respiratorio (VSR), y el 7,4% para metapneumovirus. Se realizó radiografía torácica al 70,4%, siendo patológica en el24,1%. El 20,4% presentaba tabaquismo pasivo, y el 35%antecedentes de atopia en familiares de primer grado. El85,2% ingresó en planta de hospitalización, mientras que el14,6% requirió ingreso en UCIP. En cuanto al tratamiento, hasta el 83,33% recibió adrenalina nebulizada, mientras que hasta el 38,9% recibió salbutamol nebulizado. El 14,8% ingresó en los 3 meses siguientes por proceso respiratorio. Comentarios: La bronquiolitis es una enfermedad potencialmente grave, tanto más cuanto más pequeña sea la edad del niño. Por esto, especialmente en este grupo etario, un porcentaje importante requiere ingreso en UCIP. El manejo terapéutico es un aspecto muy controvertido sin existir una indicación terapéutica de grado de evidencia Ao B. En nuestra serie la adrenalina nebulizada es el fármaco más utilizado en los lactantes más pequeños (AU)

Objectives: Describing the clinic presentation, analytic parameters, epidemiology and therapeutical management of infants younger than three months, admitted at the Hospital Universitario Central de Asturias, with the diagnosis of bronchiolitis during the first semester of 2006.Material and methods: An epidemiological retrospective study, was performed in the paediatrics department of the Hospital Universitario Central de Asturias. Clinical records, from January, 1 to June, 30 of infants younger than3 months of age hospitalised with diagnosis of bronchiolitis were reviewed, describing clinical, analytic, epidemiologic and therapeutical parameters. Results: In this period 15500 pediatric emergencies were attended, being 415 of them bronchiolitis (2.6%), admitting to the hospital 129 (31%). 54 of them were less than 3 months of age (42%), over a total amount of 88 infants who were attended less than that age (rate of admission: 61%; mean age was 47 days). 64.8% were males. Median length of admission was 6 days, and Wood-Downes-Ferrés´s scoremedian was 4. Respiratory syncytial virus (RSV) was isolated in 50% nasal culture, and metapneumovirus in 7.4%.Chest x-ray was performed in 70.4%, being pathological in24.1%. In 20.4% first grade relatives smoked, and 35% had personal records of a topy in first grade relatives. Eighty five percent were admitted to the hospitalization floor; and 14.6%were admitted at the intensive care unit. Focusing on medical therapy, 83.3% of them received nebulized epinephrine, while 38.9% received nebulized salbutamol. Nearly fifteen percent were admitted to the hospital in the next three months because of a respiratory process. Commentaries: Bronchiolitis is a potentially severe disease, in relation with the child´s age. Because of its severity, especially in this group of age, an important percentage requires admission to an intensive care unit. Therapeutical management is still controversial, as it does not exist a therapeutical indication with an A or B grade of evidence. In our cohort nebulized epinephrine was the most used therapy in the youngest infants (AU)

Development of in vitro correlate assays of immunity to infection with Yersinia pestis.

Pneumonic plague is a severe, rapidly progressing disease for which there is no effective vaccine. Since the efficacy of new vaccines cannot be tested in humans, it is essential to develop in vitro surrogate assays that are valid predictors of immunity. The F1 capsule antigen stimulates a protective immune response to most strains of Yersinia pestis. However, strains of Y. pestis that are F1- but still virulent have been isolated, and an in vitro assay, the results which can predict protection against both F1+ and F1- strains, is needed. The virulence antigen (V) is an essential virulence factor of Y. pestis and stimulates protective antibodies. We investigated potential correlates of plague immunity that are based on anti-V antibody-mediated neutralization of Yersinia-induced macrophage cytotoxicity. The neutralizing activity of sera from mice vaccinated with an F1-V fusion candidate vaccine was determined. The decrease in the level of the apoptosis-specific enzyme caspase-3 significantly predicted survival in one- and two-dose vaccination experiments. Sera from F1-V-vaccinated nonhuman primates were evaluated with macrophage assays based on caspase-3 and on other markers manifested at the different stages in cell death. Using murine- and human-derived macrophages in microscopic and fluorescence-activated-cell-sorting-based live/dead staining assays of terminal necrosis, we demonstrated a strong association between in vitro neutralization of macrophage cytotoxicity induced by serum-treated Yersinia and in vivo protection against lethal infection. These results provide a strong base for the development of reliable in vitro correlate bioassays that are predictive of protective immunity to plague.

Patología pulmonar en la fibrosis quística / Pulmonary disease in cystic fibrosis

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