Overnutrition as a risk factor for more serious respiratory viral infections in children: A retrospective study in hospitalized patients.

BACKGROUND: The prevalence of obesity has increased dramatically in children worldwide. Obesity has been recognized as a risk factor for more serious viral respiratory infections, mainly in adults. OBJECTIVE: To study the relationship between overnutrition (obesity and overweight) and clinical severity in children hospitalized with acute respiratory infections of viral origin. METHODS: One hundred and forty-three clinical records of children between 2 and 18 years old hospitalized for acute respiratory infection at Clínica Dávila (2014-2018) were analyzed, recording the respiratory viruses detected at the time of hospitalization, weight, and height. Nutritional status was estimated using Z score or body mass index, according to age. RESULTS: Eighty-tree3 children (58%) were positive for more than one respiratory virus. The main virus detected in monoinfection was adenovirus (9.8%), followed by respiratory syncytial virus (7.7%) and parainfluenza virus (7.7%). There were no deaths. Patients with obesity presented more days of hospitalization (P = .04), oxygen therapy (P = .03) and mechanical ventilation (P < .001), as well as a higher probability of requiring mechanical ventilation (P = .001) and of ICU admission (P = .003) compared with children with normal weight. Patients with overweight presented more days of mechanical ventilation (P < .001) than patients with normal weight. No significant differences were found between the presence of viral coinfection and nutritional status. CONCLUSION: Overnutrition is associated with greater severity of viral respiratory infection in hospitalized children.

Overnutrition, Nasopharyngeal Pathogenic Bacteria and Proinflammatory Cytokines in Infants with Viral Lower Respiratory Tract Infections.

Background: Little is known about the interaction between the nasopharyngeal bacterial profile and the nutritional status in children. In this study, our main goal was to evaluate the associations between overnutrition and the presence of four potentially pathogenic bacteria in the nasopharynx of infants with viral lower respiratory tract infections (LRTI). In addition, we determined whether changes in the nasopharyngeal bacterial profile were associated with mucosal and serum proinflammatory cytokines and with clinical disease severity. Methods: We enrolled 116 children less than 2 years old hospitalized for viral LRTI during two consecutive respiratory seasons (May 2016 to August 2017); their nutritional status was assessed, and nasopharyngeal and blood samples were obtained. S. aureus, S. pneumoniae, H. influenzae, M. catarrhalis, and respiratory viruses were identified in nasopharyngeal samples by qPCR. Cytokine concentrations were measured in nasopharyngeal and blood samples. Disease severity was assessed by the length of hospitalization and oxygen therapy. Results: Nasopharyngeal pathogenic bacteria were identified in 96.6% of the enrolled children, and 80% of them tested positive for two or more bacteria. The presence and loads of M. catarrhalis was higher (p = 0.001 and p = 0.022, respectively) in children with overnutrition (n = 47) compared with those with normal weights (n = 69). In addition, the detection of >2 bacteria was more frequent in children with overnutrition compared to those with normal weight (p = 0.02). Multivariate regression models showed that the presence and loads of S. pneumoniae and M. catarrhalis were associated with higher concentrations of IL-6 in plasma and TNF-α in mucosal samples in children with overnutrition. Conclusions: The nasopharyngeal profile of young children with overnutrition was characterized by an over representation of pathogenic bacteria and proinflammatory cytokines.

Primordial odontogenic tumor: report of 2 new cases.

Primordial odontogenic tumor (POT) is a recently described benign odontogenic tumor, with only 16 cases reported in the literature. We present 2 new cases of POT affecting the mandible. Case 1 is that of 12-year-old girl with an asymptomatic, slow-growing mass, causing facial asymmetry. Radiography showed a well-defined unilocular radiolucency surrounding an impacted second premolar. Case 2 is that of a 13-year-old girl with a mass involving the crown of the unerupted third molar and showing similar radiographic features. Microscopically, both lesions were composed of variably cellular fibromyxoid tissue surrounded by thin ameloblastic epithelium, with stellate reticulum-like areas, but no mineralized tissue, yielding the diagnosis of POT. Immunohistochemical analysis showed diffuse expression of CK14 in epithelial cells, whereas CK19 was expressed mainly in the basal layer. Syndecan-1 (CD138) was expressed in the stellate-like regions and in the subepithelial zone. Both patients were treated surgically, with no signs of recurrence seen after 15 and 60 months, respectively.

Overnutrition in Infants Is Associated With High Level of Leptin, Viral Coinfection and Increased Severity of Respiratory Infections: A Cross-Sectional Study.

Objective: To investigate the relationship of overnutrition (obese and overweight) with severity of illness in children hospitalized with acute lower respiratory infections (ALRIs), frequency of viral coinfections and leptin levels. Methods: We studied 124 children <2 years old that were hospitalized for ALRI. Nutritional status was calculated by z-scores according to weight-for-age z-scores, length or height-for-age z-scores, and weight-for-height z-scores. Nasopharyngeal aspirates (NPAs) were obtained and viral respiratory pathogens were identified using reverse transcription polymerase chain reactions (RT-PCR). Respiratory syncytial virus (RSV) load was assessed using quantitative RT-PCR. NPA and plasma leptin level were measured. Clinical data and nutritional status were recorded, and patients were followed up until hospital discharge. Viral coinfection was defined as the presence of two or more viruses detected in the same respiratory sample. Severity of illness was determined by length of hospitalization and duration of oxygen therapy. Results: Children with overnutrition showed a greater frequency of viral coinfection than those with normal weight (71% obese vs. 37% normal weight p = 0.013; 68% overweight vs. 37% normal weight p = 0.004). A lower RSV load was found in obese (5.91 log10 copies/mL) and overweight children (6.49 log10 copies/mL) compared to normal weight children (8.06 log10 copies/mL; p = 0.021 in both cases). In multivariate analysis, obese, and overweight infants <6 months old were associated with longer hospital stays (RR = 1.68; CI: 1.30-2.15 and obese: RR = 1.68; CI: 1.01-2.71, respectively) as well as a greater duration of oxygen therapy (RR = 1.80; IC: 1.41-2.29 and obese: RR = 1.91; CI: 1.15-3.15, respectively). Obese children <6 months showed higher plasma leptin level than normal weight children (7.58 vs. 5.12 ng/µl; p <0.046). Conclusions: In infants younger than 6 months, overnutrition condition was related to increased severity of infections and high plasma leptin level. Also, children with overnutrition showed a greater frequency of viral coinfection and low RSV viral load compared to normal weights children. These findings further contribute to the already existent evidence supporting the importance of overnutrition prevention in pediatric populations.

Damage-control techniques in the management of severe lung trauma.

BACKGROUND: Damage control (DC) has improved survival from severe abdominal and extremity injuries. The data on the surgical strategies and outcomes in patients managed with DC for severe thoracic injuries are scarce. METHODS: This is a retrospective review of patients treated with DC for thoracic/pulmonary complex trauma at two Level I trauma centers from 2006 to 2010. Subjects 14 years and older were included. Demographics, trauma characteristics, surgical techniques, and resuscitation strategies were reviewed. RESULTS: A total of 840 trauma thoracotomies were performed. DC thoracotomy (DCT) was performed in 31 patients (3.7%). Pulmonary trauma was found in 25 of them. The median age was 28 years (interquartile range [IQR], 20-34 years), Revised Trauma Score (RTS) was 7.11 (IQR, 5.44-7.55), and Injury Severity Score (ISS) was 26 (IQR, 25-41). Nineteen patients had gunshot wounds, four had stab wounds, and two had blunt trauma.Pulmonary trauma was managed by pneumorrhaphy in 3, tractotomy in 12, wedge resection in 1, and packing as primary treatment in 8 patients. Clamping of the pulmonary hilum was used as a last resource in seven patients. Five patients returned to the intensive care unit with the pulmonary hilum occluded by a vascular clamp or an en masse ligature. These patients underwent a deferred resection within 16 hours to 90 hours after the initial DCT. Four of them survived.Bleeding from other intrathoracic sources was found in 20 patients: major vessels in nine, heart in three, and thoracic wall in nine.DCT mortality in pulmonary trauma was 6 (24%) of 25 because of coagulopathy, or persistent bleeding in 5 patients and multiorgan failure in 1 patient. CONCLUSION: This series describes our experience with DCT in severe lung trauma. We describe pulmonary hilum clamping and deferred lung resection as a viable surgical alternative for major pulmonary injuries and the use of packing as a definitive method for hemorrhage control. LEVEL OF EVIDENCE: Epidemiologic study, level V.

Epidemiología en cefalea de niños y adolescentes / Epidemiology of headache in children and adolescents

Cefalea es dolor ubicado por sobre la línea órbito meatal, con etiología definida en su mayoría con la anamnesis. La prevalencia es variable según edad y es un problema asistencial importante. Los objetivos de este estudio descriptivo son: presentar una experiencia de modelo de atención, la Unidad de Cefalea del Servicio de Neurología Infantil de Hospital San Juan de Dios y describir las características epidemiológicas generales encontradas. Pacientes y Métodos: Se diseña programa de atención y se describen las características clínicas generales. Resultados: Se presenta flujograma. Se citan 225 pacientes a primera evaluación (enero-diciembre 2004) y entre enero y julio de 2004, 153 pacientes (edad promedio fue de 10,48 años, DS:2,91, rango 2 a 14 años). En la distribución por edad y sexo de los 225 pacientes, hubo mayor proporción de niños en edad prepuberal y más niñas en edad postpuberal. De 476 casos (2004-2005), 360 pacientes reciben primera atención y un 54,7 por ciento abandona controles a través del tiempo. De 112 pacientes analizados, 65 tenían antecedentes familiares de migraña. La cefalea interrumpió colegio, actividad física, estudio y/o demandó la asistencia a servicio de urgencia en un alto porcentaje; dolor bilateral: 90 casos y frontal: 67; dolor opresivo en 27 niños y pulsátil en 41. Fueron gatillantes: ejercicio físico, estrés escolar y/o familiar entre otros. Se cuantifican Cefaleas Primarias 90 casos y Secundarias 9 (IHS 2004). Discusión y conclusiones: La baja adherencia está descrita en otros cuadros crónicos. Se afectó la calidad calidad de vida en forma relevante en este grupo evaluado. El uso de protocolos de tratamiento e intervención multidisciplinaria permite abordar esta morbilidad biopsicosocialmente con grandes posibilidades de éxito.

Headache is a skull pain whose etiology is best defined through the clinical history. Its prevalence varies with age and it is a very important problem in public health. The aims in this descriptive work are: To report the experience n the Pediatric Neurology Service Headache Unit (Hospital San Juan de Dios) and to describe the epidemiologic characteristics of children consulting because of headache. Patients and methods: The protocol applied and clinical characteristics are presented. Results: The patients chart flow and general clinical aspects are described. The analysis was done in 225 patients who had a first appointment between January December 2004 and 153 patients attended between January and July (average age: 10,48, SD: 2,91, range to years old). In the first group of 225 patients, pre-pubertal boys and postpuberal girls were more frequent. . From 476 cases (2004-2005), 360 patients had a first assessment and 54, 7 percent of them abandoned follow up. In patients studied, 65 had a family history of migraine. Headache interrupted school attendance, sports, studies or required therapy in emergency room in a large number of patients; Characteristics of pain were: bilateral in 90 cases and frontal in 67; oppressive pain in 27 children and throbbing or pulsatile in 41. Triggers identified were: sports, school or familial stress. There were 90 cases which corresponded to primary headaches: and 9 to secondary etiologies. (IHS 2004). Discussion and conclusions: The low adherence to treatment is also described in other chronic diseases. The quality of life was affected in this population. The use of diagnostic and therapeutic protocols and multidisciplinary intervention helps to improve prognosis.

Caracterización de perovskitas La1-XSrXNiO3 Y La2-2XSr2XNiO4-sigma obtenidos a partir del método de auto combustión / Characterization of La1-xSrxNiO3 and La2-2xSr2xNiO4-sigma perovskites obtained through the auto combustion method

El método de auto-combustión fue utilizado para sintetizar una serie de óxidos tipo perovskita La1-xAxNiO3, donde el catión La³+ es sustituido parcialmente por Sr²+ y Mg²+. Los análisis de difracción de rayos X indican que el Sr ejerce un efecto notable sobre la estructura de los sólidos sintetizados, obteniéndose una fase simple de óxido tipo perovskita para un grado de sustitución x<= 0,1 y una mezcla de fases de óxidos tipo espinelas y NiO para x>= 0,2. Se observa que el estado de oxidación formal del Ni disminuye desde 3+ (x= 0) hasta 2,6+ (x= 0,4), indicando que el Sr facilita la reducción ya que promueve la capacidad de aceptación de electrones sobre la muestra. El Mg, por otra parte, no produce un sólido con estructura perovskita. Los estudios de reducción a temperatura programada (RTP) revelan que estos procesos ocurren a través de especies intermediarias hasta formar Ni0, SrO y La2O3, fases que se relacionaran con la actividad presentada durante los estudios catalíticos sobre estos sólidos precursores