Santiago Vidaurreta

Viral etiology of acute respiratory infections in hospitalized and outpatient children in Buenos Aires, Argentina.

Objectives: To determine and compare the viral frequency, seasonality and clinical-demographic features in 2 groups of children (hospitalized versus outpatients) with acute respiratory infections. Material and Methods: A cross-sectional, descriptive study was performed from 2008 to 2010 in 620 children <6 years of age with acute respiratory infection. Respiratory samples were studied for classical respiratory viruses by immunofluorescence and for human rhinoviruses (HRV) by real-time reverse transcription polymerase chain reaction. Clinical and demographic data were recorded. Results: Viral detection by immunofluorescence was 48% in 434 inpatients and 37% in 186 outpatients. Viral diagnosis increased to 83% and 62%, respectively, when testing for HRV. HRV (41%) and respiratory syncytial virus (RSV) (27%) were most common viruses identified, followed by metapneumovirus (9%), influenza A and parainfluenza (3%), adenovirus and influenza B (2%). HRV frequency was significantly higher in hospitalized patients (47%) than in outpatients (27%) (P < 0.001). Coinfection was detected in 12% of hospitalized and 4% of outpatients (P < 0.031). HRV and adenovirus circulated throughout the entire year. RSV, influenza A and B predominated in winter, whereas metapneumovirus and parainfluenza predominated in spring. Of 362 patients with bronchiolitis, 84% had a virus identified; HRV (42%) and RSV (38%) were predominant. Of 77 patients with pneumonia, 84% had a virus detected with HRV (43%) and RSV (29%) predominating. Conclusions: HRV were significant pathogens associated with bronchiolitis and pneumonia, especially in hospitalized patients. Both, HRV and coinfections, were risk factors for hospitalization. These findings support the importance of including HRV detection in children with acute respiratory infection.

[Acute viral respiratory infection in children under 5 years: Epidemiological study in two centers in Buenos Aires, Argentina].

INTRODUCTION Acute respiratory infections (ARI) are a major cause of hospitalization particularly at the extreme ages of life. OBJECTIVES To determine the viral diagnosis in children < 5 years old with ARI, seasonality, clinical and epidemiological characteristics. POPULATION AND METHODS A cross-sectional, descriptive and multicenter study was performed. Respiratory samples from patients with ARI hospitalized or outpatients with < 5 days of respiratory symptoms from June 2008 to May 2009 were studied for respiratory viruses. Clinical and demographic data were recorded. RESULTS A total of 347 patients were enrolled: 234 hospitalized and 112 outpatients. Hospitalized patients were younger compared with outpatients (8 vs. 19 months, p <0.001) and presented more frequently bronchiolitis (74% hospitalized vs. 24% outpatients) and pneumonia (14% hospitalized vs. 5% outpatients). Age was statistically associated with hospitalization (p= 0.01). Viral diagnosis was achieved in 81% hospitalized and 57% of outpatients. Rhinovirus was the most frequent followed by respiratory syncytial virus. The rest of respiratory viruses were observed with lower frequency. Viral circulation was observed throughout the whole year. The median length of stay was 3.5 days. Intensive care was required in 11% of hospitalized patients and 3% required mechanical ventilation. No deaths were recorded. CONCLUSIONS The use of viral diagnostic techniques allowed the identification of an etiologic agent in most of the hospitalized patients and more than half of outpatients. The addition of RT-PCR for rhinovirus, allowed the identification of this etiologic agent. Viral circulation was observed throughout the whole year. Hospitalized patients presented bronchiolitis and pneumonia more frequently than outpatients.

Tratamiento con vaselina estéril para lesión por extravasación en un prematuro

The skin of premature infants is an ineffective barrier. The stratum corneum is thinner than that found in full-term infants. We report on a premature patient with extravasation injury from sodium bicarbonate. Daily treatment with sterile petrolatum resulted in restitutio ad integrum.

Respuesta broncodilatadora del salbutamol administrado como aerosol presurizado mediante aerocámaras con válvulas o espaciadores no valvulados

Introduccion: los medicamentos para tratar el asma utilizan, fundamentalmente, la via inhalatoria. La utilidad de los espaciadores con valvulas (aerocamaras) esta demostrada; sin embargo, recientemente se ha propuesto como alternativa mas economica el uso de espaciadores sin valvulas. La eficacia clinica de estos no se ha demostrado hasta el momento. Objetivo: comparar la respuesta broncodilatadora de un inhalador de dosis medida (IDM) de salbutamol administrado a traves de una aerocamara contra un espaciador sin valvulas. Poblacion, material y metodos: estudio experimental, prospectivo, aleatorizado, simple ciego, de grupos paralelos. Se incluyeron 34 pacientes (6-16 anos) con asma, que presentaban obstruccion bronquial leve o moderada (volumen respiratorio forzado, entre 50% y 79% del valor predictivo), sin haber recibido broncodilatadores recientemente. Luego de una espirometria inicial se asignaron para recibir 100 g de salbutamol (aerosol presurizado) mediante una aerocamara con valvulas (AerochamberMR) o un espaciador sin valvulas (AeromedMR). Se determino la respuesta broncodilatadora del volumen respiratorio forzado y del FMF a los 30 minutos. Resultados: en el grupo con aerocamara ingresaron 17 pacientes (12 varones; volumen respiratorio forzado basal 67 ± 10%), y en el grupo con espaciador sin valvulas ingresaron 17 pacientes (13 varones, volumen respiratorio forzado basal 67 ± 6%). La variacion del FEV1 fue 26 ± 14% contra 16 ± 5% (p= 0,017) y la variacion del FMF fue 92 ± 48% contra 58 ± 29% (p= 0,018), para aerocamaras y espaciadores sin valvulas, respectivamente (ANOVA). Conclusion: el aerosol presurizado de salbutamol administrado a traves de una aerocamara con valvulas produce una respuesta broncodilatadora mayor que el espaciador sin valvulas en ninos con asma.

Publicación de trabajos presentados en los Encuentros Nacionales de Investigación Pediátrica de la Sociedad Argentina de Pediatría: factores involucrados

OBJECTIVE To estimate the proportion of abstracts presented at National Pediatric Research Meetings that are fully-published and describe their design and factors that influence nonpublication. METHODS Descriptive and analytical study including all abstracts presented at National Pediatric Research Meetings (1998-2011). One author per study was identified and asked to complete a survey on its design, publication and factors associated with non-publication. RESULTS Out of 746 abstracts that were submitted, the authors of 522 (70%) completed the survey. Among these, 84.3% were observational studies and 15.7%, experimental; 34% had received funding. Two hundred and seventeen abstracts were published subsequently (41.5%, 95% confidence interval [CI]: 37.3-45.9). Funded studies had better chances of being published (odds ratio [OR]: 2, 95% CI: 1.4-2.9, p 〈 0.001). Lack of time, insufficient sample size, and problems with funding were referred as the most common reasons for failure to publish. CONCLUSIONS Among allabstracts presented at National Pediatric Research Meetings, 41.5% were fully published. Lack of time was the most common reason for unpublished studies.

Lobulectomía pulmonar toracoscópica: resultados iniciales en pediatría

The objective of the present study consists of revising our initial experience with the use of thoracoscopic surgery for lung resections and their complications. Clinical histories and videos, from patients treated surgically at the Fundación Hospitalaria-Private Children Hospital and CEMIC Universitary Hospital from april 2005 to october 2008, were retrospectivelly estudied. Eleven female and 9 male patients were included. The median surgical time was 150 min (range: 60-270 min). The median time of chest tube permanence was 3 days (range: 2-10 days). Median hospital stay was 15 days (range: 3-29 days). It was concluded that thoracoscopic lung lobectomies are technically feasible and applicable to all paediatric ages; they should be considered as an alternative approach for trained groups.