Disseminated Tuberculosis Complicated With Pneumatoceles in 2 Infants

Pneumatoceles are rare complications of pulmonary tuberculosis in children. We present 2 cases in infants of disseminated tuberculosis complicated by pneumatoceles with different evolution. This complication should be considered if worsening of respiratory symptoms occurs after initiating anti-tuberculous treatment. Treatment of pneumatoceles is usually conservative and surgical treatment should be used in patients with giant cysts which cause respiratory distress.

Imported malaria in children in Madrid, Spain, 2007-2013

BACKGROUND

The majority of malaria cases diagnosed in Europe in the last few years have occurred in people living in non-endemic areas travelling back to their home country to visit friends and relatives (VFRs). Children account for 15-20% of imported malaria, with known higher risk of severe disease.

MATERIAL AND METHODS

A retrospective multicentre study was conducted in 24 hospitals in Madrid (Spain) including patients under 16 years diagnosed with malaria (2007-2013).

RESULTS

A total of 149 episodes in 147 children were reported. Plasmodium falciparum was the species most commonly isolated. Twenty-five patients developed severe malaria and there was one death related to malaria. VFR accounted for 45.8% of our children. Only 17 VFRs had received prophylaxis, and 4 of them taken appropriately. They presented more frequently with fever (98% vs. 69%), a longer time with fever (55 vs. 26%), delay in diagnosis of more than three days (62 vs. 37%), and more thrombocytopenia (65 vs. 33%) than non-VFRs, and with significant differences (p<0.05).

CONCLUSIONS

VFRs represent a large proportion of imported malaria cases in our study. They seldom took adequate prophylaxis, and delayed the visit to the physician, increasing the length of fever and subsequent delaying in diagnosis. Appropriate preventive measures, such as education and pre-travel advices should be taken in this population.

"Induced sputum versus gastric lavage for the diagnosis of pulmonary tuberculosis in children"

Background

Diagnosis of pulmonary tuberculosis (PTB) is difficult in infants and young children. For microbiological confirmation of PTB children, sequential gastric lavage (GL) is recommended. Induced sputum (IS) may be an alternative or complementary tool, but the information is limited in children in developed countries. The aim of this study is to assess the safety and diagnostic yield from IS combined with GL for PTB diagnosis in non-HIV infected children.

Methods

The study involved 22 children with suspected PTB admitted to the Getafe Hospital from January 2007 to May 2011. IS and GL were performed on three consecutive days, according to a standardized protocol. In all samples, BK staining, culture and PCR were carried out, including Genotype MTBDR plus for resistance to INH-RIF (Isoniazid-Rifampin) since 2008. A preliminary analysis of an ongoing prospective study is presented.

Results

Median age was 72 months (range 1 month to 14 years of age). Seven (33%) were ≤ 5 years of age. Seventeen were clinically diagnosed of PTB based on positive PPD and radiological criteria. Microbiological confirmation was achieved in 10 (58.8%) by either GL or IS. M. tuberculosis was identified by GL in 8 children (47.1%) and by IS in 7 (41.2%). One infant (2 IS samples) had transient oxygen desaturation recovered spontaneously.

Conclusions

IS appears to be safe and well tolerated by children for diagnosis of PTB and is more convenient. Increasing the diagnostic yield of PTB in children with PTB may be a complementary technique. Largest studies are necessary to define the role of IS in paediatric PTB.

Biodiesel production by two-stage transesterification with ethanol by washing with neutral water and water saturated with carbon dioxide

Industrial production of ethyl esters is impeded by difficulties in purifying the product due to high amounts of soap formed during transesterification. A simple biodiesel wash process was developed that allows successful purification of samples containing high amounts of soap. The key step was a first washing with neutral water, which removed the soaps without increasing the acidity or affecting the process yield. Afterward, the biodiesel was washed with water saturated with CO(2), a mild acid that neutralized the remaining soaps and extracted impurities. The acidity, free-glycerine, methanol and soaps concentrations were reduced to very low levels with high efficiency, and using non-corrosive acids. Independently of the initial acidity, it was possible to obtain biodiesel within EN14214 specifications. The process included the recovery of soaps by hydrolysis and esterification, making it possible to obtain the theoretical maximum amount of biodiesel.

Biodiesel production by two-stage transesterification with ethanol

A two-stage process consisting of two reactions steps with glycerin separation and ethanol/catalyst addition in each of them was optimized for ethyl esters production. The optimal reaction temperature was 55 °C. At an ethanol/oil molar ratio of 4.25:1 (25%v/v alcohol with respect to oil), a 99% conversion value was obtained with low ethanol consumption. In contrast to methoxide catalysts, sodium and potassium hydroxide catalysts severely complicate the purification since no phase separation took place under most conditions. With a total sodium methoxide concentration of 1.06 g catalyst/100 g oil, and adding 50% of the catalyst in each reaction step, biodiesel with a total glycerin content of 0.172% was obtained. The optimal conditions found in this study make it possible to use the same industrial facility to produce either methyl or ethyl esters.