Clinical and economic burden of respiratory syncytial virus in Spanish children: the BARI study

Respiratory syncytial virus (RSV) infection is a major cause of morbidity in children. However, its disease burden remains poorly understood, particularly outside of the hospital setting. Our study aimed to estimate the burden of medically attended acute lower respiratory infection (ALRI) cases potentially related to RSV in Spanish children. Longitudinal data from September 2017 to June 2018 of 51,292 children aged < 5 years old from the National Healthcare System (NHS) of two Spanish regions were used. Three case definitions were considered: (a) RSV-specific; (b) RSV-specific and unspecified acute bronchiolitis (RSV-specific and Bronchiolitis), and; (c) RSV-specific and unspecified ALRI (RSV-specific and ALRI). A total of 3460 medically attended ALRI cases potentially due to RSV were identified, of which 257 (7.4%), 164 (4.7%), and 3039 (87.8%) coded with RSV-specific, unspecific bronchiolitis, and unspecific ALRI codes, respectively. Medically attended RSV-specific and ALRI cases per 1000 children was 134.4 in the first year of life, 119.4 in the second, and 35.3 between 2 and 5 years old. Most cases were observed in otherwise healthy children (93.1%). Mean direct healthcare cost per medically attended RSV-specific and ALRI case was €1753 in the first year of life, €896 in the second, and €683 between 2 and 5 years old. Hospitalization was the main driver of these costs, accounting for 55.6%, 38.0% and 33.4%, in each respective age group. In RSV-specific cases, mean direct healthcare cost per medically attended case was higher, mostly due to hospitalization: €3362 in the first year of life (72.9% from hospitalizations), €3252 in the second (72.1%), and €3514 between 2 and 5 years old (74.2%). These findings suggest that hospitalization data alone will underestimate the RSV infections requiring medical care, as will relying only on RSV-specific codes. RSV testing and codification must be improved and preventive solutions adopted, to protect all infants, particularly during the first year of life.

MYH7 gene tail mutation causing myopathic profiles beyond Laing distal myopathy

OBJECTIVE

To describe a wide range of clinical and pathologic myopathic profiles associated with the p.K1729del mutation in the MYH7 gene, known to cause Laing distal myopathy.

METHODS

A study conducted in the Safor region (Spain), setting of a large cluster of patients. Clinical, neurophysiologic, muscle imaging, and muscle biopsy studies and MYH7 gene sequencing were investigated in 32 patients from 4 kindreds. Data from 36 deceased or nonexamined patients were collected from hospital records or relatives.

RESULTS

Onset ranged from congenital to the 6th decade. All patients presented weakness of great toe/ankle dorsiflexors and many had associated neck flexor, finger extensor, and mild facial weakness. In most cases, involvement of proximal and axial muscles was observed either clinically or by muscle imaging, sometimes giving rise to scapuloperoneal and limb-girdle syndromes. Disabling myalgias, skeletal deformities, and dilated cardiomyopathy in one patient were associated features. Life expectancy was not reduced but the spectrum of disability ranged from asymptomatic to wheelchair confined. Electromyographic neurogenic features were frequently recorded. Muscle fiber type disproportion, core/minicore lesions, and mitochondrial abnormalities were the most relevant pathologic alterations. All patients carried the p.K1729del mutation in MYH7.

CONCLUSIONS

The p.K1729del mutation in the MYH7 gene expresses notable clinical variability and electromyographic and pathologic features that can lead to the misdiagnosis of neurogenic atrophies, congenital myopathies, or mitochondrial myopathies. Mutations in genes encoding other sarcomeric and reticulo-sarcoplasmic proteins involved in calcium regulation share pathologic characteristics with our patients, suggesting a possible pathogenetic connection.

Epidemiología e impacto de la otitis media aguda en la Comunidad Valenciana

OBJECTIVE

To assess the burden (incidence, treatment and complications) of acute otitis media (AOM) and otitis media with effusion (OME) in children younger than 5 years of age from Valencia, Spain.

SUBJECT AND METHODS

We performed a retrospective cohort study of 1,399 children followed-up for the first 5 years of life. Seventeen pediatricians reviewed the medical records of their patients born in 1995 and 1996 and followed-up from birth until the age of 5 years. For each child, the number of otitis episodes, treatment, complications, and surgical interventions was obtained.

RESULTS

There were 2,961 episodes of AOM in the first 5 years of life (2.23 cases/child). Four hundred seventy-six cases (16.1 %) occurred before 1 year of age and 1,346 between the first and second year of life (45.5 %). By the third year of life, 59.8 % had had at least one episode. In most children (80.9 %), diagnosis was made in primary care and required a median of 1.81 visits/episode for follow-up. A total of 94.5 % were treated with antibiotics (amoxicillin-clavulanate 38.8 %, cefuroxime 14.3 %, clarithromycin 8.2 % and amoxicillin 5.9 %) and 8.5 % required a change of antibiotic therapy. Two hundred seventeen children (15.2 %) had at least one episode of OME. Twenty-six patients (1.8 %, 95 % CI: 1.2-2.7 %) required insertion of ventilation tubes. Twenty-four patients (1.7 %) had secondary hypoacusis. There was one case of meningitis and two cases of chronic otorrhea. No cases of mastoiditis were recorded.

CONCLUSIONS

The incidence of AOM in Valencia is 40,014 episodes/100,000 children younger than 5 years/year (95 % CI: 39,700-40,300). It represents a significant burden due to the large number of visits, antibiotic use, associated surgical procedures and need for auditory rehabilitation.

[Neuroimaging study with morphometric analysis of hereditary and idiopathic ataxia]

BACKGROUND

Hereditary and idiopathic ataxias are neurodegenerative disorders affecting diverse neuronal systems, particularly the cerebellum and its tracts. They are currently classified according to clinical and genetic criteria. Neuroimaging is a useful tool to help diagnosis but studies using quantitative methodology are scarce.

OBJECTIVE

To apply digital morphometry to cerebral MRI and define objective patterns for clinical evaluation and follow up.

PATIENTS AND METHODS

The study was carried out on 48 patients of whom 17 were Friedreich ataxia (FA), 6 non-Friedreich early onset spinocerebellar ataxia (EOCA), 9 autosomal dominant cerebellar ataxia type 1 (ADCA 1), 7 ADCA 3 and 9 idiopathic late onset cerebellar ataxia (ILOCA); 35 controls were grouped on early (< 30 years-old) and late age. Morphometric measures were done on previously selected MRI planes by image analyser digital software.

RESULTS

Six out of 21 measurements and 3 ratios were significantly discriminant. By categories, the structures mainly involved were as follows: atrophy of cervical spinal cord (p = 0.001), cerebellum (p = 0.038) and protuberance (p = 0.002) in FA; atrophy of spinal cord (p = 0.009), cerebellum (p = 0.035) and widening of IV ventricle (p = 0.044) in EOCA; shrinkage of protuberance (p = 0.009), middle cerebellar peduncles (p = 0.004) and spinal cord atrophy (p = 0.001) in ADCA 1; cerebellar atrophy (p = 0.041) in ADCA 3; and cerebellar atrophy (p = 0.041) and shortening of middle cerebellar peduncles (p = 0.038) in ILOCA.

CONCLUSIONS

This quantitative morphometric study confirms the existence of different pattern of cerebral involvement that is closely related with the distints clinical forms of hereditary and idiopathic ataxias. Only a few measurements can be used to obtain a morphometric profile for diagnostic and follow up purposes.