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Masuda T, Takei Y, Arao S. Is the use of gonad protection protectors necessary during infants chest radiography? Radiologia (Engl Ed) 2024; 66:107-113. [PMID: 38614527 DOI: 10.1016/j.rxeng.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/21/2022] [Indexed: 04/15/2024]
Abstract
INTRODUCTION AND OBJECTIVES To compare gonad doses with and without a gonad protector and to optimize the use of gonadal protectors in infants thorax radiography. MATERIALS AND METHODS Two pediatric anthropomorphic phantoms are used: an X-ray system for KXO-50SS/DRX-3724HD, and a digital radiography system for CALNEO Smart C12, with and without a gonad protector during infants thorax radiography. A real time skin dosimeter is placed on the X-ray system, and a real time skin dosimeter is inserted on the front side of the mammary gland, the front and back sides of the true pelvis level, and on the ovaries and testes. The X-ray system is irradiated 15 times using phantoms with and without a gonad protector. The measured entrance patient doses values of for the real time skin dosimeter are compared for each phantom, with and without the gonad protector. RESULTS The medium of measured entrance patient doses values for front side dose of the true pelvis level with and without the protector are 10.00 and 5.00 μGy at newborn, and 10.00 and 0.00μGy at one year, respectively. The medium of measured entrance patient doses values for the back side dose of the true pelvis level with and without the protector are 0.00 and 0.00 μGy at both newborn one year, respectively. The measured entrance patient doses cannot be detected in the ovaries and testes with or without the protector. No significant differences are observed in the measured entrance patient doses values for the front and back side doses of the pelvis, ovaries, and testes at newborn and one year, with and without the protector (p>0.05). CONCLUSIONS No significant difference was observed in gonad dose measurements with and without the gonad protector during infants chest radiography. We believe that gonadal protector wearing is not necessary.
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Affiliation(s)
- T Masuda
- Departamento de Tecnología Radiológica, Facultad de Ciencia y Tecnología de la Salud, Universidad de Bienestar Médico de Kawasaki, Kurashiki, Okayama, Japan.
| | - Y Takei
- Departamento de Tecnología Radiológica, Facultad de Ciencia y Tecnología de la Salud, Universidad de Bienestar Médico de Kawasaki, Kurashiki, Okayama, Japan
| | - S Arao
- Departamento de Tecnología Radiológica, Facultad de Ciencia y Tecnología de la Salud, Universidad de Bienestar Médico de Kawasaki, Kurashiki, Okayama, Japan
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Valcárcel-Nazco C, Sanromá-Ramos E, García-Pérez L, Villanueva-Micó RJ, Burgos-Simón C, Mar J. [Cost-effectiveness of universal childhood vaccination against hepatitis A in Spain: a dynamic approach]. Gac Sanit 2023; 37:102292. [PMID: 36868175 DOI: 10.1016/j.gaceta.2023.102292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 03/05/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of infant universal vaccination against hepatitis A in Spain. METHOD Using a dynamic model and decision tree model, a cost-effectiveness analysis was performed to compare three vaccination strategies against hepatitis A: non-vaccination strategy versus universal childhood vaccination of hepatitis A with one or two doses. The perspective of the study was that of the National Health System (NHS) and a lifetime horizon was considered. Both costs and effects were discounted at 3% per year. Health outcomes were measured in terms of quality adjusted life years (QALY) and the cost-effectiveness measure used was the incremental cost-effectiveness ratio (ICER). In addition, deterministic sensitivity analysis by scenarios was performed. RESULTS In the particular case of Spain, with low endemicity for hepatitis A, the difference in health outcomes between vaccination strategies (with 1 or 2 doses) and non-vaccination are practically non-existent, terms of QALY. In addition, the ICER obtained is high, exceeding the limits of willingness to pay from Spain (€22,000-25,000/QALY). The deterministic sensitivity analysis showed that the results are sensitive to the variations of the key parameters, although in no case the vaccination strategies are cost-effective. CONCLUSIONS Universal infant vaccination strategy against hepatitis A would not be a cost-effective option from the NHS perspective in Spain.
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Affiliation(s)
- Cristina Valcárcel-Nazco
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Islas Canarias, España; Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Santa Cruz de Tenerife, Islas Canarias, España; Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS), Madrid, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, España.
| | - Esther Sanromá-Ramos
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Islas Canarias, España; Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Santa Cruz de Tenerife, Islas Canarias, España
| | - Lidia García-Pérez
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Islas Canarias, España; Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Santa Cruz de Tenerife, Islas Canarias, España; Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS), Madrid, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, España
| | - Rafael Jacinto Villanueva-Micó
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, España; Instituto de Matemática Multidisciplinar, Universitat Politècnica de València, Valencia, España
| | - Clara Burgos-Simón
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, España; Instituto de Matemática Multidisciplinar, Universitat Politècnica de València, Valencia, España
| | - Javier Mar
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Unidad de Investigación AP-OSIs Gipuzkoa, Organización Sanitaria Integrada Alto Deba, Gipuzkoa, España
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de-Mir-Messa I, Sardón-Prado O, Sánchez-Solis M, Corcuera-Elosegui P, Korta-Murua J, Pérez-Fernández V, Caballero-Rabasco A, Hoo AF, Pérez-Yarza EG, Moreno-Galdó A. Development of Lung Function in Preterm Infants During the First Two Years of Life. Arch Bronconeumol 2022; 58:237-45. [PMID: 35312587 DOI: 10.1016/j.arbres.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/23/2021] [Accepted: 07/18/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION It remains unclear if prematurity itself can influence post delivery lung development and particularly, the bronchial size. AIM To assess lung function during the first two years of life in healthy preterm infants and compare the measurements to those obtained in healthy term infants during the same time period. METHODS This observational longitudinal study assessed lung function in 74 preterm (30+0 to 35+6 weeks' gestational age) and 76 healthy term control infants who were recruited between 2011 and 2013. Measurements of tidal breathing, passive respiratory mechanics, tidal and raised volume forced expirations (V'maxFRC and FEF25-75, respectively) were undertaken following administration of oral chloral hydrate sedation according to ATS/ERS recommendations at 6- and 18-months corrected age. RESULTS Lung function measurements were obtained from the preterm infants and full term controls initially at 6 months of age. Preterm infants had lower absolute and adjusted values (for gestational age, postnatal age, sex, body size, and confounding factors) for respiratory compliance and V'maxFRC. At 18 months corrected postnatal age, similar measurements were repeated in 57 preterm infants and 61 term controls. A catch-up in tidal volume, respiratory mechanics parameters, FEV0.5 and forced expiratory flows was seen in preterm infants. CONCLUSION When compared with term controls, the lower forced expiratory flows observed in the healthy preterm group at 6 months was no longer evident at 18 months corrected age, suggesting a catch-up growth of airway function.
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Madrid WA, Guzmán-Valderrábano C, Martínez-Briseño D, Torre-Bouscoulet L, Juan DHRS, Gochicoa-Rangel L. Offline exhaled nitric oxide in children: chemiluminescence vs. electrochemical devices. Bol Med Hosp Infant Mex 2021; 78:404-410. [PMID: 34571514 DOI: 10.24875/bmhim.20000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Exhaled nitric oxide (eNO) is a noninvasive marker of airway inflammation that has been used in children, using the "offline" technique. To the extent of our knowledge, no article reported in literature compares the concordance and correlation between the two different technologies used to measure eNO at tidal volume offline. This study aimed to report the concordance and correlation of the eNO measured "offline" at tidal volume, using chemioluminiscence (cl) vs electrochemical devices (eq). Methods A cross-sectional, observational, and prospective study was conducted in the National Institute of Respiratory Diseases (Instituto Nacional de Enfermedades Respiratorias), Mexico City. Healthy children and those with a lung disease between 1 and 11 years of age were included. The exhaled air sample at tidal volume was obtained by attaching a mask connected to a Mylar® bag. Results We studied 36 children. The mean ± standard deviation (SD) age of the study population was 6 ± 2.6 years; 25% of the subjects included were healthy, and the rest had a lung disease. The concordance correlation coefficient between the two measuring devices was 0.98 (p < 0.001), with a mean difference of 1.46 ± 3.5 ppb and 95% limits of agreement from -5.3 ppb to 8.3 ppb. The linear regression model equation for the estimation of eNO was eNOcl = (eNOeq·1.0718) - 0.1343 (r2 = 0.97). Conclusions The measurement of eNO at tidal volume by the offline method can be analyzed by electrochemical devices, and the results are interchangeable with those analyzed by chemiluminescence technology.
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Affiliation(s)
- Wilmer A Madrid
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Mexico City, Mexico
| | - Carlos Guzmán-Valderrábano
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Mexico City, Mexico.,Departmento de Pulmonología, Pedia-Hero. Mexico City, Mexico
| | - David Martínez-Briseño
- Departmento de Epidemiología y Estadística, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Mexico City, Mexico
| | - Luis Torre-Bouscoulet
- Laboratorio de Función Pulmonar, Instituto de Desarrollo e Innovación en Fisiología Respiratoria S de RL. Mexico City, Mexico
| | - David H Ramírez-San Juan
- Laboratorio de Función Pulmonar, Instituto de Desarrollo e Innovación en Fisiología Respiratoria S de RL. Mexico City, Mexico
| | - Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Mexico City, Mexico.,Laboratorio de Función Pulmonar, Instituto de Desarrollo e Innovación en Fisiología Respiratoria S de RL. Mexico City, Mexico
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Ruiz-Montero R, Epstein D, Guzmán Herrador B, Espín Balbino J. [Economic evaluation of the introduction of 4CMenB (Bexsero®) in the national vaccine schedule in Spain]. Gac Sanit 2019; 34:318-325. [PMID: 31776044 DOI: 10.1016/j.gaceta.2019.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/07/2019] [Accepted: 08/13/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Bexsero® (4CMenB), meningococcal B vaccine, was licensed in Europe in 2013. In Spain, despite MenB being the most frequent cause of invasive meningococcal disease (IMD), Bexsero® is recommended and financed for patients at increased risk of IMD but is not financed by the NHS in the routine vaccination schedule. OBJECTIVE to evaluate the cost-utility, epidemiological impact, and total costs of the introduction of 4CMenB into the vaccination schedule to help inform vaccine policy in Spain. METHOD We adapted a cost-utility analysis, a probabilistic decision-tree, to Spain. A cohort of new-born infants in 2015 was modelled with two dosages, using two different strategies: routine vaccination schedule with 4CMenB and non-vaccination. Costs were measured from a payer perspective and benefits were calculated in quality-adjusted life years (QALYs). A Monte Carlo analysis and 32 scenarios were performed to assess the robustness and the uncertainty of our results. RESULTS With the 3+1 dosage, routine vaccination prevented 54% of cases and deaths and an incremental cost-utility ratio (ICUR) of 351.389 €/QALY (95% confidence interval [95%CI]: 265,193-538,428) was estimated. The 2+1 dosage prevented 50% of cases and deaths, with an ICUR of 278.556 €/QALY (95%CI: 210,285-430,122). CONCLUSIONS Given the current incidence of invasive meningococcal disease in Spain and the information available from 4CMenB, our model shows that routine vaccination is not cost-effective at the current price. Only with a vaccine price of 1.45 € for the 3+1 schedule or 3.37 € for the 2+1 schedule could it be recommended based on efficiency criteria.
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Affiliation(s)
- Rafael Ruiz-Montero
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, España; Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, España.
| | - David Epstein
- Facultad de Ciencias Económicas y Empresariales, Universidad de Granada, Granada, España
| | - Bernardo Guzmán Herrador
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, España; Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, España
| | - Jaime Espín Balbino
- Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria (ibs Granada), Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
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Szulman GA, Freilij H, Behrends I, Gentile Á, Mallol J. [Recurrent wheezing: prevalence and associated factors in infants from Buenos Aires City, Argentina]. Bol Med Hosp Infant Mex 2017; 74:419-426. [PMID: 29382526 DOI: 10.1016/j.bmhimx.2017.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/26/2017] [Accepted: 08/10/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The episodes of bronchial obstruction at early age constitute a frequent problem in Pediatrics. The aim of this study was to evaluate the prevalence of recurrent wheezing in infants in Buenos Aires City, as well as to identify any associated factors. METHODS Cross-sectional study performed from 2011 to 2012 in the Children Hospital Ricardo Gutiérrez, Buenos Aires City, as part of the International Study of Wheezing in Infants. A validated questionnaire was applied to parents of infants aged between 12 and 15 months. The prevalence of wheezing, mostly the recurrent episodes (three or more), and their probable associated factors were evaluated. Data were statistically analyzed with χ2, Fisher's test, binary and logistics multiple regression analysis. The significance level was 0.05. RESULTS Over 1063 infants, 58.9% (confidence interval (CI) 95% 55.9-61.9) presented at least one episode of wheezing and 26.3% (CI95% 23.8-29.9) three or more episodes (recurrent wheezing). Risk factors associated to wheezing were male gender (p=0.001), six or more episodes of cold during the first year of life (p <0.0001), age at first cold <4 months (p <0.0001); pneumonia (p <0.0001) and smoking during pregnancy (tobacco) (p=0.01). For recurrent wheezing, risk factors we considered as six or more episodes of cold during the first year of life (p <0.0001), early (< 4 month of age) onset wheezing (p <0.0001) and nocturnal wheezing (p <0.0001). CONCLUSIONS The prevalence of recurrent wheezing among infants in Buenos Aires Ciy was high (26.3%). Some identified associated factors can be preventable.
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Affiliation(s)
- Gabriela Aída Szulman
- Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina; Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Héctor Freilij
- Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ilse Behrends
- Servicio de Alergia, Hospital Churruca, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ángela Gentile
- Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Javier Mallol
- Departamento de Medicina Respiratoria Infantil, Hospital CRS El Pino, Escuela de Medicina, Universidad de Santiago de Chile, Santiago de Chile, Chile
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Ramos-Fernández JM, Moreno-Pérez D, Gutiérrez-Bedmar M, Ramírez-Álvarez M, Martínez García Y, Artacho-González L, Urda-Cardona A. [Apnoea in infants with bronchiolitis: Incidence and risk factors for a prediction model]. An Pediatr (Barc) 2017; 88:160-166. [PMID: 28479309 DOI: 10.1016/j.anpedi.2017.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/10/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION The presence of apnoea in acute bronchiolitis (AB) varies between 1.2% and 28.8%, depending on the series, and is one of its most fearsome complications. The aim of this study is to determine the incidence of apnoea in hospitalised patients diagnosed with AB, and to define their associated risk factors in order to construct a prediction model. PATIENTS AND METHOD A retrospective observational study of patients admitted to a tertiary hospital in the last 5 years with a diagnosis of AB, according to the classic criteria. Data was collected on the frequency of apnoea and related clinical variables to find risk factors in a binary logistic regression model for the prediction of apnoea. A ROC curve was developed with the model. RESULTS Apnoea was recorded during the admission of 53 (4.4%) patients out of a total 1,197 cases found. The risk factors included in the equation were: Female (OR 0.6, 95% CI: 0.27-1.37), Caesarean delivery (OR: 3.44, 95% CI: 1.5-7.7), Postmenstrual age ≤43 weeks (OR: 6.62, 95% CI: 2.38-18.7), Fever (OR: 0.33, 95% CI: 0.09-1.97), Low birth weight (OR: 5.93, 95% CI: 2.23-7.67), Apnoea observed by caregivers before admission (OR: 5.93, 95% CI: 2.64-13.3), and severe bacterial infection (OR: 3.98, 95% CI: 1.68-9.46). The optimal sensitivity and specificity of the model in the ROC curve was 0.842 and 0.846, respectively (P<.001). CONCLUSIONS The incidence of apnoea during admission was 4.4 per 100 admissions of AB and year. The estimated prediction model equation may be of help to the clinician in order to classify patients with increased risk of apnoea during admission due to AB.
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Affiliation(s)
- José Miguel Ramos-Fernández
- Sección de Lactantes, Unidad de Gestión Clínica de Pediatría, Grupo de Investigación IBIMA, Hospital Materno-Infantil Hospital Regional Universitario de Málaga, Málaga, España.
| | - David Moreno-Pérez
- Infectología Pediátrica e Inmunodeficiencias, Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, Grupo de Investigación IBIMA, Departamento de Pediatría y Farmacología, Facultad de Medicina de la Universidad de Málaga, Málaga, España
| | - Mario Gutiérrez-Bedmar
- Departamento de Salud Pública y Psiquiatría, Facultad de Medicina Universidad de Málaga, Málaga, España
| | - María Ramírez-Álvarez
- Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil Hospital Regional Universitario de Málaga, Málaga, España
| | - Yasmina Martínez García
- Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil Hospital Regional Universitario de Málaga, Málaga, España
| | - Lourdes Artacho-González
- Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil Hospital Regional Universitario de Málaga, Málaga, España
| | - Antonio Urda-Cardona
- Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil Hospital Regional Universitario de Málaga, Málaga, España
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Calvo C, Aguado I, García-García ML, Ruiz-Chercoles E, Díaz-Martinez E, Albañil RM, Campelo O, Olivas A, Muñóz-Gonzalez L, Pozo F, Fernandez-Arroyo R, Fernandez-Rincón A, Calderon A, Casas I. [Respiratory viral infections in a cohort of children during the first year of life and their role in the development of wheezing]. An Pediatr (Barc) 2016; 87:104-110. [PMID: 27743968 PMCID: PMC7185499 DOI: 10.1016/j.anpedi.2016.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/21/2016] [Accepted: 08/02/2016] [Indexed: 11/05/2022] Open
Abstract
Introducción Las infecciones respiratorias virales que requieren hospitalización parecen conferir riesgo de desarrollar sibilancias recurrentes, pero existen pocos datos publicados en poblaciones no seleccionadas por tener factores de riesgo. Nuestro objetivo principal fue analizar si las infecciones respiratorias virales sintomáticas y asintomáticas, de diferente gravedad, durante el primer año de vida en una cohorte de recién nacidos, suponen un mayor riesgo de sibilancias recurrentes. Pacientes y métodos Se incluyeron 302 recién nacidos. Se recogió aspirado nasofaríngeo a los niños cuando presentaron una infección respiratoria y de forma periódica en los controles de salud (2, 4, 6 y 12 meses). Se estudiaron 16 virus respiratorios mediante reacción en cadena de polimerasa (PCR). Resultados Se analizaron 1.293 muestras (1.005 controles de salud y 288 infecciones respiratorias). El 30,8% de las muestras tomadas en los controles de salud fueron positivas, frente a un 77,8% en las infecciones respiratorias, p < 0,001 (OR: 3, IC 95%: 2,4-3,8). Un total de 239 (79%) lactantes tuvieron al menos una detección viral positiva durante el primer año de vida. El virus más frecuentemente identificado (71%) fue el rinovirus (RV). En 27 lactantes (11%) se detectaron sibilancias recurrentes durante su primer año de vida (2,9 DE: 1,2 episodios). El 58,3% de los lactantes cuya primera infección respiratoria requirió hospitalización desarrollaron sibilancias de repetición, frente al 8,6% de los niños cuya primera infección fue leve o asintomática, p < 0,001 (OR: 2,18; lC 95%: 1,05-4,5). Conclusiones En nuestra serie, las infecciones respiratorias virales graves en los primeros meses de vida supusieron un factor de riesgo para desarrollar sibilancias recurrentes. No ocurrió lo mismo con las infecciones respiratorias leves.
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Affiliation(s)
- Cristina Calvo
- Servicio de Pediatría, Hospital Severo Ochoa, Leganés, Madrid, España.
| | - Isabel Aguado
- Servicio de Pediatría, Hospital Severo Ochoa, Leganés, Madrid, España
| | | | | | | | | | - Olga Campelo
- Centro de Salud Leganés Norte, Leganés, Madrid, España
| | | | | | - Francisco Pozo
- Laboratorio de Gripe y Virus Respiratorios, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, España
| | | | | | - Ana Calderon
- Laboratorio de Gripe y Virus Respiratorios, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, España
| | - Inmaculada Casas
- Laboratorio de Gripe y Virus Respiratorios, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, España
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Troncoso P, Villagrán A, Vera M, Estay A, Ortiz M, Serrano C, Hernández C, Harris PR. [Maternal infection due to Helicobacter pylori does not increase the risk of the infection in the first trimester of the life of their infants]. ACTA ACUST UNITED AC 2016; 87:474-479. [PMID: 27425773 DOI: 10.1016/j.rchipe.2016.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 06/07/2016] [Accepted: 06/09/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION H. pylori infection is acquired early in childhood. However, there is little information available regarding the role of breastfeeding and neonatal acquisition of the infection. OBJECTIVE To evaluate factors affecting the acquisition of H. pylori in newborns and infants from infected mothers. PATIENTS AND METHOD Consecutive mothers and their newborns were recruited into the study from the maternity unit, immediately after delivery. After signing informed consent, one stool sample from the mother was obtained before hospital discharge. Three stool samples of the newborns were then collected at home at 15, 60, and 90 days of life, for the detection of H. pylori antigen (Monoclonal HpSAg, sensitivity 94% and specificity 97%). The socio-epidemiological and biomedical variables were also analysed using a questionnaire. RESULTS A total of 32 mother-child pairs (64 subjects) were enrolled. The mean maternal age was 30.1±5.1 years, with 53% vaginal delivery, and 85% exclusively breastfed. There were 13 (40%) infected mothers. No H. pylori infection was detected in newborns and infants up to 3 months of follow-up. No significant differences were found in socioeconomic level between infected versus non-infected mothers (both groups mostly in the very high socioeconomic category: 28% and 32%, respectively, P=.15) and in the number of family members between infected versus non-infected mothers (3.8±0.8 vs 4.2±1.8 persons, P=.18). CONCLUSION Despite having a significant percentage of H. pylori-infected mothers, no newborn was infected at the third month of life. The protective role of breastfeeding cannot be ruled out.
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Affiliation(s)
- Paula Troncoso
- Laboratorio de Inmunología e Infección Gastrointestinal, Departamento de Gastroenterología y Nutrición Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento de Pediatría y Cirugía Infantil, Universidad de La Frontera, Temuco, Chile
| | - Andrea Villagrán
- Laboratorio de Inmunología e Infección Gastrointestinal, Departamento de Gastroenterología y Nutrición Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Macarena Vera
- Laboratorio de Inmunología e Infección Gastrointestinal, Departamento de Gastroenterología y Nutrición Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alberto Estay
- Departamento de Neonatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marlene Ortiz
- Laboratorio de Inmunología e Infección Gastrointestinal, Departamento de Gastroenterología y Nutrición Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Serrano
- Laboratorio de Inmunología e Infección Gastrointestinal, Departamento de Gastroenterología y Nutrición Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Caroll Hernández
- Laboratorio de Inmunología e Infección Gastrointestinal, Departamento de Gastroenterología y Nutrición Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paul R Harris
- Laboratorio de Inmunología e Infección Gastrointestinal, Departamento de Gastroenterología y Nutrición Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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10
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Wegner A A, Cespedes F P, Godoy M ML, Erices B P, Urrutia C L, Venthur U C, Labbé C M, Riquelme M H, Sanchez J C, Vera V W, Wood V D, Contreras C JC, Urrutia S E. [High flow nasal cannula in infants: Experience in a critical patient unit]. ACTA ACUST UNITED AC 2015; 86:173-81. [PMID: 26363858 DOI: 10.1016/j.rchipe.2015.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/11/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The high flow nasal cannula (HFNC) is a method of respiratory support that is increasingly being used in paediatrics due to its results and safety. OBJECTIVE To determine the efficacy of HFNC, as well as to evaluate the factors related to its failure and complications associated with its use in infants. PATIENTS AND METHOD An analysis was performed on the demographic, clinical, blood gas, and radiological data, as well as the complications of patients connected to a HFNC in a critical care unit between June 2012 and September 2014. A comparison was made between the patients who failed and those who responded to HFNC. A failure was considered as the need for further respiratory support during the first 48hours of connection. The Kolmogorov Smirnov, Mann-Whitney U, chi squared and the Exact Fisher test were used, as well as correlations and a binary logistic regression model for P≤.05. RESULTS The study included 109 patients, with a median age and weight: 1 month (0.2-20 months) and 3.7kg (2-10kg); 95 percentile: 3.7 months and 5.7kg, respectively. The most frequent diagnosis and radiological pattern was bronchiolitis (53.2%) and interstitial infiltration (56%). Around 70.6% responded. There was a significant difference between failure and response in the diagnosis (P=.013), radiography (P=018), connection context (P<.0001), pCO2 (median 40.7mmHg [15.4-67 mmHg] versus 47.3mmHg [28.6-71.3mmHg], P=.004) and hours on HFNC (median 60.75hrs [5-621.5 hrs] versus 10.5hrs [1-29 hrs], P<.0001). The OR of the PCO2 ≥ 55mmHg for failure was 2.97 (95% CI; 1.08-8.17; P=.035). No patient died and no complications were recorded. CONCLUSION The percentage success observed was similar to that published. In this sample, the failure of HFNC was only associated with an initial pCO2 ≥ 55mmHg. On there being no complications reported as regards it use, it is considered safe, although a randomised, controlled, multicentre study is required to compare and contrast these results.
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Affiliation(s)
- Adriana Wegner A
- Pediatra Intensivista, Unidad de Paciente Crítico Pediátrico (UPCP), Complejo Asistencial Dr. Sotero del Río, Santiago, Chile.
| | - Pamela Cespedes F
- Pediatra Intensivista, Unidad de Paciente Crítico Pediátrico (UPCP), Complejo Asistencial Dr. Sotero del Río, Santiago, Chile
| | - María Loreto Godoy M
- Pediatra Intensivista, Unidad de Paciente Crítico Pediátrico (UPCP), Complejo Asistencial Dr. Sotero del Río, Santiago, Chile
| | - Pedro Erices B
- Pediatra Intensivista, Unidad de Paciente Crítico Pediátrico (UPCP), Complejo Asistencial Dr. Sotero del Río, Santiago, Chile
| | - Luis Urrutia C
- Pediatra Intensivista, Unidad de Paciente Crítico Pediátrico (UPCP), Complejo Asistencial Dr. Sotero del Río, Santiago, Chile
| | - Carina Venthur U
- Pediatra, UPCP Complejo Asistencial Dr. Sotero del Río, Santiago, Chile
| | - Marcela Labbé C
- Pediatra, UPCP Complejo Asistencial Dr. Sotero del Río, Santiago, Chile
| | - Hugo Riquelme M
- Terapista Respiratorio, UPCP Complejo Asistencial Dr. Sotero del Río, Santiago, Chile
| | - Cecilia Sanchez J
- Enfermera, UPCP Complejo Asistencial Dr. Sotero del Río, Santiago, Chile
| | - Waldo Vera V
- Terapista Respiratorio, UPCP Complejo Asistencial Dr. Sotero del Río, Santiago, Chile
| | - David Wood V
- Terapista Respiratorio, UPCP Complejo Asistencial Dr. Sotero del Río, Santiago, Chile
| | | | - Efren Urrutia S
- Terapista Respiratorio, UPCP Complejo Asistencial Dr. Sotero del Río, Santiago, Chile
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11
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García-Elorriaga G, Palma-Alaniz L, García-Bolaños C, Ruelas-Vargas C, Méndez-Tovar S, Del Rey-Pineda G. [Microbiology of bronchoalveolar lavage in infants with bacterial community-acquired pneumonia with poor outcome]. Bol Med Hosp Infant Mex 2015; 72:307-312. [PMID: 29421528 DOI: 10.1016/j.bmhimx.2015.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/11/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is one of the most common infectious causes of morbidity and mortality in children <5 years of age. The aim of the study was to clarify the bacterial etiologic diagnosis in infants with CAP. METHODS A prospective, cross-sectional and descriptive study in patients 6 months to 2 years 11 months of age with CAP with poor outcome was conducted. Patients were admitted to the Pediatric Pneumology Service and underwent bronchoscopy with bronchoalveolar lavage (BAL), taking appropriate measures during the procedure to limit the risk of contamination. RESULTS Aerobic bacteria isolated were Moraxella sp. 23%, Streptococcus mitis 23%, Streptococcus pneumoniae 18%, Haemophilus influenzae 12%, Streptococcus oralis 12%, and Streptococcus salivarius 12%. CONCLUSIONS In contrast to other reports, we found Moraxella sp. to be a major bacterial pathogen, possibly because of improved detection with bronchoscopy plus BAL.
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Affiliation(s)
- Guadalupe García-Elorriaga
- Hospital de Infectología, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, México D.F., México.
| | - Laura Palma-Alaniz
- Laboratorio Clínico, Unidad Médica de Atención Especializada Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, México D.F., México
| | - Carlos García-Bolaños
- Neumología pediátrica, Unidad Médica de Atención Especializada Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, México D.F., México
| | - Consuelo Ruelas-Vargas
- Servicio de Endoscopia, Unidad Médica de Atención Especializada Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, México D.F., México
| | - Socorro Méndez-Tovar
- Laboratorio Clínico, Unidad Médica de Atención Especializada Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, México D.F., México
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12
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López Muñoz AC, Busto Aguirreurreta N, Tomás Braulio J. [Preoperative fasting guidelines: an update]. ACTA ACUST UNITED AC 2015; 62:145-56. [PMID: 25443866 DOI: 10.1016/j.redar.2014.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 11/22/2022]
Abstract
Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery.
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13
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Domínguez Aurrecoechea B, Fernández Francés M, Ordóñez Alonso MÁ, López Vilar P, Pérez Candás JI, Merino Ramos L, Aladro Antuña A, Fernández López FJ, Pérez López AM. [Infectious diseases and use of health care resources in children less than 2 years-old who attend kindergarten]. An Pediatr (Barc) 2015; 83:149-59. [PMID: 25455913 DOI: 10.1016/j.anpedi.2014.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/24/2014] [Accepted: 10/07/2014] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Parents often ask paediatricians for advice about the best way to care for their children. There are discrepancies in the literature on this subject. The objective of this study is to evaluate the influence of attending kindergartens on the risk of acute infections and the use of health care resources in children less than 24 months. POPULATION AND METHODS A prospective longitudinal study was conducted on two cohorts of children 0-24 months (born between 1 January and 30 September 2010), who were grouped according to whether they attended kindergarten or not, and were usually seen in 33 pediatric clinics of the Principality of Asturias Public Health Service. RESULTS AND CONCLUSIONS A total of 975 children were studied, of whom 43.7% attended a kindergarten at 24 months. Attending kindergarten increases the risk of pneumonia by 131%, recurrent wheezing by 69%, bronchitis by 57%, and otitis media by 64%. Early exposure to kindergarten increases the risk of pneumonia from 2.31 to 2.81, and the mean emergency room visits from 1 to 2.3. The mean antibiotic cycle is 1.7 in children who do not go to kindergarten, 3.4 if started within the first 6 months, and 2 if they start at 18 months. Day-care attendance is a risk factor of infectious diseases that increases if attending kindergartens from an early age.
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14
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Calvo C, García-García ML, Arroyas M, Trallero G, Cabrerizo M. [Human parechovirus-3 infection in a neonate with fever and suspected sepsis]. An Pediatr (Barc) 2013; 81:49-51. [PMID: 24286884 DOI: 10.1016/j.anpedi.2013.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 09/03/2013] [Accepted: 09/14/2013] [Indexed: 11/26/2022] Open
Abstract
The human parechovirus (HPeV) are viruses of the recently described Picornaviridae family and are causing several infections in young children. The pathology associated with these viruses is beginning to emerge. The HPeV type 3, has been described particularly in association with sepsis-like febrile syndromes, meningitis and encephalitis in very young infants and neonates. We report the case of a 14-day-old girl with a fever and clinical sepsis that required hospitalization and in which HPeV-3 was identified in the cerebrospinal fluid. The blood, urine and cerebrospinal fluid bacterial cultures were negative, and the patient improved. This case illustrates the usefulness of investigating parechovirus infection in neonates with fever or suspected sepsis.
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Affiliation(s)
- C Calvo
- Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, Madrid, España.
| | - M L García-García
- Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - M Arroyas
- Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - G Trallero
- Unidad de Enterovirus, Área de Virología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España
| | - M Cabrerizo
- Unidad de Enterovirus, Área de Virología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España
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15
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León-Carrillo B, Baldris-Catafau J, Jiménez-Martínez S. [The most prevalent environmental risk factors in respiratory syncytial virus bronchiolitis in infants from 0 to 24 months in a seasonal study performed in two hospitals]. Enferm Clin 2013; 23:160-3. [PMID: 23928150 DOI: 10.1016/j.enfcli.2013.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 02/23/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Our aim is to describe the environmental aspects of children between 0 and 24 months, who arrived in the Emergency Department of the Hospital General de Cataluña and Hospital Parc Tauli (both within Barcelona province), and were diagnosed with respiratory syncytial virus bronchiolitis from November 2010 to February 2011. METHOD A cross-sectional observational study was conducted on children of both sexes, with ages from 0 to 24 months, and diagnosed with bronchiolitits respiratory syncytial virus +. Data was obtained by completing a non-validated questionnaire, with information provided by parents and the medical history. RESULTS The most common features in the study were: a mean age of 3.8 months, most were males, with siblings of school age, mothers who did not smoke during pregnancy, were in a non-smoking environment in their home, and finally, less than 5 people living together in their home. CONCLUSIONS The most common risk factors n order of prevalence were, having siblings of school age, male sex, and living in smoking environment. It was observed that the majority of children had risk associated factors associated, with only 8.2% of samples not presenting any risk factors.
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Affiliation(s)
- Beatriz León-Carrillo
- Servicio de Urgencias de Pediatría, Hospital General de Cataluña, San Cugat del Vallès, Barcelona, España.
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