Infección respiratoria por bocavirus humano en lactantes de Córdoba, Argentina / Human bocavirus respiratory infection in infants in Córdoba, Argentina

Bocavirus humano (BoVh) ha sido relacionado con la infección respiratoria aguda (IRA) en los niños (prevalencia 0,9% a 33%), aunque las características clínicas aún no han sido claramente establecidas. Objetivos. Identificar la presencia de BoVh en pacientes con IRA internados en el Hospital de Niños de Córdoba y describir los casos sin coinfección detectada. Método. Se realizó la pesquisa de BoVh por PCR convencional a partir de secreciones nasales de 222 niños menores de 2 años hospitalizados por IRA durante 2011 y se registraron los datos demográficos, clínicos y radiológicos. Resultados. Se identificaron 15 pacientes BoVh+ (6,8%), con una mediana de edad de 3,5 meses (rango 1 a 22), 7/15 en coinfección (5 virus respiratorio sincicial, 1 parainfluenza-3, 1 Bordetella pertussis). Casos sin coinfección: neumonía 5/8, bronquiolitis 3/8; dos requirieron cuidados intermedios, 7/8 oxigenoterapia, 7/8 broncodilatadores, 6/8 antibióticos; enfermedad asociada 1/8 (microcefalia/cardiopatía). Conclusiones. Se identificó BoVh en 15 de 222 niños (6,8%); predominó el diagnóstico de neumonía sin casos graves ni complicaciones al alta.

It has been suggested that human bocavirus (HBoV) is related to acute respiratory infection (ARI) in children (prevalence: 0.9% to 33%) although clinical characteristics have not been clearly established yet. Objectives. To identify the presence of HBoV in patients with ARI hospitalized in Hospital de Niños de Córdoba and describe cases without co-infection. Method. HBoV screening was done by traditional PCR. Specimens to be screened were obtained from nasal secretions of 222 children under 2 years of age hospitalized due to an ARI during 2011. Demographic, clinical and radiological data were recorded. Results. Fifteen HBoV+ patients (6.8%) were identified. Their median age was 3.5 months (range: 1-22), 7/15 in co-infection (5 respiratory syncytial virus, 1 parainfluenza-3, 1 Bordetella pertussis). Cases without co-infection: pneumonia 5/8, bronchiolitis 3/8; two required intermediate care, 7/8 oxygen therapy, 7/8 bronchodilators, 6/8 antibiotics; associated disease 1/8 (microcephalus/heart disease). Conclusions. HBoV was identified in 15 out of 222 children (6.8%); the diagnosis of pneumonia was predominant without severe cases nor complications upon discharge.

Consumo de tabaco en médicos residentes de pediatría en la Argentina: Prevalencia actual y tendencia en los últimos diez años / Tobacco consumption among pediatric residents in Argentina: Current prevalence and trend over the past 10 years

Introducción. Los pediatras se encuentran en una posición estratégica para actuar en la prevención del tabaquismo. Objetivos. Estimar la prevalencia del tabaquismo en residentes de pediatría, analizar los factores asociados, describir su conducta preventiva y evaluar las diferencias en la última década. Métodos. Estudio transversal, por encuesta anónima, autoadministrada, que incluyó a residentes de pediatría de ocho hospitales de la Argentina. Se evaluaron el hábito de fumar, los factores asociados, la actitud hacia el consumo de tabaco de los pacientes o los padres, y se compararon los resultados con los de 2002. Resultados. De 448 encuestados, 20,1% fumaban. No hubo diferencias signifcativas entre fumadores y no fumadores respecto del sexo, los hijos, el número de guardias y el tener un jefe fumador. El padre fumador fue un factor de riesgo para tabaquismo solo en las mujeres (OR 1,98; IC 95% 1,09 a 3,61; p= 0,01). Los que vivían en pareja fumaban menos (OR 0,57; IC 95% 0,34 a 0,96; p= 0,03). Solo 18,1% refrieron tener una conducta activa frente al tabaquismo de los pacientes, sin diferencias entre fumadores y no fumadores. No hubo diferencia con la prevalencia del tabaquismo de 2002, pero sí mayor proporción de residentes que aconsejaban (32,4% contra 26,1%; p <0,01) y advertían a sus pacientes (37,7% contra 18,6%; p <0,01), y que recibieron información durante su formación (63,6% contra 39,8%; p <0,01). Conclusiones. El 20,1% de los médicos residentes de pediatría eran fumadores, siendo más frecuente en las mujeres con un padre fumador. La conducta activa frente al tabaquismo de los pacientes o sus padres fue muy baja. Pese a las políticas ofciales, el tabaquismo en este grupo no se ha modifcado en la última década, aunque aumentó la proporción de quienes recibieron información durante su formación, y aconsejan y advierten a los pacientes sobre sus riesgos.(AU)

Introduction. Pediatricians are in a strategic position to prevent smoking. Objectives. To estimate the prevalence of smoking among pediatric residents, analyze associated factors, describe preventive actions, and assess the differences observed over the past decade. Methods. Cross-sectional study with a self-administered, anonymous survey conducted among pediatric residents from eight Argentine hospitals. Smoking habit, associated factors, and attitude towards patients or their parents smoking were evaluated; results were compared to those obtained in 2002. Results. Out of 448 surveyed physicians, 20.1% smoked. There were no signifcant differences between smokers and non-smokers in terms of gender, having children, number of on-call shifts, and having a supervisor who smokes. Having a parent who smoked was a risk factor for tobacco use only among women (OR: 1.98; 95% CI: 1.09-3.61; p = 0.01). Surveyed residents living with a couple had a lower smoking rate (OR: 0.57; 95% CI: 0.34-0.96; p = 0.03). Only 18.1% referred having an active behavior towards smoking patients, no differences were observed between smokers and non-smokers. In addition, there were no differences in smoking prevalence from 2002, but there was a higher rate of residents who advised their patients (32.4% versus 26.1%; p < 0.01) and warned them against smoking (37.7% versus 18.6%; p < 0.01), and of those who received information on this topic during their training (63.6% versus 39.8%; p < 0.01). Conclusions. Among resident pediatricians, 20.1% were smokers, with a higher prevalence among women with a father or mother who is a smoker. The rate of active behavior regarding patients or parents who smoke was very low. In spite of offcial policies, tobacco use in this group has not changed over the past decade, but there was an increase in the rate of those who received information during their training and of those who advised their patients of smoking risks.(AU)

Validez de la radiografía de tórax para diferenciar etiologia bacteriana de viral en niños hospitalizados con neumonía / Accuracy of chest radiograph in hospitalized children with pneumonia

RESUMEN Objetivo. Analizar la validez de la radiografía de tórax para diferenciar etiología bacteriana de viral en niños internados por neumonía.Población, material y métodos. Se analizaron las radiografías de 175 menores de 5 años internados por neumonía con etiología confirmada (48 bacterianas y 127 virales). Las imágenes fueron valoradas por un pediatra (P) y dos radiólogos (R1 y R2) independientemente y a ciegas para los datos del paciente,utilizando la escala de Khamapirad (menos 3 a mas7 puntos).Se calcularon acuerdos intra e inter observadores por índice Kappa . Mediante prueba de Student se evaluó la asociación entre los resultados de P y la etiología, asumiendo un nivel de significación de p> 0,05. Se efectuó curva ROC (ReceiverOperator Characteristic) para identificar el mejor punto de corte para predecir una etiología.Resultados. El grado de acuerdo inter-observador fue satisfactorio: k= 0,80 entre P y R1 y k= 0,83, entre P y R2. El puntaje radiológico asignado por P fue significativamente mayor en neumonías bacterianas que en virales (3,7 mas o menos 1,1 vs. menos1,4 mas o menos 1,2; p=0,001), con un excelente grado de acuerdo entre sus dos lecturas (k= 0,93). Se identificó un puntaje radiológico mas o menos 1 como el mejor punto para diferenciar neumonías bacterianas de virales. La escala mostró una sensibilidad de 100 por ciento (IC 95 por ciento = 90 menos100), especificidad de 98 por ciento (IC 95 por ciento = 93 menos 99), valor predictivo positivo de 96 por ciento (IC 95 por ciento = 85 menos 99) y negativo de 100 por ciento (IC 95 por ciento = 96 menos100) para predecir etiología bacteriana.Conclusiones. La radiografía de tórax se mostró precisa y exacta para diferenciar etiología bacteriana de viral en niños internados por neumonía.(AU)

Human bocavirus respiratory infection in infants in Córdoba, Argentina. / Human bocavirus respiratory infection in infants in Córdoba, Argentina.

UNLABELLED: It has been suggested that human bocavirus (HBoV) is related to acute respiratory infection (ARI) in children (prevalence: 0.9

to 33

) although clinical characteristics have not been clearly established yet. OBJECTIVES: To identify the presence of HBoV in patients with ARI hospitalized in Hospital de Niños de Córdoba and describe cases without co-infection. METHOD: HBoV screening was done by traditional PCR. Specimens to be screened were obtained from nasal secretions of 222 children under 2 years of age hospitalized due to an ARI during 2011. Demographic, clinical and radiological data were recorded. RESULTS: Fifteen HBoV+ patients (6.8

) were identified. Their median age was 3.5 months (range: 1-22), 7/15 in co-infection (5 respiratory syncytial virus, 1 parainfuenza-3, 1 Bordetella pertussis). Cases without co-infection: pneumonia 5/8, bronchiolitis 3/8; two required intermediate care, 7/8 oxygen therapy, 7/8 bronchodilators, 6/8 antibiotics; associated disease 1/8 (microcephalus/heart disease). CONCLUSIONS: HBoV was identified in 15 out of 222 children (6.8

); the diagnosis of pneumonia was predominant without severe cases nor complications upon discharge.

Tobacco consumption among pediatric residents in Argentina. Current prevalence and trend over the past 10 years. / Tobacco consumption among pediatric residents in Argentina. Current prevalence and trend over the past 10 years.

INTRODUCTION: Pediatricians are in a strategic position to prevent smoking. OBJECTIVES: To estimate the prevalence of smoking among pediatric residents, analyze associated factors, describe preventive actions, and assess the differences observed over the past decade. METHODS: Cross-sectional study with a self-administered, anonymous survey conducted among pediatric residents from eight Argentine hospitals. Smoking habit, associated factors, and attitude towards patients or their parents smoking were evaluated; results were compared to those obtained in 2002. RESULTS: Out of 448 surveyed physicians, 20.1

smoked. There were no significant differences between smokers and non-smokers in terms of gender, having children, number of on-call shifts, and having a supervisor who smokes. Having a parent who smoked was a risk factor for tobacco use only among women (OR: 1.98; 95

CI: 1.09-3.61; p = 0.01). Surveyed residents living with a couple had a lower smoking rate (OR: 0.57; 95

CI: 0.34-0.96; p = 0.03). Only 18.1

referred having an active behavior towards smoking patients, no differences were observed between smokers and non-smokers. In addition, there were no differences in smoking prevalence from 2002, but there was a higher rate of residents who advised their patients (32.4

versus 26.1

; p < 0.01) and warned them against smoking (37.7

versus 18.6

; p < 0.01), and of those who received information on this topic during their training (63.6

versus 39.8

; p < 0.01). CONCLUSIONS: Among resident pediatricians, 20.1

were smokers, with a higher prevalence among women with a father or mother who is a smoker. The rate of active behavior regarding patients or parents who smoke was very low. In spite of official policies, tobacco use in this group has not changed over the past decade, but there was an increase in the rate of those who received information during their training and of those who advised their patients of smoking risks.

Predictores de coqueluche al ingreso en lactantes hospitalizados con infección respiratoria aguda baja. / [Pertussis predictors in hospitalized infants with acute lower respiratory tract infection].

BACKGROUND: Pertussis, or whooping cough, caused by Bordetella pertussis (BP) is a re-emerging problem in our environment. Although generally considered that the disease is relatively easy to identify infections respiratory syncytial virus (RSV) can present with similar symptoms in infants remains difficult discrimination. OBJECTIVE: Compare clinical symptoms at admission and complementary studies in infants hospitalized with acute respiratory infection (ARI) and RSV by BP to establish markers that enable their early clinical prediction. MATERIALS AND METHODS: Observational, analytical, case-crossover cross comparing younger than 6 months hospitalized with suspected IRA and pertussis (2007-2012) in which BP identified (PCR and culture) and / or VRS (immunofluorescence in nasal secretions). Coinfections were excluded. Bivariate analysis was performed by calculating OR with 95

CI. Were considered significant at p <0.05. The variables studied were age, sex, hits cough, cyanosis, vomiting, apnea, wheezing and CBC with differential RESULTS: We included 174 infants, 72 (41

) BP and 102 (59

) VRS. Age 2 ± 1 months (range :1-6). In both groups was documented cough and wheeze (OR: 1.2 (0.9 to 1.5) p: 0.1 and OR = 0.9 (0.8 to 1.06) p: 0.2, respectively ). Cyanosis (87

vs. 6

, OR: 14.8 p <0.01), apnea (38

vs. 3

, OR: 13.4 p <0.01) and vomiting (26

vs. 5

, OR: 3.4 p <0.01) were more frequent in infants with BP. The absolute lymphocyte count was significantly higher in children with BP (9387 ± 6317 vs. 5127 ± 2766, p <0.01). By ROC curve was identified at 9000 cells / ml as the best point to differentiate VSR BP (AUC = 0.73, 95

CI :0,64-0, 81). CONCLUSIONS: In infants under 6 months with IRA income presence of apnea, cyanosis and lymphocytosis allowing predict significantly differentiate between pertussis those with RSV infections.

Predictores de coqueluche al ingreso en lactantes hospitalizados con infección respiratoria aguda baja / [Pertussis predictors in hospitalized infants with acute lower respiratory tract infection].

BACKGROUND: Pertussis, or whooping cough, caused by Bordetella pertussis (BP) is a re-emerging problem in our environment. Although generally considered that the disease is relatively easy to identify infections respiratory syncytial virus (RSV) can present with similar symptoms in infants remains difficult discrimination. OBJECTIVE: Compare clinical symptoms at admission and complementary studies in infants hospitalized with acute respiratory infection (ARI) and RSV by BP to establish markers that enable their early clinical prediction. MATERIALS AND METHODS: Observational, analytical, case-crossover cross comparing younger than 6 months hospitalized with suspected IRA and pertussis (2007-2012) in which BP identified (PCR and culture) and / or VRS (immunofluorescence in nasal secretions). Coinfections were excluded. Bivariate analysis was performed by calculating OR with 95

CI. Were considered significant at p <0.05. The variables studied were age, sex, hits cough, cyanosis, vomiting, apnea, wheezing and CBC with differential RESULTS: We included 174 infants, 72 (41

) BP and 102 (59

) VRS. Age 2 ± 1 months (range :1-6). In both groups was documented cough and wheeze (OR: 1.2 (0.9 to 1.5) p: 0.1 and OR = 0.9 (0.8 to 1.06) p: 0.2, respectively ). Cyanosis (87

, OR: 13.4 p <0.01) and vomiting (26

, OR: 3.4 p <0.01) were more frequent in infants with BP. The absolute lymphocyte count was significantly higher in children with BP (9387 ± 6317 vs. 5127 ± 2766, p <0.01). By ROC curve was identified at 9000 cells / ml as the best point to differentiate VSR BP (AUC = 0.73, 95

CI :0,64-0, 81). CONCLUSIONS: In infants under 6 months with IRA income presence of apnea, cyanosis and lymphocytosis allowing predict significantly differentiate between pertussis those with RSV infections.