Clinical and epidemiological characteristics of patients with influenza A (H1N1) 2009 attended to at the emergency room of a children's hospital.

In June 2009, the first influenza pandemic of the twenty-first century, due to the swine origin influenza A (H1N1) 2009 virus, was declared. This study aimed to describe the epidemiological and clinical features, complications, lethality and risk factors for hospital admission of microbiologically confirmed cases of influenza A (H1N1) 2009 infection seen at the emergency department of a children's hospital. All cases of children with influenza A (H1N1) 2009 viral infection, confirmed microbiologically by real-time reverse transcription polymerase chain reactions and treated in the emergency room between July and December 2009, were prospectively included. Patients were compared according to admission requirement to study variables associated with the risk of hospitalisation. Oseltamivir was the antiviral used for the treatment and its safety was analysed. Four hundred and twelve patients with influenza A (H1N1) 2009 infection were included. The most frequent symptoms were: fever (96%), cough (95%) and coryza (90%). Eighty-five patients (20.6%) were admitted: three to the paediatric intensive care unit and two died. Hospitalised children were younger than those not admitted (median age 5 vs 8 years; p = 0.001). Age under 1 year (OR 6.01; CI 95% 2.77-13.05), pneumonia (OR 7.99; CI 95% 3.50-18.22) and haemoglobinopathy or underlying blood disorders (OR 5.99; CI 95% 1.32-27.30) were statistically significant risk factors for admission. No differences were observed regarding onset of antiviral treatment among admitted and non-admitted patients. Treatment with oseltamivir was well tolerated. In conclusion, the incidence of severe cases and lethality of influenza A (H1N1) 2009 infection were low in our setting, even in a population with risk factors for developing complications.

[Patient characteristics and health care burden during the influenza A (H1N1) 2009 pandemic in the university Hospital Vall d'Hebron of Barcelona]. / Características de los pacientes y carga asistencial durante la pandemia de gripe A (H1N1) 2009 en el Hospital Universitario Vall d'Hebron de Barcelona.

BACKGROUND AND OBJECTIVE: The influenza A (H1N1) 2009 pandemic initially had a mild impact in Catalonian hospitals, but in the autumn there was an important pandemic wave. We describe the main characteristics of patients seen in the Vall d'Hebron University Hospital in Barcelona (HUVH) during this pandemic, the risk factors associated with hospitalization and the health-care burden generated. MATERIAL AND METHOD: We included all cases of influenza A (H1N1) 2009 with laboratory confirmation seen in the HUVH from July 2, 2009 to January 22, 2010. We performed a descriptive analysis of the cases and a multivariate analysis to identify variables associated with the risk of hospitalization. RESULTS: The diagnosis was confirmed in 741 patients; 56.8% were under 16 years, while only 2.8% were 65 and over. Thirty three per cent of children had no risk factor for complications, whereas in adults it was 45%. One hundred and ninety cases were hospitalized, 26 of them in the intensive care unit (ICU) with 5 deaths. The factors associated with risk of hospitalization were, age less than one year, immunodeficiency, and neuromuscular disease in children; and chronic lung disease in adults. The diagnosis of pneumonia in the emergency department was an important predictor of hospitalization in both children and adults. The maximum caseload was recorded on November 19, with 43 hospital admissions, 6 of them in the ICU. CONCLUSIONS: Between July and September 2009 the pandemic had a low impact on hospital resources, but in autumn there was a marked increase in emergency department visits and hospitalizations. Children had higher rates of confirmed cases, while adults had higher rates of hospitalizations. The risk of hospitalization was higher in patients with certain conditions especially in those with pneumonia. The pandemic wave was a moderate work load for HUVH, since it did not involve any modification of the usual health care programs.

[Contact tracing of paediatric pertussis cases at a tertiary hospital in Barcelona, Spain]. / Estudio de contactos de casos pediátricos de tos ferina en un hospital de tercer nivel de Barcelona.

BACKGROUND AND OBJECTIVES: Pertussis remains an important cause of morbimortality despite current vaccination strategies. This study was designed to describe the results and characteristics of close contacts of pertussis cases diagnosed in children less than 16 years in a tertiary hospital in Barcelona. PATIENTS AND METHODS: Cross-sectional study. Data were collected from chart review of contacts of paediatric cases of pertussis in Vall d'Hebron University Hospital from 2005 to 2009. Only patients with microbiological study done were included. The odds ratio (OR) and 95% confidence interval (95% CI) were calculated as association measure. RESULTS: Ninety-one index cases and 404 contacts were studied. The prevalence of positive cases among contacts was 33.2%. Contacts of index cases younger than 6 months had a higher risk of being positive for pertussis than contacts of older children (OR: 3.38; 95% CI: 1.88-6.10). Primary cases were identified as 16.7% of the contacts studied, who were the source of infection for 67.7% of index cases younger than 6 months and for 26.9% of older index cases. CONCLUSIONS: Contact tracing of paediatric pertussis cases is a necessary clinical activity. It is more likely to find primary cases in the contact investigation of children less than 6 months. Preventive strategies should be targeted primarily to frequent contacts of this age group.

Glucose intolerance and diabetes are observed in the long-term follow-up of nonpancreatectomized patients with persistent hyperinsulinemic hypoglycemia of infancy due to mutations in the ABCC8 gene.

OBJECTIVE: To report the long-term follow-up of three nonpancreatectomized patients with persistent hyperinsulinemic hypoglycemia of infancy due to mutations in the ABCC8 gene. RESEARCH DESIGN AND METHODS: Oral glucose tolerance test (OGTT) and venous 24-h glucose-insulin profile were performed yearly from adolescence. RESULTS: Patient 1 (now aged 31 years) developed insulin-dependent diabetes at the age of 25 years. In patient 2 (now aged 17 years), impaired fasting glucose and a diabetic OGTT response with normal A1C values have been observed since the age of 10 years. In patient 3 (now aged 24 years), intolerant OGTT response and hyperglycemic episodes with normal A1C have been observed since the age of 16 years. All patients presented relatively low insulin levels during hyperglycemia, normal BMI, and negative autoantibodies (GAD antibody, insulinoma-associated protein 2, and islet cell antibody). CONCLUSIONS: Development of glucose metabolism impairment ranging from glucose intolerance to insulin-dependent diabetes is observed in the evolution of these patients.

Estudio de contactos de casos pediátricos de tos ferina en un hospital de tercer nivel de Barcelona / Contact tracing of paediatric pertussis cases at a tertiary hospital in Barcelona, Spain

Fundamento y objetivo: La tos ferina sigue siendo una importante causa de morbimortalidad a pesar de las actuales estrategias vacunales. Se diseñó este estudio para describir los resultados y las características de los contactos estrechos de casos de tos ferina diagnosticados en menores de 16 años en un hospital de tercer nivel de Barcelona. Pacientes y método: Estudio transversal. Los datos se recogieron a partir de las historias clínicas de los contactos de los casos pediátricos diagnosticados de tos ferina en el Hospital Universitario Vall d’Hebron de 2005 a 2009. Se incluyeron solo pacientes con estudio microbiológico realizado. Se calculó la odds ratio (OR) con su intervalo de confianza del 95% (IC 95%) como medida de asociación. Resultados: Fueron estudiados 91 casos índice y 404 contactos. La prevalencia de casos positivos entre los contactos fue del 33,2%. Los contactos de los casos índice menores de 6 meses presentaron más riesgo de ser positivos que los contactos de los niños mayores (OR 3,38; IC 95% 1,88-6,10). Se identificaron como casos primarios el 16,7% de los contactos estudiados. Estos representaron la fuente de contagio para el 67,7% de los casos índice menores de 6 meses y para el 26,9% de los niños mayores. Conclusiones: El estudio de contactos de casos pediátricos de tos ferina es una actividad clínica necesaria. Es más probable hallar casos primarios en el estudio de contactos de niños menores de 6 meses. Las estrategias preventivas deben ir dirigidas fundamentalmente a los contactos frecuentes de este grupo (AU)

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Características de los pacientes y carga asistencial durante la pandemia de gripe A (H1N1) 2009 en el Hospital Universitario Vall d’Hebron de Barcelona / Patient characteristics and health care burden during the influenza A (H1N1) 2009 pandemic in the university Hospital Vall d’Hebron of Barcelona

La pandemia de gripe A (H1N1) 2009 repercutió inicialmente de forma leve en los hospitales de Cataluña, pero en el otoño se produjo una destacada onda pandémica. Se describen las principales características de los pacientes atendidos en el Hospital Universitaro Vall d’Hebron de Barcelona (HUVH) en el transcurso de la pandemia, la factores asociados a riesgo de hospitalización y la carga asistencial generada. Pacientes y métodos. Se incluyen todos los casos de gripe A (H1N1) 2009 con confirmación microbiológica, atendidos desde el 2 de julio de 2009 al 22 de enero de 2010. Se ha realizado un análisis descriptivo de los casos y un análisis multivariado para conocer las variables asociadas al riesgo de hospitalización. Resultados El diagnóstico se confirmó en 741 pacientes, de los que el 56,8% tenían menos de 16 años, mientras que los de 65 y más años representaron únicamente el 2,8%. Un 33% de los niños no presentaron ningún factor de riesgo de complicaciones, en cambio en los adultos fueron el 45%. Fueron hospitalizados 190 casos, de ellos 26 en UCI con 5 defunciones. La edad inferior a un año, la inmunodeficiencia y la patología neuromuscular fueron los factores asociados de forma significativa al riesgo de hospitalización en niños, y la patología crónica pulmonar en los adultos. El diagnóstico de neumonía en urgencias fue un factor determinante de hospitalización, tanto en niños como adultos. La máxima carga asistencial se registró el 19 de noviembre con 43 pacientes hospitalizados, 6 de ellos en UCI.(..) (AU)

Background and objective: The influenza A(H1N1) 2009 pandemic initially had a mild impact in Catalonian hospitals, but in the autumn there was an important pandemic wave. We describe the main characteristics of patients seen in the Vall d’Hebron University Hospital in Barcelona (HUVH) during this pandemic, the risk factors associated with hospitalization and the health-care burden generated. Material and method: We included all cases of influenza A (H1N1) 2009 with laboratory confirmation seen in the HUVH from July 2, 2009 to January 22, 2010. We performed a descriptive analysis of the cases and a multivariate analysis to identify variables associated with the risk of hospitalization. Results: The diagnosis was confirmed in 741 patients; 56.8% were under 16 years, while only 2.8% were 65and over. Thirty three per cent of children had no risk factor for complications, whereas in adults itwas45%.One hundred and ninety cases were hospitalized, 26 of them in the intensive care unit (ICU) with 5 deaths. The factors associated with risk of hospitalization were, age less than one year, immunodeficiency, and neuromuscular disease in children; and chronic lung disease in adults. The diagnosis of pneumonia in the emergency department was an important predictor of hospitalization in both children and adults. The maximum caseload was recorded on November 19, with 43 hospital admissions, 6 of them in the ICU. Conclusions: Between July and September 2009 the pandemic had a low impact on hospital resources, but in autumn there was a marked increase in emergency department visits and hospitalizations. Children had higher rates of confirmed cases, while adults had higher rates of hospitalizations. The risk of hospitalization was higher in patients with certain conditions especially in those with pneumonia. The pandemic wave was a moderate work load for HUVH, since it did not involve any modification of the usual healthcare programs (AU)