Infecciones por el virus EV-D68 en niños hospitalizados en un hospital de alta complejidad / EV-D68 virus infections in children admitted to a tertiary-care hospital

Introducción: Los reportes de infecciones por enterovirus D68 (EV-D68) han aumentado en los últimos años. Material y métodos: Cohorte prospectiva. Se realizó la búsqueda de EV-D68 en niños internados en el Hospital de Pediatría Juan P. Garrahan entre 1-5-2016 y 30-9-2016 con: infección respiratoria aguda baja (IRAB) que requirieran cuidados intensivos, parálisis aguda fláccida (PAF) asimétrica con compromiso de sustancia gris en resonancia magnética nuclear (RMN) o identificación de cualquier enterovirus con cuadro clínico compatible. La identificación de EV-D68 se realizó en el Servicio de Neurovirus, Instituto Nacional de Enfermedades Infecciosas INEI-ANLIS "Dr. CG. Malbrán". Resultados: n: 6. PAF: cuatro niños presentaron PAF asimétrica, con arreflexia y RMN compatible con mielitis. Requirieron ventilación mecánica en unidades de cuidados intensivos (UCI) dos de los 4 niños. Todos presentaron parálisis residual. Se identificó EV-D68 en secreciones nasofaríngeas (SNF) de todos ellos. En líquido cefalorraquídeo sólo en uno. Miocarditis: Una niña sana de 5 años se internó en UCI por disfunción miocárdica y fiebre. Presentaba además derrame pericárdico moderado. Recibió gamaglobulina e.v. con buena evolución. En SNF se identificaron virus sincicial respiratorio (VSR) y EV-D68. IRAB grave: se identificó EV-D68 en un paciente de 14 meses que permaneció en UCI por IRAB grave con requerimientos de ventilación no invasiva por 72 hs, con buena evolución posterior. Se constató coinfección VSR y EV-D68 en SNF. Conclusiones: Se reportan 6 pacientes internados con infección por EV-D68. La vigilancia epidemiológica activa es esencial para identificar la circulación, las características clínicas y el pronostico de las infecciones por virus emergentes (AU)

Introduction: Reports on enterovirus D68 (EV-D68) infections have increased over the past years. Material and methods: A prospective cohort study. A search for EV-D68 infection was conducted in children hospitalized at Hospital de Pediatría Juan P. Garrahan between 1-5-2016 and 30-9-2016 with: acute lower respiratory infection (ALRI) requiring intensive care unit (UCI) admission, acute flaccid paralysis (AFP), asymmetry with grey matter involvement on magnetic resonance imaging (MRI), or identification of any enterovirus associated with compatible features. The identification of EV-D68 was performed at the Department of Neuroviruses of the InstitutoNacional de EnfermedadesInfecciosas INEI-ANLIS "Dr. CG. Malbrán". Results: n: 6. AFP: four children had asymmetric AFP with areflexia and MRI compatible with myelitis. Two of four required mechanical ventilation in the ICU. All of them presented with residual paralysis. EV-D68 was identified in the nasopharyngeal swab (NPS) in all of them and in the cerebrospinal fluid in only one. Myocarditis: A 5-year-old healthy girl was admitted to the ICU because of myocardial dysfunction and fever associated with moderate pericardial effusion. She was put on IV gamma globulin with a good response. In the NPS respiratory syncytial virus (RSV) and EV-D68 were identified. Severe ALRI: EV-D68 was identified in a 14-month-old patient who was admitted to the UCU because of severe ALRI requiring non-invasive ventilation for 72 hours with a good outcome. A RSV and EV-D68 coinfection was found in the NPS. Conclusions: We report six inpatients with a EV-D68 infection. Active epidemiological surveillance is crucial to identify circulation of the virus, clinical features, and prognosis of emerging viruses (AU)

Design and validation of a practical index for trauma assessment.

In the past 20 years a variety of indices have been suggested for measuring the severity of trauma, however none of them meets the requirement of being a simple and objective instrument that can be utilized efficiently by lay persons and providers of health services without previous experience in triaging. A new system has been proposed which meets this requirement and which has been validated with 197 injured persons at the emergency ward of the Valle University Hospital in Call, Colombia. The instrument showed a high level of concordance with the conventional triaging method and classifies victims into four categories: critical with recovery unlikely, critical but recoverable, moderately serious, and ambulatory. There is discussion on the reliability of this instrument and it is recommended that it be validated with victims from larger disasters. Regardless, it has the advantage of being specific and free of the subjectivity that characterizes other indices.

[Drug use among students in Cali, Colombia]. / Uso de drogas entre estudiantes de Cali, Colombia.

The use of alcohol, tobacco, marihuana, cocaine, and bazuco was examined in a cross-sectional study of a random sample of 512 secondary-school students enrolled in public and private schools in Cali, Colombia. The overall prevalence of use for any of these substances was 59.38% in the public schools and 36.96% in the private schools (z = 4.6, P less than 0.05). The probability of finding an alcohol user was about 55.26%. The frequency of use for all the substances was 18.9% in the public schools and 7.46% in the private ones. Experience with marihuana, cocaine, and bazuco was more frequent in the public schools. The average age of users (19.91 years) was higher than that of non-users (16.25 years): t = 8.34, P less than 0.05. Students in the public schools with a family history of mental illness had almost a ninefold greater risk of being substance users (RR = 8.84, IC 95% = 1.22-3.37); among students in the private schools, having personal conflicts with authority figures (teachers and the police) was a significant risk factor (RR = 2.03, IC 95% = 1.22-3.37).

Diseno y validacion de un indice practico para evaluacion del trauma, 1988 / Design and evaluation of a practical index for trauma evaluation, 1988

En los ultimos 20 anos se han propuesto diversas escalas para medir severidad de trauma, sin embargo, ninguna de ellas cumple las exigencias de ser un instrumento simple y objetivo que pueda utilizarse eficientemente por personas legas y/o proveedores de servicios de salud sin experincia en procedimientos de triage. Se propone una nueva escala que reune estos requisitos y se valida con 197 personas accidentadas que acudieron al servicio de urgencias del Hospital Universitario del Valle en Cali, Colombia. El instrumento disenado mostro una gran concordancia con el metodo convencional de triage y permitio clasificar las victimas en cuatro categorias: criticos dificilmente recuperables, criticos recuperables, moderadamente graves y diferibles. Se dicute la confiabilidad del instrumento y se recomienda su revalidacion en una serie de victimas mas grande. Mientas tanto, el mismo tiene la ventaja de ser concreto y exento de la subjetividad que caracteriza a otros indices.