Respiratory viral coinfections in pediatric patients in the primary care setting: a multicenter prospective study within the COPEDICAT network.

Acute respiratory viral infections pose a significant healthcare burden on the pediatric population globally, but data on the dissemination pattern in the community due to the COVID-19 pandemic are scarce. We conducted a two-year prospective multicenter study in Catalonia (Spain) that examined the prevalence and coinfection dynamics of respiratory viruses among 1276 pediatric patients from different age groups attending primary care. Coinfection analysis demonstrated complex patterns and revealed a coinfection rate of 23.8% for SARS-CoV-2, often in association with rhinovirus or influenza A. This study provides valuable data to understand post-pandemic viral interactions, which is imperative for public health interventions.

Diagnosis accuracy of waist-to-height ratio to predict cardiometabolic risk in children with obesity.

BACKGROUND: Waist-to-height ratio (WHtR) predicts abdominal fat and cardiometabolic risk. In children with obesity, the most adequate cut-off to predict cardiometabolic risk as well as its ability to predict risk changes over time has not been tested. Our aim was to define an appropriate WHtR cut-off to predict cardiometabolic risk in children with obesity, and to analyze its ability to predict changes in cardiometabolic risk over time. METHODS: This is an observational prospective study secondary to the OBEMAT2.0 trial. We included data from 218 participants (8-15 years) who attended baseline and final visits (12 months later). The main outcome measure was a cardiometabolic risk score derived from blood pressure, lipoproteins, and HOMA index of insulin resistance. RESULTS: The optimal cut-off to predict the cardiometabolic risk score was WHtR ≥0.55 with an area under the curve of 0.675 (95% CI: 0.589-0.760) at baseline and 0.682 (95% CI: 0.585-0.779) at the final visit. Multivariate models for repeated measures showed that changes in cardiometabolic risk were significantly associated with changes in WHtR. CONCLUSION: This study confirms the clinical utility of WHtR to predict changes in cardiometabolic risk over time in children with obesity. The most accurate cut-off to predict cardiometabolic risk in children with obesity was WHtR ≥0.55. IMPACT: In children, there is no consensus on a unique WHtR cut-off to predict cardiometabolic risk. The present work provides sufficient evidence to support the use of the 0.55 boundary. We have a large sample of children with obesity, with whom we compared the previously proposed boundaries according to cardiometabolic risk, and we found the optimal WHtR cut-off to predict it. We also analyzed if a reduction in the WHtR was associated with an improvement in their cardiometabolic profile.

Schools as a Framework for COVID-19 Epidemiological Surveillance of Children in Catalonia, Spain: A Population-Based Study.

Objective: We describe and analyze the childhood (<18 years) COVID-19 incidence in Catalonia, Spain, during the first 36 weeks of the 2020-2021 school-year and to compare it with the incidence in adults. Methods: Data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests were obtained from the Catalan Agency for Quality and Health Assessment. Overall, 7,203,663 SARS-CoV-2 tests were performed, of which 491,819 were positive (6.8%). We collected epidemiological data including age-group incidence, diagnostic effort, and positivity rate per 100,000 population to analyze the relative results for these epidemiological characteristics. Results: Despite a great diagnostic effort among children, with a difference of 1,154 tests per 100,000 population in relation to adults, the relative incidence of SARS-CoV-2 for <18 years was slightly lower than for the general population, and it increased with the age of the children. Additionally, positivity of SARS-CoV-2 in children (5.7%) was lower than in adults (7.2%), especially outside vacation periods, when children were attending school (4.9%). Conclusions: A great diagnostic effort, including mass screening and systematic whole-group contact tracing when a positive was detected in the class group, was associated with childhood SARS-CoV-2 incidence and lower positivity rate in the 2020-2021 school year. Schools have been a key tool in epidemiological surveillance rather than being drivers of SARS-CoV-2 incidence in Catalonia, Spain.

Validation of bioelectrical impedance analysis for body composition assessment in children with obesity aged 8-14y.

BACKGROUND & AIMS: The aim was to generate a predictive equation to assess body composition (BC) in children with obesity using bioimpedance (BIA), and avoid bias produced by different density levels of fat free mass (FFM) in this population. METHODS: This was a cross-sectional validation study using baseline data from a randomized intervention trial to treat childhood obesity. Participants were 8 to 14y (n = 315), underwent assessments on anthropometry and BC through Air Displacement Plethysmography (ADP), Dual X-Ray Absorptiometry and BIA. They were divided into a training (n = 249) and a testing subset (n = 66). In addition, the testing subset underwent a total body water assessment using deuterium dilution, and thus obtained results for the 4-compartment model (4C). A new equation to estimate FFM was created from the BIA outputs by comparison to a validated model of ADP adjusted by FFM density in the training subset. The equation was validated against 4C in the testing subset. As reference, the outputs from the BIA device were also compared to 4C. RESULTS: The predictive equation reduced the bias from the BIA outputs from 14.1% (95%CI: 12.7, 15.4) to 4.6% (95%CI: 3.8, 5.4) for FFM and from 18.4% (95%CI: 16.9, 19.9) to 6.4% (95% CI: 5.3, 7.4) for FM. Bland-Altman plots revealed that the new equation significantly improved the agreement with 4C; furthermore, the observed trend to increase the degree of bias with increasing FM and FFM also disappeared. CONCLUSION: The new predictive equation increases the precision of BC assessment using BIA in children with obesity.

A propòsit d'un cas de TIBOLA / A propósito de un caso de TIBOLA / Report of a case of TIBOLA

Introducció. La malaltia TIBOLA (Tick-Borne Lymphadenopathy) va ser descrita inicialment a l’est d’Europa i des de fa pocs anys se n’estan comunicant més casos a la nostra zona. S’ha relacionat amb la Rickettsia slovaca, transmesa per la picada de la paparra Dermacentor marginatus, habitual de la península Ibèrica i que s’ha trobat en senglars. Cas clínic. Presentem el cas d’un nen de 10 anys a qui es va extreure una d’aquestes paparres, i que presentava simptomatologia compatible amb aquesta malaltia i serologia positiva a Rickettsia conorii. Comentaris. Hem de sospitar el diagnòstic davant la presència d’una escara necròtica al cuir pilós amb adenopaties regionals doloroses. La serologia a altres rickèttsies pot ser positiva per reacció creuada. Les tècniques moleculars com la PCR en sang i en mostra extreta de la lesió d’inoculació ens poden ajudar a fer el diagnòstic etiològic (AU)

Introducción. La enfermedad TIBOLA (Tick-Borne Lymphadenopathy) fue descrita inicialmente en el este de Europa y desde hace pocos años se están comunicando más casos en nuestra zona. Se ha relacionado con la Rickettsia slovaca, transmitida por la picadura de la garrapata Dermacentor marginatus, habitual de la península Ibérica y que se encuentra en jabalíes. Caso clínico. Presentamos el caso de un niño de 10 años a quien se extrajo una de estas garrapatas, y que presentaba síntomas compatibles con esta enfermedad y serología positiva a Rickettsia conorii. Comentarios. Tenemos que sospechar este diagnóstico ante la presencia de una escara necrótica en cuero cabelludo y adenopatías regionales dolorosas. La serología a otras rickettsias puede ser positiva por reacción cruzada. Las técnicas moleculares como la PCR en sangre y en muestra de la lesión de inoculación nos pueden ayudar al diagnóstico etiológico (AU)

Introduction. TIBOLA (Tick-Borne LymphAdenopathy) was first reported in Eastern Europe and new cases have been recently reported in our country. This illness is caused by Rickettsia slovaca, which is transmitted by the Dermacentor marginatus tick bite; this tick is widely found among boars in the Iberian Peninsula. Case Report. A 10-year-old child with history of having a tick attached to the scalp, presented with symptoms suggestive of TIBOLA; serology was positive for Rickettsia conorii. Discussion. The diagnosis of TIBOLA should be suspected in the presence of a necrotic eschar at the inoculation site in the scalp associated with painful regional lymphadenopathies. Serology shows cross-reaction with other rikettsiae. Molecular techniques such as PCR in serum or inoculation lesion samples can also aid in the diagnosis (AU)