[Active search of celiac disease among first degree relatives of known celiac patients]. / Búsqueda activa de enfermedad celíaca en familiares de primer grado de casos celíacos.

BACKGROUND: Active search of celiac disease (CD) among risk groups has significantly increased the scope of known clinical variants. AIM: To measure the frequency and clinical characteristics of CD among first degree relatives (FDR) of known celiac cases. MATERIAL AND METHODS: Between January 2012-August 2013, 37 patients with celiac disease brought 113 FDR for assessment. Their clinical data was recorded and a blood sample was obtained to measure serum Immunoglobulin A (IgA) levels, anti-transglutaminase (tTG) and anti-endomisial (EMA) antibodies. Cases with positive serology were advised to have an intestinal biopsy. RESULTS: Fourteen relatives (12.4%) had positive serological results and none had IgA deficiency. Among IgA-tTG (-) cases, measurement of IgA/IgG-tTG identified an additional case. Two of the 14 relatives were EMA positive. All 14 cases were advised to have an intestinal biopsy, but only 6 accepted the procedure. In two, the intestinal lesion was classified Marsh ≥ 2 and active CD was diagnosed. Histology in the remaining four was Marsh 0/1 and were diagnosed potential CD, remaining under control, without gluten free diet. CONCLUSIONS: Serological prevalence of CD among first degree relatives of known celiac cases was 15 fold greater than in THE general Chilean population, strongly supporting the idea of implementing active search to customary clinical practice. Determination of IgA/IgG-tTG may be useful to improve the yield of active search. Intestinal biopsies were crucial to differentiate active classic CD from potential CD.

A prospective, randomized, controlled trial of noninvasive ventilation in pediatric acute respiratory failure.

OUTCOMES: To compare the benefits of noninvasive ventilation (NIV) plus standard therapy vs. standard therapy alone in children with acute respiratory failure; assess method effectiveness in improving gas exchange and vital signs; and assess method safety. DESIGN: Prospective, randomized, controlled study. SITE: Two pediatric intensive care units in Santiago, Chile, at Clínica Santa María and Clínica Dávila, respectively. PATIENTS AND METHODS: Fifty patients with acute respiratory failure admitted to pediatric intensive care units were recruited; 25 patients were randomly allocated to noninvasive inspiratory positive airway pressure and expiratory positive airway pressure plus standard therapy (study group); the remaining 25 were given standard therapy (control group). Both groups were comparable in demographic terms. INTERVENTIONS AND MEASUREMENTS: The study group received NIV under inspiratory positive airway pressure ranging between 12 cm and 18 cm H2O and expiratory positive airway pressure between 6 cm and 12 cm H2O. Vital signs (cardiac and respiratory frequency), Po2, Pco2, pH, and Po2/Fio2 were recorded at the start and 1, 6, 12, 24, and 48 hrs into the study. RESULTS: Heart rate and respiratory rate improved significantly with NIV. Heart rate and respiratory rate were significantly lower after 1 hr of treatment compared with admission (p = 0.0009 and p = 0.004, respectively). The trend continued over time, heart rate being significantly lower than control after the first hour and heart rate after 6 hrs. With NIV, Po2/Fio2 improved significantly from the first hour. The endotracheal intubation was significantly lower (28%) in the NIV group than in the control group (60%; p = 0.045). CONCLUSIONS: NIV improves hypoxemia and the signs and symptoms of acute respiratory failure. NIV seems to afford these patients protection from endotracheal intubation.

Búsqueda activa de enfermedad celíaca en familiares de primer grado de casos celíacos / Active search of celiac disease among first degree relatives of known celiac patients

Background: Active search of celiac disease (CD) among risk groups has significantly increased the scope of known clinical variants. Aim: To measure the frequency and clinical characteristics of CD among first degree relatives (FDR) of known celiac cases. Material and Methods: Between January 2012-August 2013, 37 patients with celiac disease brought 113 FDR for assessment. Their clinical data was recorded and a blood sample was obtained to measure serum Immunoglobulin A (IgA) levels, anti-transglutaminase (tTG) and anti-endomisial (EMA) antibodies. Cases with positive serology were advised to have an intestinal biopsy. Results: Fourteen relatives (12.4%) had positive serological results and none had IgA deficiency. Among IgA-tTG (-) cases, measurement of IgA/IgG-tTG identified an additional case. Two of the 14 relatives were EMA positive. All 14 cases were advised to have an intestinal biopsy, but only 6 accepted the procedure. In two, the intestinal lesion was classified Marsh ≥ 2 and active CD was diagnosed. Histology in the remaining four was Marsh 0/1 and were diagnosed potential CD, remaining under control, without gluten free diet. Conclusions: Serological prevalence of CD among first degree relatives of known celiac cases was 15 fold greater than in THE general Chilean population, strongly supporting the idea of implementing active search to customary clinical practice. Determination of IgA/IgG-tTG may be useful to improve the yield of active search. Intestinal biopsies were crucial to differentiate active classic CD from potential CD.

Campaña de invierno 1998: descripción de los niños hospitalizados en el servicio de pediatría del Hospital San Juan de Dios / Winter campaign 1998: main features of hospitalized children in pediatric services of the San Juan de Dios hospital

Se describen las características de los niños ingresados en el Servicio de Pediatría del Hospital San Juan de Dios durante la campaña de invierno 1998. El 84,8 por ciento de las historias clínicas de los niños admitidos (335/395) fueron revisadas. En ellas se estudió la distribución por sexo, edad, peso de nacimiento, estado nutricional, patologías asociadas y métodos diagnósticos tratamientos utilizados. Esta información ha probado ser útil para el diseño anual de la campaña. Entre los datos obtenidos destaca que el 56,7 por ciento eran de sexo masculino y que sólo el 9 por ciento tuvieron peso de nacimiento inferior a 2.500 g. El estado nutricional de los niños mayores de 1 año de vida mostró un 10,2 por ciento de niños en riesgo y un 7,6 por ciento de desnutridos. Se detectó patología asociada en el 40 por ciento de los casos, siendo 96,3 por ciento de ellas patologías crónicas y múltiples en el 28,7 por ciento. Las patologías asociadas más frecuentes fueron respiratorias (48,4 por ciento) y prematurez (20,2 por ciento). Sólo un 2,4 por ciento de los pacientes fueron ingresados a la unidad de cuidados intensivos. El promedio de días de hospitalización fue de 6,27 días pero el 4,8 por ciento de los pacientes tuvieron hospitalizaciones superiores a 15 días. El estudio de laboratorio completo no fue realizado en todos los pacientes. La etiología más frecuentemente encontrada fue la viral, la que fue detectada por medio de inmunofluorescencia indirecta. El primer lugar correspondió al virus respiratorio sincicial, seguido por el adenovirus. El 38 por ciento de los casos recibieron antibióticos, principalmente penicilina únicamente o asociada a cloxacilina. En el 95 por ciento de los casos tuvieron requerimiento de oxígeno. Los diagnósticos de egreso fueron fundamentalmente bronconeumonía (91,6 por ciento) aislada o asociada a síndrome bronquial obstructivo. Nueve niños (2,7 por ciento) fallecieron durante su estada en el hospital y su edades fluctuaron entre 1 mes y tres días de vida y 3 años diez meses