Versión argentina de la herramienta de evaluación de la alimentación pediátrica PediEAT / Argentine version of the PediEAT, a pediatric eating assessment tool

Introducción. Durante la infancia, los niños pueden experimentar algún grado de dificultad al comer. Existe una herramienta, desarrollada en Estados Unidos, de evaluación de la alimentación pediátrica (PediEAT), que permite identificar síntomas problemáticos. Objetivo. Realizar una adaptación transcultural para una versión argentina, con adecuación cultural y equivalencia semántica respecto a su versión original. Población y métodos. Se utilizó una versión autoadministrada del PediEAT que fue respondida por familias y/o cuidadores de niños de 6 meses a 7 años. Se realizó una primera fase de evaluación de validez del contenido con un grupo de expertos. Luego, una fase de pretest con familias mediante entrevistas cognitivas para comprobar la comprensión de las palabras y frases. Se realizaron las modificaciones necesarias para que quedara adaptada al contexto. Resultados. En la fase de evaluación de validez del contenido con el grupo de 8 expertos, de los 80 ítems se modificaron 36. En el pretest, se realizaron entrevistas cognitivas a 18 cuidadores; se realizaron cambios en 11 ítems para mejorar la comprensión por parte de la población argentina. La versión argentina fue aprobada por los autores originales. Conclusiones. El instrumento PediEAT versión argentina resulta lingüísticamente equivalente a su versión original, lo que permite su uso para la detección de problemáticas alimentarias en niños.

Introduction. During childhood, children may experience some degree of difficulty eating. A tool (PediEAT) has been developed in the United States and is available to assess pediatric eating and to identify problematic symptoms. Objective. To obtain an Argentine version that is transculturally adapted, culturally adequate, and semantically equivalent to the original version. Population and methods. A self-administered version of the PediEAT was used and completed by families and/or caregivers of children aged 6 months to 7 years. In the first phase, content validity was assessed by a group of experts. This was followed by a pre-test phase with families using cognitive interviews to test word and phrase comprehension. The necessary changes were made to obtain a version adapted to the context. Results. The tool's content validity was assessed by a group of 8 experts; as a result, 36 of the 80 items were changed. During the pre-test phase, cognitive interviews were conducted with 18 caregivers; 11 items were changed to improve comprehension by the Argentine population. The Argentine version was approved by the original authors. Conclusions. The Argentine version of the PediEAT tool is linguistically equivalent to the original version, and this allows its use to screen for feeding problems in children.

Inflammation induces stunting by lowering bone mass via GH/IGF-1 inhibition in very preterm infants.

BACKGROUND: Sustained systemic inflammatory response (SIR) was associated with poor postnatal growth in very preterm infants (VPI). We hypothesize that VPI with sustained SIR will exhibit linear growth retardation related to lower bone mass accrual mediated by GH/IGF-1 axis inhibition at term corrected age (CA). METHODS: C-reactive protein (CRP), procalcitonin (PCT), growth hormone (GH), insulin-like growth factor 1 (IGF-1), calcium, phosphorus, alkaline phosphatase, anthropometric, nutritional, neonatal and maternal data were collected prospectively in 23 infants <32 weeks gestational age. Body composition using dual-energy X-ray absorptiometry was performed at term CA. Analysis was undertaken with multiple linear regression models. RESULTS: At term CA 11 infants with sustained SIR compared with 12 infants without sustained SIR present significantly lower IGF-1, length z-score (LZS), bone mineral content (BMC) and lean mass (LM), and higher GH and fat mass (FM). LZS was associated significantly with PCT, BMC with IGF-1, FM and LM with CRP, GH with bronchopulmonary dysplasia and CRP, and IGF-1 with invasive mechanical ventilation, CRP and PCT. CONCLUSIONS: In addition to the known effect on linear growth failure, sustained SIR induces lower bone mass accrual related to higher GH and lower IGF-1 levels in VPI. IMPACT: Very preterm infants (VPI) with sustained systemic inflammatory response (SIR) compared with VPI without SIR present stunting, lower bone mass, higher GH and lower IGF-1 levels at term corrected age. SIR may help to explain the influence of non-nutritional factors on growth and body composition in VPI. SIR induces postnatal stunting related to lower bone mass accrual via GH/IGF-1 axis inhibition in VPI. VPI with SIR need special attention to minimize inflammatory stress, which could result in improved postnatal growth. Research on inflammatory-endocrine interactions involved in the pathophysiology of postnatal stunting is needed as a basis for new interventional approaches.

Diagnostic Value of Clinical Prediction Scores for Acute Appendicitis in Children Younger than 4 Years.

INTRODUCTION: Acute appendicitis can be difficult to diagnose, especially in children < 4 years old. The aim of the present study was to assess the diagnostic value of Alvarado score (AS), appendicitis inflammatory response (AIR) score, and pediatric appendicitis score (PAS) in children younger than 4 years. MATERIALS AND METHODS: All children younger than 4 years who underwent appendicectomy between 2005 and 2019 were included retrospectively. The diagnostic performance of the scores was analyzed using the area under the receiver-operating characteristic (ROC) curve and by calculating the diagnostic performances at optimal criterion value cutoff points. RESULTS: In this study, 100 children were included (58 boys and 42 girls) with a median age of 39.5 (12-47) months. Ninety children were diagnosed with pathologically proven acute appendicitis. The area under ROC curve of AS was 0.73, AIR score was 0.79, and PAS was 0.69 (p > 0.05, respectively). In children with low risk of acute appendicitis, negative predictive values were 75.0% for AS, 50.0% for AIR score, and 66.7% for PAS (p < 0.05, respectively). The positive predictive values in children with high risk of acute appendicitis were of 92.7% for AS, 92.6% for AIR score, and 93.6% for PAS (p > 0.05, respectively). AS, AIR score, and PAS plus positive ultrasonography have 0.58, 0.49, and 0.88 area under ROC curve. CONCLUSION: The three scores can be of assistance in the suspicion of acute appendicitis. PAS markedly improved combined with positive ultrasonography, but none can be used in setting the diagnosis of acute appendicitis in young children.

Instrumentos CIF para procesos de rehabilitación / CIF instruments for rehabilitation processes

INTRODUCCIÓN Las múltiples manifestaciones de la parálisis cerebral (PC) requieren un abordaje integral centrado en la persona, que incorpore componentes socioambientales, como el que propone la Clasificación Internacional del Funcionamiento, de la Discapacidad y la Salud (CIF). OBJETIVO Analizar los perfiles funcionales y la calidad de vida relacionada con la salud (CVRS) de niños/as y adolescentes (NNA) de 4 a 18 años con PC según su compromiso motor, de siete ciudades argentinas. MÉTODO Estudio transversal observacional, en el que se incluyeron NNA con PC que asisten a instituciones de salud. Se realizaron evaluaciones clínicas y entrevistas por medio de instrumentos específicos basados en la CIF y adaptados al contexto local (perfiles de funcionamiento elaborados a partir de los Conjuntos básicos de PC y la versión argentina del cuestionario CP QOL para valoración de la CVRS). Sus resultados se analizaron en relación a la severidad del compromiso motor según la función motora gruesa (GMFCS). Las diferencias estadísticas entre grupos se evaluaron mediante test de Kruskal Wallis o T de Student, según correspondía (p<0,05). RESULTADOS Se recolectaron datos de 118 NNA con PC, de los cuales el 66,1% presentó un compromiso motor severo (GMFCS nivel IV-V). En el 51,7 % de los casos no hubo complicaciones al momento de nacimiento, y en el 66,1% de los casos la lesión cerebral ocurrió durante el embarazo y hasta los primeros 28 días de vida. El 97,5% presentó certificado único de discapacidad. En los perfiles funcionales, los NNA con mayor compromiso motor, GMFCS IV-V, presentaron problemas completos en categorías referidas a actividad y participación a diferencia de sus pares. Dentro de los factores ambientales, familiares cercanos (e310) y amigos (e320) fueron facilitadores sin importar el nivel del compromiso motor. Respecto a la CVRS se observó que los NNA con compromiso motor más severo presentaban menor puntuación en la dimensión de autonomía (p=0,01). DISCUSIÓN Aquellos NNA con PC con mayor compromiso motor presentan más limitaciones para realizar sus actividades de la vida diaria. Los instrumentos basados en CIF permiten evaluar dimensiones vinculadas a la actividad, participación y factores ambientales que resultan fundamentales para evaluar los procesos de rehabilitación.

Estudio del crecimiento de la estatura en una muestra de niños, niñas y adolescentes sanos de Córdoba, Argentina / Height growth study of healthy children and adolescents from Córdoba, Argentina

OBJETIVO: Describir el crecimiento en estatura, estimar la edad pico del estirón, la velocidad de crecimiento en dicho punto, la talla final adulta esperada y los patrones diferenciales en una muestra poblacional de ambos sexos. SUJETOS Y MÉTODO: Se realizó un estudio transversal recabando prospectivamente datos demográficos, clínicos y antropométricos en sujetos sanos de ambos sexos, entre 2015 y 2016. Se calcularon los percentiles para la estatura mediante el método LMS (sesgo, mediana y coeficiente de variabilidad) y luego se ajustaron dichos valores utilizando el modelo 1 de Preece-Baines. RESULTADOS: Se evaluaron 861 sujetos, edades 2 - 18 años, 377 varones y 484 mujeres. La edad estimada al pico del estirón (h0) fue de 13,6 años en los niños y de 11,0 años en las niñas, con una velocidad de crecimiento lineal en ese punto (V2) de 6,4 cm/año para ambos sexos. La estatura adulta media esperada (hj) se estimó en 173,7 cm en los chicos y en 160,0 cm en las chicas. CONCLUSIONES: El modelo 1 de Preece-Baines permitió estimar satisfactoriamente la edad pico del estirón, la velocidad de crecimiento en dicho punto y la talla final adulta esperada.

OBJECTIVE: Based on a sample of children and adolescents of both genders, our objective is to des cribe height growth, estimate the peak age at growth spurt, growth rate at this point, the final adult height expected, and differential patterns SUBJECTS AND METHOD: A cross-sectional study was conduc ted using demographic, clinical, and anthropometric data collected prospectively from children and adolescents of both sexes between 2015 and 2016. Height percentiles were calculated using the LMS (skewness, median, and coefficient of variation) method and then adjusted using the Preece-Baines model 1. RESULTS: We evaluated 861 participants (484 girls, 377 boys), aged between 2 and 18 years. The estimated peak age at growth spurt (he) was 13.6 years in boys and 11.0 years in girls, with a peak growth rate (V2) at this point of 6.4 cm/year for both sexes. The mean expected adult height (h1) was 173.7 cm in boys and 160.0 cm in girls. CONCLUSIONS: Preece-Baines model 1 provides satisfactory estimates for the peak age at growth spurt, peak growth rate at this point, and final expected adult height.

Sustained Neonatal Inflammation Is Associated with Poor Growth in Infants Born Very Preterm during the First Year of Life.

OBJECTIVE: To determine whether a sustained neonatal systemic inflammatory response was associated with poor postnatal growth among infants born very preterm during the first year of life. STUDY DESIGN: We studied prospectively 192 infants born preterm (birth weight ≤1.5 kg and gestational age ≤31 weeks). Weight, length, and head circumference were measured at birth, term, 4, and 12 months of corrected age. Serial C-reactive protein and procalcitonin were measured at 1, 3, 7, 14, and 28 days of age and averaged for each infant. A sustained neonatal systemic inflammatory response was defined as an average C-reactive protein level greater than the median for the group. Analysis was undertaken with linear mixed models. RESULTS: Decreases in mean z scores for weight, length, and head circumference were associated with the presence of a sustained neonatal systemic inflammatory response from birth to 12 months of corrected age (ß [95% CI] = -0.282 [-0.306 to -0.258]; -1.899 [-2.028,-1.769]; -0.806 [-0.910, to -0.701], P < .001, respectively) in main effect models. This association remained significant after including interaction terms for bronchopulmonary dysplasia, neonatal sepsis, and necrotizing enterocolitis (ß [95% CI] = -0.393 [-0.520 to -0.265]; -2.128 [-2.754, -1.503]; -1.102 [-1.604, -0.600]; P < .001; respectively) in interaction models. CONCLUSIONS: A sustained neonatal systemic inflammatory response was associated with poor postnatal growth, particularly poor linear growth. Serial C-reactive protein and procalcitonin may be useful markers for identifying infants at risk for postnatal growth failure.

Differences between preschoolers with asthma and allergies in urban and rural environments.

OBJECTIVE: Previous studies have provided conflicting results about how living in a rural or urban environment influences schoolchildren with asthma and allergic diseases in different ways. The aim of the present study was to evaluate if recurrent wheezing preschoolers from rural or urban areas differ in asthma, allergic diseases, and atopy. METHODS: A cross-sectional-study in Rafaela, Argentina, on 143 preschoolers with recurrent wheezing from rural and urban settings was performed (2010-2012). Diagnosis of asthma (by positive asthma predictive index [API]), allergic diseases (rhinitis, dermatitis), and atopy (by skin prick test [SPT], peripheral blood eosinophils, and serum total IgE) were assessed. RESULTS: Preschoolers from rural settings had significantly higher prevalence of vaginal delivery, longer breastfeeding, earlier onset of wheezing, more parental smoking, siblings, shared a bedroom, and more exposure to chemicals used in plant fumigation or farm animals, and unpasteurized milk consumption, in comparison to preschoolers living in urban setting. In contrast, preschoolers from urban areas had significantly higher prevalence of parental history of allergy, positive skin prick test, and positive API. After multivariate analysis adjusting for covariates, maternal smoking [odds ratio (OR) = 3.44] and positive SPT (OR = 5.57) significantly increase the risk of asthma diagnosis (positive API); in contrast, living in rural setting (OR = 0.04), and having more siblings (OR = 0.51) decrease their risk. CONCLUSIONS: Recurrent wheezing preschoolers from rural areas had a significant inverse odds of being diagnosed with asthma (type-2 inflammation) when compared to those from urban areas. Exposure to farm animals and consumption of unpasteurized milk might have a role.

Protective effect of early placement of nasogastric tube with solid dilator on tissue damage and stricture formation after caustic esophageal burns in rabbits.

BACKGROUND: The ingestion of caustic substances remains an important public health issue worldwide. Children represent 80% of the ingestion injury population globally. Accidental alkaline material accounts for most caustic ingestions. There is no conclusive evidence of tissue damage and stricture protection of a nasogastric-tube with a solid dilator in the literature, therefore it was hypothesized that early intraesophageal tube placement does not cause additional histopathologic damage and prevents strictures. METHODS: An exploratory study on experimental caustic esophageal burns in a rabbit model was designed. In the treated group a silicone tube was placed immediately after causing the burns, while the untreated group followed the natural course of the burn. On the twenty-secondday, an esophagectomy was performed on all animals for microscopic (Histopathologic Damage Score and Stenosis Index) and macroscopic analysis. RESULTS: Forty animals were randomly divided into two groups. The Histopathologic Damage Score was 3.7±1.1 in the treated group versus 3.9±1.2 in the untreated group (p=.9690). The Stenosis Index was 0.6±0.1 in treated rabbits versus 2.3±0.2 in untreated (p<.0001). CONCLUSION: The early placement of an intraesophageal tube with solid dilator prevents stenosis formation and does not produce greater tissue damage.

[Protein losing gastroenteropathy and possible relationship to cytomegalovirus infection: Ménétrier disease in a child]. / Gastroenteropatía perdedora de proteínas y posible relación con una infección por citomegalovirus: Presentación de un caso de enfermedad de Ménétrier infantil.

Ménétrier's disease is a childhood protein-losing gastroenteropathy characterized by hypertrophy of the gastric mucosa, of unknown etiology, although most of reported cases have been associated with viral infections. Clinical manifestation is edema and biochemically there are hypoproteinemia and hypoalbuminemia. This disease is very rare in children and they have a benign and self-limiting course in contrast to adults where tend to be chronic and occasionally to become malignant. We present a child with Ménétrier disease with edema and ascites possibly associated with a cytomegalovirus infection.

Gastroenteropatía perdedora de proteínas y posible relación con una infección por citomegalovirus: Presentación de un caso de enfermedad de Ménétrier infantil / Protein losing gastroenteropathy and possible relationship to cytomegalovirus infection: Ménétrier disease in a child

La enfermedad de Ménétrier infantil es una gastroenteropatía perdedora de proteínas caracterizada por hipertrofa de la mucosa gástrica, de causa desconocida, aunque la mayoría de los casos informados se han asociado a infecciones virales. Se manifesta clínicamente por edema y bioquímicamente por hipoproteinemia e hipoalbuminemia. Es poco común en los niños, en quienes tiene un carácter benigno y autolimitado, a diferencia de los adultos, en los que tiende a cronifcarse y, en ocasiones, a malignizarse. Se presenta un caso de enfermedad de Ménétrier infantil con síndrome ascítico edematoso posiblemente asociado a una infección por citomegalovirus.

Ménétrier's disease is a childhood protein-losing gastroenteropathy characterized by hypertrophy of the gastric mucosa, of unknown etiology, although most of reported cases have been associated with viral infections. Clinical manifestation is edema and biochemically there are hypoproteinemia and hypoalbuminemia. This disease is very rare in children and they have a benign and self-limiting course in contrast to adults where tend to be chronic and occasionally to become malignant. We present a child with Ménétrier disease with edema and ascites possibly associated with a cytomegalovirus infection.

Análisis de la curva flujo-volumen en niños y adolescentes con rinitis alérgica sin asma / Analysis of the fow-volume curve in children and adolescents with allergic rhinitis without asthma

Introducción. Existen evidencias epidemiológicas, funcionales y patológicas que vinculan las vías aéreas superior e inferior, reconocidas clínicamente como una vía aérea única. Los pacientes con rinitis alérgica sin asma podrían presentar anormalidades espirométricas subclínicas. Objetivos. Describir los resultados de las curvas fujo-volumen en un grupo de pacientes con rinitis alérgica sin asma y analizar las posibles asociaciones entre las variables antropométricas, clínicas y bioquímicas con los resultados anormales de las pruebas espirométricas. Población y métodos. Estudio observacional descriptivo, en el que se incluyeron niños y adolescentes de entre 6 y 18 años con síntomas de rinitis alérgica sin asma. Se estableció la edad, el sexo, el índice de masa corporal y la duración de la rinitis por la historia clínica. Se realizaron pruebas cutáneas con alérgenos, espirometría por curva fujo-volumen, determinación de eosinóflos en la sangre y la secreción nasal, e IgE sérica total. Resultados. Se estudiaron 84 pacientes; 21 (25%; IC 95% 15,1 a 34,8) presentaron alguna variable espirométrica alterada. El índice FEV1/FVC fue el más afectado (10/84; 12% IC 95% 4,3 a 19,4). El análisis de regresión logística múltiple determinó que la alteración espirométrica se asoció con el número de eosinóflos en la sangre (OR 1,00229; IC 95% 1,00022 a 1,00436; p= 0,03) y el índice de masa corporal (OR 1,31282; IC 95% 1,08611 a 1,58685; p= 0,0049). Conclusiones. Los resultados muestran la presencia de alteraciones espirométricas en un importante porcentaje de niños y adolescentes con rinitis alérgica sin asma. El recuento absoluto de eosinóflos en la sangre y el índice de masa corporal estarían asociados a la alteración subclínica de la función pulmonar.

Introduction. There is epidemiological, functional and pathologic evidence that relates upper and lower airways, clinically known as a single respiratory tract. Patients with allergic rhinitis without asthma may present subclinical abnormal spirometry parameters. Objectives. To describe the results of the fow-volume curve in a group of patients with allergic rhinitis without asthma and analyze the possible associations between anthropometric, clinical and biochemical outcome measures with abnormal spirometry results. Population and Methods. Observational, descriptive study including children and adolescents aged 6 to 18 years old with symptoms of allergic rhinitis without asthma. Age, gender, body mass index and duration of rhinitis were determined as per the subject's medical record. Allergen skin tests, fow-volume curve spirometry, determination of eosinophil count in blood and in nasal secretions, and total serum IgE were performed. Results. A total of 84 patients were studied; 21 (25%; 95% CI: 15.1-34.8) presented at least one altered spirometry outcome measure. The FEV1/FVC ratio was the most affected outcome measure (10/84; 12%; 95% CI: 4.3-19.4). The multiple logistic regression analysis determined that spirometry alterations were associated with the number of blood eosinophils (OR: 1.00229; 95% CI: 1.00022-1.00436; p= 0.03) and the body mass index (OR: 1.31282; 95% CI: 1.08611-1.58685; p= 0.0049). Conclusions. Our results showed spirometry alterations in a considerable percentage of children and adolescents with allergic rhinitis without asthma. The blood eosinophil count and the body mass index could be associated with a sub-clinical alteration of pulmonary function.

Predictibilidad de la propagación espacial y temporal de la epidemia de influenza a h1n1 en Argentina / Predictability space and time spread of h1n1 influenza epidemic in Argentina

Antecedentes: La epidemia de influenza A H1N1 se expandió rápidamente en el ámbito mundial dadas las actuales condiciones de alta interconectividad y velocidad de los transportes, imperantes tanto entre las personas como entre los países y las regiones. La diseminación espacial de la epidemia puede ser explicada mediante la modelización matemática de fenómenos complejos por la teoría de la percolación, que permite estimar un umbral más allá del cual se produce el traspaso de la epidemia entre distintas regiones geográficas. Objetivo: el objetivo de este trabajo fue probar lacapacidad predictiva del modelo de percolación aplicado al análisis de la epidemia de influenza A H1N1 registrada en la Argentina en 2009, de acuerdo a los datos relevados por el Ministerio de Salud Pública de la Nación. Material y métodos: para aplicar el mencionado modelo se consideró al país como un conjunto de figuras geométricas irregulares, contiguas y continuas, que pueden representarse en dos dimensiones en una carta geográfica plana. Se analizó la proporción de provincias infectadas en el momento de la percolación con respecto al tiempo y se compararon los valores observados con los esperados mediante ecuaciones de estimación curvilínea en un modelo logístico. Resultados: la percolación ocurrió en el día 45. El valor esperado que generó el modelo fue de 42,4 días, intervalo de confianza de 95 % 28,5-56,3. La diferencia entre el valor observado y el esperado arrojó un valor de p = 0,997. Conclusión: se concluye que el modelo posee un buen ajuste y una adecuada capacidad predictiva.

SUMMARY: Background: the influenza A H1N1 epidemic has spread rapidly worldwide on account of the current conditions of high interconnectivity and transport speed both among people and countries. The spatial and temporal spread of the epidemics can be explained by complex mathematic models how percolation theory which allows to estimate a threshold beyond which the transmission of the infection among different geographic regions occurs. Objective: the aim of this study was to test the predictive ability of the percolation model of influenza A H1N1 epidemic in Argentina according to data gathered by the National Department of Public Health. Methods: in the model,the country was considered as a set of irregular, contiguous and continuous geometric figures, which can be represented in two dimensions on a plane. We analyzed the proportion of infected provinces at the moment of percolation in relation to time in days and compared observed and expected values by curvilinear quations in a logistic model. Results: percolation occurred on day 45. The expected value generated by the model was 42.4 days, 95 % CI 28.5 to 56.3. The difference between observed and expected values was p = 0.997. Conclusion: we conclude that the model has good fit and predictive capacity.

Síndrome de Phelan McDermid: descripción de cinco pacientes e informe del primer caso descripto en gemelas siamesas / Phelan McDermid Syndrome: five patients description and report on the frst case described in conjoined twins

El síndrome de Phelan McDermid es producido por una pérdida de material genético, en un cromosoma del par 22, a nivel de la banda q13.3. Se describieron cinco pacientes con deleción 22q13.3 para correlacionar genotipo-fenotipo y comunicar el primer caso descripto en gemelas siamesas. Se registraron antecedentes perinatales, psicomotores, conducta, lenguaje y presencia de dismorfas. Se realizó cariotipo e hibridación in situ fuorescente (FISH) para región crítica 22q13.3. Presentaron hipotonía, dismorfas menores, retraso madurativo y retraso o ausencia del lenguaje. Se confrmó deleción 22q13.3 en los cinco pacientes, encontrándose una deleción en dos casos y un anillo del cromosoma 22 en tres, siendo uno con línea pura, y las siamesas, con mosaicismo, con una línea celular normal. En pacientes con clínica sugestiva y fenotipo evocador de síndrome velo-cardio-facial, se debe realizar cariotipo y FISH para región crítica 22q11.2 con sonda control 22q13.3, para detectar la deleción del Síndrome de Phelan McDermid.

Phelan McDermid Syndrome is caused by the loss of genetic material in a chromosome from pair 22, at the band q13.3. We describe fve patients with deletion 22q13.3 in order to establish a genotype-phenotype association, and report the frst case described in conjoined twins. We analyzed the perinatal history, psychomotor behavior, language, and the presence of minor dysmorphism. Karyotypes and in situ hibridization (FISH) for critical region 22q13.3 were performed to all patients. There were hypotonia, developmental delay, and delay or absence of language. A 22q13.3 deletion was detected in all patients described, two cases had a deletion and the other three had a ring of chromosome 22, one in a pure cell line, while the twins presented mosaicism. Karyotype and FISH for 22q11.2 critical region should be performed, with 22q13.3 control probe to detect the deletion of Phelan McDermid syndrome in all patients with clinical phenotype suggestive and evocative of velo-cardio-facial syndrome.

Predictibilidad de la propagación espacial y temporal de la epidemia de influenza A H1N1 en la Argentina por el método de percolación

La epidemia de influenza A H1N1 se expandió rápidamente a nivel mundial dadas las actuales condiciones de alta interconectividad y velocidad de los transportes, imperantes tanto entre las personas como entre los países y las regiones. La diseminación espacial de la epidemia puede ser explicada mediante la teoría de la percolación, que permite estimar un umbral más allá del cual se produce el traspaso de la epidemia entre distintas regiones geográficas. El objetivo de este trabajo fue probar la capacidad predictiva del modelo de percolación aplicado al análisis de la epidemia de influenza A H1N1 registrada en la Argentina en 2009, de acuerdo a los datos relevados por el Ministerio de Salud Pública de la Nación. Para aplicar el mencionado modelo se consideró al país como un conjunto de figuras geométricas irregulares, contiguas y continuas, que pueden representarse en dos dimensiones en una carta geográfica plana. Se analizó la proporción de provincias infectadas en el momento de la percolación con respecto al tiempo y se compararon los valores observados con los esperados mediante ecuaciones de estimación curvilínea en un modelo logístico. La percolación ocurrió en el día 45. El valor esperado que generó el modelo fue de 42,4 días, intervalo de confianza de 95 % 28,5-56,3. La diferencia entre el valor observado y el esperado arrojó un valor de p = 0,997. Se concluye que el modelo posee un buen ajuste y una adecuada capacidad predictiva.

Spatial and temporal spread predictability of influenza A H1N1 epidemic in Argentina by the percolation method. The influenza A H1N1 epidemic has spread rapidly worldwide on account of the current conditions of high interconnectivity and transport speed both among people and countries. The spatial spread of the epidemics can be explained by the percolation theory which allows to estimate a threshold beyond which the transmission of the infection among different geographic regions occurs. The aim of this study was to test the predictive ability of the percolation model of influenza A H1N1 epidemic in Argentina according to data gathered by the National Department of Public Health. In the model, the country was considered as a set of irregular, contiguous and continuous geometric figures, which can be represented in two dimensions on a plane. We analyzed the proportion of infected provinces at the moment of percolation in relation to time in days and compared observed and expected values by curvilinear equations in a logistic model. Percolation occurred on day 45. The expected value generated by the model was 42.4 days, 95 % CI 28.5 to 56.3. The difference between observed and expected values was p = 0.997. We conclude that the model has good fit and predictive capacity.

Análisis sobre la variabilidad de la frecuencia cardíaca: un nuevo enfoque en la metodología de la investigación clínica de la sepsis neonatal / Heart rate variability analysis: a new approach in clinical research methodology for neonatal sepsis

Los conocimientos sobre sepsis neonatal se han incrementado notablemente, pero aún no se dispone de ninguna prueba clínica o bioquímica lo sufcientemente sensible y específca para el diagnóstico temprano y oportuno de la enfermedad. Esta situación sería consecuencia de la utilización de procedimientos analíticos que podrían perder elementos importantes de información biológica. Se han propuesto nuevos métodos de análisis no-lineal para series temporales de datos fsiológicos; de particular interés resulta el estudio de la variabilidad de la frecuencia cardíaca, que aparentemente permitiría detectar anormalidades con una antelación de 12-24 h a las manifestaciones clínicas o bioquímicas de la infección.

The knowledge on neonatal sepsis has increase signifcantly, but a clinical or biochemical marker is not available for an early and appropriate diagnosis. This fact results of an inadequate analysis which might be missing important quantum of biological information. A new method of nonlinear analysis have been proposed to investigate time series of physiological data, particularly heart rate variability analysis, that apparently would detect abnormal changes which precedes clinical or biochemical signs of infection by as much as 12-24 hours.