[Barriers to access treatment for eating disorders: Literature review]. / Barreras de acceso a tratamiento en Trastornos de la Conducta Alimentaria: Una revisión de la literatura.

BACKGROUND: Eating disorders (EDs) are disabling, potentially fatal, and costly mental disorders. According to recent data, Chile has the highest prevalence of both anorexia nervosa (AN) and bulimia nervosa (BN) in Latin America. However, there is no published data regarding the barriers experienced by patients with EDs in Chile until they start treatment. AIM: To review and synthesize the literature regarding barriers to access to treatment for patients with EDs. METHODS: A search was conducted through PubMed/ Medline, PsychInfo, Web of Science, Scopus, Embase, Scielo, and Google Scholar. Seventy-two studies were selected for full-text reading. RESULTS: 53 studies were included, all conducted in developed countries. A wide range of barriers was found, which can be classified according to their role. These barriers were predominantly at the level of the patient with an ED, the family and social environment, the health professionals, the sociocultural context, and the healthcare system. The barriers most commonly found in studies were the patient's ego-syntonic behaviors and the social stigma associated with EDs. DISCUSSION: The national context calls for discussing access problems in patients with EDs in Chile. The barriers found in this study should be considered when designing public policies, although the role of the cost of treatment should be more emphasized in Chile.

[Seasonal variation of acute myocardial infarction deaths in Chile]. / Variación estacional de las defunciones por infarto agudo del miocardio en Chile.

BACKGROUND: Hospitalization and deaths due to cardiovascular diseases (CVD), have a peak in frequency during winter. AIM: To assess the existence of seasonal variation in deaths due to acute myocardial infarction (AMI) in Chile. MATERIAL AND METHODS: Analysis of death report databases available at the website of the Chilean Ministry of Health. The seasonality of deaths due to AMI (codes ICD-10 I21, I22, I23) occuring in Chile between 2001-2016 were analyzed using a geometric model assuming a sinusoidal cyclic pattern. RESULTS: During the period 2001-2016, a total of 94,788 deaths due to AMI were registered, corresponding to 93,349 corrected deaths. Of the latter, 29.2% occurred in winter, 24.9% in spring, 24.0% in autumn and 21.8% in summer. The geometric model showed a marked sinusoidal pattern for the aggregated data. The peak-to-low ratio of deaths was 1.41 (95% CI 1.38-1.44). The peak of deaths occurred during July in 14 out of 16 years analyzed. CONCLUSIONS: In Chile, deaths due to AMI have a marked seasonal pattern, characterized by a higher number of deaths in winter and a lower number in summer.

[Development of communicative abilities in infants with Down syndrome after systematized training in gestural communication]. / Desarrollo de habilidades comunicativas en lactantes con síndrome de Down posterior a capacitaciones sistematizadas en comunicación gestual.

INTRODUCTION: Gestural communication, understood as the use of non-verbal gestures before the word appears, is a strength in children with Down syndrome (DS). OBJECTIVE: To describe com munication development behaviors in children with DS, before and after gestural communication training, based on the "Signs, words and games" workshops of the Baby Signs® program. SUBJECTS AND METHOD: Prospective study of children with DS between 18 and 22 months of cognitive age, who were trained in gestural communication according to the "Baby Signs®" methodology, evaluating communication skills through the MacArthur inventory adapted for children with DS (Communica tive Development Inventories, CDI-DS), analyzing the scores before and three months after the in tervention. The evaluated items were: Early comprehension, First sentences comprehension, Starting to speak, Vocabulary list, and Decontextualized language use (part 1) and total, early and late gestures (part 2). RESULTS: 21 children completed the workshops, with an average chronological age of 27.5 months and 19.8 months of cognitive age. 29% of the participants increased their scores in sentence comprehension, 62% in vocabulary production with gestures, 33% improved in vocabulary compre hension, 57% lost early gestures, and 43% increased late gestures production. CONCLUSIONS: Gestural communication training favors the communication skills development in a group of children with DS, mainly in the initial understanding and gesture production. There is important inter-individual variability, therefore is necessary to consider child to child recommendations.

Ambulatory blood pressure monitoring in school children with a history of extreme prematurity. / Monitorización ambulatoria de presión arterial en escolares con antecedente de prematurez extrema.

INTRODUCTION: Extremely premature children have a higher incidence of High Blood Pressure (HBP) and risk of renal damage due to decreased glomerular count with consequent hyperfiltration of the remnants. OBJECTIVES: To assess the prevalence of altered blood pressure values in outpatient measurement and ambulatory blood pressure monitoring (ABPM) in preterm infants ≤ 32 weeks and/ or ≤ 1,500 g birth weight between 5 and 7 years of age, as well as the presence of early renal damage markers. PATIENTS AND METHODS: An isolated measurement of blood pressure, ABPM and laboratory tests (microalbuminuria/creatininuria ratio in an isolated urine sample, serum creatinine, blood urea nitrogen and urinalysis) were performed. RESULTS: 30 patients were recruited, of whom valid measu rements of ABPM were obtained in 19 cases, of which nine (47,4%) presented some abnormalities, principally nocturnal day/night difference or DIP absent. No abnormal laboratory tests were found. DISCUSSION: Our study detected a high prevalence of abnormalities in ABPM principally DIP absence, which has been related to an increased risk of progression to hypertension. The importance of per forming ABPM in the study is emphasized in patients with risk factors for developing hypertension in order to detect early alterations and close management and follow-up.

Good health indicators in children with Down syndrome: High frequency of exclusive breastfeeding at 6 months. / Buenos indicadores de salud en niños con síndrome de Down: Alta frecuencia de lactancia materna exclusiva a los 6 meses.

AIM: To describe the frequency of exclusive breastfeeding at 6 months in binomial of mother and in fants with Down Syndrome (DS) attending at the Health net UC CHRISTUS (PSSPSD-UC), and iden tify the main factors associated with exclusive breastfeeding cessation. PATIENTS AND METHODS: Prevalence study of exclusively breastfeeding at 6 months of age that includes mother-child binomial of Chilean infants with (DS) aged 6-24 months, who attend the PSSPSD-UC. An on-line questionnaire was conducted, which included demographic data, child's background and experience in breastfee ding. RESULTS: The total sample consisted of 73 binomials. Forty-six percent (34/73) of the mothers exclusively breastfed until 6 months or longer, 67.1% (49/73) of the infants had a disease or malfor mation that interfere with breast feeding. Among the 39 mothers who did not exclusively breastfeed until 6 months, 25 (64.1%) referred child factors. Hospitalization during the first 6 months was the most significant factor affecting the cessation of breastfeeding (OR = 6,13). CONCLUSIONS: First study in Chile that describes the frequency of exclusive breastfeeding at 6 months of age in children with DS, which shows a large rate of exclusively breastfeeding in the studied sample. The adequate support and education in breastfeeding could allow to achieve a better rate of exclusive breastfeeding in this vulnerable group.

Clinical profile of children with diabetic ketoacidosis in fifteen years of management in a Critical Care Unit. / Perfil clínico de niños con cetoacidosis diabética en una Unidad de Paciente Crítico.

INTRODUCTION: Diabetic ketoacidosis (DKA) is the main cause of morbidity and mortality in children with type 1 diabetes mellitus (T1DM) due to clinical and biochemical alterations associated, cerebral edema as one of the most critical because of the high mortality rates and long-term neurological se quelae. OBJECTIVE: To analyze the clinical characteristics and complications of patients with DKA ad mitted to a pediatric intensive care unit. PATIENTS AND METHODS: Retrospective study of DKA patients treated at the Hospital Clínico, Pontificia Universidad Católica de Chile (UPCPUC) between 2000 and 2015. Demographic characteristics, clinical manifestations, biochemical alterations, treatment, complications, and prognosis were assessed. Patients with T1DM onset were compared with those patients already diagnosed with diabetes, analyzing variables according to distribution. RESULTS: 46 DKA events were identified, 67% of them were the first episode of DKA. 66% of patients already diagnosed with diabetes were admitted due to poor adherence to treatment. The main symptoms described were: 63% polydipsia, 56% polyuria, 48% vomiting, 39% weight loss and 35% abdominal pain, and mean blood sugar levels of 522 mg/dL, pH 7.17, and plasma osmolality of 305 mOsm/L. 89% of patients received insulin infusion, and 37% presented hypokalemia. No episodes of cerebral edema or deaths were registered. CONCLUSIONS: Most of the DKA admissions were due to T1DM onset. In the group of patients already diagnosed with diabetes, the poor adherence to treatment was the main cause of decompensation. There were no serious complications or deaths associated with DKA management during the studied period. Early diagnosis and proper and standardized treatment contributed to reducing morbidity and mortality in children with DKA.

Increase in Hospital Discharges for Inflammatory Bowel Diseases in Chile Between 2001 and 2012.

AIM: To determine the number of annual hospital discharges for inflammatory bowel diseases in Chile. The hypothesis is that there is a significant increase in the hospital discharges due to this disease from 2001 to 2012. MATERIALS AND METHODS: This is a descriptive study. Data were obtained from the Web site of the Department of Health Statistics. All hospital discharges from 2001 to 2012 were included. The following variables were analyzed: length of stay, hospital mortality, and eventual surgical procedure. Data are presented as descriptive statistics. The B-coefficient was calculated to establish the significance of the annual trend. RESULTS: There were 13,001 hospital discharges with the diagnosis of ulcerative colitis or Crohn's disease, corresponding to 0.067% of all hospital discharges in the whole period. Within these discharges, 31.2% were Crohn's disease and 68.8% were ulcerative colitis. At least one surgical procedure was performed in 12.9% of the hospitalizations. There was a significant increase in the annual rate of hospital discharges from 5.25 in 2001 to 8.64 per 100 thousand inhabitants in 2012. This increase was from 1.68 to 3.11 in Crohn's disease and from 3.58 to 5.53 in ulcerative colitis. However, a decrease was observed in length of stay, need of surgical treatment and in-hospital mortality. CONCLUSION: From 2001 until 2012, there has been a significant increase in hospital discharges for inflammatory bowel diseases in Chile, associated with a decrease in length of stay, need of surgery and in-hospital mortality.

Infant morbidity and mortality attributable to prenatal smoking in Chile.

OBJECTIVE: To estimate annual infant morbidity and mortality attributable to prenatal smoking in Chile during 2008-2012. METHODS: Population-attributable fractions (PAFs) for several infant outcomes were calculated based on previous study estimates of prenatal smoking prevalence and odds ratios associated with exposure (prenatal smoking relative to non-prenatal smoking). Prenatal smoking-attributable infant morbidity and mortality cases were calculated by multiplying the average annual number of morbidity and mortality cases registered in Chile during 2008-2012 by the corresponding PAF. RESULTS: PAFs for 1) births ≤ 27 weeks; 2) births at 28-33 weeks; 3) births at 34-36 weeks; and 4) full-term low-birth-weight infants were 12.3%, 10.6%, 5.5%, and 27.4% respectively. PAFs for deaths caused by preterm-related causes and deaths caused by sudden infant death syndrome were 11.9% and 40.0% respectively. Annually, 2 054 cases of preterm-birth and full-term low-birth-weight (1 in 9 cases), 68 deaths caused by preterm-related causes (1 in 8 cases), and 26 deaths caused by sudden infant death syndrome (1 in 3 cases) were attributable to prenatal smoking. CONCLUSIONS: In Chile, infant morbidity and mortality attributable to prenatal smoking are unacceptably high. Comprehensive individual and population-based interventions for tobacco control should be a public health priority in the country, particularly among female adolescents and young women who will be the mothers of future generations.

[Heavy menstrual bleeding affects quality of life in adolescents]. / El sangrado menstrual excesivo afecta la calidad de vida en adolescentes.

INTRODUCTION: Heavy menstrual bleeding (HMB) occurs in 37% of adolescents and compromise their quality of life. OBJECTIVE: To measure the magnitude of the impact of the SME on the quality of life in adolescents. PATIENTS AND METHOD: We interviewed adolescents diagnosed with HMB between 10 and 18 years old and one of their guardians. PedsQL 4.0 generic core scale was applied to measure quality of life, its Proxy PedsQL 4.0 version was applied to the guardian and 3 more questions to adolescents about limitation of daily activities. The concordance between the guardian's perception of the adolescent quality of life and the adolescent's perception was evaluated with the Bland and Altman graph. RESULTS: 46 adolescents and guardians were evaluated. The total average PedsQL 4.0 score for adolescents was 64.48 (SD 14.54), with a range of 18.48 to 88.04 with a greater involvement in the emotional dimension. 50% of adolescents missed school, 80.4% physical education and 65.2% outdoor activities or parties. There was no agreement between the perception of the girls and guar dians. CONCLUSIONS: We evidence a deterioration in the quality of life of the surveyed adolescents, being the emotional dimension most affected. The performance in the questionnaire was also lower than in samples of chronic diseases published with this same tool.

[High frequency of dyslipidemia in children and adolescents with Down Syndrome]. / Alta frecuencia de dislipidemias en niños y adolescentes con Síndrome de Down.

Down Syndrome (DS) shows an increased risk of chronic diseases, associated to higher morbidity and mortality for cardiovascular disease. Some studies have shown a worse lipid profile in children with DS, however, until now there is no recommendation for screening for dyslipidemia in these subjects. OBJECTIVE: To describe the frequency of dyslipidemia in a population of Chilean children and adolescents with DS. PATIENTS AND METHOD: Retrospective study, including patients with DS, aged 2 to 18 years, who participated in a special health care program for people with DS in Health Net UC CHRISTUS, between 2007 and 2015. Patients who had a lipid profile between their routine laboratory tests were included. Clinical characteristics, relevant comorbidities, malformations, medications, nutritional status and pubertal development were obtained from medical records. Diagnosis of dyslipidemia was considered according to the criteria of the NHLBI 2011. RESULTS: The medical records of 218 children with DS were revised, 58,3% had some type of dyslipidemia. The most frequent single dyslipidemias were low HDL Chol (15,1%) and hypertriglyceridemia (12,8%). Atherogenic dyslipidemia (low HDL plus hypertriglyceridemia) was the most frequent combined dyslipidemia (13,3%). The occurrence of atherogenic dyslipidemia was not associated with overnutrition and obesity. CONCLUSIONS: A high frequency of dyslipidemia was found in Chilean children and adolescents with DS. Our results make us suggest that lipid profile should be performed early in all patients with DS, independent of the presence of risk factors for dyslipidemia.

[Morbidity profile among adolescents with Down syndrome]. / Perfil de morbilidad en adolescentes chilenos con síndrome de Down.

BACKGROUND: There is a paucity of information about morbidity and mortality of adolescents with Down syndrome (DS). AIM: To describe morbidity and mortality of a cohort of Chilean adolescents with DS. MATERIAL AND METHODS: Review of electronic clinical records of 67 ambulatory patients with DS aged 10 to 20 years (37 women), seen between the years 2007 and 2014 in outpatient clinics of a University hospital. RESULTS: The mean age at the last consultation was 13 ± 3 years. Ninety-eight percent of patients had a chronic condition: 37.1% where overweight or obese, 58.2% had a congenital heart disease, 11.9% where being evaluated or had the diagnosis of autism and 44.8% had hypothyroidism. Pubertal development was consistent with chronologic age in 93.7% of patients. In three patients puberty had been suppressed. In women, average age of menarche was 12.2 ± 1.1 years. There were no deaths reported. CONCLUSIONS: There was a high rate of comorbidities in this group of adolescents with DS, most of them with frequencies comparable to those reported in literature.

Vitamin D levels and vitamin D receptor gene polymorphisms in asthmatic children: a case-control study.

BACKGROUND: Vitamin D deficiency and single nucleotide polymorphisms (SNP) in the gene encoding vitamin D receptor (VDR) have been associated with asthma. OBJECTIVE: To compare 25-hydroxyvitamin D (25OHD) levels and the frequency of 3 SNPs in the VDR gene between asthmatic and healthy children. METHODS: In persistent asthmatic and healthy control children, the 25OHD levels were measured using radioimmunoassay and SNPs (FokI, ApaI, and TaqI) were analyzed by a PCR-RFLP assay. Relevant medical history was collected. RESULTS: About 75 asthmatic (median age: 9.1 years) and 227 healthy children (10.3 years) were studied. In the whole population, the proportion of sufficient, insufficient, and deficient levels of 25OHD were 14.9%, 44%, and 41.1%, respectively. 25OHD sufficiency status was similar in asthmatic and healthy children (p = 0.57). However, the proportion of 25OHD sufficient levels among asthmatics according to the Global Initiative for Asthma treatment steps 2, 3, and 4 was significantly different (8.6%, 16.6%, and 43.7%, respectively, p = 0.046). All patients on step 4 of the treatment (16/16) were heterozygous for the C allele (FokI VDR SNP). There was a lower presence of the C allele among asthmatics in step 2 (30/33), step 3 (16/24), and controls (45/50), p = 0.007, but this significance did not persist after logistic regression. No significant differences in ApaI and TaqI were found. CONCLUSIONS: We found a possible association of vitamin D sufficiency status and FokI C allele with higher requirement of therapy to reach asthma control, suggesting that it may be involved in treatment response. Variations in VDR might also play a role in the 25OHD levels.

[High rates of overweight and obesity in Chilean children with Down syndrome]. / Malnutrición por exceso: alta frecuencia de sobrepeso y obesidad en escolares chilenos con síndrome de Down.

BACKGROUND: Overweight and obesity in Down syndrome (DS) is a common problem. Chile has a high prevalence of DS. AIM: To determine overweight and obesity rates in students with DS and evaluate the concordance of three different growth charts. MATERIAL AND METHODS: Seventy nine students with DS aged between 6 and 18 years (56% males), from three different schools, were included. Weight and height were measured and their body mass index (BMI) was calculated. The nutritional diagnosis was made according to BMI. Myrelid SDM/2002, National Center for Health Statistics (NCHS)/2000, World Health Organization (WHO)/2007 charts for people with DS were used. RESULTS: Thirty percent of participants had hypothyroidism, 22.8% congenital heart disease and 5% asthma. Overweight and obesity rates according to SDM/2002, NCHS/2000 and WHO/2007 were 43, 57 and 66% respectively. The concordance between WHO/2007 and NCHS/2000 was almost perfect, but not with SDM/2002. CONCLUSIONS: A high rate of overweight and obesity was found in this group of children with DS, independent of the charts used or their comorbidities.

[Measles outbreaks in developed countries: A lesson for Chile]. / Brotes de sarampión en países desarrollados: Una lección para Chile.

The measles vaccine has been used for over 50 years and has proven to be safe, effective and inexpensive, Nevertheless, in 2013 145,700 measles deaths occurred, mostly in countries with low per capita income and weak health infrastructure. The occurrence of measles cases is not restricted to developing countries, but also affects developed countries (Europe and USA), where is associated with a reduction in vaccination coverage, explained by a loss of confidence of some parents in the vaccine. This perspective article addresses the loss of confidence in the vaccine, and the individual and collective consequences of the decision to not vaccinate a child. Various strategies to reverse this phenomenon are presented, most notably the continuing education of health professionals, parents and patients using scientific arguments, given in an understandable and interesting language. Finally, the current situation of Chile (a country with current certification of measles elimination) is presented, emphasizing the importance of maintaining this condition.

Higher latitude and lower solar radiation influence on anaphylaxis in Chilean children.

BACKGROUND: Recent studies suggest an association between higher latitude, a proxy of vitamin D (VD) status, and allergic diseases. Chile provides an ideal setting to study this association due to its latitude span and high rates of VD deficiency in southern regions. The aim of this study is to explore the associations of latitude and solar radiation with anaphylaxis admission rates. METHODS: We reviewed anaphylaxis admissions in Chile's hospital discharge database between 2001 and 2010 and investigated associations with latitude and solar radiation. RESULTS: 2316 anaphylaxis admissions were registered. Median age of patients was 41 yr; 53% were female. National anaphylaxis admission rate was 1.41 per 100,000 persons per year. We observed a strong north-south increasing gradient of anaphylaxis admissions (ß 0.04, p = 0.01), with increasing rates south of latitude 34°S. A significant association was also observed between solar radiation and anaphylaxis admissions (ß -0.11, p = 0.009). Latitude was associated with food-induced (ß 0.05, p = 0.02), but not drug-induced (ß -0.002, p = 0.27), anaphylaxis. The association between latitude and food-induced anaphylaxis was significant in children (ß 0.01, p = 0.006), but not adults (ß 0.003, p = 0.16). Anaphylaxis admissions were not associated with regional sociodemographic factors like poverty, rurality, educational level, ethnicity, or physician density. CONCLUSIONS: Anaphylaxis admission rates in Chile are highest at higher latitudes and lower solar radiation, used as proxies of VD status. The associations appear driven by food-induced anaphylaxis. Our data support a possible role of VD deficiency as an etiological factor in the high anaphylaxis admission rates found in southern Chile.

[Concordance of nasal swabs and nasopharyngeal swabs in the detection of respiratory viruses by direct immunofluorescence]. / Concordancia del hisopado nasal con el hisopado nasofaríngeo en la detección de virus respiratorios por inmunofluorescencia directa.

BACKGROUND: The most used test for the diagnosis of viral respiratory infection is the detection of viral antigens by direct immunofluorescence (DFA), in samples taken by nasopharyngeal swab (NPS) or aspirate (NPA). It would be desirable to have a less uncomfortable technique to obtain a sample from the patient, but of equal performance. AIM: To evaluate the diagnostic agreement between nasal swab (NS) and nasopharyngeal swab (NPS) in the detection of respiratory viruses by DFA and compare the degree of discomfort of both techniques in pediatric patients. METHODOLOGY: Cross-sectional study in children who consulted to a pediatric emergency service with respiratory symptoms. Two samples (NPS and NS) per child were collected. The concordance between the two was determined by Kappa (K) coefficient and the degree of discomfort by a visual pain scale. RESULTS: We obtained 112 samples from 56 children, one by each technique. 82.1% were concordant, K = 0.61 (CI 95%, 0.39-0.83) for the detection of any virus, and K = 0.69 (CI 95%, 0.46-0.92) and K = 0.76 (CI 95%, 0.51-1) for syncytial respiratory virus and influenza A detection, respectively. The degree of discomfort was significantly lower for the NS. CONCLUSION: There is considerable agreement in the detection of respiratory viruses by DFA between samples obtained by NS and NPS, but not enough to recommend a change in the sampling method in this population.

[Nosocomial infections after cardiac surgery in infants and children with congenital heart disease]. / Infecciones asociadas a la atención en salud (IAAS) en pacientes pediátricos post-operados de cardiopatías congénitas.

INTRODUCTION: Nosocomial infections generate high morbidity and mortality in children undergoing cardiac surgery. OBJECTIVE: To determine risk factors for nosocomial infections in children after congenital heart surgery. METHODS: A retrospective case-control study, in patients younger than 15 years undergoing surgery for congenital heart disease from January 2007 to December 2011 admitted to the Pediatric Critical Patient Unit (UPC-P) in a university hospital. For cases, the information was analyzed from the first episode of infection. RESULTS: 39 patients who develop infections and 39 controls who did not develop infection were enrolled. The median age of cases was 2 months. We identified a number of factors associated with the occurrence of infections, highlighting in univariate analysis: age, weight, univentricular heart physiology, complexity of the surgical procedure according to RACHS-1 and cardiopulmonary bypass (CPB) time ≥ 200 minutes. Multivariate analysis identified CPB time ≥ 200 minutes as the major risk factor, with an OR of 11.57 (CI: 1.04 to 128.5). CONCLUSION: CPB time ≥ 200 minutes was the mayor risk factor associated with the development of nosocomial infections.

[Early detection of cytomegalovirus infection in allogeneic hematopoietic stem cell transplant patients by real time-quantitative PCR]. / Detección precoz de infección por citomegalovirus en pacientes sometidos a trasplante alogéneico de precursores hematopoyéticos por reacción de polimerasa en cadena cuantitativa en tiempo real.

INTRODUCTION: CMV pp65-antigenemia (antigenemia) has been used for monitoring CMV viremia in allogeneic hematopoietic stem cell transplant (aHSCT) recipients. Recently, real time quantitative PCR (RT-qPCR) has been used as a better approach than antigenemia for CMV diagnosis. The objective of this study was to assess the correlation of CMV viremia between RT-qPCR and antigenemia in aHSCT patients. MATERIAL AND METHODS: Observational prospective study of all aHSCT patients during 10 months in our center. CMV RT-qPCR in whole blood was performed weekly from day +7 to +100 after aHSCT. Simultaneous antigenemia was performed from engrafment to day +100. Concordance between both assays was evaluated. RESULTS: Eighteen patients were included. In 120 simultaneous samples, 96 were concordant by both methods (80%). Kappa coefficient was 0.583. In 42% of cases without concordant results, patients were on antiviral therapy. Thirteen patients (72%) developed CMV infection (20 episodes). In 17 episodes, both the antigenemia and CMV RT-qPCR were positive. CMV RT-qPCR was detectable 1-2 weeks before antigenemia in 45% of the episodes. CONCLUSION: Both methods had a moderate concordance and CMV RT-qPCR detects CMV reactivations earlier than antigenemia, especially in neutropenic patients.

[Higher risk for health care associated infections in hospitalized children with special health needs]. / Mayor riesgo de infecciones asociadas a atención en salud en niños con necesidades especiales hospitalizados.

BACKGROUND: Nosocomial infections (NIs) represent an important public health issue, being associated with high morbidity, mortality and costs. OBJECTIVES: To identify risk factors of NIs in a cohort of hospitalized pediatric patients, with emphasis in children with special health care needs (CSHCN). PATIENTS AND METHODS: We studied patients hospitalized in Sótero del Río Pediatric Hospital at Santiago-Chile, between September and December, 2009. Relative Risk (RR) was calculated between CSHCN-3 (children attended by three or more health care professionals) versus non CSHCN-3, and between children with medical complexity (CMC) versus non CMC, using log-binomial models. RESULTS: 920 patients were included. Prevalence of NIs was 12.7%. The most frequent diagnoses were gastrointestinal and respiratory viral infections. Both crude and adjusted by confounders (age and sex), CSHCN-3 and CMC presented significantly higher risk of NIs compared to patients without these conditions (RR 2.91 and RR 2.16, respectively). CONCLUSION: CSHCN-3 and CMC represent independent conditions associated to a 2-3 fold risk of NIs.

[Clinical features of Eosinophilic Colitis in infants with persistent rectal bleeding]. / Características clínicas asociadas a colitis eosinofílica en lactantes con rectorragia persistente.

UNLABELLED: The most common presentation of cow's milk protein allergy (CMP) in infants is known as eosinophilic colitis (EC). The aim of this study is to evaluate EC characteristics in infants evaluated with colonoscopy due to the presence of rectorrhagia. PATIENTS AND METHODS: A retrospective case-control study. Left-sided colonoscopy records of infants with persistent rectal bleeding, conducted between January 2006 and March 2011, were reviewed. The cases corresponded to infants with rectal biopsy compatible with EC and controls with negative biopsy. Telephone questionnaires to parents were conducted, evaluating personal and family history. RESULTS: Complete records were obtained in 61 (79%) of the 77 procedures. 33 (54%) of them were males. Examination average age was 6.3 ± 5.9 months. 25 (41%) patients had EC on their histology. Between cases and controls, no significant difference in gestational age, birth weight and gender, only regarding age at the time of rectal bleeding, were observed. There was also no difference in personal history regarding obstructive bronchitis, allergic rhinitis, family history of asthma, allergic rhinitis or other food allergies. Those who received artificial feeding did not presented greater risk of EC. The most common symptoms in the cases did not differ significantly from the controls. CONCLUSIONS: The prevalence of EC in the children studied was 40.9%. Our results show that there are groups of patients with persistent rectal bleeding in which there is no personal or family history that helps diagnosing EC. An endoscopic study could be considered in these patients to establish a correct diagnosis of this condition, avoid unnecessary diets and not to delay the detection of other diseases.