Pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1) in Argentina.

BACKGROUND: While the Northern Hemisphere experiences the effects of the 2009 pandemic influenza A (H1N1) virus, data from the recent influenza season in the Southern Hemisphere can provide important information on the burden of disease in children. METHODS: We conducted a retrospective case series involving children with acute infection of the lower respiratory tract or fever in whom 2009 H1N1 influenza was diagnosed on reverse-transcriptase polymerase-chain-reaction assay and who were admitted to one of six pediatric hospitals serving a catchment area of 1.2 million children. We compared rates of admission and death with those among age-matched children who had been infected with seasonal influenza strains in previous years. RESULTS: Between May and July 2009, a total of 251 children were hospitalized with 2009 H1N1 influenza. Rates of hospitalization were double those for seasonal influenza in 2008. Of the children who were hospitalized, 47 (19%) were admitted to an intensive care unit, 42 (17%) required mechanical ventilation, and 13 (5%) died. The overall rate of death was 1.1 per 100,000 children, as compared with 0.1 per 100,000 children for seasonal influenza in 2007. (No pediatric deaths associated with seasonal influenza were reported in 2008.) Most deaths were caused by refractory hypoxemia in infants under 1 year of age (death rate, 7.6 per 100,000). CONCLUSIONS: Pandemic 2009 H1N1 influenza was associated with pediatric death rates that were 10 times the rates for seasonal influenza in previous years.

Overweight and lifestyle behaviors of low socioeconomic elementary school children in Buenos Aires.

BACKGROUND: There is growing interest in understanding the role that lifestyle behaviors play in relation to children's weight status. The objective of the study was to determine the association between children s BMI and dietary practices and maternal BMI. METHODS: 330 students (168M) aged 8.9 + 2 y from 4 suburban Buenos Aires elementary schools, and their mothers aged 36.2 + 7 y were examined between April and September 2007. Mothers were asked about their children s lifestyle. Data included parental education levels socioeconomic status, mothers and children s BMI, and Tanner stage. RESULTS: All families were in the low socio-economic class. 79% of parents had an elementary education or less. 61 (18.5%) of children were obese (OB) (BMI>95%ile per CDC norms), and 53 (16.1%) overweight (OW) (BMI>85<95%ile). 103 (31.2%) of mothers were OB (BMI>30 kg/m2), and 102 (30.9%) OW (BMI>25<30). 63% the children were pre-pubertal. 40% had a TV set in their bedroom. 13% of the children skipped breakfast and only 38% watched TV

Experiencia educativa para estudiantes de medicina de la Universidad de Buenos Aires (UBA) en la evaluación del Calendario Nacional de Vacunación de niños que concurrieron a Hospitales de la Ciudad Autónoma de Buenos Aires (CABA) / Educational experience for medical students at the University of Buenos Aires (UBA) in the evaluation of the National Vaccination Calendar of children who attended hospitals of the Autonomous City of Buenos Aires (CABA)

Objetivos: La participación de alumnos en estudios que evalúan el cumplimiento del programa de Inmunizaciones (PAI) y sus causales representa una experiencia relevante. La evaluación del cumplimiento del PAI permite proponer estrategias para aumentar coberturas.Métodos: Estudio observacional, analítico, transversal. Población: Neonatos a 11 años de edad, realizado en 6 hospitales de la CABA. Período: 1/06-31/12/2014. Participaron estudiantes del internado anual rotatorio capacitados sobre PAI,supervisados por docentes.Criterio de inclusión: Presentar el carné de vacunación, no tener condiciones que impidieran indicación del PAI.Resultados: Encuestas 531. Esquema incompleto o no recibió ninguna vacuna 25,7 por ciento. Se asociaron a incumplimiento las siguientes variables: Edad <1 año, edad materna <28 años, escasa educación materna, embarazo no controlado, ausencia de control de salud, internados, consulta porenfermedad. Análisis multivariado: falta de control de salud: RR 2,1(IC 95 por ciento:1,4-2,9).Como motivo de OPV predominó olvido (71,8 por ciento). Los alumnos refirieron útil su participación. Consideraron positivo aprender a investigar, contacto con pacientes y familiares, trabajar en equipo. Negativo: restó tiempo para estudiar.Conclusiones: Interactuar con la comunidad permitiría eliminar barreras que condicionan OPV. La comunicación es valiosa para lograr este objetivo. La participación supervisada de alumnos fue una experiencia innovadora, al introducirlos en la investigación clínica.

Introduction: The participation of students in research studies is a valuable teaching objective. Particularly evaluating implementation of the National immunization Program and their causal, allowing to propose strategies to increase coverage.Methods: An observational, analytical, crosssectional study. Population: Newborn to 11 years old, conducted in 6 hospitals of Buenos Aires city. Period: 1/06-31/12/2014. Pediatrics students belonging to the pediatric annualtraining in pediatrics, supervised by their teachers. Inclusion criteria: Presentation the vaccination card, have no conditions that would prevent indication of the vaccines.Results: 531 surveys were completed.Incomplete scheme, or no received vaccine 25.7 percent. The following variables were associated with non-compliance schedule: Age <1 year, maternal age <28 years, lowmaternal education, uncontrolled pregnancy, lack of health control, boarding, ambulatory consult for disease. Multivariate analysis: lackof control health: RR 2.1 (95 percent CI: 1.4-2.9).Family forgot vaccinate the child prevailed (71.8 percent). Students reported their participation useful. They considered positive learning how to research, contact with patients andfamilies, teamwork. As negative: Rest time to study.Conclusions: Interacting with the community enable barriers that condition not comply with the scheme. Communication is valuable to achieving this aim. Supervised student participation was an innovative experience to introduce in clinical research.

Comparison of different anthropometric indices for identifying insulin resistance in schoolchildren.

OBJECTIVES: Anthropometric indices have been associated with insulin resistance in children. This study (1) determined the association between insulin resistance and anthropometric indices, including body mass index (BMI), waist circumference (WC), WC/height, weight/(sitting height)(2), and WC/sitting height, and (2) compared the abilities of these five indices to identify children with insulin resistance. METHODS: Data were collected from six elementary schools in Argentina between April and August 2007. Anthropometric data and Tanner staging were obtained. Fasting serum concentrations of glucose, lipids, and insulin were measured. RESULTS: Six hundred twenty-five children (318 boys) between 6 and 14 years old were examined. The mean age of the children was 9.6 +/- 2.0 years. Ninety-six (15.4%) of the children were obese, 91 (14.6%) were overweight, and 438 (70.1%) were normal weight using Centers for Disease Control and Prevention norms. Sixty percent, 23.0%, 14.0%, and 3.0% were Tanner stage I, II, III, and IV, respectively. The areas under the receiver operator characteristic curves were as follows: WC = 0.78 +/- 0.021 (95% confidence interval [CI] 0.74-0.82), BMI = 0.77 +/- 0.022 (95% CI 0.73-0.82), weight/(sitting height)(2) = 0.76 +/- 0.022 (95% CI 0.72-0.81), WC/height = 0.67 +/- 0.027 (95% CI 0.62-0.72), and WC/sitting height = 0.67 +/- 0.27 (95% CI 0.62-0.72), indicating that BMI, WC, and weight/(sitting height)(2) were acceptable predictors for insulin resistance, whereas WC/height and WC/sitting height were fair predictors as the areas under the curve were <0.7. CONCLUSIONS: This study suggests that WC and BMI are (and remain) the best correlates for insulin resistance. In contrast, the indices of the ratio between WC and height were fair predictors for insulin resistance. Additional longitudinal studies should be done to further confirm these findings.

[Congenital tuberculosis. Infrequent presentation of a common disease]. / Tuberculosis congénita. Presentación infrecuente de una enfermedad habitual.

Congenital tuberculosis is a severe rapidly progressive disease which differs from neonatal tuberculosis because patients present tuberculous lesions during their first weeks of life, primary hepatic complex or hepatic caseous granulomas, confirmation of tuberculosis in placenta or in maternal genital tract (uterus or adnexa), and exclusion of birth channel or postnatal exposure. We report a case of a 20 days newborn baby admitted to the neonatal unit with fever, hepatoesplenomegaly, abdominal distension and respiratory symptoms. Abdominal echography showed ascitis, diffuse hepatomegaly and splenomegaly, focal hipoecoical spleen images and portal lymphadenopathy. Thorax X-ray with micronodular infiltrates. Maternal pneumonia with pleural effusion was reported during pregnancy. Empirical treatment was initiated with 4 antituberculous drugs: isoniazid, rifampicin, pyrazinamide and ethambutol suspecting tuberculosis. She died the next day. M. tuberculosis was obtained in a gastric lavage culture, blood cultures and post mortem spleen puncture.

Tuberculosis Congénita: presentación infrecuente de una enfermedad habitual / Congenital Tuberculosis: infrequente presentation of a common disease

La tuberculosis congénita es una forma clínica grave, rápidamente progresiva, que se diferencia de la forma neonatal por aparición de la lesión en las primeras semanas de vida, presencia de complejo primario hepático o granulomas caseosos,confirmación de tuberculosis en la placenta o tracto genital la madre (útero o anexos) y exclusión de exposición en el canal de parto o post-natal por contacto con foco tuberculoso incluyendoal personal hospitalario. Comunicamos un caso de un recién nacido de 20 días ingresó a neonatología por síndrome febril sin foco evidente evolucionó con hepatoesplenomegalia, distensión abdominal y dificultad respiratoria. Ecografía abdominal con ascitis, hepatoesplenomegalia difusa, imágenes hipoecoicas en bazoadenopatías adyacentes al tronco celíaco y en hilio hepático.de tórax con infiltrado micronodulillar. Antecedente materno de neumonía con derrame durante el embarazo. Ante la sospecha de tuberculosis congénita comenzó tratamiento empírico con 4 drogas: isoniacida, rifampicina, pirazinamida y etambutol. Fallece al día siguiente. Se recibió posteriormente desarrollo de M. tuberculosis en cultivo de lavado gástrico, hemocultivoy punción esplénica

Congenital tuberculosis is a severe rapidly progressive disease which differs from neonatal tuberculosis because patients present tuberculous lesions during their first weeks of life, primary hepatic complex or hepatic caseous granulomas, confirmation of tuberculosis in placenta or in maternal genital tract (uterus or adnexa), and exclusion of birth channel or postnatal exposure. We report a case of a 20 days newborn baby admitted to the neonatal unit with fever, hepatoesplenomegaly, abdominal distension and respiratory symptoms. Abdominal echography showed ascitis, diffuse hepatomegaly and splenomegaly, focal hipoecoical spleen images and portal lymphadenopathy. Thorax X-ray with micronodular infiltrates. Maternal pneumonia with pleural effusion was reported during pregnancy. Empirical treatment was initiated with 4 antituberculous drugs: isoniazid, rifampicin, pyrazinamide and ethambutol suspecting tuberculosis. She died the next day. M. tuberculosis was obtained in a gastric lavage culture, blood cultures and post mortem spleen puncture.

Egresos por enfermedad respiratoria en lactantes y niños en hospitales de la Ciudad de Buenos Aires / Respiratory diseases discharges in infants and children in Buenos Aires city hospitals

Introducción.Las enfermedades respiratorios en niños son una de las causas más frecuentes de consulta,ausentismo escolar y morbilidad.Favorecen el uso inapropiado de antibióticos y sintomáticos y la aparición de secuelas.Objetivos.Conocer la epidemiología,estimar costos y generar líneas de acción.Material y métodos.Informes de hospitalización de 12 hospitales generales,2 de niños y 1 especializado,durante 1996.Población:mayor de 28 días y menor de 15 años.Conclusiones.Las IRAB son la principal causa de egresos,con alto predominio estacional y en menores de 5 años.La letalidad se asoció fuertemente con enfermedades de base.Significan una alta erogación para el sistema de salud,por lo que deberían evitarse internaciones innecesarias