Climate-limited vegetation change in the conterminous United States of America.

The effects of climate change on vegetation composition and distribution are evident in different ecosystems around the world. Although some climate-derived alterations on vegetation are expected to result in changes in lifeform fractional cover, disentangling the direct effects of climate change from different non-climate factors, such as land-use change, is challenging. By applying "Liebig's law of the minimum" in a geospatial context, we determined the climate-limited potential for tree, shrub, herbaceous, and non-vegetation fractional cover change for the conterminous United States and compared these potential rates to observed change rates for the period 1986 to 2018. We found that 10% of the land area of the conterminous United States appears to have climate limitations on the change in fractional cover, with a high proportion of these sites located in arid and semiarid ecosystems in the Southwest part of the country. The rates of change in lifeform fractional cover for the remaining area of the country are likely limited by non-climate factors such as the disturbance regime, land management, land-use history, soil conditions, and species interactions and adaptations.

Thirty-six years of butterfly monitoring, snow cover, and plant productivity reveal negative impacts of warmer winters and increased productivity on montane species.

Climate change is contributing to declines of insects through rising temperatures, altered precipitation patterns, and an increasing frequency of extreme events. The impacts of both gradual and sudden shifts in weather patterns are realized directly on insect physiology and indirectly through impacts on other trophic levels. Here, we investigated direct effects of seasonal weather on butterfly occurrences and indirect effects mediated by plant productivity using a temporally intensive butterfly monitoring dataset, in combination with high-resolution climate data and a remotely sensed indicator of plant primary productivity. Specifically, we used Bayesian hierarchical path analysis to quantify relationships between weather and weather-driven plant productivity on the occurrence of 94 butterfly species from three localities distributed across an elevational gradient. We found that snow pack exerted a strong direct positive effect on butterfly occurrence and that low snow pack was the primary driver of reductions during drought. Additionally, we found that plant primary productivity had a consistently negative effect on butterfly occurrence. These results highlight mechanisms of weather-driven declines in insect populations and the nuances of climate change effects involving snow melt, which have implications for ecological theories linking topographic complexity to ecological resilience in montane systems.

Inmunización con vacunas ARN mensajero contra la COVID-19 en pacientes adolescentes con antecedente de síndrome inflamatorio multisistémico: serie de casos / Immunization with messenger RNA vaccines against COVID-19 in adolescents with a history of multisystem inflammatory

Los niños cursan mayormente la infección por el virus SARS-CoV-2 en forma leve. Sin embargo, de forma muy infrecuente algunos pueden desarrollar una patología con marcada gravedad denominada síndrome inflamatorio multisistémico en niños relacionado temporalmente con COVID-19 (SIM-C). Dado su reciente surgimiento, aún hay aspectos de su fisiopatología que se desconocen. La posibilidad de recidiva en caso de reinfección o ante la vacunación contra SARS-CoV-2 son nuevos interrogantes a los que nos enfrentamos. Reportamos una serie de casos de 4 pacientes adolescentes que cursaron SIM-C y meses después han sido vacunados contra SARS-CoV-2 con plataformas ARN mensajero (ARNm) sin presentar recurrencia de la enfermedad ni efectos adversos cardiológicos

In most cases, children with SARS-CoV-2 have a mild infection. However, very rarely, some children may develop a severe disease called multisystem inflammatory syndrome in children temporally associated with COVID-19 (MIS-C). Given its recent emergence, some aspects of its pathophysiology are still unknown. The possibility of recurrence in case of reinfection or SARS-CoV-2 vaccination are new questions we are facing. Here we report a case series of 4 adolescent patients who developed MIS-C and, months later, received the SARS-CoV-2 vaccine with messenger RNA (mRNA) platforms without disease recurrence or cardiac adverse events.

Immunization with messenger RNA vaccines against COVID-19 in adolescents with a history of multisystem inflammatory syndrome: a case series. / Inmunización con vacunas ARN mensajero contra la COVID-19 en pacientes adolescentes con antecedente de síndrome inflamatorio multisistémico: serie de casos.

In most cases, children with SARS-CoV-2 have a mild infection. However, very rarely, some children may develop a severe disease called multisystem inflammatory syndrome in children temporally associated with COVID-19 (MIS-C). Given its recent emergence, some aspects of its pathophysiology are still unknown. The possibility of recurrence in case of reinfection or SARS-CoV-2 vaccination are new questions we are facing. Here we report a case series of 4 adolescent patients who developed MIS-C and, months later, received the SARS-CoV-2 vaccine with messenger RNA (mRNA) platforms without disease recurrence or cardiac adverse events.

Los niños cursan mayormente la infección por el virus SARS-CoV-2 en forma leve. Sin embargo, de forma muy infrecuente algunos pueden desarrollar una patología con marcada gravedad denominada síndrome inflamatorio multisistémico en niños relacionado temporalmente con COVID-19 (SIM-C). Dado su reciente surgimiento, aún hay aspectos de su fisiopatología que se desconocen. La posibilidad de recidiva en caso de reinfección o ante la vacunación contra SARS-CoV-2 son nuevos interrogantes a los que nos enfrentamos. Reportamos una serie de casos de 4 pacientes adolescentes que cursaron SIM-C y meses después han sido vacunados contra SARS-CoV-2 con plataformas ARN mensajero (ARNm) sin presentar recurrencia de la enfermedad ni efectos adversos cardiológicos.

Análisis bibliométrico de la incontinencia urinaria masculina. Una mirada de los últimos 20 años / Bibliometric Analysis of Urinary Incontinence. An Overview of the Last 20 Years

Introducción y Objetivo En las últimas décadas, la incidencia y prevalencia de la incontinencia urinaria han venido en aumento. Existen numerosas publicaciones sobre este tema, se han introducido nuevos dispositivos, y se hanmodificado las líneas demanejo de esta patología. El objetivo de este estudio es realizar un análisis bibliométrico de las publicaciones sobre incontinencia urinaria masculina en las revistas indexadas. Métodos Se realizó un análisis bibliométrico descriptivo de corte retrospectivo de la literatura médica disponible en la base de datos Web of Science (WOS) en relación con incontinencia urinaria masculina entre 2002 y 2020. Por medio de la WOS, se obtuvieron las variables a analizar, y se elaboraron tablas y gráficas en el programa Microsoft Office Excel 2017. Resultados Encontramos un total de 498 publicaciones en 88 revistas. Hubo un crecimiento exponencial de las publicaciones a partir de 2006. Las 3 revistas conmayor porcentaje de publicaciones fueron: J Urol, con 25,2% (125), Neurol Urodyn, con 16,5% (82), European Urology Journal, con 11,1% (55); sólo 5 de las 20 revistas con más publicaciones tuvieron un factor de impacto 3. El país que tuvomayor porcentaje fue Estados Unidos con 21,2% (105), seguido por países europeos. En América Latina, el país con mayor número de publicaciones fue Brasil, con 2,6% (13). No se encontraron estudios colombianos con esta búsqueda específica. Conclusión Este es el primer estudio bibliométrico sobre incontinencia urinaria masculina. Con el tiempo, han aumentado las publicaciones acerca de este tema, y la mayoría está concentrada en revistas de Estados Unidos y Europa. No es predominante la publicación en revistas de alto factor de impacto, y es muy baja la cantidad de publicaciones que aporta Colombia y los demás países latinoamericanos.

Introduction In the last decades, the incidence and prevalence of urinary incontinence have been increasing. There are many publications about this subject, there are new devices, and the treatment of this condition has changed with time. The objective of the present study was to perform a bibliometric analysis of the publications about male urinary incontinence in the indexed journals. Methods We performed a retrospective descriptive bibliometric analysis of the medical literature available on the Web of Science (WOS) database about male urinary incontinence between 2002 and 2020. Through the WOS database, the variables to be analyzed were obtained, and tables and graphs were created using the Microsoft Office Excel 2017. Results We found 498 publications in 88 journals. Since 2006, there has been an exponential growth in publications. The 3 journals with the highest percentage of publications were: J Urol, with 25.1% (125), Neurol Urodyn, with 16.5% (82), European Urology Journal, with 11.4% (57); only 5 of the 20 journals with the highest number of publications had an impact factor ≥ 3. The country with the highest percentage of publications was the United States with 21,2% (105), followed by European countries. In Latin America, the country with the highest number of publications was Brazil, with 2,6% (13). No Colombian studies were found with this specific research. Conclusion The present is the first bibliometric analysis on male urinary incontinence. Over time, publications on this topic have increased, and most of them are concentrated in journals from the United States and Europe. The publication in journals with a high impact factor is not predominant, and the number of publications from Colombia and other Latin American countries is very low.

[Effectiveness and safety of two phototherapy devices for the humanised management of neonatal jaundice]. / Efectividad y seguridad de 2 dispositivos de fototerapia para el manejo humanizado de la ictericia.

INTRODUCTION: Neonatal jaundice is common, especially in premature infants. Compliance with treatment protocols and standard serum bilirubin curves forces the clinician to separate the child from the mother after birth for short phototherapy. The objective of this study is to evaluate the effectiveness and safety of two innovative devices for phototherapy including a LED light mesh: one sleeping bag and one blanket compared to conventional hospital or ambulatory phototherapy. METHODS: Two randomised clinical trials were conducted: one with newborns >2,000g at birth in the Neonatal Care Unit and the other with premature infants followed-up in an outpatient clinic (PMC). The gold standard for bilirubin measurement was serum bilirubin, and ambulatory controls were performed with the Bilicheck®. Parents and health personnel completed a questionnaire on comfort and perceptions. RESULTS: In the study using the bag, a linear regression was performed for the decrease in bilirubin in mg/dL/h, controlling by early jaundice (<36h) and the device type. The results were similar between the 2 devices. For the blanket trial in the PMC, the decrease in bilirubin levels with the new device was significantly greater with no differences in temperatures, duration of phototherapy, re-admission, mortality, or side effects for both trials. Parents and staff satisfaction with the two devices was identical for the 2 trials. CONCLUSION: These 2 small studies add a 'grain of sand' to humanisation of newborn care, avoiding the mother-and-child separation for both the intra-hospital high-risk hyperbilirubinaemia, as well as for the lower-risk hyperbilirubinaemia in an outpatient clinic.

Engaging people with lived experience in the grant review process.

People with lived experience are individuals who have first-hand experience of the medical condition(s) being considered. The value of including the viewpoints of people with lived experience in health policy, health care, and health care and systems research has been recognized at many levels, including by funding agencies. However, there is little guidance or established best practices on how to include non-academic reviewers in the grant review process. Here we describe our approach to the inclusion of people with lived experience in every stage of the grant review process. After a budget was created for a specific call, a steering committee was created. This group included researchers, people with lived experience, and health systems administrators. This group developed and issued the call. After receiving proposals, stage one was scientific review by researchers. Grants were ranked by this score and a short list then reviewed by people with lived experience as stage two. Finally, for stage three, the Steering Committee convened and achieved consensus based on information drawn from stages one and two. Our approach to engage people with lived experience in the grant review process was positively reviewed by everyone involved, as it allowed for patient perspectives to be truly integrated. However, it does lengthen the review process. The proposed model offers further practical insight into including people with lived experience in the review process.

Factores asociados a la insuficiencia renal aguda en pacientes hospitalizados en la unidad de cuidados intensivos de la Clínica Ibagué, 2016-2017 / Acute renal failure in patients hospitalized in the intensive care unit in Ibague Clinic 2016-2017

Resumen Objetivo: establecer la asociación de la insuficiencia renal aguda con los factores demográficos y clínicos en pacientes hospitalizados en la unidad de cuidados intensivos en Colombia. Métodos: estudio analítico de casos y controles cuya fuente de información fue la historia clínica del paciente, en una muestra de 130 casos y 184 controles; pacientes mayores de 18 años, que tenían una tasa de filtración glomerular mayor de 60 ml/min y que cumplían los criterios AKIN mencionar el nombre completo de la sigla. Con la prueba de independencia se estableció el efecto de los factores de interés sobre el desenlace (caso-control), con el Odds Ratio (OR) como medida de asociación con su intervalo de confianza del 95 %. La regresión logística permitió controlar las variables presumibles de confusión. Resultados: la edad promedio de los pacientes fue de 62,2 años (DE=16,7 años), hombres provenientes de la zona urbana y donde la hipertensión sobresalió en el 52,2 % de ellos. Al ingreso, el 55,7 % presentó síndrome coronario y el 40 % desarrolló insuficiencia renal aguda (IRA); el 84,6 % de los pacientes estaba en el estadio I, según la clasificación AKIN. La administración de solución salina al 0,9 % en las primeras 24 horas de ingreso incrementó la oportunidad de IRA 1,8 veces, con respecto a los que se les administró lactato de ringer (OR=1,8 IC (95 % OR: 1,2-2,8), ajustando las demás variables. Conclusión: La administración de lactato ringer disminuyó el desarrollo de la insuficiencia renal aguda. La edad de los pacientes y sus antecedentes posoperatorios, fueron los factores que se relacionaron con la presencia de IRA.

Abstract Objective: To establish the association of acute renal failure with demographic and clinical factors in patients hospitalized in an intensive care unit in a Colombian city. Methods: Analytical case-control study whose source of information was the patient's clinical history, in a sample of 130 cases and 184 controls; the cases were about patients older than 18 years, who had a glomerular filtration rate higher than 60 ml / min and who were able to fulfilled the AKIN criteria. With the independence test, it was established the effect of the factors of interest on the result (case-control), with the Odds Ratio (OR) as a measure of the association with its 95% confidence interval. The logistic regression allowed to control the presumable variables of confusion. Results: The average age of patients was 62.2 years (SD-16.7 years) with a predominance of men from the urban area and where hypertension stood out in 52.2% of them. On admission, 55.7% had coronary syndrome and 40% developed acute renal failure (ARF); 84.6% of the patients were stage according to the AKIN classification. The administration of saline in the first 24 hours of admission increased the possibility of ARF 1.8 times compared to those administered with Ringer's lactate (OR 1.8 CI (95% OR: 1.2-2.8), adjusting for other variables. Conclusion: The administration of ringer's lactate decreases the development of acute renal failure; also, age of the patient and if it came from the postoperative period, were the factors that were related to the presence of kidney disease.

Social Class for Collective Health Research: A Conceptual and Empirical Challenge.

Social Determination of Health (SDH)/Collective Health is a Latin American framework that sees the Marxist core concept of social class as fundamental for understanding health inequalities. In contrast to social stratification approaches, Marxist proposals seek to understand health as part of the historical transformations of capitalism's mode of production. In this article we aim to analyze the relationship between social class and health inequalities using data from the IV Oral Health National Study in Colombia. We conducted hierarchical cluster analyses to classify the population in five class positions and three living conditions clusters, which reflect how the spheres of production and social reproduction relate to social classes in Colombia. To measure oral health we use DMFT, as well as care and treatment needs indexes. Through variance analysis models we found that people from more exploited class positions and worse living conditions have more active disease and higher treatment needs. Despite technical and conceptual challenges, we conclude that a social class analytical framework can be operationalised via the interrelated spheres of production and social reproduction, which sheds light on the relationship between health inequalities and the class structure of the capitalist system.

Series de Pediatría Garrahan. El niño y las infecciones / Garrahan Pediatrics Series. The child and the infections

Las consultas pediátricas por temas infectológicos son frecuentes y relevantes durante toda la infancia, desde la etapa neonatal hasta la adolescencia. En este nuevo volumen de las Series Garrahan: El ñino y las infecciones, se han seleccionado temas específicos, sobre la base de la actualización del conocimiento, los cambios epidemiológicos y de las conductas clínicas ocurridos en los últimos años y la necesidad del manejo adecuado de estas afecciones, ya sea ambulatorio o durante la internación. Entre sus aspectos sobresalientes se incluyen: El estudio de temas destacados como el abordaje del niño febril; las infecciones de piel y partes blandas, incluidas las asociadas con mordeduras; las infecciones en el recién nacido; las infecciones respiratorias bajas, incluida la tuberculosis; y las infecciones osteoarticulares, del sistema nervioso central e intraabdominales. La inclusión de un capítulo especial sobre la prevención de infecciones para ayudar a reducir su incidencia. El enfoque práctico, con discusión de casos clínicos y definición de conductas, y ubicando al pediatra en un papel central como coordinador de la atención interdisciplinaria. Aspectos clave y lecturas recomendadas en el cierre de cada capítulo. Una obra actualizada que aporta información científica y la experiencia de los profesionales del Hospital Garrahan, dedicada a todos los miembros del equipo de salud que atienden y cuidan niños dondequiera que trabajen al servicio de la salud infantil

Sociocultural dynamics that influence Chagas disease health care in Colombia.

Chagas disease (CD) is a Latin America endemic and neglected tropical disease that affects primarily poor people living in rural areas. Its current low profile leads to many diagnostic, treatment, and control challenges. This study aimed to identify and characterize the sociocultural dynamics that influence CD health care in Colombia. Data for our ethnographic study was collected in 2013 and included participant observation in two main endemic areas in Colombia. In addition, 81 people belonging to four groups (patients and family members; health care workers; researchers; and officers) were recruited through snowball sampling technique and participated in informal and semi-structured interviews. People from the first two groups also participated in social cartography excercises. Data analysis resulted in the identification of three main sociocultural dynamics. Local Understandings: Patients reported confusions around disease transmission, treatment effectiveness and development of future complications. Providers' Knowledge and Training: Failures in professional's knowledge and training mostly affect the primary level of care in rural areas. Professionals undergo minimal training during medical school and lack access to continuous education. In contrast, clinicians working at tertiary university hospitals or at the CD unit of the Colombian National Institute of Health (NIH) exhibited great knowledge and competency. Health Care System Barriers: The Colombian market-based health care reform augmented access barriers, which impacted CD care greatly. We identified geographic and bureaucratic itineraries that depended on type of insurance plan, insurance contracts with service providing institutions, and levels of care. This study shows that people's experience of these sociocultural dynamics vary depending on their mobility from rural to urban contexts. It unveils the importance of analyzing the structure of the health care system. In the Colombian case, its for-profit orientation has become one of the most important obstacles for comprehensive, integrated, and timely health care responses.

Care and consumption: A Latin American social medicine's conceptual framework to comprehend oral health inequalities.

This article offers a conceptual framework that arises out of the Latin American Social Medicine/Collective Health (LASM/CH) tradition to comprehend inequalities in oral health. We conducted a dialogue between the LASM/CH proposal called social determination of health (in particular one of its nuclear categories 'ways of living together') and studies that address social inequalities and oral health. This dialogue allowed us to redefine oral health-disease-treatment as a process that either promotes or harms well-being and is modulated by different ways of living together where not only patients and professionals, but also governments, supranational bodies, and national and international markets represented by food, pharmaceutical, insurance, personal care, and cosmetic companies interact. The article proposes the cycle particular-consumption care/institutional-consumption care as the construct that allows investigators to think about how ways of living together relate to oral health inequalities. 'Particular-consumption care' includes ways and possibilities to access healthy foods and practice protective hygienic measures. 'Institutional-consumption care' refers to institutional responses related to supply, access to services, capabilities for resolution, and pedagogical practices.

Efecto de una intervención cognoscitivo conductual para el manejo de los celos en la relación de pareja / Effect of a cognitive behavioral intervention for jealousy management in couple relationships

Resumen El objetivo de este estudio fue reducir los niveles de celos en seis mujeres, estudiantes universitarias, con edades entre los 18 y 35 años de edad, que presentaban celos patológicos. El proceso terapéutico utilizado se basó en la guía de intervención cognitivo comportamental para el manejo de los celos en la relación de pareja. La intervención tuvo una duración de dos meses y se desarrolló en siete sesiones, bajo un diseño AB y con seguimiento a los 6 meses a dos de las consultantes. Los resultados muestran una disminución en el puntaje de la Escala Interpersonal de Celos. Se encontraron diferencias significativas en los resultados globales de la escala en la aplicación pre y pos test (p<,05), así como en la frecuencia de conductas asociadas al problema. Se discuten las bondades y limitaciones de la intervención.

Abstract The aim of this study was to reduce the level of jealousy in six female college students with ages ranging from 18 to 35 years who presented pathological jealousy. The therapeutic process used was based on the cognitive-behavioral intervention guide for jealousy management in couple relationships. Under an AB design, the intervention had a timespan of two months and was developed throughout seven sessions. A follow-up was performed six months later for two of the six subjects. The results show a decrease in Interpersonal Jealousy Scale score and significant differences were found in the global results of the IJS scores in pre- and post-application of the intervention (p<,05). Other differences were seen in the frequency of behavior associated to problematic jealousy. The strengths and limitations of the intervention are discussed.

Regulation of human subcutaneous adipocyte differentiation by EID1.

Increasing thermogenesis in white adipose tissues can be used to treat individuals at high risk for obesity and cardiovascular disease. The objective of this study was to determine the function of EP300-interacting inhibitor of differentiation (EID1), an inhibitor of muscle differentiation, in the induction of beige adipocytes from adipose mesenchymal stem cells (ADMSCs). Subcutaneous adipose tissue was obtained from healthy women undergoing abdominoplasty. ADMSCs were isolated in vitro, grown, and transfected with EID1 or EID1 siRNA, and differentiation was induced after 48 h by administering rosiglitazone. The effects of EID1 expression under the control of the aP2 promoter (aP2-EID1) were also evaluated in mature adipocytes that were differentiated from ADMSCs. Transfection of EID1 into ADMSCs reduced triglyceride accumulation while increasing levels of thermogenic proteins, such as PGC1α, TFAM, and mitochondrial uncoupling protein 1 (UCP1), all of which are markers of energy expenditure and mitochondrial activity. Furthermore, increased expression of the beige phenotype markers CITED1 and CD137 was observed. Transfection of aP2-EID1 transfection induced the conversion of mature white adipocytes to beige adipocytes, as evidenced by increased expression of PGC1α, UCP1, TFAM, and CITED1. These results indicate that EID1 can modulate ADMSCs, inducing a brown/beige lineage. EID1 may also activate beiging in white adipocytes obtained from subcutaneous human adipose tissue.

Acceso de personas con discapacidad a la formación superior desde la perspectiva de terapia ocupacional / Access to higher education to people with disability from perspective of occupational therapy

Según la OMS el acceso a los servicios básicos de formación en personas con discapacidad se ve ampliamente limitado, impactando negativamente en los procesos de inclusión laboral. Se propuso el objetivo de identificar la evidencia científica relacionada con el acceso a la forma-ción superior de personas con discapacidad. Se realizó la búsqueda de evidencia en las bases de datos Labordoc, Ebsco, Scielo y Lilacs, a través de los tesauros "Discapacidad", "Competencias laborales", "Profesional", "Formación", "Tecnológico", "Técnico", "Educación superior" "estu-dio"y "Terapia Ocupacional", realizando con estos 10 combinaciones mediante el uso del boléano "AND". Los análisis fueron realizados mediante el establecimiento de frecuencias para variables como país, tipo de estudio, idioma y periodo de publicación. Se encontró un total de 20 artícu-los, en donde la mayor publicación fue Labordoc con el 45%, el periodo de tiempo con más pu-blicaciones es entre 2009-2013 con un 45%, el idioma con más evidencia fue el inglés con el 60%, Brasil y Colombia fueron los países con mayor número de publicaciones, cada uno con un 15%. En el marco legislativo en discapacidad, se hacen evidentes aún las brechas entre la normatividad y la realidad, especialmente en la ejecución e implementación de programas, así como la falta de participación de diversas profesiones, por lo que a partir de este análisis, se hace extensiva la invitación a investigar y publicar artículos con relación a la formación superior desde cada uno de los enfoques de formación.

According to WHO access to basic training in people with disabilities is greatly limited negative impact on the processes of labor inclusion. To identify the scientific evidence related the access to higher education for people with disabilities. The search for evidence on the basis of Labor-doc , Ebsco , Lilacs and SciELO data was conducted through thesauri "Disability" , "Skills ", " Professional ", " Training ", " Technology ", " Technical " "Higher Education " and " Occupa-tional Therapy" , performing with these 10 combinations using the boolean "AND". Analyses were performed by setting frequencies for variables such as country, study type , language and publication period . A total of 20 items , where most public Labordoc with 45% , was found the time most published between 2009-2013 is 45% , most evidently language was English with 60 % , Brazil and Colombia were the countries with the highest number of publications , each with 15% . Despite major advances in the legislative framework on disability, are evident even gaps between norms and reality, especially in the execution and implementation of programs and the lack of participation of various professions , so from this analysis is extended the invitation to research and publish articles regarding the top from each training approaches training.

Invasive infections caused by Streptococcus pneumoniae in a tertiary-level children's hospital before the introduction of the conjugate vaccine: clinical characteristics and serotypes involved.

Invasive pneumococcal diseases are the main cause of morbidity and mortality in children. In the Hospital "Prof. Dr. Juan P. Garrahan", between October 1st , 2008 and September 30th, 2011 all invasive pneumococcal diseases with positive blood cultures were retrospectively studied before the implementation of the universal immunization schedule with the 13-valent pneumococcal conjugate vaccine. A total of 124 patients were identified, and their mean age was 48.3 months (range: 1-216). In this population, 58.9% (n: 73) were OVER 2 years old and 89% (n: 65) of them had an underlying disease. The most frequent clinical presentation was pneumonia. The most frequent S. pneumoniae serotypes identified were: 14 (22.5%, n: 25), 6 (14.4%, n: 16), 19 (8.1%, n: 9), 23 (7.2%, n: 8), 1 (6.3%, n: 7), 5 (4.5%, n: 5), and 7 (7.2%, n: 8). Of the S. pneumoniae serotypes in this series, 82.2% is included in the 13-valent pneumococcal conjugate vaccine. Continuous epidemiological surveillance is essential to further identify the epidemiology and study the evolution of invasive pneumococcal disease in Argentina.

Infecciones invasivas por Streptococcus pneumoniae en un hospital pediátrico de tercer nivel antes de la introducción de la vacuna conjugada: Características clínicas y serotipos involucrados / Invasive infections caused by Streptococcus pneumoniae in a terciary care pediatric hospital before the introduction of the conjugate vaccine: Clinical characteristics and serotypes involved

Las enfermedades invasivas por neumococo constituyen la principal causa de morbimortalidad en los niños. En el Hospital "Prof. Dr. Juan P. Garrahan" se estudiaron retrospectivamente todas las infecciones invasivas por neumococo con hemocultivos positivos entre el 1 de octubre de 2008 y el 30 de septiembre de 2011, antes de la vacunación universal con la vacuna conjugada de 13 serotipos. Se identificaron 124 pacientes, con una media de edad de 48,3 meses (r: 1-216). El 58,9% de la población era mayor de 2 años (n: 73) y el 89% (n: 65) de ellos tenían una enfermedad de base. La principal forma de presentación fue la neumonía. Los serotipos de S. pneumoniae más frecuentes fueron: 14 (22,5%, n: 25), 6 (14,4%, n: 16), 19 (8,1%, n: 9), 23 (7,2%, n: 8), 1 (6,3%, n: 7), 5 (4,5%, n: 5) y 7 (7,2%, n: 8). El 82,8% de los serotipos de S. pneumoniae de esta serie están incluidos en la vacuna conjugada de 13 serotipos. Es esencial mantener la vigilancia epidemiológica para identificar la evolución y epidemiología de la enfermedad invasiva por neumococo en la Argentina.

Invasive pneumococcal diseases are the main cause of morbidity and mortality in children. In the Hospital "Prof. Dr. Juan P. Garrahan", between October 1st , 2008 and September 30th, 2011 all invasive pneumococcal diseases with positive blood cultures were retrospectively studied before the implementation of the universal immunization schedule with the 13-valent pneumococcal conjugate vaccine. A total of 124 patients were identified, and their mean age was 48.3 months (range: 1-216). In this population, 58.9% (n: 73) were OVER 2 years old and 89% (n: 65) of them had an underlying disease. The most frequent clinical presentation was pneumonia. The most frequent S. pneumoniae serotypes identified were: 14 (22.5%, n: 25), 6 (14.4%, n: 16), 19 (8.1%, n: 9), 23 (7.2%, n: 8), 1 (6.3%, n: 7), 5 (4.5%, n: 5), and 7 (7.2%, n: 8). Of the S. pneumoniae serotypes in this series, 82.2% is included in the 13-valent pneumococcal conjugate vaccine. Continuous epidemiological surveillance is essential to further identify the epidemiology and study the evolution of invasive pneumococcal disease in Argentina.

Clinical features and outcome of 2009 influenza A (H1N1) virus infections in children with malignant diseases: a case-control study.

BACKGROUND: The impact of the novel 2009 influenza A (H1N1) (2009 H1N1) virus in children with malignant diseases under therapy is not well known. OBJECTIVE: To analyze the clinical features and outcome in children with anticancer therapy infected with the 2009 H1N1 virus. PATIENTS AND METHODS: Descriptive, case-control study. Between May and July 2009, 24 cases of 2009 (H1N1) virus infections in children with malignant diseases were registered and 48 control cases of similar patients infected with common influenza A virus (IA) diagnosed between 2006 and 2008 were selected. RESULTS: Median age for cases was 72 months and for controls was 83 months (P ≥ 0.05). Children with IA showed neutropenia more frequently (52% vs. 17%), longer period of time with illness before diagnosis (3 d vs. 1.7 d), higher rate of earlier medical consultation (69% vs. 25%), and more antibiotic therapy courses (54% vs. 4%; P ≤ 0.05) than patients with 2009 H1N1 virus. Children infected with this virus presented hypoxemia more frequently (42% vs. 8%) and higher rates of intensive care unit hospitalizations (29% vs. 2%; P ≤ 0.05). Three children with 2009 H1N1 virus and 1 in the control group died. CONCLUSIONS: Children infected with 2009 H1N1 virus presented more morbidity and mortality than patients infected with seasonal IA virus.