Hipertensión enmascarada en niños con factores de riesgo de hipertensión arterial / Masked hypertension in children with risk factors for hypertension

INTRODUCCIÓN La hipertensión enmascarada (HE) en niños se define por registros de presión arterial (PA) normal en el consultorio y elevados fuera de él. El Monitoreo Ambulatorio de Presión Arterial de 24 horas (MAPA) permite su diagnóstico. Existe poca información reportada sobre su prevalencia en el ámbito local. OBJETIVOS Estimar la prevalencia de HE en niños con factores de riesgo para el desarrollo de hipertensión arterial (HTA). MÉTODOS Se realizó un estudio prospectivo observacional de corte transversal. Se incluyeron en forma consecutiva pacientes asistidos en forma ambulatoria en el Hospital General de Niños P. de Elizalde (HGNPE) entre el 1/7/2015 y el 15/10/2016, de 5 a 11 años de edad, con PA normal y al menos un factor de riesgo para desarrollar HTA (neonatal, personal y familiar). Se realizó MAPA durante 24 horas con dispositivo validado (monitor oscilométrico Spacelab modelo 90207 y 90217). Se estimó prevalencia de HE y su intervalo de confianza (IC95%) sobre el total de pacientes evaluados. El tamaño de muestra se estimó en 110 pacientes, con las aprobaciones pertinentes. RESULTADOS Se incluyó a 100 pacientes, con una edad promedio de 8,6±1,9 años; 56 eran mujeres. El tiempo promedio de MAPA fue 22,8±2,7 horas. Los factores de riesgo observados fueron antecedentes neonatales en 22 pacientes (parto prematuro, el más frecuente); todos tenían al menos un antecedente personal (los más frecuentes, ingesta aumentada de sal en 82 pacientes y obesidad en 73); 87 presentaron al menos un antecedente familiar (los más frecuentes, HTA y diabetes en 87 y 63 casos, respectivamente). El MAPA permitió identificar 10 pacientes con HE (10%; IC95%: 5,3-17,6%); 7 con hipertensión nocturna aislada (7%; IC95: 3,2-14%); y 23 como pre-hipertensión (23%; IC95: 15,8-32,2%). Los 10 pacientes con HE incluyeron 7 varones, 9 obesos y 8 con un antecedente familiar. DISCUSIÓN La prevalencia de HE en niños con factores de riesgo de desarrollar HTA fue del 10%. Es necesario completar el tamaño muestral para determinar si se mantiene esta prevalencia.

Rotavirus genotypes in children in the Basque Country (North of Spain): rapid and intense emergence of the G12[P8] genotype.

Between July 2009 and June 2011, rotavirus was detected in 507 of 4597 episodes of acute gastroenteritis in children aged <3 years in Gipuzkoa (Basque Country, Spain), of which the G-type was determined in 458 (90·3%). During the annual seasonal epidemic of 2010-2011, the unusual G-type 12 was predominant, causing 65% (145/223) of cases of rotavirus gastroenteritis. All the G12 strains were clustered in lineage III and were preferentially associated with P-type 8. This epidemic was characterized by broad geographical distribution (rural and urban) and, over 7 months, affected both infants and children, the most frequently affected being children between 4 and 24 months. Of children with rotavirus G12, 16% required hospital admission, the admission rate in children aged <2 years being 20·7 cases/10 000 children. The sudden emergence and predominance of G12 rotaviruses documented in this winter outbreak suggest that they may soon become a major human rotavirus genotype.

A swimming pool-related outbreak of pharyngoconjunctival fever in children due to adenovirus type 4, Gipuzkoa, Spain, 2008.

An outbreak of pharyngoconjunctival fever affecting 59 children was detected in a municipality of northern Spain in July 2008. The outbreak was related to insufficient doses of water disinfectant in the municipal swimming pool.

Comparison of the automated nonradiometric Bactec MGIT 960 system with Löwenstein-Jensen, Coletsos, and Middlebrook 7H11 solid media for recovery of mycobacteria.

The aim of this study was to evaluate the sensitivity of as well as the time to detection of mycobacteria by three procedures: solid media with traditional reading, microscopy on solid media, and liquid culture using the automated nonradiometric Bactec MGIT 960 system. A total of 2832 respiratory specimens were tested, 315 of which were positive for mycobacteria. The most frequently isolated species was Mycobacterium tuberculosis (201 isolates). One hundred twenty mycobacteria other than tuberculosis were isolated, 72 of which were Mycobacterium xenopi strains. Sensitivity of each of the different media compared to all media combined for growth of Mycobacterium tuberculosis was 93%, 76.1%, 79.6%, and 75.1% for Bactec MGIT 960, Middlebrook 7H11 plates, Löwenstein-Jensen, and Coletsos, respectively. Sensitivity of the Bactec MGIT 960 for detection of all mycobacterial isolates was 75.1%. When this automated system was supplemented with visual inspection, the sensitivity increased to 89.4%. The sensitivity of Middlebrook 7H11 plates, Löwenstein-Jensen, and Coletsos was 50.8%, 60.7%, and 52.3%, respectively. Time to detection of Mycobacterium tuberculosis using the Bactec MGIT 960 system and Middlebrook 7H11 plates with microscopic reading was 12.7 and 13 days, respectively; using the traditional Löwenstein-Jensen and Coletsos media, time to detection was 22.8 and 22.7 days, respectively.

In-vitro, in-vivo and ex-vivo studies with oral beta-lactams against Streptococcus pneumoniae.

In-vitro killing curves, a protection model in immunocompetent mice and an ex-vivo model in volunteers were used to evaluate the efficacy of amoxycillin, cefuroxime axetil and cefpodoxime proxetil against a penicillin-intermediate-resistant Streptococcus pneumoniae (MIC = 1 mg/L) (PRP) and a penicillin-susceptible S. pneumoniae (MIC = 0.01 mg/L) (PSP). In vitro, the maximal bactericidal activity was obtained with amoxycillin (1 x MIC versus 2 x MIC cefpodoxime and 4 x MIC cefuroxime). Mice were challenged by intraperitoneal inoculation and treated orally every 8 h for 48 h with 2.5, 5, 7.5 and 10 mg/kg doses of these three beta-lactams. The rate of survival for the PSP strain was 100% with any dose of the three tested antibiotics. For the PRP strain only amoxycillin showed 100% survival with 5, 7.5 or 10 mg/kg doses. Twelve healthy volunteers were randomized in three groups and each received two doses of the oral antibiotic. Blood samples were collected from each subject 0.5 h and 2 h after drug administration and serum inhibitory and bactericidal titres were measured. Similar values were obtained with the three beta-lactams against PSP but against PRP only the serum of volunteers that had taken amoxycillin exhibited serum bactericidal titres of > or = 8. This study suggests a more predictable therapeutic efficacy against pneumococcal infection with amoxycillin than with available oral cephalosporins.