Impaired intestinal immunity and microbial diversity in common carp exposed to cadmium.

Waterborne cadmium (Cd) accumulates in the fish intestine and causes irreversible toxicity by disrupting intestinal immunity and microbial diversity. To explore the toxicity of environmentally available high Cd concentration on intestinal immunity and microbial diversity of fish, we selected the widely used bioindicator model species, Common carp (Cyprinus carpio). Literature review and Cd pollution data supported sequential doses of 0.2, 0.4, 0.8, 1.6, 3.2, and 6.4 mg/L Cd for 30 days. Based on intestinal tissue Cd accumulation, previous studies, and environmentally available Cd data, 0.4 and 1.6 mg/L Cd were selected for further studies. Intestinal Cd bioaccumulation increased significantly to ~100 times in fish exposed to 1.6 mg/L Cd. We observed villous atrophy, increased goblet cells with mucus production, muscularis erosion, and thickened lamina propria due to intense inflammatory cell infiltration in the intestine at this Cd concentration. Cd-induced immunosuppression occurred with increased lysozyme, alkaline phosphate (AKP), and acid phosphate (ACP). High levels of catalase (CAT), total antioxidant capacity (T-AOC), malondialdehyde (MDA), and hydrogen peroxide (H2O2) suggested induced oxidative stress and poor metabolism by α-amylase and lipase suppression for Cd toxicity. Proteobacteria (41.2 %), Firmicutes (21.8 %), and Bacteroidetes (17.5 %) were the dominant bacterial phyla in the common carp intestine. Additionally, potential pathogenic Cyanobacteria increased in Cd-treated fish. The decrease of beneficiary bacteria like Aeromonas, and Cetobacterium indicated Cd toxicity. Overall, these findings indicate harmful consequences of high Cd concentration in the intestinal homeostasis and health status of fish.

Nivel asistencial por definir en hospitalización pediátrica / Level of care to be defined in pediatric hospitalization

INTRODUCCIÓN: En muchas plantas de hospitalización pediátrica se atienden pacientes que requieren más cuidados que los que se suponen para estas unidades. El objetivo de este trabajo es tratar de documentar esta situación y proponer mejoras asistenciales. MATERIAL Y MÉTODOS: Se han revisado los ingresos de 2012, 2014 y 2016 de un hospital secundario sin Cuidados Intensivos, buscando criterios de ingreso en Cuidados Intermedios que define la literatura. Se ha realizado una encuesta de opinión en la Sociedad Española de Pediatría Hospitalaria. RESULTADOS: Los pacientes que se adecúan a los criterios de Cuidados Intermedios suponen un 18,2% (2012), 20,8% (2014) y 19,8% (2016) del total de los ingresos pediátricos (médicos) del hospital secundario analizado. Han participado 15 hospitales. La mayoría, el 80% (12), donde se incluyen todos los terciarios con UCIP, contestan que se atienden en planta pacientes con estas características. Los hospitales con UCIP han trasladado desde su planta a intensivos el 1,22% de los ingresos; los hospitales sin UCIP, el 1,23% (p= 0,98); los hospitales secundarios sin UCIP, el 1,01%, y los hospitales comarcales, el 3% (p < 0,001). Los hospitales en los que este problema no se percibe trasladan el 2,41%, frente a los que sí, el 1,12% (p < 0,001). CONCLUSIONES: Existe conciencia de que se atienden pacientes con mayores requerimientos que los que se suponen en este nivel asistencial. Esto se hace con seguridad, pero convierte parte de nuestra asistencia en un nivel no bien definido entre la hospitalización habitual y los cuidados intensivos. Se deben establecer vías de colaboración para definir, regular y abordar esta situación

INTRODUCTION: In many pediatric hospitalization wards, there exist patients who require a higher level of care than routine inpatient pediatric general care. The aim of that study is to document this situation and to propose care improvements. METHODS: Admissions of 2012, 2014 and 2016 in a secondary hospital without a PICU were reviewed. Criteria for the need of Intermediate care were recorded. A survey was carried out in the Spanish Society of Hospital Pediatrics (SEPHO). RESULTS: Patients who met the criteria for Intermediate Care accounted for 18.2% (2012), 20.8% (2014) and 19.8% (2016) of the total pediatric (medical) admissions of the secondary hospital analyzed. 15 hospitals have participated. 80% of them (12), including all tertiary centers with PICU, refer that patients with criteria for intermediate care are admitted in the ward. Hospitals with PICU have transferred from ward to intensive care 1.22% of admitted patients and hospitals without PICU 1.23% (p = 0.98). Secondary hospitals without PICU have transferred 1% and primary hospitals, 3% (p < 0,001). Hospitals with perception of that fact have transferred 1.12% of admitted patients and the hospitals without this perception, 2.45% (p < 0,001). CONCLUSIONS: Patients with a higher level of care than routine inpatient care are admitted in many wards. This is done safely, but it turns part of our care at a level not well defined between the standard hospitalization and intensive care. Collaboration should be established to define, regulate and address this situation

Ships' Ballast Water Treatment by Chlorination Can Generate Toxic Trihalomethanes.

The International Maritime Organization (IMO) will enforce a new abundance-based performance standard for ballast water in September, 2017. Strong oxidants, like chlorine, have been proposed as a method for achieving this standard. However chlorine treatment of ballast water can produce hazardous trihalomethanes. We assessed maximum trihalomethane production from one chlorine dose for three types of ballast water (fresh, brackish and marine) and three levels of total organic carbon (TOC) concentration (natural, filtered, enhanced). While the current standard test considers a 5 day voyage, there is a high possibility of shorter trips and sudden change of plans that will release treated waters in the environment. Water source and TOC significantly affected trihalomethane production, with the highest amounts generated in brackish waters and enhanced TOC concentration. The concentration of brominated trihalomethanes increased from background levels and was highest in brackish water, followed by marine and fresh water.

Modeling sampling strategies for determination of zooplankton abundance in ballast water.

Ballast water has been a major source of non-indigenous species introductions. The International Maritime Organization has proposed performance standard that will establish an upper limit for viable organisms in discharged ballast. Here we test different sampling efforts for zooplankton in ballast water on a commercial vessel. We fit different probability density functions to find the most representative and evaluated sampling efforts necessary to achieve error rates (α, ß) of <0.05. Our tests encompassed four seasonal trials and five sample volumes. To estimate error rates, we performed simulations which drew from 1 to 30 replicates of each volume (0.10-3.00m3) for mean densities ranging between 1 and 20 organisms m-3. Fieldwork and simulations suggested that >0.5m3 samples had the best accuracy and precision, and that the Poisson distribution fit these communities best. This study provides the first field test of a sampling strategy to assess compliance with the future IMO standard for large vessels.

Population attenuation in zooplankton communities during transoceanic transfer in ballast water.

Successful biological invasion requires introduction of a viable population of a nonindigenous species (NIS). Rarely have ecologists assessed changes in populations while entrained in invasion pathways. Here, we investigate how zooplankton communities resident in ballast water change during transoceanic voyages. We used next-generation sequencing technology to sequence a nuclear small subunit ribosomal DNA fragment of zooplankton from ballast water during initial, middle, and final segments as a vessel transited between Canada and Brazil. Operational taxonomic unit (OTU) diversity decreased as voyage duration increased, indicating loss of community-based genetic diversity and development of bottlenecks for zooplankton taxa prior to discharge of ballast water. On average, we observed 47, 26, and 24 OTUs in initial, middle, and final samples, respectively. Moreover, a comparison of genetic diversity within taxa indicated likely attenuation of OTUs in final relative to initial samples. Abundance of the most common taxa (copepods) declined in all final relative to initial samples. Some taxa (e.g., Copepoda) were represented by a high number of OTUs throughout the voyage, and thus had a high level of intraspecific genetic variation. It is not clear whether genotypes that were most successful in surviving transit in ballast water will be the most successful upon introduction to novel environments. This study highlights that population bottlenecks may be common prior to introduction of NIS to new ecosystems.

Situación de la pediatría hospitalaria en España: informe de la Sociedad Española de Pediatría Hospitalaria (SEPHO) / Status of pediatric hospital medicine in Spain: A report by the Spanish Pediatric Hospital Medicine Society (SEPHO)

Son pocos los informes sobre la situación de la pediatría hospitalaria en España. Desde la Sociedad Española de Pediatría Hospitalaria (SEPHO) se ha impulsado la realización de un estudio para conocer el estado en que se dispensa la atención hospitalaria pediátrica. Para ello se han consultado los datos publicados por el Ministerio de Sanidad y el Instituto Nacional de Estadística, y se han analizado los resultados de una encuesta informática diseñada y elaborada por la SEPHO disponible en Internet para su cumplimentación desde noviembre de 2011 hasta diciembre de 2012 entre hospitales españoles. Los resultados de esta encuesta forman parte del inicio de nuestra andadura como asociación, en la necesidad de conocer el estado actual de la asistencia al niño y su familia durante su hospitalización, con el objetivo de poder estudiar y, en su caso, proponer recomendaciones de mejora y homogenización de la asistencia. Se trata de un estudio, inédito hasta la fecha, del estado de la atención hospitalaria pediátrica por cuanto es vista y analizada desde la perspectiva directa de los profesionales implicados en la hospitalización general pediátrica. Se han incluido hospitales de distinto tamaño y complejidad asistencial. El objetivo del presente informe es presentar los resultados de la encuesta y contrastarlos con los datos demográficos y asistenciales de fuentes oficiales

Few reports are available on the status of Pediatrics Hospital Medicine in Spain. This has prompted the Spanish Society of Hospital Pediatrics (SEPHO) to conduct a study to determine the status of pediatric hospital care received. Data released by the Ministry of Health, the National Institute of Statistics have been used in the study, and an analysis was made of the results of a computerized survey designed and developed by SEPHO and available on the Internet for completion from November 2011 to December 2012 among Spanish hospitals. The results of this survey are part of the beginning of our journey as an association, and the current status of child and family welfare during hospitalization needs to be determined in order to consider and, where appropriate, make recommendations for improvement and standardization of care. The study, still unpublished, is to determine the state of pediatric hospital care as seen and analyzed from the perspective of the professionals directly involved in pediatric general hospital care. We included hospitals of different size and complexity of care. The aim of this report is to present the results of the survey and relate it to demographic and health care data from official sources

[Status of pediatric hospital medicine in Spain: a report by the Spanish Pediatric Hospital Medicine Society (SEPHO)]. / Situación de la pediatría hospitalaria en España: informe de la Sociedad Española de Pediatría Hospitalaria (SEPHO).

Few reports are available on the status of pediatric hospital medicine in Spain. This has prompted the Spanish Society of Hospital Pediatrics (SEPHO) to conduct a study to determine the status of pediatric hospital care received. Data released by the Ministry of Health, the National Institute of Statistics have been used in the study, and an analysis was made of the results of a computerized survey designed and developed by SEPHO and available on the Internet for completion from November 2011 to December 2012 among Spanish hospitals. The results of this survey are part of the beginning of our journey as an association, and the current status of child and family welfare during hospitalization needs to be determined in order to consider and, where appropriate, make recommendations for improvement and standardization of care. The study, still unpublished, is to determine the state of pediatric hospital care as seen and analyzed from the perspective of the professionals directly involved in pediatric general hospital care. We included hospitals of different size and complexity of care. The aim of this report is to present the results of the survey and relate it to demographic and health care data from official sources.

Sociedad Española de Pediatría Hospitalaria / Spanish Society of Hospital Paediatrics

No disponible

Síndrome de deleción de genes contiguos en Xp21: una forma inusual de presentación / Delection syndrome In Xp21: An unusual form of presentation

Introducción. Describimos el caso de un lactante en el que la asociación de distrofia muscular de Duchenne (DMD) yuna pseudohipertrigliceridemia condujeron al diagnóstico de un síndrome de deleción de genes contiguos en Xp21. Caso clínico.Niño de 7 meses de edad remitido por retraso psicomotor. En la exploración destacaba una hipotonía axial marcada. Laanalítica mostró una elevación de las enzimas musculares con niveles de creatinfosfocinasa de 12.829 UI/L, junto con cifraselevadas de triglicéridos en sangre. Los hallazgos del electromiograma fueron compatibles con afectación miopática. El estudiogenético de distrofinopatías mostró la existencia de una deleción en el gen de la distrofina. La analítica ampliada identificóconcentraciones elevadas de glicerol tanto en sangre como en orina, compatibles con un déficit de glicerolcinasa. El estudiogenético confirmó la existencia de una deleción en Xp21 de los genes responsables de la DMD, del déficit de glicerolcinasa,de la hipoplasia suprarrenal congénita (gen DAX1) y del retraso mental (gen IL1RAPL1). Conclusiones. En lactantes y niñospequeños con afectación miopática, la elevación de las cifras de creatinfosfocinasa y pseudohipertrigliceridemia debeconsiderarse el síndrome de deleción de genes contiguos en Xp21 para prevenir y tratar las complicaciones metabólicas derivadasde la hipoplasia suprarrenal (AU)

Introduction. We report a case of an infant where the association of Duchenne’s muscular dystrophy (DMD) andpseudohypertriglyceridaemia led to the diagnosis of contiguous gene deletion syndrome in Xp21. Case report. A 7-month-oldmale infant who was referred due to psychomotor retardation. The examination revealed pronounced axial hypotonia. Labfindings showed high levels of muscular enzymes with creatine phosphokinase levels of 12,829 IU/L, together with high bloodlevels of triglycerides. Electromyogram findings were consistent with myopathic compromise. The genetic study for dystrophinopathiesrevealed the existence of a deletion in the dystrophin gene. Further lab findings identified high glycerol concentrationsboth in blood and in urine that were compatible with a glycerol kinase deficiency. The genetic study confirmed the existence ofa deletion in Xp21 of the genes responsible for DMD, the glycerol kinase deficiency, the congenital adrenal hypoplasia (geneDAX1) and mental retardation (gene IL1RAPL1). Conclusions. In infants and small children with myopathic compromise,increased levels of creatine phosphokinase and pseudohypertriglyceridaemia it is essential to take into account contiguousgene deletion syndrome in Xp21 to be able to prevent and treat the metabolic complications arising from adrenal hypoplasia (AU)

[Contiguous gene deletion syndrome in Xp21: an unusual form of presentation]. / Síndrome de deleción de genes contiguos en Xp21: una forma inusual de presentación.

INTRODUCTION: We report a case of an infant where the association of Duchenne's muscular dystrophy (DMD) and pseudohypertriglyceridaemia led to the diagnosis of contiguous gene deletion syndrome in Xp21. CASE REPORT: A 7-month-old male infant who was referred due to psychomotor retardation. The examination revealed pronounced axial hypotonia. Lab findings showed high levels of muscular enzymes with creatine phosphokinase levels of 12,829 IU/L, together with high blood levels of triglycerides. Electromyogram findings were consistent with myopathic compromise. The genetic study for dystrophinopathies revealed the existence of a deletion in the dystrophin gene. Further lab findings identified high glycerol concentrations both in blood and in urine that were compatible with a glycerol kinase deficiency. The genetic study confirmed the existence of a deletion in Xp21 of the genes responsible for DMD, the glycerol kinase deficiency, the congenital adrenal hypoplasia (gene DAX1) and mental retardation (gene IL1RAPL1). CONCLUSIONS: In infants and small children with myopathic compromise, increased levels of creatine phosphokinase and pseudohypertriglyceridaemia it is essential to take into account contiguous gene deletion syndrome in Xp21 to be able to prevent and treat the metabolic complications arising from adrenal hypoplasia.

[Infectious acute gastroenteritis in the emergency department of an urban hospital]. / Gastroenteritis aguda infecciosa en urgencias de un hospital urbano.

OBJECTIVES: To examine the etiology, clinical, analytical and evolutionary characteristics of gastroenteritis in the pediatric population in the Emergency Department of Dr. Peset University Hospital in Health Care Area 10 in Valencia, Spain, over a 1-year period (2005). PATIENTS AND METHODS: Children < 15 years of age with acute diarrhea were prospectively enrolled in the Emergency Department. Data were collected through information sheets. Their stools were examined for diarrheagenic bacteria and viruses (rotavirus and adenovirus). RESULTS: 794 episodes of gastroenteritis were recorded. The incidence of rotavirus was 22 %, adenovirus 8 %, Campylobacter jejuni 7 % and Salmonella spp. 4 %. Socioeconomic characteristics were not helpful in differentiating disease due to specific enteropathogens. Ninety per cent cases caused by viruses only affected children under three years of age. Rotavirus gastroenteritis had a marked seasonal pattern (90 % cases in December-February). Among infants < or = 6 months of age rotavirus was less frequent as cause of diarrhea in breast-fed infants than in bottle-fed. Macroscopic blood in stools was reported almost exclusively among patients with a bacterial infection. In 96 % of all cases of diarrhea there was no dehydration, in 2 % it was mild, in 2 % moderate and none severe. Ten of the seventeen cases (59 %) of moderate dehydration were caused by rotavirus. Six percent of all children were hospitalised. CONCLUSIONS: Rotavirus was significantly more associated with the need for intravenous fluid therapy and hospitalisation than episodes negative for rotavirus. Rotavirus accounted for 3 % of hospitalisations in infants aged 1 month-2 years.

Gastroenteritis aguda infecciosa en urgencias de un hospital urbano / Infectious acute gastroenteritis in the emergency department of an urban hospital

Objetivos: Analizar la etiología, características clínicas, analíticas y evolutivas de la gastroenteritis aguda infecciosa en la unidad de urgencias del Hospital Universitario Doctor Peset, en el Departamento de Salud 10 de Valencia (España) durante el año 2005. Pacientes y métodos: Se incluyeron los niños menores de 15 años que consultaron por diarrea aguda en la unidad de urgencias. La recogida de datos se realizó mediante un cuestionario estructurado. Se remitieron muestras de heces para estudio microbiológico de bacterias y virus (rotavirus y adenovirus). Resultados: Se recogieron 794 casos. Rotavirus originó el 22 % de los casos; adenovirus, el 8 %; Campylobacter spp. el 7 %, y Salmonella spp. el 4 %. Las características socioeconómicas de los padres no se relacionaron con ningún agente causal. El 90 % de los casos producidos por virus afectaron a niños menores de 3 años. El 90 % de los casos por rotavirus se dieron en diciembre-febrero. Entre los lactantes de hasta 6 meses rotavirus fue menos frecuente en los que seguían lactancia materna frente a los alimentados con fórmula artificial. La presencia de sangre macroscópica en heces fue casi exclusiva de la infección bacteriana. En el 96 % de los casos no hubo deshidratación, en el 2 % fue leve, en el 2 % moderada y en ninguno grave. Un total de 10 de los 17 casos (59 %) con deshidratación moderada fueron causados por rotavirus. El 6 % de los niños fueron hospitalizados. Conclusiones: Rotavirus se asoció significativamente a la necesidad de fluidoterapia intravenosa e ingreso y causó el 3 % de los ingresos entre 1 mes y 2 años de edad (AU)

Objectives: To examine the etiology, clinical, analytical and evolutionary characteristics of gastroenteritis in the pediatric population in the Emergency Department of Dr. Peset University Hospital in Health Care Area 10 in Valencia, Spain, over a 1-year period (2005). Patients and methods: Children < 15 years of age with acute diarrhea were prospectively enrolled in the Emergency Department. Data were collected through information sheets. Their stools were examined for diarrheagenic bacteria and viruses (rotavirus and adenovirus). Results: 794 episodes of gastroenteritis were recorded. The incidence of rotavirus was 22 %, adenovirus 8 %, Campylobacter jejuni 7 % and Salmonella spp. 4 %. Socioeconomic characteristics were not helpful in differentiating disease due to specific enteropathogens. Ninety per cent cases caused by viruses only affected children under three years of age. Rotavirus gastroenteritis had a marked seasonal pattern (90 % cases in December-February). Among infants # 6 months of age rotavirus was less frequent as cause of diarrhea in breast-fed infants than in bottle-fed. Macroscopic blood in stools was reported almost exclusively among patients with a bacterial infection. In 96 % of all cases of diarrhea there was no dehydration, in 2 % it was mild, in 2 % moderate and none severe. Ten of the seventeen cases (59 %) of moderate dehydration were caused by rotavirus. Six percent of all children were hospitalised. Conclusions: Rotavirus was significantly more associated with the need for intravenous fluid therapy and hospitalisation than episodes negative for rotavirus. Rotavirus accounted for 3 % of hospitalisations in infants aged 1 month-2 years (AU)

Hipoplasia pulmonar infantil / Lung hypoplasia in childhood

No disponible

Controversias en el diagnóstico del secuestro pulmonar / Controversies in the diagnosis of pulmonary sequestration

No disponible

[Cerebral infarct secondary to carotid artery dissection]. / Infarto cerebral isquémico por disección de arteria carótida interna.

Dissection of the internal carotid artery is an important cause of ischemic stroke in children and young patients. Trauma and/or an underlying structural defect of the arterial wall have been suggested to be predisposing factors. The typical patient presents with ipsilateral headache or neck pain, ipsilateral Horner's syndrome and delayed ischemic symptoms. Diagnosis is given by ultrasound, transcranial Doppler, magnetic resonance imaging, magnetic resonance angiography and conventional angiography. Treatment of this type of injury includes anticoagulation therapy, antiplatelet therapy and surgery. We report a 14-year-old boy with internal carotid artery dissection who presented with ischemic stroke.

Infarto cerebral isquémico por disección de arteria carótida interna / Ischemic stroke secondary to carotid artery dissection

La disección de la arteria carótida interna es una causa importante de ictus isquémico en niños y pacientes jóvenes. En la patogenia se han implicado traumatismos y/o un posible defecto estructural de la pared arterial. Las manifestaciones clínicas típicas incluyen cefalea o dolor de cuello y síndrome de Horner en el lado de la disección, con la aparición después de síntomas isquémicos cerebrales. La ecografía, el Doppler transcraneal, la resonancia magnética (RM), la angiorresonancia y la angiografía proporcionan el diagnóstico. Las opciones de tratamiento comprenden anticoagulantes, antiagregantes plaquetarios y cirugía. Presentamos un adolescente de 14 años con un ictus isquémico secundario a disección de la arteria carótida interna. (AU)