Pediatric Anaphylaxis: A 20-Year Retrospective Analysis.

BACKGROUND: Anaphylaxis is a steadily increasing global problem defined as an acute hypersensitivity multisystem reaction that is potentially fatal. In the pediatric age, the leading cause is food. In other allergic diseases, intrinsic heterogeneity has been reported in the clinical presentation, severity, and triggers of anaphylaxis. This study analyzes the features and management approach of the anaphylactic reactions in children evaluated at the pediatric clinic in Pavia. MATERIALS AND METHODS: A retrospective study was conducted on patients with anaphylaxis between 2001 and 2021. RESULTS: A total of 148 patients with a median age of 5 years were enrolled, and 80% of the patients had other atopic comorbidities that were correlated with the severity of anaphylaxis. The main trigger of anaphylaxis was food. Most reactions involved mucocutaneous, respiratory, and gastrointestinal systems, and occurred at home. Adrenaline was administered only in a minority of cases. CONCLUSIONS: Considering that anaphylaxis is a potentially life-threatening condition requiring prompt management, the use of adrenaline should be implemented. Our data also suggest the importance of educating and spreading awareness of anaphylactic management within the medical community.

Colonización nasofaríngea por serotipos de Streptococcus pneumoniae en niños uruguayos antes y después de la introducción de las vacunas antineumocóccicas conjugadas / Nasopharyngeal colonization from Streptococcus pneumoniae serotypes in Uruguayan children before and after pneumococcal conjugate vaccines / Colonização nasofaríngea por sorotipos de Streptococcus pneumoniae em crianças uruguaias antes e após da introdução de vacinas pneumocócicas conjugadas

Resumen: Las vacunas conjugadas neumocóccicas (VCN) son efectivas para el control de las infecciones severas en niños y también limitan la colonización nasofaríngea por los serotipos que integran sus fórmulas. En Uruguay, no se dispone de publicaciones recientes sobre los serotipos albergados en el reservorio nasofaríngeo de los niños, ni antes ni luego de la introducción de las VCN. Con el objetivo de caracterizar la colonización nasofaríngea de niños menores de 2 años y describir los serotipos de S. pneumoniae identificados antes y después de la introducción de las vacunas conjugadas antineumocóccicas en el certificado esquema de vacunación (CEV) de Uruguay, se llevó a cabo un estudio descriptivo, retrospectivo, incluyendo tres períodos de tiempo: años 2002- 2003 y 2014-2015 en Paysandú, y 2012-2013 en Montevideo. Los aislamientos de S. pneumoniae se realizaron en laboratorios locales y la serotipificación por "quellung" se efectuó en el Departamento de Laboratorios de Salud Pública. Se procesaron 831 muestras, con 54,8% de recuperación de neumococos (n=456), de los cuales 223 fueron tipificados. El estudio previo a la vacunación mostró portación de serotipos invasores, con predominio de los serotipos 6A, 6B, 14 y 19F, todos incluidos en la vacuna 13-valente. En los niños de la policlínica de HIV, la colonización por neumococos invasores fue mucho menor, y el otro estudio, también posvacunación, evidenció la casi desaparición de cepas invasoras (6/93), con predominio de serotipos poco habituales, lo que constituyó un llamado de atención para instrumentar una vigilancia que monitorice la dinámica de la colonización infantil.

Summary: Pneumococcal conjugate vaccines (PCV) are effective against children's severe infections and they also constrain nasopharyngeal colonization due to the serotypes in their formulas. There are no recent publications in Uruguay regarding serotypes hosted in the children's nasopharyngeal reservoir, either from before or after the introduction of the PCV. With the purpose of characterizing nasopharyngeal colonization of children under 2 years of age and describing the S. pneumoniae serotypes before and after the pneumococcal conjugate vaccines in the Uruguayan National Vaccination Report, we carried out a descriptive retrospective study including three periods: 2002- 2003 and 2014-2015 in Paysandú, and 2012-2013 in Montevideo. S. pneumoniae was isolated in local laboratories and the "quellung" serotypification was carried out in the Laboratories of the Public Health Department. We processed 831 samples and recovered 54.8% pneumococci (n=456), of which 223 were typified. Prior to the vaccination, the study showed invasive serotype carriage, mainly of the 6A, 6B, 14 and 19F serotypes, all included in the 13-valent vaccine. At the HIV clinic, colonization from invasive pneumococci was much lower and the post vaccination study showed the almost complete disappearance of the invasive strains (6/93), mainly of the less common serotypes, which called the attention towards the increase of vigilance towards the monitoring of children colonization dynamics.

Resumo: As Vacinas Pneumocócicas Conjugadas (VPC) são eficazes contra infecções graves em crianças e também restringem a colonização nasofaríngea, devido aos sorotipos utilizados em suas fórmulas. Não há publicações recentes no Uruguai relativas aos sorotipos que incluem reservatório nasofaringeos nas crianças, nem de antes ou depois das vacinas VPN. Com o objetivo de caracterizar a colonização nasofaríngea de crianças menores de 2 anos de idade e descrevendo os sorotipos S. pneumoniae antes e depois das vacinas antipneumocócicas conjugadas no Relatório Nacional de Vacinação do Uruguai, realizou-se um estudo retrospectivo descritivo, incluindo três períodos: 2002- 2003 e 2014-2015 em Paysandú e 2012-2013 em Montevideo. S. pneumoniae foi isolada em laboratórios locais e a soro tipificação "quellung" foi realizada nos Laboratórios do Departamento de Saúde Pública. Foram processadas 831 amostras e recuperado 54,8% de pneumococo (n = 456), dos quais 223 foram tipificados. Antes da vacinação, o estudo mostrou transporte de sorotipos invasores, principalmente dos sorotipos 6A, 6B, 14, 19F, todos incluídos na vacina 13-valente. Na clínica de HIV, a colonização invasiva de pneumococos foi muito menor, e o estudo pós-vacinação mostrou o desaparecimento quase total das cepas invasivas (6/93), principalmente dos sorotipos menos comuns, o que sugere a necessidade de aumentar a vigilância no monitoramento da dinâmica de colonização de crianças.

Treatment of Dimpling from Cellulite.

BACKGROUND: Cellulite can be seen on the skin in widespread alterations of the skin surface and dimpling. The purpose of this study was to assess the effectiveness and safety of the manual subcision technique to treat dimpling from cellulite, using a specific class IIA medical device (Celluerase). METHODS: The multi-center observational study assessed 200 women treated in a single session for different dimpling, using manual subcision administered by Celluerase. Aesthetic outcomes were evaluated by the authors, and the patients assessed satisfaction levels. RESULTS: Two hundred women between 20 and 55 years were treated. The medical evaluation of patients saw improvements with an average score of 8.1, whereas the subjective evaluation by patients gave an average improvement score of 7.8. Adverse events were reported. DISCUSSION: Women have septa orientation at right angels to the skin surface, and those with cellulite have an irregular septa conformation, with some septa being hypertrophic-thickened, and others being narrowed-lysed. Magnetic resonance imaging has confirmed that cellulite depressions are associated with a significant increase of thickness of underlying subcutaneous fibrous septa. Subcision has immediate results because it eliminates traction on the skin. CONCLUSION: The study has shown the effectiveness and safety of the manual subcision in the treatment of dimpling. The device used, designed specifically for this technique, has shown itself to be very helpful and effective in terms of practical use, aesthetic outcome and safety, with various advantages compared with other commonly used devices.

Muerte inesperada del lactante: Análisis de 591 casos / Sudden infant death: 591 cases analysis

Antecedentes: la muerte inesperada del lactante (MIL) sin asistencia, ya sea en domicilio o a su arribo al hospital conlleva a un impedimento en la firma del certificado de defunción y al necesario peritaje forense a los efectos de descartar las causas no naturales. Conocer la causa de muerte es de suma importancia no sólo para las autoridades sanitarias sino para los Pediatras a afectos actuar sobre los factores implicados. Objetivos: el objetivo de esta revisión es analizar las patologías encontradas y las circunstancias que rodearon a la muerte en los casos MIL, a los efectos de identificar factores de riesgo. Métodos: se incluyeron en este estudio 591 menores de un año fallecidos en forma súbita e inesperada, en domicilio o a su arribo a un centro asistencial, ingresados al Programa MIL, entre octubre de 1998 y diciembre de 2015, con intervalo libre 2002-2006. No todos los fallecidos en dicho período en iguales circunstancias fueron enviados para su estudio. Se reunió historia clínica, circunstancias de la muerte y la familia fue entrevistada. Los casos fueron analizados por el grupo interdisciplinario. Se clasificó como: Muerte Explicable cuando se encuentra una causa y Muerte Indeterminada cuando no se encuentra una causa. Estas últimas están constituidas por Síndrome de Muerte Súbita del Lactante (SMSL) y las Zonas Grises (ZG). Se agruparon como ZG aquellos casos en los que no había una causa que con certeza explicara la muerte, pero había factores predisponentes que pudieron causarla o favorecerla. Estas ZG fueron distribuidas en 6 categorías. Para clasificar como SMSL el grupo exige la ausencia de colecho, de decúbito prono, de almohada y de otros entornos factibles de causar sofocación. Resultados: se estudiaron 591 casos. Se identificó una causa de muerte en 339 casos (57.4%). En 252 la muerte fue indeterminada (42.6%). Se encontró infección respiratoria en 29% de los casos (50% de las muertes explicables); anomalía cardíaca en 15%; diarrea con deshidratación en 4.5%; sofocación accidental en 3%; se identificó una causa violenta en 1.5%. Hubo variación entre los dos períodos (1998-2001 y 2007-2015). De los casos indeterminados, 242 correspondieron ZG y 10 a SMSL. En 91% de las ZG menores de 4 meses de edad que tienen el dato evaluable, hubo un entorno de sueño inseguro. El colecho se observó en 72%, principalmente múltiple o asociado a decúbito prono u otros factores de riesgo. En neonatos, el 81% de las ZG evaluables, tuvo un factor de riesgo asociado a las condiciones de sueño. Conclusiones: se identificaron patologías sobre las que es posible actuar desde la prevención (infecciones respiratorias, diagnóstico prenatal de cardiopatías). En los casos indeterminados, se identificaron factores de riesgo modificables desde el primer nivel de atención con la implementación de campañas educativas y recomendaciones sobre sueño seguro dirigidas a la comunidad.

Background: sudden unexpected death in infancy (SUDI) carries an impediment to sign the death certificate. A legal autopsy is mandatory to exclude unnatural death. To know the cause of death in infancy is relevant to health authorities and paediatrics. Objectives: to investigate the pathologies and risk factors in the cases of SUDI studied. Methods: autopsies between October 1998 and December 2015 were analysed. There was a free interval (2002 to 2006). It does not include every case of SUDI in the local population. The clinical records were gathered, the circumstances of death investigated and the family was interviewed. The cases were discussed in a multidisciplinary team. The cases were classified as Explained Death or Undetermined. The undetermined deaths were classified either as Gray Zone (GZ) or SIDS cases. Six categories were considered in GZ. To consider a case as SIDS, a safe sleep environment is required; that means no co-sleeping, no prone sleeping and no pillows use that could eventually cause suffocation. Cases were coded as GZ when a clear cause of death was not identified, but abnormalities were found that could have predisposed or contributed to death. GZ were divided in 6 categories. Results: 591 cases were examined. A cause of death was identified in 339 cases (57.4%). In 252 cases, it was undetermined (42.6%). A respiratory infection was found in 29% of the autopsies (50% of the explained deaths). A cardiac anomaly was found in 15%; dehydration secondary to diarrhoea in 4.5%; suffocation in 3%; a violent cause was identified in 1.5%. There were variations between both periods (1998-2001 and 2007-2015). 252 deaths remained unexplained after the autopsy (42.6%), these were the undetermined cases. 242 were classified as Gray Zone (GZ) and 10 as SIDS cases. 91% of the evaluable GZ cases <4 months old had an unsafe sleeping environment. Co-sleeping was observed in 72% of the evaluable <4 month cases; it was mainly multiple or associated with prone sleeping position. In newborns, 81% of the evaluable ZG cases had a sleep related risk factor. Conclusions: The study improved allowed to identify pathologies amenable to intervention and prevention (respiratory infections, prenatal diagnosis of congenital heart disease). Sleep related risk factors were identified, amenable to prevention through community education programs.

Virulence profiles in uropathogenic Escherichia coli isolated from pregnant women and children with urinary tract abnormalities.

Uropathogenic Escherichia coli is the leading etiologic agent of urinary tract infections, encompassing a highly heterogeneous group of strains. Although many putative urovirulence factors have been described, none of them appear in all uropathogenic E. coli strains, a fact that suggests that this group would be composed of different pathogenic subgroups. In this work, a study was performed on two collections of E. coli isolates proceeding from urine cultures from two groups of patients with urinary tract infection: pregnant women and children with urinary tract abnormalities. The isolates were analyzed for their virulence content and for their phylogeny by means of PCR determinations and of phenotypic assays. Associations among the virulence traits analyzed were searched for and this approach led to the identification of five urovirulence profiles. From a total of 230 isolates, 123 (53%) could be assigned to one of these profiles. A few loci appeared as markers of these profiles so that their presence allowed predicting the general virulence content of the strains. It is presumed that these conserved associations among the virulence functions would be devoted to ensure the coherence of the bacterial pathogenic strategy. In addition, three profiles appeared with significantly different frequencies depending on the host of origin of the isolates, indicating the existence of a correlation between the virulence content of the strains and their host specificity.

Community-acquired methicillin-resistant Staphylococcus aureus, Uruguay.

A novel, methicillin-resistant [corrected] Staphylococcus aureus clone (Uruguay clone) with a non-multidrug-resistant phenotype caused a large outbreak, including 7 deaths, in Montevideo, Uruguay. The clone was distinct from the highly virulent community clone represented by strain MW2, although both clones carried Panton-Valentine leukocidin gene and cna gene.

[A strategy for the management of hospitalized children with acute lower respiratory infections]. / Estrategia de atención de niños hospitalizados por infecciones respiratorias agudas bajas.

OBJECTIVES: To improve the quality of care provided to hospitalized children having acute lower respiratory infections (ALRI), to increase the knowledge on this health condition, and to broaden the utilization of health care resources through a program called "Winter Plan". METHODS: The program comprised the use of guidelines for diagnosis and treatment, disease-oriented hospitalizations to provide an increased level of care, management of health care resources and implementation of computerized medical records. Systematic investigation of viral etiology was performed in order to rationalize the use of medications and reduce nosocomial infections. RESULTS: During program implementation (19/V-19/IX/99), 3,317 children were admitted; 1,347 (40.61%) had ALRI, of which 1,096 (81%) were included in the study. Of them, 71% aged less than 1 year. Most ALRI were viral (68%). Admission criteria were: oxygen saturation <95%, tachypnea, retractions or pleural effusion (92.4% of the children). The demand magnitude prevented compliance with isolation guidelines in all cases. Treatment guidelines were followed in a high percentage of cases: 73% of children having bronchiolitis and 72% of those with viral pneumonia received no antibiotics and 96% of children with bacterial pneumonia were put on antibiotics as recommended; use of bronchodilators and corticosteroids was reduced. Medication costs were reduced especially in the corticosteroid group, which meant a greater impact on hospitalization costs. CONCLUSIONS: To decrease ALRI morbidity and mortality there is a need to continue improving the quality of health care during hospitalization and to reinforce health promotion actions and preventive programs at the primary level.