RESUMEN
Bronchiolitis is the most common lower respiratory tract illness of infancy and is primarily caused by an infection with the respiratory syncytial virus (RSV). An inadequately elevated hospitalisation rate and the use of different treatments with unproven efficacy lead to high cost in terms of public health. Implementation of evidence based guidelines can reduce these costs but not parents satisfaction and quality of care. Palivizumab is a preventive medication with specific indications. Post-bronchiolitis bronchial hyperreactivity has been demonstrated, particularly if the first episode required hospital admission. However, no medication has proven its efficacy to reduce this postbronchiolitis hyperreactivity.
Asunto(s)
Bronquiolitis/tratamiento farmacológico , Hiperreactividad Bronquial/diagnóstico , Hiperreactividad Bronquial/tratamiento farmacológico , Hiperreactividad Bronquial/epidemiología , Bronquiolitis/diagnóstico , Bronquiolitis/epidemiología , Broncodilatadores/uso terapéutico , HumanosRESUMEN
The authors investigated the risk of wheezing illnesses in relation to contemporaneous pollutant exposures (gas cooking, heating, and smoking) in childhood and adolescence in a cohort of 2,289 United Kingdom subjects. Data from two questionnaires assessing wheezing at ages 7-8 and 15-17 years and one questionnaire on current and past pollutant exposures at age 16-18 years were studied (1987-1996). The 1,868 subjects returning all three questionnaires were divided into three groups representing childhood (10.5%), adolescent (10.9%), and persistent (i.e., both; 16.3%) wheezing and compared with 1,165 controls (62.4%) without wheezing. The estimated risks of childhood wheezing were increased by exposure to any gas in childhood (odds ratio (OR) = 1.47, 95% confidence interval (CI): 1.05, 2.04) and exposure to a gas hob in childhood (OR = 1.56, 95% CI: 1.13, 2.16) and were increased further in those persistently exposed. Risk of persistent wheezing in adolescence was paradoxically reduced by exposure to a gas hob (OR = 0.67, 95% CI: 0.50, 0.91), possibly because of selection avoidance. Contemporaneous exposure to combined smoking by both parents was associated with wheezing in all groups (odds ratios ranged from 1.62 (95% CI: 1.06, 2.46) to 1.93 (95% CI: 1.10, 3.38)). Maternal smoking alone was associated with persistent wheezing and with both childhood (OR = 1.90, 95% CI: 1.06, 3.39) and persistent (OR = 2.18, 95% CI: 1.15, 4.14) wheezing if smoking occurred throughout childhood and adolescence. The authors conclude that exposures to gas cooking and smoking in childhood and adolescence increase the overall risk of wheezing.
Asunto(s)
Contaminación del Aire Interior/efectos adversos , Culinaria , Combustibles Fósiles/efectos adversos , Ruidos Respiratorios/etiología , Fumar/efectos adversos , Contaminación por Humo de Tabaco/efectos adversos , Adolescente , Niño , Estudios de Cohortes , Femenino , Encuestas Epidemiológicas , Calefacción , Humanos , Masculino , Medición de Riesgo , Reino UnidoAsunto(s)
Proteína C-Reactiva/análisis , Calcitonina/sangre , Fiebre/complicaciones , Riñón/lesiones , Precursores de Proteínas/sangre , Infecciones Urinarias/complicaciones , Adolescente , Biomarcadores/sangre , Péptido Relacionado con Gen de Calcitonina , Niño , Preescolar , Femenino , Humanos , Lactante , Riñón/diagnóstico por imagen , Masculino , Estudios Prospectivos , Curva ROC , Cintigrafía , Radiofármacos , Sensibilidad y Especificidad , Ácido Dimercaptosuccínico de Tecnecio Tc 99mRESUMEN
Exercise-induced asthma (EIA) is a possible cause of poor physical performance in children. No data are available on the value of respiratory symptoms to discriminate children with bad physical fitness from children with EIA. We evaluated respiratory symptoms in school-age children during and after exercise in relation to EIA. The population of 149 primary schools (849 classes with 15,241 children) was enrolled in the study. EIB was assessed using the 6-min free-running-test (6MFRT) in 15,241 children. At the end or at premature arrest of the 6MFRT, signs reported by the children and clinical symptoms observed by supervising physicians were recorded. Peak flow measurements were obtained before and 5 and 10 min after the 6MFRT, a decrease of 15% or more being defined as significant. The 6MFRT was positive in 7.4% of primary schoolchildren. Girls were more likely to have a positive test than boys (8.5% vs. 6.4%, P < 0.001), and children living in urban areas more than those living in rural areas (8.9% vs. 7.0%, P < 0.01). Premature arrest was seen in 3.5% (i.e., n = 353) of the children. The main reasons for premature arrest were dyspnea and chest pain. Among them, only 21% had a positive 6MFRT, while 89% with a positive 6MFRT could terminate the test. Premature arrest, breathlessness, chest tightness, wheezing, and cough had a positive predictive value to detect a EIA of 21.9%, 20.8%, 36.4%, 41.2%, and 28.3%, respectively, and a sensitivity of 10.8%, 29.5%, 14.9%, 4.8%, and 13.0%, respectively. In conclusion, EIA was detected in 7.4% of schoolchildren. A slightly higher incidence was observed in girls and children from an urban area. Neither premature arrest nor clinical signs and symptoms were good predictors of EIA in primary schoolchildren.
Asunto(s)
Asma Inducida por Ejercicio/diagnóstico , Asma Inducida por Ejercicio/fisiopatología , Broncoconstricción , Aptitud Física , Asma Inducida por Ejercicio/epidemiología , Bélgica/epidemiología , Broncoconstricción/fisiología , Niño , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Prevalencia , Sensibilidad y EspecificidadRESUMEN
We report the history of an 8-year-old girl who was treated for suspected lung lesions of respiratory papillomatosis with Indole-3-Carbinol, local and intravenous injections of Cidofovir for 27 months. This is the first report where a complete cure of the lung lesions occurred in a child, and was sustained for at least 24 months.
Asunto(s)
Antivirales/uso terapéutico , Citosina/análogos & derivados , Citosina/uso terapéutico , Indoles/uso terapéutico , Neoplasias Pulmonares/tratamiento farmacológico , Organofosfonatos/uso terapéutico , Papiloma/tratamiento farmacológico , Antivirales/administración & dosificación , Quimioterapia Adyuvante , Niño , Cidofovir , Citosina/administración & dosificación , Quimioterapia Combinada , Femenino , Humanos , Indoles/administración & dosificación , Inyecciones Intralesiones , Inyecciones Intravenosas , Neoplasias Pulmonares/virología , Organofosfonatos/administración & dosificación , Probenecid/uso terapéuticoRESUMEN
A 4.5-year-old boy with complement deficiency developed infection of the psoas caused by Streptococcus pneumoniae. Pyomyositis of the psoas muscle is uncommon but should be included in the differential diagnosis of fever and lameness. The most useful diagnostic test is computed tomography guided needle aspiration, and underlying conditions should be sought.
Asunto(s)
Síndromes de Inmunodeficiencia/diagnóstico , Miositis/diagnóstico , Infecciones Neumocócicas/diagnóstico , Absceso del Psoas/diagnóstico , Streptococcus pneumoniae/aislamiento & purificación , Antibacterianos , Preescolar , Drenaje/métodos , Quimioterapia Combinada/administración & dosificación , Estudios de Seguimiento , Humanos , Síndromes de Inmunodeficiencia/complicaciones , Masculino , Miositis/complicaciones , Miositis/terapia , Infecciones Neumocócicas/complicaciones , Infecciones Neumocócicas/terapia , Absceso del Psoas/complicaciones , Absceso del Psoas/terapia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
Adenoidectomy is one of the most common surgical procedures in children. On rare occasions it can be complicated by a retropharyngeal abscess (RA). We report the case of a 9-year-old girl with an RA extending to the mediastinum following adenoidectomy. The mediastinal collection was successfully treated with computed tomography-guided percutaneous drainage to avoid extensive surgical procedure. Surgeons should be aware of these dramatic complications and should avoid overzealous surgery in the removal of the adenoid tissue.
Asunto(s)
Absceso/etiología , Adenoidectomía/efectos adversos , Enfermedades del Mediastino/etiología , Absceso Retrofaríngeo/etiología , Absceso/terapia , Niño , Femenino , Humanos , Enfermedades del Mediastino/terapia , Absceso Retrofaríngeo/terapiaRESUMEN
The purpose of this study was to characterise Lyme meningitis (LM) in a Belgian paediatric population and to suggest findings that could allow early distinction from aseptic meningitis (AM). The medical records of patients hospitalised between 1993 and 2000 and with a discharge diagnosis of LM (n=14) or AM (n=16) were retrospectively reviewed. The Kruskal-Wallis test was used to compare data. Of the patients, 16 were identified with AM and 14 with LM, amongst which 7 presented with isolated LM and 7 with associated peripheral facial palsy (PFP). Patients with AM, when compared with LM, complained of more pronounced signs and symptoms of meningitis (fever, headaches, and neck stiffness); they statistically displayed a shorter period of symptoms before admission (1.6 vs 15 days), higher neutrophilic component (mean 56% vs 2.4%), and lower protein levels (mean 0.39 vs 1.12 g/l) on cerebrospinal fluid analysis. In the neuroborreliosis group, the duration of symptoms was shorter and the cerebrospinal protein level was lower in cases of LM associated with PFP compared to isolated LM (mean 1.3 vs 15 days; mean 0.55 g/l vs 1.12 g/l). Conclusions. Our results suggest that some clinical data and laboratory findings may help the physician to diagnose aseptic or Lyme meningitis before completion of serologic testing. LM should be suspected in cases of meningitis with very low CSF neutrophilic counts and high protein levels associated with prolonged duration of symptoms, low grade fever, and absence of pronounced signs of meningitis.