¿Nuevo horizonte tras el reinicio escolar? Estudio de 45 casos de COVID-19 en un centro de salud / A new horizon after restarting school activity? Study of 45 cases of covid-19 in a primary care center

INTRODUCCIÓN: desde la aparición del SARS-CoV-2 se está observando que los niños de todo el mundo no parecen vulnerables a la infección, pero casi todos los datos se recogieron durante periodos de cierre escolar y medidas de distancia social. El temor a un colapso de los sistemas sanitarios lleva a los Gobiernos a mantener políticas restrictivas globales que pueden causar más daño que beneficio, especialmente en los niños y sus familias. Por ello, es necesario confirmar el papel epidemiológico de los menores en esta pandemia, en condiciones de vida cotidiana, tras la reapertura de los colegios, que conlleva un aumento de sus contactos físicos y sociales. PACIENTES Y MÉTODOS: se presenta el análisis de 45 casos consecutivos diagnosticados de COVID-19 entre las semanas 34 y 44 de 2020 -que incluyen los primeros dos meses del reinicio escolar- recogidos entre los 5250 niños adscritos a los cuatro cupos de Pediatría de un centro de salud urbano de la Comunidad de Madrid. Se constata que los niños presentan una clínica leve e inespecífica y apenas transmiten la infección en el entorno familiar, al igual que han mostrado otros estudios publicados desde el inicio de 2020. CONCLUSIÓN: son necesarios y urgentes amplios estudios poblacionales para crear una base sólida que permita relajar las medidas restrictivas sobre los niños y sus familias. Atención Primaria es una plataforma privilegiada para llevarlos a cabo, pues permite observar de cerca y en condiciones reales el papel que juegan los niños en la dinámica de la infección

INTRODUCTION: since the emergence of SARS-CoV-2, it has been observed that children around the world do not seem vulnerable to the infection, but almost all the data was collected during periods of school closure and firm measures of social distance. The fear of a collapse of health systems leads governments to maintain global restrictive policies that can do more harm than good, especially for children and their families. Therefore, it is necessary to confirm the epidemiological role of children in this pandemic, in daily living conditions, after the reopening of schools and the increase in their physical and social contacts. METHODS: the analysis of 45 consecutive cases diagnosed of COVID-19 between weeks 34 to 44 of 2020 -which includes the first two months after restanting school activity- collected in an urban Primary Care in the Community of Madrid is presented. It is found that children present mild and nonspecific symptoms and barely transmit the infection in their immediaty environment, as has been shown in other studies published since the beginning of 2020. CONCLUSION: Primary Care is a privileged platform to observe in real conditions the role that children play in the dynamics of infection. It is urgent to carry out extensive population studies in order to confirm the low contagiousness of children, since the restriction of their movements and social relationships can cause more harm than good, at different levels

A global multinational survey of cefotaxime-resistant coliforms in urban wastewater treatment plants.

The World Health Organization Global Action Plan recommends integrated surveillance programs as crucial strategies for monitoring antibiotic resistance. Although several national surveillance programs are in place for clinical and veterinary settings, no such schemes exist for monitoring antibiotic-resistant bacteria in the environment. In this transnational study, we developed, validated, and tested a low-cost surveillance and easy to implement approach to evaluate antibiotic resistance in wastewater treatment plants (WWTPs) by targeting cefotaxime-resistant (CTX-R) coliforms as indicators. The rationale for this approach was: i) coliform quantification methods are internationally accepted as indicators of fecal contamination in recreational waters and are therefore routinely applied in analytical labs; ii) CTX-R coliforms are clinically relevant, associated with extended-spectrum ß-lactamases (ESBLs), and are rare in pristine environments. We analyzed 57 WWTPs in 22 countries across Europe, Asia, Africa, Australia, and North America. CTX-R coliforms were ubiquitous in raw sewage and their relative abundance varied significantly (<0.1% to 38.3%), being positively correlated (p < 0.001) with regional atmospheric temperatures. Although most WWTPs removed large proportions of CTX-R coliforms, loads over 103 colony-forming units per mL were occasionally observed in final effluents. We demonstrate that CTX-R coliform monitoring is a feasible and affordable approach to assess wastewater antibiotic resistance status.

Granuloma aséptico facial idiopático: ¿sabemos diagnosticarlo? / Idiopathic facial aseptic granuloma: do we know how to diagnose it?

El granuloma aséptico facial idiopático es una lesión nodular e indolora exclusiva de la infancia que suele aparecer en la zona de las mejillas. Presenta un amplio diagnóstico diferencial con otras lesiones nodulares. Se ha relacionado con el espectro de la rosácea por lo que, debido a las posibles implicaciones oculares de esta, se recomienda el seguimiento oftalmológico de los pacientes. Debido a su carácter benigno y autorresolutivo, como demuestra el caso clínico presentado, se recomienda un tratamiento conservador

Idiopathic facial aseptic granuloma is a pediatric condition characterized by red-violaceous nodule usually located on the cheeks. Differential diagnosis with other facial nodules must be done. The pathogenesis is still unclear but seems to be associated with rosacea. It is important keeping in mind the possible ophthalmological damage of rosacea so follow up is recommended. As we show in the case report, it is a benign lesion and it tends to spontaneous resolution, so we can avoid invasive treatments

Clínica neurológica en un cuadro respiratorio: cuando Na importa / Neurological symptoms in an acute respiratory pattern: when Na matters

La aparición de clínica neurológica en un cuadro respiratorio agudo, una vez descartadas hipoxia e hipercapnia secundarias a insuficiencia respiratoria grave, nos debe hacer pensar en una hiponatremia subyacente, formando parte de un síndrome de secreción inadecuada de hormona antidiurética (SIADH). Esta alteración hidroelectrolítica se ha considerado un factor de mal pronóstico en la evolución del proceso respiratorio, por lo que es deseable detectarla precozmente y corregirla. Presentamos el caso de un lactante que debutó con hipoactividad y pausas de apnea previas a la clínica respiratoria de una bronquiolitis

The appearance of neurological symptoms in an acute respiratory pattern, once hypoxia and hypercapnia are ruled out secondary to severe respiratory failure, should lead us to think about an underlying hyponatremia, forming part of a syndrome of inappropriate secretion of antidiuretic hormone (SIADH). This hydroelectrolytic alteration has been considered a factor of poor prognosis in the evolution of the respiratory process, so it is desirable to detect it early and correct it. We present the case of an infant who debuted with hypoactivity and apnea pauses prior to the respiratory symptoms of bronchiolitis

Effect of solar photo-Fenton process in raceway pond reactors at neutral pH on antibiotic resistance determinants in secondary treated urban wastewater.

Solar photo-Fenton process in raceway pond reactors was investigated at neutral pH as a sustainable tertiary treatment of real urban wastewater. In particular, the effect on antibiotic resistance determinants was evaluated. An effective inactivation of different wild bacterial populations was achieved considering total and cefotaxime resistant bacteria. The detection limit (1 CFU mL-1) was achieved in the range 80-100 min (5.4-6.7 kJ L-1 of cumulative solar energy required) for Total Coliforms (TC) (40-60 min for resistant TC, 4.3-5.2 kJ L-1), 60-80 min (4.5-5.4 kJ L-1) for Escherichia coli (E. coli) (40 min for resistant E. coli, 4.1-4.7 kJ L-1) and 40-60 min (3.9-4.5 kJ L-1) for Enterococcus sp. (Entero) (30-40 min for resistant Entero, 3.2-3.8 kJ L-1) with 20 mg L-1 Fe2+ and 50 mg L-1 H2O2. Under these mild oxidation conditions, 7 out of the 10 detected antibiotics were effectively removed (60-100%). As the removal of antibiotic resistance genes (ARGs) is of concern, no conclusive results were obtained, as sulfonamide resistance gene was reduced to some extent (relative abundance <1), meanwhile class 1 integron intI1 and ß-lactam resistance genes were not affected. Accordingly, more research and likely more intensive oxidative conditions are needed for an efficient ARGs removal.

Determination of pesticides in sewage sludge from an agro-food industry using QuEChERS extraction followed by analysis with liquid chromatography-tandem mass spectrometry.

An analytical method was developed and validated for the determination of ten pesticides in sewage sludge coming from an agro-food industry. The method was based on the application of Quick, Easy, Cheap, Effective, Rugged, and Safe (QuEChERS) extraction for solid sewage sludge and SPE extraction for sludge aqueous phase, followed by liquid chromatography (LC) coupled to hybrid quadrupole/linear ion trap mass spectrometry (QqLIT-MS). The QuEChERS method was reported 14 years ago and nowadays is mainly applied to the analysis of pesticides in food. More recent applications have been reported in other matrices as sewage sludge, but the complexity of the matrix makes necessary the optimization of the cleanup step to improve the efficiency of the analysis. With this aim, several dispersive solid-phase extraction cleanup sorbents were tested, choosing C18 + PSA as a d-SPE sorbent. The proposed method was satisfactorily validated for most compounds investigated, showing recoveries higher than 80% in most cases, with the only exception of prochloraz (71%) at low concentration level. Limits of quantification were lower than 40 ng l-1 in the aqueous phase and below 40 ng g-1 in the solid phase for the majority of the analytes. The method was applied to solid sludge and the sludge aqueous phase coming from an agro-food industry which processes fruits and vegetables. Graphical abstract Application of LC/MS/MS advanced analytical techniques for determination of pesticides contained in sewage sludge.