Prevalencia y severidad de Hiponatremias en niños internados en el Hospital Pediátrico: estudio de cohorte / Prevalence and severity of hyponatremia in children admitted to a pediatric hospital: a cohort study

Introducción: Para disminuir la aparición de hiponatremias en los últimos años se aumentaron las concentraciones de sodio en las soluciones de mantenimiento, llegando a recomendarse las isotónicas, con mejoras de laboratorio pero con dudoso impacto clínico. En el Hospital Garrahan se utiliza una solución estándar hipotónica con cloruro de sodio 0,45%. Antes de reemplazar la solución según recomendaciones internacionales se decidió establecer la prevalencia de hiponatremia en pacientes internados, y su asociación con la solución estándar de hidratación. Población y métodos: Pacientes de 1 mes a 18 años, internados en el Hospital Garrahan. Estudio prospectivo y observacional. Se registró si el paciente recibía hidratación parenteral y la concentración de sodio. Se consideró hiponatremia significativa la presencia de sodio sérico menor a 130 mEq/L. y/o la presencia de síntomas compatibles con hiponatremia. Resultados: En 3003 internaciones la prevalencia global de hiponatremias diagnosticadas fue 4.4%, y asciende a 6.3% si se consideran solo los pacientes que fueron estudiados con ionograma (se le extrajo ionograma al 70,6% de los pacientes internados). La prevalencia de hiponatremias significativas fue de 1.5% (n=44) de los internados, y las hiponatremias significativas en internados que recibían la solución hipotónica estándar de mantenimiento fue de 0.3% (n=9). Conclusiones: En una población donde se utiliza una solución estándar con cloruro de sodio 0,45% -pero se modifica individualmente para las necesidades de cada paciente- la prevalencia de hiponatremias totales y significativas fue similar e incluso inferior a la publicada en otras series. (AU)

Introduction: To reduce the appearance of hyponatremia, in recent years, sodium concentrations were increased in maintenance solutions, and isotonic solutions were recommended, leading to improvements in laboratory studies, but with a doubtful clinical impact. A standard hypotonic solution with 0.45% sodium chloride is used at Garrahan Hospital. Before replacing the solution according to international recommendations, it was decided to determine the prevalence of hyponatremia in inpatients and its association with the standard hydration solution. Population and methods: Patients from 1 month to 18 years old, hospitalized at Garrahan Hospital. Prospective and observational study. Parenteral hydration of the patient and the sodium concentration were recorded. Significant hyponatremia was defined as serum sodium less than 130 mEq/L, and/or the presence of symptoms of hyponatremia. Results: In 3003 hospitalizations, the overall prevalence of diagnosed hyponatremia was 4.4%, increasing to 6.3% if only patients in whom a ionogram was performed were included (a ionogram was performed in 70.6% of the inpatients). Of all inpatients, 1.5% (n=44) had significant hyponatremia, and 0.3% (n=9) of the patients receiving the standard maintenance hypotonic solution had significant hyponatremia. Conclusions: In a population in whom a standard solution with 0.45% sodium chloride is used - but which is individually modified according to the needs of each patient - the prevalence of total and significant hyponatremia was similar and even lower than that reported in other series (AU)

[Low-risk community-acquired pneumonia: implications of its outcome due to the determining factors for admission not contemplated by the scores]. / Neumonía adquirida en la comunidad de bajo riesgo: Consecuencias evolutivas de los determinantes de internación no contemplados por los scores.

OBJECTIVES: The decision to admit patients with community-acquired pneumonia (CAP) to hospital are based on stratification scales. This classification into risk groups is not perfect. In low-risk community-acquired pneumonia (LR-CAP), physicians often depend on their subjective impressions to decide the need for hospitalisation, which suggests the existence of conditions not considered by the scores. The aim of this article was to describe the determining factors for admission in LR-CAP, and to analyse the relationship between these causes and clinical outcome. MATERIAL AND METHODS: A descriptive, observational, retrospective study, based on the review of medical records during a 2 year-period. It included patients over 18 years, who were hospitalised in a third level hospital in Argentina due to LR-CAP. RESULTS: A total of 80 cases were identified. The causes that led to hospitalisation were: comorbidities not included in the scores, development of pleural effusion and sepsis, lack of response to ambulatory antibiotic treatment, oral intolerance, and social causes. HIV infection was associated with an unfavourable clinical progress during hospital admission (p=.03), as well as the lack of response to outpatient treatment (p=.03) and the development of pleural effusion (p=.03). Social causes were associated with a need for longer intravenous treatment. CONCLUSIONS: HIV infection, social causes, and lack of response to ambulatory treatment were related to unfavourable clinical progress.

Dental considerations and recommendations in Eisenmenger syndrome: A report of an unusual paediatric case.

BACKGROUND: Eisenmenger syndrome (ES) is a heart cyanotic condition characterised by elevated pulmonary vascular resistance and an intra-cardiac right-to-left shunting of blood through a systemic-to-pulmonary circulation connection. Affected children usually exhibit severe hypoxia, clubbing of fingers/toes, haemoptysis, anaemia, and organ damage. CASE REPORT: During autumn 2015, the patient and her parents arrived at the paediatric dentistry clinic. The patient presented with the main complaint of generalised inflamed gingival tissues, severely protruded upper incisors, and evident abnormal mouth breathing. TREATMENT: This was performed under local analgesia, rubber-dam isolation, and antimicrobial prophylaxis with amoxicillin (50 mg/kg). The patient's parents agreed to the treatment plan through a signed informed consent. This treatment consisted of the placement of pit and fissure sealants on the four permanent first molars (which included enamel preparation with fissurotomy burs), in-depth gingiva/dental frequent cleanings, local fluoride varnish applications, and an exhaustive programme of at-home oral hygiene (brushing, flossing, and chlorhexidine mouth rinses), including adequate nutrition. Gingivoplasty surgery to remove residual enlarged tissues was indicated for the near future. FOLLOW-UP: The child did not return to the clinic. When contacted, the parents reported that their daughter's systemic condition worsened significantly. She was confined to a bed at home under palliative care, with a life-span expectation of only a few months. CONCLUSION: Comprehensive dental care of children with ES requires careful consideration of their medical condition, and dental care delivery should be coordinated with the paediatric cardiologist. General analgesia should be considered only in strictly selected cases, due to the high peri-operative mortality reported.

Activation of aryl hydrocarbon receptor regulates the LPS/IFNγ-induced inflammatory response by inducing ubiquitin-proteosomal and lysosomal degradation of RelA/p65.

Several studies have identified the aryl hydrocarbon receptor (AhR) as a negative regulator of the innate and adaptive immune responses. However, the molecular mechanisms by which this transcription factor exerts such modulatory effects are not well understood. Interaction between AhR and RelA/p65 has previously been reported. RelA/p65 is the major NFκB subunit that plays a critical role in immune responses to infection. The aim of the present study was to determine whether the activation of AhR disrupted RelA/p65 signaling in mouse peritoneal macrophages by decreasing its half-life. The data demonstrate that the activation of AhR by TCDD and ß-naphthoflavone (ß-NF) decreased protein levels of the pro-inflammatory cytokines TNF-α, IL-6 and IL-12 after macrophage activation with LPS/IFNγ. In an AhR-dependent manner, TCDD treatment induces RelA/p65 ubiquitination and proteosomal degradation, an effect dependent on AhR transcriptional activity. Activation of AhR also induced lysosome-like membrane structure formation in mouse peritoneal macrophages and RelA/p65 lysosome-dependent degradation. In conclusion, these results demonstrate that AhR activation promotes RelA/p65 protein degradation through the ubiquitin proteasome system, as well as through the lysosomes, resulting in decreased pro-inflammatory cytokine levels in mouse peritoneal macrophages.

Chitooligosaccharides as novel ingredients of fermented foods.

Chitooligosaccharides (COSs) have been clinically evaluated for their immunostimulating effects after oral intake. Similar to dietary supplements, prebiotics and biopreservatives, these water-soluble bioactives are easily incorporated into dairy products and beverages. Notwithstanding, the use of COS in fermented foods would be limited by its antimicrobial properties. In order to study the interaction with yoghurts as a model of fermented food, the effects of COS on chemical composition, viability, morphology and metabolism of lactic acid bacteria, fatty acid profiles and conjugated linoleic acid (CLA) were assessed over 28 days and after chemical digestion. There were no significant differences between the nutritional composition of controls and yoghurts supplemented with concentrations up to 0.1% w/w of COS. However, the acidification of milk decreased at 0.5% (p < 0.05) and the formation of yoghurt failed at 3.0%, without affecting viable counts. Lipid hydrolysis of yoghurts supplemented with 0.1% COS was not affected by chemical digestion. No significant differences were found between CLA percentages of controls and supplemented yoghurts after digestion. Although the nutritional composition, fatty acids and viable counts were not significantly modified after COS supplementation, the present study shows that COS diminishes bacterial acidification at concentrations higher than 0.1%, thus limiting the amounts that could be added to yoghurt.

Activation of AHR mediates the ubiquitination and proteasome degradation of c-Fos through the induction of Ubcm4 gene expression.

The ubiquitin-proteasome system (UPS) is a specific, non-lysosomal pathway responsible for the controlled degradation of abnormal and short-half-life proteins. Despite its relevance in cell homeostasis, information regarding control of the UPS component gene expression is lacking. Data from a recent study suggest that the aryl hydrocarbon receptor (AHR), a ligand-dependent transcription factor, might control the expression of several genes encoding for UPS proteins. Here, we showed that activation of AHR by TCDD and ß-naphthoflavone (ß-NF) results in Ubcm4 gene induction accompanied by an increase in protein levels. UbcM4 is an ubiquitin-conjugating enzyme or E2 protein that in association with ubiquitin ligase enzymes or E3 ligases promotes the ubiquitination and 26S proteasome-mediated degradation of different proteins, including p53, c-Myc, and c-Fos. We also present data demonstrating increased c-Fos ubiquitination and proteasomal degradation through the AHR-mediated induction of UbcM4 expression. The present study shows that AHR modulates the degradation of proteins involved in cell cycle control, consistent with previous reports demonstrating an essential role of the AHR in cell cycle regulation.

Probiotics and their effect on oral bacteria count in children: a pilot study.

AIM: To assess the effect of the daily ingestion of a mixture of probiotics on the amount of Streptococcus mutans in the oral cavity of preschool-age patients with a high risk of caries. MATERIALS AND METHODS: Forty patients, aged between 4 and 6 years, with a high risk of dental caries were included in this pilot study. Patients were randomly assigned to two study groups: the Experimental Group (A) included patients who brushed their teeth and used fluoridated toothpaste in addition to consuming probiotics daily, and the Control Group (B) inclused patients who brushed their teeth and used fluoridated toothpaste but did not consume probiotics. Using the CariScreen, the microorganism count was determined at different times: baseline, 7, 14, 21 and 30 days. To identify the differences between both groups, a Mann-Whitney U test was performed, with a significance level of 0.05. RESULTS: It was observed that both groups showed similar microbial counts at the beginning of the trial (p>0.05), and a significant decrease in the count at the end of the study was found in the experimental group (p<0.05) 15 days after suspending ingestion. CONCLUSION: We found a significant reduction of RLU values in preschool children who ingested the tested probiotics in relation to the baseline values and 15 days after ceasing consumption.

Evidence on antimicrobial properties and mode of action of a chitosan obtained from crustacean exoskeletons on Pseudomonas syringae pv. tomato DC3000.

Pseudomonas syringae pv. tomato DC3000 (Pto DC3000) causes bacterial speck of tomato, a widely spread disease that causes significant economical losses worldwide. It is representative of many bacterial plant diseases for which effective controls are still needed. Despite the antimicrobial properties of chitosan has been previously described in phytopathogenic fungi, its action on bacteria is still poorly explored. In this work, we report that the chitosan isolated from shrimp exoskeletons (70 kDa and 78 % deacetylation degree) exerts cell damage on Pto DC3000. Chitosan inhibited Pto DC3000 bacterial growth depending on its concentration, medium-pH, and presence of metal ion (Mg(+2)). Biochemical and cellular changes resulting in cell aggregation and impaired bacterial growth were also viewed. In vivo studies using fluorescent probes showed cell aggregation, increase in membrane permeability, and cell death, suggesting the chitosan antibacterial activity is due to its interaction as a polycation with Pto DC3000 membranes. Transmission electron microscopic analysis revealed that chitosan also caused morphological changes and damage in bacterial surfaces. Also, the disease incidence in tomato inoculated with Pto DC3000 was significantly reduced in chitosan pretreated seedlings, revealing a promising action of chitosan as nontoxic biopesticide in tomato plants. Indeed, a wider comprehensive knowledge of the mechanism of action of chitosan in phytopathogenic bacterial cells will increase the chances of its successful application to the control of spread disease in plants.

Leucemia mieloide aguda con t(8; 21)(q22; q22): reporte de casos / Acute myeloid leukaemia with t(8; 21)(q22; q22): case report

La leucemia mieloide aguda es una neoplasia hematopoyética caracterizada por la proliferación clonal de blastos inmaduros en médulas ósea interfiriendo con sus funciones normales. Tiene una supervivencia aproximada de 35% afectando principalmente a adultos mayores de 60 años y niños menores de un año y preferentemente al sexo masculino. Un hallazgo frecuente es la presencia de la translocación cromosómica t (8; 21) (q22; q22) que involucra a los genes RUNX1 y RUNX1T1. La detección de esta alteración tiene implicancia diagnóstica y pronóstica de la enfermedad. El objetivo de este trabajo es describir y reportar dos casos de leucemia mieloide aguda en pacientes masculinos de 14 y 24 años que presentaron clínica, laboratorio y morfología típicos de la enfermedad pero con edad de aparición no habitual, enfatizando además, el pronóstico bueno desde el punto de vista citogenético de esta translocación en ambos casos.

Acute myeloid leukemia is a haematopoietic neoplasia characterized by clonal proliferation of immature blasts in bone marrow, interfering with its normal functions. Overall survival is about 35% affecting mainly male adults over 60 years old and infants under one year old. Genetic translocation t(8;21)(q22;q22) is a recurrent finding and involves RUNX1 and RUNX1T1 genes. The detection of this genetic translocation is relevant to the diagnosis and prognosis of the disease. The objective of this work is to report two cases of acute myeloid leukaemia in 14 and 24 years old male patients with typical clinical, laboratorial and morphological findings but with unusual appearing ages, emphasizing the good prognosis from the genetic point of view of this translocation in both cases.

Intergeneric phylogenetic relationships in catfishes of the Loricariinae (Siluriformes: Loricariidae), with the description of Fonchiiloricaria nanodon: a new genus and species from Peru.

Recent investigations in the upper Río Huallaga in Peru revealed the presence of an intriguing species of the Loricariinae. To characterize and place this species within the evolutionary tree of the subfamily, a molecular phylogeny of this group was inferred based on the 12S and 16S mitochondrial genes and the nuclear gene F-reticulon4. The phylogeny indicated that this distinctive species was a member of the subtribe Loricariina. Given its phylogenetic placement, and its unusual morphology, this species is described as a new genus and new species of Loricariinae: Fonchiiloricaria nanodon. This new taxon is diagnosed by usually possessing one to three premaxillary teeth that are greatly reduced; lips with globular papillae on the surface; the distal margin of lower lip bearing short, triangular filaments; the premaxilla greatly reduced; the abdomen completely covered by plates, with the plates between lateral abdominal plates small and rhombic; a caudal fin with 14 rays; the orbital notch absent; five lateral series of plates; dorsal-fin spinelet absent; preanal plate present, large and solid, and of irregular, polygonal shape, the caudal peduncle becoming more compressed posteriorly for the last seven to 10 plates.

Sediment and pollutant load modelling using an integrated urban drainage modelling toolbox: an application of City Drain.

Numerical and computational modelling of flow and pollutant dynamics in urban drainage systems is becoming more and more integral to planning and design. The main aim of integrated flow and pollutant models is to quantify the efficiency of different measures at reducing the amount of pollutants discharged into receiving water bodies and minimise the consequent negative water quality impact. The open source toolbox CITY DRAIN developed in the Matlab/Simulink environment, which was designed for integrated modelling of urban drainage systems, is used in this work. The goal in this study was to implement and test computational routines for representing sediment and pollutant loads in order to evaluate catchment surface pollution. Tested models estimate the accumulation, erosion and transport of pollutants--aggregately--on urban surfaces and in sewers. The toolbox now includes mathematical formulations for accumulation of pollutants during dry weather period and their wash-off during rainfall events. The experimental data acquired in a previous research project carried out by the Environmental Engineering Research Centre (CIIA) at the Universidad de los Andes in Bogotá (Colombia) was used for the calibration of the models. Different numerical approaches were tested for their ability to calibrate to the sediment transport conditions. Initial results indicate, when there is more than one peak during the rainfall event duration, wash-off processes probably can be better represented using a model based on the flow instead of the rainfall intensity. Additionally, it was observed that using more detailed models (compared with an instantaneous approach) for representing pollutant accumulation do not necessarily lead to better results.

Retention of granular sludge at high hydraulic loading rates in an anaerobic membrane bioreactor with immersed filtration.

This study shows the results of an Anaerobic Membrane Bioreactor with immersed filtration cartridges for granular biomass retention working at high hydraulic loading rates. Biomass retention capabilities, granular biomass structure and activity, filtration cartridges flux and organic material degradation performance were evaluated. Four reactors with a volume of 0.005 m3 were tested. Two different filtration cartridges were used (10 and 100 microm) with effective surface area of 0.05 m2. The filtration cartridges were submerged in the reactors for suction type filtration. Three organic loading rates were tested in the first two reactors and seven in the other two. Selective biomass washout and an increment in the biomass methanogenic activity was observed in the reactors at hydraulic loading rates between 1.2 and 4.5 m/h. Analyses of biomass granulometry showed an increase of larger size granular biomass. The immersed membrane anaerobic bioreactor maintain most of the advantages without biomass activity loss.

Changes in thyroid function in puppies fed a high iodine commercial diet.

Abnormally low(131)I uptakes were noticed in dogs fed with commercial diets at the University Animal Clinic in Buenos Aires, but the total iodine content of eight different commercial diets examined was found to provide an iodine intake above daily requirements. To investigate this anomaly, 18 dogs were distributed into three groups, fed either: (1) a home-prepared diet; (2) a commercial diet; (3) a home-prepared diet supplemented with potassium iodide equivalent to that found in the commercial diet. The(131)I uptake in dogs of groups B and C was significantly decreased, as was basal serum thyroxine (T(4)) and free thyroxine (FT(4)), whereas urinary iodide excretion and serum thyroid stimulating hormone (TSH), were increased. The thyroid releasing hormone (TRH)-TSH test showed an increased response in dogs from group B, while the TRH-T(4)test was inhibited in both groups B and C. The results demonstrate that the excessive amount of iodine present in some commercial diets in Argentina causes a significant impairment of thyroid function and hypothyroidism.

Commercial diet induced hypothyroidism due to high iodine. A histological and radiological analysis.

A number of puppies of the School Hospital of the Faculty of Veterinary Science-UBA showed bone changes. Measurement of the iodine content of the commercial diet showed a significant increase in its content. Iodine excess causes alterations in thyroid function and morphology, and its hormones have a direct action on bone formation. Three groups of puppies were fed on different diets: a home-prepared diet, a commercial diet (containing 5.6 mg potassium iodide/kg dry food), and a home-prepared diet supplemented with 5.6 mg potassium iodide/kg dry food. Groups B and C developed hypothyroidism. A significant decrease (p<0.05) in the styloid apophyseal surface was found in groups B and C vs. A, determined by radiography. Histologically, the hypertrophied cartilage was shorter in groups B and C than in group A (p<0.0001). The present results suggest that commercial diets with a high iodine content may cause hypothyroidism and changes in bone metabolism.

[Food intake and anthropometric evaluation of an aborigine mission in the province of Salta, Argentina]. / Ingesta alimentaria y evaluación antropométrica de una misión aborigen de la provincia de Salta. República Argentina.

OBJECTIVES: To evaluate the food intake of families at the "El Chañar" aboriginal mission and make an anthropometric evaluation of the children between 6 and 14. DESIGN: This crossover and descriptive study covered two units of analysis. SETTING: It was carried out at the "El Chañar" aboriginal community. PARTICIPANTS: All the mission families and all children between 6 and 14. INTERVENTIONS: A) A food questionnaire was administered to all the families at the mission by the method of remembering the 24 hours of the day prior to the study. B) For the anthropometric study, the following were determined: weight, size (stature) and brachial perimeter, triceps cutaneous fold and brachial muscular circumference. MEASUREMENTS AND MAIN RESULTS: Foods taken were expressed in terms of nutrients, and the results expressed as a percentage of requirements. In 1994 the nutrient most in deficit was calcium, in that 100% of the families had less than 10% of what was required. The findings showed deficiencies in food intake and growth levels below the International Reference Norms. CONCLUSIONS: Wild foods are not an essential component of the aborigines' habitual diet. Their consumption have declined over time under the influence of 'criollo' (creole) food.

Síndrome de desmielinización osmótica / Osmotic demyelinization syndrome

Elsíndrome de desmielinización osmótica (SDO), es un cuadro de deterioro neurológico con áreas de desmielinización intra y extraprotuberanciales, asociado con lacorrección rápida de las hiponatremias crónicas. Se presenta un paciente con esta patología. Se sugiere que la prevención de este síndrome puede efectuarse corrigiendo las hiponatremias crónicas a un ritmo menor de 0.5 mEq/l/hora y que reviste importancia el tratamiento de la hipokalemia concomitante (AU)##

[Clinical and anatomopathological study of 5 patients with vasculitis and anti-neutrophil cytoplasmic antibodies with cytoplasmatic pattern]. / Estudio clínico y anatomopatológico en cinco casos de vasculitis portadores de anticuerpos anticitoplasmáticos de neutrófilos con patrón citoplasmático.

We report five patients with vasculitis and antineutrophil cytoplasmic antibodies with cytoplasmatic pattern. All had severe upper and lower respiratory tract necrotizing lesions. Three had kidney failure due to rapidly progressive glomerulonephritis. The pathological study showed a crescentic glomerulonephritis, a chronic granulomatous inflammation in the lungs and in the nasal mucosa, an acute nonspecific inflammation or a chronic granulomatous inflammation and focal blood vessel fibrinoid necrosis. All patients with simultaneous involvement of lungs and kidneys had high titers of antineutrophil cytoplasmic antibodies. The nomenclature and classification of these diseases is discussed.

[Risk factors of cardiovascular disease in a Chilean school population: I: Blood lipids in 552 children and adolescents 6-15 years of age]. / Factores de riesgo de enfermedad cardiovascular en una población de escolares Chilenos: I parte: lípidos séricos en 552 niños y adolescentes de 6-15 años.

The distribution of serum cholesterol (TC), low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL)-cholesterol and triglycerides (TG), and the prevalence of risk-considered values were studied in school children from Concepción, Chile (6 to 15 years old; 326 boys, 226 girls). The mean TC levels were 146 mg/dl for boys and 154 mg/dl for girls but 9.1% of the sampled children had TC values between 175 and 190 mg/dl, and 10% were over 190 mg/dl. Mean LDL-C was 83 mg/dl in boys and 89 mg/dl in girls; 6% of samples showed values between 130 and 159 mg/dl, and 1.3% over 160 mg/dl. Mean HDL-C was 46 mg/dl for boys and 48 mg/dl for girls. The mean TG values were 80 mg/dl for boys and 93 mg/dl for girls.