Profile of inflammatory mediators in tonsils of patients with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome.

The purpose of this study was to analyze the levels of white blood cells and profile of proinflammatory Th1, Th2, Th17, and T regulatory tissue cytokines in the tonsils of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) patients to contribute to the pathophysiological understanding of the PFAPA syndrome. A cohort of PFAPA patients who had tonsillectomy during 2010 and 2011 was included and compared to control patients who had tonsillectomy for tonsillar hypertrophy. White blood cell counts were measured during flares in PFAPA patients and before tonsillectomy in the control group. Cytokine gene expression was analyzed in removed tonsils by real-time PCR. Nine PFAPA patients with a median age of 5.3 years (1.7-8 years) and 17 hypertrophic tonsils of patients with a median age of 4.8 years (2.3-8.4 years) participated in this study. Tonsillectomy was performed during afebrile period between PFAPA flares. Three of the nine patients had recurrent episodes of aphthous stomatitis without fever after tonsillectomy. Leukocyte and neutrophil counts were higher in PFAPA patients compared to controls (p < 0.05). Eosinophil counts were lower in PFAPA patients during flares (p = 0.006). IL-1ß, TNF-α, TGF-ß, IL-17, and IFN-γ levels were similar in the tonsils of patients and controls. IL-4 gene expression in the tonsils was lower in PFAPA patients compared to those of the controls (p = 0.04). Proinflammatory, effector, and regulatory cytokine gene expression in tonsil tissue of PFAPA children removed in a noninflammatory asymptomatic interval and in control patients were similar. However, IL-4 cytokine gene expression in the tonsils and peripheral blood eosinophils were lower in the PFAPA patients suggesting a potential pathogenesis pathway based on an inhibition of Th2 responses.

Aporte del estudio endoscópico de la deglución en niños con limitaciones neurológicas / Fiberoptic endoscopic evaluation of swallowing in children with neurologic impairments

Children with neurological disabilities are a healthcare problem with a growing incidence and require a multidisciplinary team for a proper manage. They frequently show swallowing disorders (sD) that must be suspected, diagnosed and treated by specialists. The sD study has several tools that have evolved over time. One of such tools is the fiberoptic endoscopic evaluation of swallowing (Fees). Since its appearance 20 years ago up to our days, Fees has been validated for the study of pharyngeal swallow. Fees are a standardized and systematic study that permits to evaluate the swallowing process through a direct visualization of the upper airways with a nasal flexible endoscopy. Besides the proper equipment, it also requires a full knowledge of pediatric anatomy and training, which can limit its use. It can be easily transported. It does not use radioactive elements which permit repeated and safe use in children. Along with diagnosis, Fees also provides treatment and management recommendations for patients.

Los niños con limitaciones neurológicas son un problema de salud cuya incidencia va en aumento y requiere de un equipo multidisciplinario para su manejo. Frecuentemente presentan trastornos de la deglución (TD) que deben ser sospechados, diagnosticados y manejados por especialistas. En el estudio de los TD existen distintas herramientas que han ido evolucionando en el tiempo. Uno de estos es el estudio endoscópico de la deglución (Fees), que desde su aparición hace 20 años a la actualidad es un examen que ha sido validado para el estudio de la deglución faríngea. La Fees es un estudio estandarizado y sistemático que a través de la visualización directa de las vía aérea superior con un endoscopio flexible nasal, permite la evaluación de la deglución al observar el paso de alimentos. Además del equipo adecuado, requiere un conocimiento acabado de la anatomía pediátrica y entrenamiento por parte del especialista lo que pueden limitar su uso y es fácilmente transportable no utiliza elementos radioactivos lo que permite su uso repetido y seguro en niños. Junto con realizar un diagnóstico la Fees permite entregar las recomendaciones de tratamiento y manejo para el paciente.

Infecciones respiratorias asociadas a traqueostomías en niños / Respiratory infections due to tracheostomy in children

Tracheostomy is the communication between the trachea and the exterior. This procedure is indicated in situations of critical upper airway obstruction or need of long term mechanical ventilation. This condition of airway exposed directly to the environment, without the natural mechanisms of defence, determines a higher risk for infections. This paper seeks defining microbiological situations in patients with tracheostomy and suggests treatment guidelines.

La traqueostomía es un procedimiento que comunica la tráquea con el exterior, indicada en situaciones de obstrucción crítica de la vía aérea alta o necesidad de ventilación mecánica prolongada. Esta situación de comunicación de la vía aérea con el medio, sin los mecanismos de protección naturales, determina un mayor riesgo de infecciones respiratorias. Este artículo busca definir situaciones microbiológicas frecuentes en pacientes con traqueostomía y sugerir líneas de manejo.

Mecanismos de resistencia antimicrobiana en patógenos respiratorios / Antimicrobial resistance mechanisms in respiratory pathogens

Las infecciones del tracto respiratorio representan la indicación más frecuente de antibióticos en pacientes ambulatorios, lo cual se hace sobre bases empíricas. Una falla clínica al tratamiento puede explicarse por resistencia antimicrobiana, que últimamente ha aumentado en patógenos respiratorios. Los microorganismos desarrollan nuevos mecanismos de resistencia antibiótica y comparten virulencia por diversos sistemas. Este fenómeno representa un problema clínico y dificulta el manejo de patologías infecciosas, por lo cual es necesario utilizar nuevas estrategias para el uso adecuado de antimicrobianos. Patógenos respiratorios como S. pneumoniae y S. pyogenes presentan resistencia a betalactámicos por mutaciones en las uniones proteicas a penicilina (PBP) y la resistencia a macrólidos se explica por dos mecanismos: metilación del ribosoma y expulsión del antibiótico por bombas de eflujo;H. ínfluenzae y M. catarrhalis expresan resistencia a betalactßmicos debido a hidrólisis enzimßtica por b-lactamasas.

Respiratory tract infections are the most frequent indication of antibiotics in outpatient settings, based on empirical data. Clinical treatment failure can be explained by antimicrobial resistance, which has recently increased in respiratory pathogens. Microorganisms develop new antimicrobial resistance mechanisms and virulence is shared by different systems. This phenomenon represents a clinical problem and hampers the handling of infectious diseases. It is therefore necessary to utilize new strategies for the appropriate use of antimicrobials. Respiratory pathogens such as S. pneumoniae and S pyogenes present antimicrobial resistance to beta-lactams by mutations in penicilin binding proteins (PBP); resistance to macrolides is explained by two mechanisms: ribosome methylation and antibiotic export by efflux pumps. H. ínfluenzae and M. catarrhalis express beta-lactam resistance due to enzymatic hydrolysis by b-lactamases.

[Disphagia caused by a lingual thyroid: report of one case]. / Tiroides lingual como causa de disfagia: Caso clínico.

We report an 11 year-old boy who presented with difficulty in swallowing without symptoms of hypothyroidism. The physical examination revealed a mass at the base of the tongue. The thyroid hormone profile showed a primary hypothyroidism (a serum TSH of 10.8 IU/mL with normal-low thyroxin of 6.0 microg/dL and low triiodothyronine of 57.8 ng/dL). Antithyroid antibodies were negative. The fiberoptic endoscopy showed a reddish mass, without evidence of haemorrhage or ulceration, confirmed as a well circumscribed, hypodense mass in the base of the tongue by computed tomography of the oropharynx and neck. Tc-99-pertechnetate scanning showed an abnormal area of uptake at the base of the tongue and no uptake in the normal thyroid location, concordant with an ectopic lingual thyroid gland. Levothyroxine in a suppressive dose was started that resulted in a reduction of the size of the mass and disappearance of dysphagia.

Tiroides lingual como causa de disfagia: Caso clínico / Disphagia caused by a lingual thyroid: Report of one case

We report all year-old boy who presented with difficulty in swallowing without symptoms of hypothyroidism. The physical examination revealed a mass at the base of the tongue. The thyroid hormone profile showed a primary hypothyroidism (a serum TSH of 10.8 IU/mL with normal-low thyroxin of 6.0 fig/dL and low triiodothyronine of 57.8 ng/ dL). Antithyroid antibodies were negative. The fiberoptic endoscopy showed a reddish mass, without evidence of haemorrhage or ulceration, confirmed as a well circumscribed, hypodense mass in the base of the tongue by computed tomography of the oropharynx and neck. Tc-99-pertechnetate scanning showed an abnormal area of uptake at the base of the tongue and no uptake in the normal thyroid location, concordant with an ectopic lingual thyroid gland. Levothyroxine in a suppressive dose was started that resulted in a reduction of the size of the mass and disappearance of dysphagia.

Pai syndrome: report of seven South American patients.

Frontonasal dysplasia is etiologically heterogeneous and various subsets are known. Pai syndrome is one subset, which is characterized by mild hypertelorism, midline cleft lip, nasal and facial polyps, pericallosal lipoma, ocular anomalies, and normal neuropsychological development. Here, we report seven South American patients and review earlier reported cases. The phenotype is clinically variable and five reported patients were severely affected. The cause of Pai syndrome is unknown to date. Several literature findings have been noted: nondiagnostic and discordant minor signs in a parent of two separate families with an affected child; discordant phenotype in monozygotic twins in one instance; and a de novo reciprocal translocation, 46,X,t(X;16)(q28;q11.2) in one instance.

Actualización en el manejo médico de la otitis media con efusión y la otitis media aguda / Update on the medical management of the otitis media with effusion and the acute otitis media

La otitis media con efusión y la otitis media aguda son dos patologías frecuentes en la población pediátrica. Existen diversas medidas costo-fectivas para su manejo que permiten optimizar los resultados. Si bien muchas de estas conductas se practican diariamente, la evidencia en torno a ello es escasa y muchas veces débil. Nuevas áreas de investigación sugieren que el screening es una medida efectiva, permitiendo identificar a sujetos de mayor riesgo. El uso de nuevas vacunas no esta recomendado de manera rutinaria.

Rol de los antibióticos en el tratamiento de la otitis media aguda no complicada: revisión bibliográfica / Role of antibiotic therapy in the management of non-complicated acute otitis media: bibliographic review

Este trabajo pretende dar una visión actualizada acerca de este problema, mediante una revisión de los trabajos de mayor relevancia publicados en la literatura, para intentar fundamentar la decisión de utilizar o no antibióticos en pacientes pediátricos que se presentan clínicamente con una OMA no complicada.