Consultas ambulatorias pediátricas atendidas en el servicio de urgencia de un hospital universitario / Pediatric outpatient consultation at the emergency department of a university hospital

Introducción: Conocer el perfil epidemiológico de las consultas pediátricas atendidas en el servicio de urgencia (SU) es esencial para planificar los procesos de atención médica y orientar los programas de educación e investigación. Objetivos: Describir las características de la población infantil y los principales motivos de consulta (MC) atendidos en un SU pediátrico. Pacientes y Método: Estudio clínico descriptivo retrospectivo de las visitas realizadas a un SU infantil en un hospital académico de Santiago durante un período de doce meses. Se analizaron los MC por grupo etario, gravedad, estacionalidad, forma de egreso y frecuencia de visitas recurrentes. Resultados: Se evaluaron 24.531 consultas pediátricas, 51,9 por ciento (n = 12.720) eran varones. La edad de los pacientes osciló entre un día y 15 años, con una mediana de 36,5 meses. El 1,5 por ciento de los pacientes (n = 362) eran recién nacidos (RN), 17,6 por ciento (n = 4.326) lactantes, 51,9 por ciento (n = 12.725) preescolares y 29 por ciento (n = 7.118) escolares. Los principales MC fueron fiebre (n = 6.643, 28,2 por ciento), síntomas gastrointestinales (n = 5.606, 23,8 por ciento) y síntomas respiratorios (n = 5.018, 21,3 por ciento), los cuales no difirieron significativamente según género. La mayoría de los pacientes (95,5 por ciento) fueron enviados a su domicilio. El riesgo de hospitalización fue más elevado en los RN y en aquellos que consultaron por ictericia (OR = 7,20; IC 95 por ciento 3,12-16,6), síntomas neurológicos (OR = 6,90; IC 95 por ciento 4,60-10,4) e intoxicaciones (OR = 6,45; IC 95 por ciento 2,82-14,7). Alrededor del 4 por ciento fueron consultas repetidas, especialmente en los RN. Conclusiones: El perfil epidemiológico de las consultas pediátricas atendidas en el SU fue similar al descrito en estudios internacionales. Sin embargo, encontramos una menor tasa de hospitalización a pesar que los pacientes presentaban un perfil de riesgo similar en la admisión al SU.

Introduction: To determine the epidemiological profile of pediatric consultations treated at the emergency department (ED) is essential for planning processes of medical care and to guide education programs and research. Objectives: To describe the characteristics of the child population and the main reasons for consultation (RFC) seen in a pediatric emergency service. Patients and Method: A retrospective, descriptive clinical study was conducted regarding the visits to the Children's Emergency Service of an academic hospital in Santiago, for a period of twelve months. RFC were analyzed by age group, severity, seasonality, disposition and frequency of recurrent visits. Results: 24,531 pediatric consultations were evaluated, 51.9 percent were male (n = 12,720). The age of the patients ranged between one day old and 15 years, with a median age of 36.5 months. 1.5 percent of patients were newborns (NB), 17.6 percent were infants (n = 4,326), 51.9 percent were preschoolers (n = 12,725) and 29 percent were school children (n = 7,118). Major RFC were fever (n = 6,643, 28.2 percent), gastrointestinal symptoms (n = 5,606, 23.8 percent) and respiratory symptoms (n = 5,018, 21.3 percent), which did not differ significantly according to gender. Most patients (95.5 percent) were sent to their homes. The risk of hospitalization was more elevated in NB and in those with jaundice (OR = 7.20, 95 percent CI 3.12 to 16.6), neurological symptoms (OR = 6.90, 95 percent CI 4.60 -10.4) and poisoning (OR = 6.45, 95 percent CI 2.82 to 14.7). About 4 percent were repeat visits, especially in the NB group. Conclusions: The epidemiological profile of pediatric consultations seen at the ED was similar to that described in previous studies. However, a lower rate of hospitalization was found even though the patients had similar risk profile.

[Pediatric outpatient consultation at the emergency department of a university hospital]. / Consultas ambulatorias pediátricas atendidas en el Servicio de Urgencia de un hospital universitario.

INTRODUCTION: To determine the epidemiological profile of pediatric consultations treated at the emergency department (ED) is essential for planning processes of medical care and to guide education programs and research. OBJECTIVES: To describe the characteristics of the child population and the main reasons for consultation (RFC) seen in a pediatric emergency service. PATIENTS AND METHOD: A retrospective, descriptive clinical study was conducted regarding the visits to the Children's Emergency Service of an academic hospital in Santiago, for a period of twelve months. RFC were analyzed by age group, severity, seasonality, disposition and frequency of recurrent visits. RESULTS: 24,531 pediatric consultations were evaluated, 51.9% were male (n=12,720). The age of the patients ranged between one day old and 15 years, with a median age of 36.5 months. 1.5% of patients were newborns (NB), 17.6% were infants (n=4,326), 51.9% were preschoolers (n=12,725) and 29% were school children (n=7,118). Major RFC were fever (n=6,643, 28.2%), gastrointestinal symptoms (n=5,606, 23.8%) and respiratory symptoms (n=5,018, 21.3%), which did not differ significantly according to gender. Most patients (95.5%) were sent to their homes. The risk of hospitalization was more elevated in NB and in those with jaundice (OR=7.20, 95% CI 3.12 to 16.6), neurological symptoms (OR=6.90, 95% CI 4.60 -10.4) and poisoning (OR=6.45, 95% CI 2.82 to 14.7). About 4% were repeat visits, especially in the NB group. CONCLUSIONS: The epidemiological profile of pediatric consultations seen at the ED was similar to that described in previous studies. However, a lower rate of hospitalization was found even though the patients had similar risk profile.

Importancia actual de la vitamina D: déficit prevalente y asociación a diversas patologías / Current importance of vitamin D

En los últimos años se ha detectado una epidemia mundial de bajos niveles de vitamina D en la población general, la que ha alertado sobre su correlación con diversas enfermedades. Hay muchas razones que pueden ser las causales de este importante problema, siendo la baja exposición a luz solar uno de los principales. Nuestra especialidad juega un rol central en promover una foto exposición más saludable o suplementando a pacientes de alto riesgo para lograr niveles adecuados de esta vitamina. En nuestra revisión analizamos brevemente las causas de bajos niveles de vitamina D, sus funciones y las recientes correlaciones de su déficit con varias condiciones, entre ellas; el cáncer de piel, atopia y enfermedades autoinmunes. Finalmente recomendamos búsqueda activa y suplementación cuando sea necesario.

In the last few years, a worldwide epidemic of low levels of vitamin D in general population has been discovered, raising an alert about its correlation with health problems. Many reasons may be responsible for this important problem, and insufficient exposure to sunlight may be the main one. Our specialty has a key role in promoting a healthy sun exposure or supplementing high risk patients, to keep adequate levels of this vitamin. In our review, we analyze briefly the causes for low levels of vitamin D, its functions and newly discovered correlations with diseases, including skin cancer, atopy and autoimmune conditions. Finally we recommend screening and supplementation, when necessary.

Bocavirus humano en Chile: características clínicas y epidemiológicas en niños con infecciones respiratorias / Human bocavirus in Chile: clinical characteristics and epidemiological profile in children with acute respiratory tract infections

Background: Human bocavirus (HBoV) is a newly discovered parvovirus found in children with acute respiratory tract infections (ARTI). Objectives: To describe the epidemiological and clinical profile of children < 5 years old consulting for ARTI, comparing cases of HBoV monoinfection and coinfection with other known respiratory viruses. Furthermore, we aimed to estimate the prevalence of viral shedding in asymptomatic children and perform phylogenetic analysis. Patients and Methods: We investigated the presence of HBoV in nasopharyngeal secretions from children consulting for AlRTI and among asymptomatic controls, between 2007 and 2008, by polymerase chain reaction. Results: HBoV was detected in 79 (21.8 percent) of 362 nasopharyngeal swabs obtained from children with ARTI. In 60/79 (76 percent), coinfection with other respiratory viruses was confirmed. Most common symptoms were cough, fever and rhinorrhea. Children infected only with HBoV showed significantly lower frequencies of respiratory distress, oxygen requirements and hospital admission than those with coinfection. HBoV was detected in 6/16 (37.5 percent) samples from asymptomatic children. The phylogenetic analysis of viruses from Chilean patients revealed that circulating HBoV was closely related to original strains. Conclusions: HBoV was found either in symptomatic and asymptomatic children. The severity of the disease was greater when HBoV was associated to other respiratory viruses.

Introducción: Bocavirus humano (HBoV) es un nuevo parvovirus encontrado en niños con infecciones respiratorias agudas (IRA). Objetivos: Describir la epidemiología y perfil clínico en niños < 5 años con IRA, comparando aquellos con HBoV como único agente identificado, con los que tenían co-infección con otro virus respiratorio. Además se evaluó su prevalencia en niños asintomáticos, y se realizó análisis filogenético. Materiales y Métodos: Se investigó la presencia de HBoV, por medio de reacción de polimerasa en cadena, en muestras de secreción nasofaríngea obtenida en niños con IRA y en controles asintomáticos, entre 2007 y 2008. Resultados: Se detectó HBoV en 79 (21,8 por ciento) de 362 muestras obtenidas en pacientes con IRA. En 60/79 (76 por ciento), se demostró co-infección. Los síntomas más frecuentes fueron tos, fiebre y rinorrea. Los pacientes con HBoV como único agente identificado mostraron frecuencias significativamente menores de dificultad respiratoria, requerimiento de oxígeno y hospitalización, comparado con los co-infectados. HBoV se detectó en 6/16 (37,5 por ciento) muestras de niños asintomáticos. El análisis filogenético de las cepas chilenas demuestra estrecha relación con las cepas originales. Conclusiones: HBoV está presente en niños chilenos con IRA y asintomáticos. La gravedad de la enfermedad fue mayor en el grupo con co-infección.

[Kawasaki disease: a clinical serie]. / Enfermedad de Kawasaki: una serie clínica.

INTRODUCTION: Kawasaki disease (KD) is a serious disease in children due to its potential complications and sequelae if not promptly and adequately managed. OBJECTIVES: To describe clinical and epidemiological characteristics of children hospitalized due to KD at a tertiary care center and identify risk factors for poor outcome. PATIENTS AND METHODS: Retrospective and descriptive study of 32 medical records of patients hospitalized with diagnosis of KD at a tertiary care center of Santiago, Chile between February 1999 and May 2007. RESULTS: The annual frequency was of 5 cases, mainly boys and during spring. The median age at diagnosis was 1.5 years and 87.5% of the children were younger than 5 years. Typical presentation prevailed in all ages (68,7%). Coronary artery affection, including dilatation or aneurisms, occurred in 21.9% of the cases, with aneurysms in 3 cases. All patients were treated with aspirin and intravenous immunoglobulin (IVIG); 4 patients required a second dose. No deaths were reported. The identified risk factors for poor outcome were age older than 5 years and hypoalbuminemia. CONCLUSIONS: KD is an infrequent disease that mainly occurs in children younger than 5 years and with a typical presentation. There are risk factors associated with poor outcome.

Enfermedad de Kawasaki: una serie clínica / Kawasaki disease: a clinical serie

Introduction: Kawasaki disease (KD) is a serious disease in children due to its potential complications and sequelae if not promptly and adequately managed. Objectives: To describe clinical and epidemiological characteristics of children hospitalized due to KD at a tertiary care center and identify risk factors for poor outcome. Patients and Methods: Retrospective and descriptive study of 32 medical records of patients hospitalized with diagnosis of KD at a tertiary care center of Santiago, Chile between February 1999 and May 2007. Results: The annual frequency was of 5 cases, mainly boys and during spring. The median age at diagnosis was 1.5 years and 87.5 percent of the children were younger than 5 years. Typical presentation prevailed in all ages (68,7 percent). Coronary artery affection, including dilatation or aneurisms, occurred in 21.9 percent of the cases, with aneurysms in 3 cases. All patients were treated with aspirin and intravenous immunoglobulin (IVIG); 4 patients required a second dose. No deaths were reported. The identified risk factors for poor outcome were age older than 5 years and hypoalbumin-emia. Conclusions: KD is an infrequent disease that mainly occurs in children younger than 5 years and with a typical presentation. There are risk factors associated with poor outcome.

Introducción: La enfermedad de Kawasaki (EK) es una afección grave en pediatría, por sus eventuales complicaciones y secuelas si no es tratada adecuada y precozmente. Objetivos: Describir el perfil clínico-epidemiológico de los niños hospitalizados en una clínica de la Región Metropolitana e identificar factores de riesgo para evolución desfavorable. Pacientes y Métodos: Estudio descriptivo, retrospectivo, de 32 pacientes hospitalizados en la Clínica Santa María con diagnóstico de egreso de EK entre febrero de 1999 y mayo de 2007. Resultados: La frecuencia anual fue de 5 casos, con predominio en primavera y en el sexo masculino. La mediana para la edad fue de 1,5 años, 87,5 por ciento tenían menos de 5 años. Predominó la presentación típica (68,7 por ciento). Hubo dilatación y/o aneurisma de arterias coronarias en 21,9 por ciento, con 3 casos de aneurismas. El tratamiento se realizó con inmunoglobulina intravenosa (IGIV) y ácido acetilsalicílico. Cuatro pacientes requirieron una segunda dosis de IGIV. No hubo fallecidos. Como factores de riesgo para mala evolución se encontraron la edad de presentación sobre 5 años y la hipoalbuminemia. Conclusiones: La EK es una patología poco frecuente, predominante en niños bajo 5 años de edad y con presentación típica. Sugieren evolución de mayor gravedad la presentación sobre los 5 años y la hipoalbuminemia a cualquier edad.

[Human bocavirus in Chile: clinical characteristics and epidemiological profile in children with acute respiratory tract infections]. / Bocavirus humano en Chile: características clínicas y epidemiológicas en niños con infecciones respiratorias.

BACKGROUND: Human bocavirus (HBoV) is a newly discovered parvovirus found in children with acute respiratory tract infections (ARTI). OBJECTIVES: To describe the epidemiological and clinical profile of children < 5 years old consulting for ARTI, comparing cases of HBoV monoinfection and coinfection with other known respiratory viruses. Furthermore, we aimed to estimate the prevalence of viral shedding in asymptomatic children and perform phylogenetic analysis. PATIENTS AND METHODS: We investigated the presence of HBoV in nasopharyngeal secretions from children consulting for AlRTI and among asymptomatic controls, between 2007 and 2008, by polymerase chain reaction. RESULTS: HBoV was detected in 79 (21.8%) of 362 nasopharyngeal swabs obtained from children with ARTI. In 60/79 (76%), coinfection with other respiratory viruses was confirmed. Most common symptoms were cough, fever and rhinorrhea. Children infected only with HBoV showed significantly lower frequencies of respiratory distress, oxygen requirements and hospital admission than those with coinfection. HBoV was detected in 6/16 (37.5%) samples from asymptomatic children. The phylogenetic analysis of viruses from Chilean patients revealed that circulating HBoV was closely related to original strains. CONCLUSIONS: HBoV was found either in symptomatic and asymptomatic children. The severity of the disease was greater when HBoV was associated to other respiratory viruses.

Índice glcémico e insulinemico de dos tipos de pasta de presentación larga y corta en individuos sanos / Glycemic and insulinemic index of two types pasta of short and long presentation in healthy subjects

AIM: To measure the glucose and insulin responses of a standard dry pasta and a dry pasta enriched with egg in their long and short presentation. MATERIAL AND METHODS: The glycemic index (GI) and the insulin index (II) were determined in a randomized, cross over protocol in 10 healthy volunteers between 26 and 58 years of age. Each subject underwent ten tests: six with the standard meal (bread) and four with the study pastas. Every study pasta was evaluated 10 times. Blood glucose and insulin levels were measured in the fasted state and over the 180 min following commencement of consumption of the foods. The Area Under the Curve (AUC) was calculated for the values above baseline for the 3-hour period following the meal. GI and II were calculated as the ratio of glucose and insulin Auks for a given test meal and the AUCs for the standard meal. RESULTS: Both type of pasta in their long and short presentation had lower GI than the standard meal (long pasta A: 47.8+/-54.4 percent, pasta B: 58.6+/-95.4 percent; short pasta A:71.4+/-32.8, pasta B: 79.9+/-47.6 percent percent p<.001). The II was lower with the two type of large pasta compare to the standard meal and to the two type of short pasta (p<.005). CONCLUSIONS: This study has shown that dry pasta with or without addition of egg put in the mass, is low Gl food. Long dry pasta has lower insulin response.

Introducción: Las pastas secas (industrializadas) se caracterizan por ser manufacturadas a base de harina dura de trigo y otros cereales, llamado semolina, a diferencia del pan que se prepara con harina fina, lo que supone que la respuesta insulinémica y glicémica debiera ser menor que la del pan. Objetivo: Medir la respuesta glicémica e insulinsulinémica de una pasta seca estándar y una pasta seca enriquecida con huevo, de presentación larga (espagueti) y corta (corbata). Material y Métodos: El índice glicémico (IG) e índice insulinémico (II) se determinaron en 10 sujetos sanos entre 26 y 58 años de edad. En forma aleatoria a cada sujeto se le midió la glicemia e insulina en ayuno y después de ingerir en forma isoglucídica alimento estándar (pan marraqueta) o los 2 tipos de pasta en presentación larga o corta a los 15,45,60,90,120,150 y 180 minutos. Posteriormente se calculó el área bajo la curva (ABC) de glucosa e insulina en cada sujeto. Los IG e II fueron calculados como la razón entre el ABC para un alimento de prueba dado y el ABC del alimento estándar (considerado el 100 por ciento). RESULTADOS : Ambos tipos de pasta en presentación larga y corta presentaron menor IG que el alimento estándar (marraqueta) ( pasta larga A: 47,8+/-54,4, pasta larga B: 58,6+/-95,4 por ciento; pasta corta A:71,4+/-32,8 por ciento, pasta corta B: 79,9+/-4,.6 por ciento p<001). El II de los dos tipos de pasta larga fue menor que el alimento estándar y los mismos tipos de pasta, pero cortas (p<.005). El II de las pastas cortas no se diferenció del alimento estándar. Conclusión: Este estudio demostró que las pastas secas con o sin adición de huevo tienen una menor respuesta glicémica que el alimento estándar, por lo tanto, se pueden clasificar como alimento de bajo IG. Además las pastas de presentación larga tienen una menor respuesta insulinémica.

Ingesta de alimentos de origen animal versus origen vegetal y riesgo cardiovascular / Intake of animal versus vegetable food and cardiovascular risk

Cardiovascular mortality has been associated with changes in lifestyle and food habits. The occidental diet has been characterized by high intake of animal fat and meat, and it is associated whit increased risk of type 2 diabetes and high blood pressure, an increase in levels of markers of endothelial dysfunction, and presence of pro-thrombotic risk factors. We search the Pubmed database and other review references. Inclusion criteria were: papers published after 1999, randomized controled clinical studies, case-control studies, systematic reviews and methanalyses. Vegetarians groups show less cardiovascular morbidity and mortality than non-vegetarians. The evidence indicated that a decreasing intake of red meat, saturate fat, trans fat, and mainly processed meat, and an increase in the intake of whole grain cereals, fruits, vegetables and fish, are associated with a better overall cardiovascular health and survival.

El aumento de la mortalidad cardiovascular en el último tiempo está fuertemente asociado a cambios en los hábitos de alimentación. La dieta occidental caracterizada por una alta ingesta de alimentos de origen animal, presenta mayor riesgo de diabetes tipo 2 (DM 2), hipertensión arterial (HTA), aumento de marcadores de disfunción endotelial y factores protrombóticos. La búsqueda se realizó en la biblioteca online Pubmed y en referencias de otras revisiones. Los criterios de inclusión fueron: artículos de 1999 en adelante, ensayos clínicos aleatorizados-controlados, estudios caso-control, revisiones sistemáticas y meta análisis. En grupos con alto consumo de alimentos de origen vegetal se ha evidenciado una menor morbi-mortalidad cardiovascular, comparado con los grupos con alta ingesta de alimentos de origen animal. La evidencia apoya que la disminución en el consumo de carnes rojas, grasas saturadas y grasas trans, así como el aumento en el consumo de cereales integrales, frutas, vegetales y pescado, disminuye la morbi-mortalidad global y cardiovascular.

¿Es efectiva la consejería para aumentar el consumo de frutas y verduras y disminuir el riesgo cardiovascular en prevención secundaria?: una revisión / Is counseling an effective strategy to increase fruits and vegetables consumption and decrease the cardiovascular risk in secondary prevention?: a review

Introducción: El consumo de frutas y verduras, dado su alto contenido de fibra y antioxidantes, se ha asociado a una mejoría de algunos de los parámetros biológicos que modifican el riesgo cardiovascular, como el colesterol total, colesterol LDL y la presión arterial. Dentro de las estrategias dirigidas a aumentar la ingesta de vegetales, la consejería es una de las más estudiadas. Métodos: se realizó una búsqueda en la base de datos MEDLINE, y en referencias de otras revisiones. Resultados: se revisaron 42 resúmenes (36 de MEDLINE y 6 de la revisión del United States Preventive Service Task Forcé) de los cuales se seleccionaron 30. De estos 30, 8 cumplieron con los criterios de inclusión. Se encontró evidencia epidemiológica sólida que asoció el consumo de frutas y verduras a una disminución del riesgo cardiovascular (RCV). No encontramos evidencia suficiente respecto a la efectividad de la consejería para modificar el perfil de riesgo en prevención secundaria. Conclusiones: la consejería produce cambios modestos en la dieta y el perfil de riesgo en pacientes sanos, sin embargo se necesita más información respecto su efectividad en pacientes con enfermedad CV y a sus efectos a largo plazo.

Introduction: Consumption of fruits and vegetables, due to their high fiber and antioxidant contain, has been associated with an improvement in some biological parameters that modify cardiovascular risk, such as total cholesterol, LDL cholesterol and blood pressure. One of the most investigated strategies to increase the consumption of vegetables is counselling. Method: We searched the MEDLINE database and other review references. Results: 42 abstraéis were reviewed (36from MEDLINE and 6 of United States Preventive Service Task Force Review) and 30 were selected. Of the 30, 8 match with the inclusion criteria. We found solid epidemiological evidence that showed the association between the intake of fruits and vegetables and cardiovascular risk factors. We did not find enough evidence to demonstrate that counselling is effective in modifying the risk profile in secondary prevention. Conclusion: counselling produces modest changes in the diet and the risk profile in healthy patients, but there is still a need for more information about its effectiveness in long term changes in patients with high cardiovascular risk.

[Etiology of acute fever without source in infants consulting at an emergency department]. / Etiología del síndrome febril agudo sin foco en niños bajo 36 meses de edad que consultan a un servicio de urgencia.

UNLABELLED: Fever is a frequent symptom of consultation in Pediatric Emergency Department. OBJECTIVES: to describe causes of acute fever of unknown origin (FUO) in infants under 36 months of age, the utility of requested tests and pediatrician decisions. PATIENTS AND METHODS: 309 cards of children under 36 months who consulted at Emergency Department for acute FUO were reviewed. RESULTS: 64 % were classified with well clinical condition. Most frequent causes were: probable viral respiratory infections (72%), urinary tract infection (7.4%), pneumonia (2.9%), bacteremia (1.9%), and bacterial meningitis (1.3%). Streptococcus pneumoniae was the most frequent agent isolated from blood cultures. Tests of best utility were: urine analysis and urine culture. Leukocytes count < 15.000/mm(3) and PCR < 4.0 mg/dl had a negative predictive value of 96 %. Nine point seven percent of the patients were hospitalized, while 14.2% received antibiotic treatment at home. CONCLUSIONS: We suggest to perform urine analysis and culture as the initial study for children with acute FUO and well clinical condition.

Etiología del síndrome febril agudo sin foco en niños bajo 36 meses de edad que consultan a un servicio de urgencia / Etiology of acute fever without source in infants consulting at an emergency department

La fiebre es uno de los síntomas frecuentes de consulta en Servicios de Urgencia pediátricos. Objetivos: Describir causas del síndrome febril agudo sin foco evidente (SFASF) en niños bajo 36 meses de edad, utilidad de exámenes solicitados y conducta del médico. Pacientes y Métodos: Se analizaron 309 fichas de niños bajo 36 meses, que consultaron en el servicio de urgencia por SFASF. Resultados: 64 por ciento fue catalogado de buen aspecto clínico al ingreso. Las causas más frecuentes fueron infecciones probablemente virales respiratorias 72 por ciento, infección urinaria 7,4 por ciento, neumonía 2,9 por ciento, bacteriemia 1,9 por ciento y meningitis bacteriana 1,3 por ciento. Streptococcus pneumoniae fue el agente más frecuentemente aislado de sangre. Los exámenes de mayor utilidad fueron sedimento de orina y urocultivo. Un recuento de leucocitos < 15.000/mm³ y PCR < 4,0 mg/dL tuvieron un valor predictor negativo de 96 por ciento. Se hospitalizó a 9,7 por ciento de los niños, 14,2 por ciento recibió antimicrobianos ambulatorios. Conclusiones: Sugerimos como estudio inicial del niño con SFASF y de buen aspecto general, la realización de un examen de orina con urocultivo.

Fever is a frequent symptom of consultation in Pediatric Emergency Department. Objectives: to describe causes of acute fever of unknown origin (FUO) in infants under 36 months of age, the utility of requested tests and pediatrician decisions. Patients and Methods: 309 cards of children under 36 months who consulted at Emergency Department for acute FUO were reviewed. Results: 64 percent were classified with well clinical condition. Most frequent causes were: probable viral respiratory infections (72 percent), urinary tract infection (7.4 percent), pneumonia (2.9 percent), bacteremia (1.9 percent), and bacterial meningitis (1.3 percent). Streptococcus pneumoniae was the most frequent agent isolated from blood cultures. Tests of best utility were: urine analysis and urine culture. Leukocytes count < 15.000/mm³ and PCR < 4.0 mg/dl had a negative predictive value of 96 percent. Nine point seven percent of the patients were hospitalized, while 14.2 percent received antibiotic treatment at home. Conclusions: We suggest to perform urine analysis and culture as the initial study for children with acute FUO and well clinical condition.

Infección del tracto urinario en un servicio de urgencia pediátrico: Frecuencia y características clínicas / Urinary tract infection in a pediatrics emergency department: Frequency and clinical parameters

La infección del tracto urinario (ITU) es una de las infecciones bacterianas frecuentes en pediatría. Con el objetivo de caracterizar niños con ITU que consultan en un servicio de urgencia (SU) chileno, se revisaron 18.302 consultas pediátricas, donde se solicitó urocultivo a 1.173, de ellos 246 fueron positivos. La frecuencia de ITU fue de 1,34% en el total de consultas y de 21% en quienes se solicitó urocultivo. El riesgo relativo para ITU fue 1,78 veces mayor en mujeres. La presentación clínica principal fue fiebre y molestias urinarias. Sobre 2 años de edad fueron factores de riesgo la presencia de molestias urinarias e ITU previa. El agente más frecuentemente aislado fue Escherichia coli (86%). Se hospitalizó el 9% de los niños con ITU. La ITU es frecuente en consultantes al SU pediátrico debiendo considerarse el análisis de orina en lactantes febriles, especialmente varones bajo 12 meses de edad.

[Urinary tract infection in a pediatrics emergency department: frequency and clinical parameters]. / Infección del tracto urinario en un servicio de urgencia pediátrico: Frecuencia y características clínicas.

Urinary tract infection (UTI) is a frequent bacterial infection in children. The objective was to define the profile of children with UTI that consulted in a Chilean pediatric emergency department (PED). We reviewed 18302 consultants and identified 1173 patients in whom urine culture (UC) were obtained. UC was positive in 264 cases. UTI represented 1.34% from total consultants and 21% from whom UC were obtained. UTI was 1.78 times more frequent in girls. The most common clinical presentation was fever and urinary tract symptoms. In older than 2 years, urinary tract symptoms and previous UTI, was a risk factor for UTI. The most frequent organism isolated was Escherichia coli (86%). Nine percent of child with UTI were hospitalized. UTI is a frequent diagnosis in PED and is important to consider urinalysis in febrile infants, especially boys younger than 12 months.

La mantención de peso en humanos podría ser equivalente a la restricción calórica de los modelos animales? / Weight maintenance in humans. Could it mimic calorie restriction of animal models?

BACKGROUND: Energy restriction (ER) extends life span in animals, by decreasing oxidative stress. AIM: To compare adiposity, metabolic variables and DNA oxidative damage, among adults, reporting a constant body weight (weight maintainers), versus those reporting a progressive increase (weight gainers). SUBJECTS AND METHODS: Clinical history, dietary recall, anthropometric measures, abdominal CT scan and fasting blood samples (to measure lipoproteins, glucose and insulin), were obtained in 44 males. These subjects were classified as weight maintainers if they had a change in weight of 3 kg or less in the last 10 years, or weight gainers, if they had a weight increment of more than 6 kg, in the same lapse. Oxidative damage was assessed by 8-hydroxydeoxyguanosine (8-OHdG), in DNA extracted from circulating lymphocytes, in 5 weight maintainers, 8 weight gainers and 5 healthy elders. RESULTS: Energy Intake was 18% higher in weight gainers (p <0.01). Adiposity and central fat were higher among weight gainers (p <0.01). Abdominal fat correlated with serum lipoproteins, glucose and insulin sensitivity, assessed by the Homeostasis Model Assessment (HOMA). 8-OHdG levels did not differ between groups. CONCLUSIONS: The analysis of weight change based on the clinical history correlates with actual body composition, thus it may be a reliable indicator of long term energy Intake. This method could be comparable to weight clamp models employed in animals to study aging.

Infección por virus de inmunodeficiencia humana, embarazo y deseo de reproducción: Comité de SIDA Pediátrico Sociedad Chilena de Pediatría / Human immunodeficiency infection, pregnancy and family planning: Pediatric AIDS Committee, Chilean Pediatric Society

El avance del conocimiento sobre la infección por el virus de la inmunodeficiencia humana durante las últimas décadas ha determinado cambios notables en el tratamiento y pronóstico de la enfermedad. La mejoría de la sobrevida y la disminución de la transmisión perinatal constituyen dos hechos importantes que modifican las recomendaciones sobre el embarazo y deseo de reproducción en mujeres infectadas con este virus. Los argumentos médicos, legales, morales y éticos apoyan a las parejas que conviven con el VIH en su deseo de ser padres y los pone en situación similar a parejas que padecen de otras patologías crónicas como diabetes mellitus o insuficiencia renal.

Complicaciones en niños con varicela en cuatro hospitales de Santiago-Chile: espectro clínico y estimación de costos directos / Varicella complications requiring hospitalization in four hospitals in Santiago, Chile: clinical spectrum and estimation of direct costs

Background: The knowledge of varicella complications and their associated cost may help for a better evaluation of varicella immunization benefits. Aim: To determine frequency, type, outcome and affected population of varicella complications in children requiring hospitalization, and to estimate their direct costs. Material and methods: Retrospective analysis of medical records of children admitted to four hospitals in Santiago, Chile, due to varicella complications between January 1997 and February 1999. Calculation of direct costs of hospitalizations in a sample of 30 patients. Results: One hundred fifty four patients were identified, 74 percent were younger than 5 years old, only one was immunocompromised. Complications identified were skin and soft tissue infections in 63 percent, invasive infections in 25,3 percent, neurological in 7.1 percent and miscellaneous in 4,5 percent. Staphylococcus aureus and Group A ß-haemolytic Streptococcus (GABS) were predominantly isolated. S. aureus was the main agent identified in superficial infections and GABS in invasive infections (sterile sites). Two patients died due to invasive infections (streptococcal toxic shock and S. aureus septicaemia) and 11 required surgical procedures. The average cost per hospitalization was US$ 600 in public hospitals and US$ 1,800 in the private hospital. Conclusions: Varicella complications requiring hospitalization are due mainly to bacterial infections and they affect immunocompetent toddlers. These complications can be severe and even fatal