Postinfectious bronchiolitis obliterans in children: the South American contribution.

UNLABELLED: Postinfectious bronchiolitis obliterans (PIBO) is an infrequent chronic lung that causes irreversible obstruction and, or, obliteration of the smaller airways. This review particularly focuses on more than 30 studies from South America. CONCLUSION: The initial PIBO event occurs in the early years of life and is strongly associated with adenovirus infection and the need for mechanical ventilator support. Treatment requires a multidisciplinary strategy. Multicentre studies are needed to determine progression, optimal management and long-term follow-up.

[Clinical characteristics of respiratory infection due to Mycoplasma pneumoniae in hospitalized children]. / Características clínicas de la enfermedad respiratoria causada por Mycoplasma pneumoniae en niños hospitalizados.

INTRODUCTION: Studies on Mycoplasma pneumoniae infection are scarce in Chile. OBJECTIVE: To describe clinical characteristics associated with M. pneumoniae in children requiring hospitalization. MATERIAL AND METHODS: All children with a respiratory infection requiring hospitalizations between 2000-2005, whom had a M. pneumoniae specific IgM > or = 1:32, were analyzed. RESULTS: Fifty children meeting study criteria were identified with an average length of hospitalization of 4 days (range: 1-10); mean age was 5.4 years (46% were younger than 5 years). Common clinical features were cough (92%), fever (82%), malaise (74%) and respiratory distress (72%). At admission 40/45 children had hypoxemia. Chest-X ray showed interstitial pattern (69.3%), consolidation (51%) and hyperinsuflation (28.5%). Six patients had pleural effusion. Eighty four percent of patients had a favorable clinical outcome; eight children required admission to the PICU all of whom recovered. CONCLUSION: Respiratory infections associated with M. pneumoniae in our series of children had a highly variable and non-specific clinical spectrum. Chest-X rays showed different pattern in concordance with previous publications.

Características clínicas de la enfermedad respiratoria causada por Mycoplasma pneumoniae en niños hospitalizados / Clinical characterizes of respiratory infection due to Mycoplasma pneumoniae in hospitalized children

Introduction: Studies onMycoplasmapneumoniae infection are scarce in Chile. Objective: To describe clinical characteristics associated withM. pneumoniae in children requiring hospitalization. Material and Methods: All children with a respiratory infection requiring hospitalizations between 2000-2005, whom had aM. pneumoniae specific IgM ≥ 1:32, were analyzed. Results: Fifty children meeting study criteria were identified with an ave-rage length of hospitalization of 4 days (range: 1-10); mean age was 5.4 years (46 percent were younger than 5 years). Common clinical features were cough (92 percent), fever (82 percent), malaise (74 percent) and respiratory distress (72 percent). At admission 40/45 children had hypoxemia. Chest-X ray showed interstitial pattern (69.3 percent), consolidation (51 percent) and hyperinsuflation (28.5 percent). Six patients had pleural effusion. Eighty four percent of patients had a favorable clinical outcome; eight children required admission to the PICU all of whom recovered. Conclusión: Respiratory infections associated withM. pneumoniae in our series of children had a highly variable and non-specific clinical spectrum. Chest-X rays showed different pattern in concordance with previous publications.

Introducción: La infección por Mycoplasma pneumoniae es una condición respiratoria poco estudiada en nuestro medio. Objetivo: Describir las características clínicas de los niños hospitalizados porM. pneumoniae. Materiales y Métodos: Se analizaron todos los pacientes hospitalizados por infecciones respiratorias durante el 2000-2005, con IgM específica; se utilizó como diagnóstico de enfermedad por M. pneumoniae la presencia de fluorescencia verde manzana 2 a 3 positivo en títulos ≥ 1:32 diluciones. Resultados: Se analizaron 50 hospitalizaciones, con estadía promedio de 4 días (rango: 1-10); la edad promedio fue 5,4 años (46 por ciento bajo 5 años). Los síntomas más frecuentes fueron tos (92 por ciento), fiebre (82 por ciento), compromiso del estado general (74 por ciento) y dificultad respiratoria (72 por ciento). Al momento del ingreso 40/45 presentaron hipoxemia. La radiografía de tórax (RT) reveló infiltrado intersticial (69,3 por ciento), foco de consolidación (51 por ciento) e hi-perinsuflación (28,5 por ciento). Seis presentaron efusión pleural asociada. En 84 por ciento la evolución fue favorable; sin embargo, 8 niños ingresaron a la Unidad de Paciente Critico para monitorización. No hubo decesos Conclusiones: La infección respiratoria asociada aM. pneumoniae en niños produjo manifestaciones inespecíficas y variables de un caso a otro. La RT reveló una variedad de presentaciones similar a lo mostrado en la literatura médica.

Eficacia y seguridad de la vacuna influenza en niños: detrás de la evidencia / Effectiveness and safety of influenza vaccine in children

La infección por virus Influenza es una enfermedad respiratoria aguda que se asocia a una elevada tasa de morbilidad y mortalidad. Todos los niños son susceptibles de desarrollar la infección, por lo que la mejor estrategia de prevención podría ser la vacunación universal pediátrica. Tradicionalmente,han sido reconocidos ciertos sujetos de mayor riesgo de desarrollar complicaciones. Si bien existe mucha evidencia que demuestra que la vacuna anti-influenza puede prevenir síntomas respiratorios, hospitalizaciones y muertes; recientemente, algunas publicaciones han mostrado resultados conflictivos revelando inconsistencias en las actuales indicaciones en términos de eficacia y efectividad. El presente artículo, revisa la evidencia publicada en torno a esta interesante controversia médica.

Guía clínica para el diagnóstico y cuidado de niños/adolescentes con bronquiolitis obliterante post-infecciosa, 2009 / Clinical guide for diagnosis and care of children and adolescents with post-infectious bronchiolitis obliterans, 2009

Bronchiolitis obliterans in children is an infrequent clinical syndrome, characterized by chronic airflow obstruction associated to inflammatory changes and different degrees of fibrosis in the small airways. Etiologies are varied but the most frequent one is the association with viral infections, mainly adenovirus. There is no consensus regarding diagnostic criteria, but a spectrum of persistent symptoms together with a mosaic pattern, bronchiectasis and persistent atelectasis is considered useful. Pulmonary biopsy has been questioned because of its low yield, invasiveness and complications. No specific treatment is available, therefore its treatment is supportive. Probably the best strategy is the aggressive use of antibiotics, constant kinesic and nutritional support and early pulmonary rehabilitation. This clinical guide represents a multidisciplinary effort, based on current evidence, to provide practical tools for the diagnosis and care of children and adolescents affected by post-infectious bronchiolitis obliterans.

La bronquiolitis obliterante (BO) es un síndrome clínico poco frecuente en niños, caracterizado por la obstrucción crónica al flujo de aire asociado a cambios inflamatorios y distintos grados de fibrosis en la vía aérea pequeña. Si bien existen muchas etiologías, la causa más frecuente se asocia a infecciones respiratorias virales, principalmente adenovirus. No existe un consenso para establecer su diagnóstico; sin embargo, se considera un espectro de síntomas persistentes asociados a un patrón en mosaico, bronquiectasias y atelectasias persistentes. El papel de la biopsia pulmonar ha sido cuestionado por su bajo rendimiento, invasividad y complicaciones. No existe un tratamiento específico por lo que el manejo es soporte. Probablemente la mejor estrategia constituya el empleo de antibióticos en forma agresiva, soporte kinésico y nutricional constante y una precoz rehabilitación pulmonar. Estas guías clínicas representan un esfuerzo multidisciplinario, basado en evidencias actuales para brindar herramientas prácticas para el diagnóstico y cuidado de niños y adolescentes con BO post infecciosa.

Guía clínica para el diagnóstico y cuidado de niños/adolescentes con bronquiolitis obliterante post-infecciosa, 2009 / Clinical guidelines for the diagnosis and care of children and adolescents with post-infectious bronchiolitis obliterans, 2009

La bronquiolitis obliterante (BO) es un síndrome clínico poco frecuente en niños, caracterizado por la obstrucción crónica al flujo de aire asociado a cambios inflamatorios y distintos grados de fibrosis en la vía aérea pequeña. Si bien existen muchas etiologías, la causa mas frecuente se asocia a infeccionesrespiratorias virales, principalmente adenovirus. No existe un consenso para establecer su diagnóstico; sin embargo, se considera un espectro de síntomas persistentes asociados a un patrón en mosaico, bronquiectasias y atelectasias persistentes. El rol de la biopsia pulmonar ha sido cuestionado por subajo rendimiento, invasividad y complicaciones. No existe un tratamiento específico por lo que elmanejo es soporte. Probablemente la mejor estrategia constituya el empleo de antibióticos en forma agresiva, soporte kinésico y nutricional constante y una precoz rehabilitación pulmonar. Estas guías clínicas representan un esfuerzo multidisciplinario, basado en evidencias actuales para brindarherramientas prácticas para el diagnóstico y cuidado de niños y adolescentes con BO post infecciosa.

[Hospitalization due to influenza in children in Santiago, Chile, 2001-2005]. / Hospitalización por influenza en un Servicio de Pediatría de Santiago de Chile, 2001-2005.

BACKGROUND: Influenza cause high hospitalization rates and complications in children. OBJECTIVE: To describe clinical and epidemiological characteristics of influenza infection in hospitalized children. PATIENTS AND METHODS: In Universidad Católica Hospital, all hospitalizations due to influenza in children aged 15 days to 14 years, occurring between January 2001 and December 2005 were reviewed. RESULTS: Of a total of 3570 admissions associated with a respiratory illness, 124 (3.5%) were due to influenza, of which 75% presented between the months of April and June. Median age was 20.5 months (60% younger than 2 years) and 24% had an underlying risk factor. Most common symptoms were fever (94%) and dry cough (61%) and 75% of the children required oxygen. The most frequent complication was pneumonia (53%). The mean duration of hospitalization and oxygen use were 4.4 and 2.5 days respectively. Fifty two children (49.1%) received an antibiotic and nine children were admitted to intensive care unit. No deaths were recorded. CONCLUSION: Influenza virus cause serious complications and affects mostly healthy children younger than 2 years.

Hospitalización por influenza en un Servicio de Pediatría de Santiago de Chile, 2001-2005 / Hospitalization due to influenza in children in Santiago, Chile, 2001-2005

Background: Influenza cause high hospitalization rates and complications in children. Objective: To describe clinical and epidemiological characteristics of influenza infection in hospitalized children. Patients and methods: In Universidad Católica Hospital, all hospitalizations due to influenza in children aged 15 days to 14 years, ocurring between January 2001 and December 2005 were reviewed. Results: Of a total of 3570 admissions associated with a respiratory illness, 124 (3.5 percent) were due to influenza, of which 75 percent presented between the months of April and June. Median age was 20.5 months (60 percent younger than 2 years) and 24 percent had an underlying risk factor. Most common symptoms were fever (94 percent) and dry cough (61 percent) and 75 percent of the children required oxygen. The most frequent complication was pneumonia (53 percent). The mean duration of hospitalization and oxygen use were 4.4 and 2.5 days respectively. Fifty two children (49.1 percent) received an antibiotic and nine children were admitted to intensive care unit. No deaths were recorded. Conclusion: Influenza virus cause serious complications and affects mostly healthy children younger than 2 years.

Introducción: El virus influenza produce elevadas tasas de hospitalización y complicaciones en niños. Objetivo: Describir el perfil clínico-epidemiológico de los niños hospitalizados por influenza en un hospital universitario. Pacientes y Métodos: Estudio descriptivo de las hospitalizaciones respiratorias y por influenza entre enero 2001 y diciembre 2005 en el Hospital Clínico de la Pontificia Universidad Católica. Resultados: Se hospitalizaron 3.570 niños por alguna causa respiratoria, 124 (3,5 por ciento) correspondieron a influenza confirmada, 75 por ciento ocurrieron entre abril y junio. La edad promedio fue 20,5 meses (60 por ciento) < 2 años), 24 por ciento tenían algún factor de riesgo identificado. Los síntomas más frecuentes fueron: fiebre (94 por ciento) y tos seca (61 por ciento). El 75 por ciento) presentó hipoxemia, siendo la complicación más frecuente la neumonía (53 por ciento). El promedio (días) de hospitalización y oxígeno fue 4,4 y 2,5; respectivamente. En 52/109 se indicaron antibacterianos, 9 niños ingresaron a cuidados intensivos. No hubo fallecidos. Conclusión: La hospitalización por influenza se asoció a serias complicaciones y afecta especialmente a niños sanos menores de 2 años.

Empiema y efusión pleural en niños / Empyema and pleural efussion in children

Introducción: El empiema pleural (EP) es una complicación grave de la neumonía adquirida en la comunidad (NAC). Objetivos: Describir las características de los pacientes hospitalizados por EP en el Servicio de Pediatría del Hospital de la Universidad Católica durante el período 2000-2005. Se identificaron 86 hospitalizaciones por NAC con efusión pleural, practicándose en 59 (70 por ciento), al menos una toracocentesis. Se consideró EP a la presencia de pus, tinción de Gram con bacterias, cultivo positivo o pH < 7,10 en el líquido pleural, siendo las efusiones para-neumónicas los controles. Resultados: Se analizaron 24 EP y 25 controles [promedio 2,9 años (rango: 8 meses - 14,3 años)], 78 por ciento de edad inferior a 5 años con diferencia entre los grupos EP y controles [1,6 vs 3,3 años, respectivamente (p = 0,01)]. El promedio global (días) de síntomas previo al ingreso en los EP fue 7 (rango: 2-21), siendo los más frecuentes fiebre (100 por ciento) y tos (96 por ciento). Se identificó algún microorganismo en 15/24 EP, Streptococcus pneumoniae fue el más frecuente (n: 9). En 48 niños, el manejo inicial fue conservador, requiriéndose cuatro rescates quirúrgicos luego del cuarto día. El promedio (días) de hospitalización fue significativamente superior en el grupo EP vs controles [15 (rango: 5-38) vs 9 (rango: 3-16) (p < 0,01)]. Requirieron drenaje pleural 83 por ciento del grupo EP y 36 por ciento de los controles (p = 0,002). No hubo diferencia en el número de días de empleo de oxígeno [6 vs 4,5 (p = 0,36)] o drenaje pleural [3 vs 2,5 (p = 0,29)]. No se registraron fallecidos. Conclusión: El EP en niños fue una condición respiratoria aguda que se asoció a estadías hospitalarias prolongadas, especialmente en los de menor edad, no requiriéndose, en la mayoría, una intervención quirúrgica de rescate.

Introduction: Pleural empyema (PE) is a serious complication of community-acquired pneumonia (CAP). Objectives: To describe the clinical profile of hospitalized patients with PE in the pediatric ward of the Catholic University Hospital between 2000-2005. Patients y methods: Retrospectively, all pediatric admission due to CAP and pleural effusion (86 children) were identified. In 59 (70 percent) children > 1 thoracocentesis were performed. We considered PE as the presence in the pleural effusion of pus, and/or a positive gram strain and/ or positive culture, and/or a pH < 7.10. Children with effusions not meeting any criteria were used as controls. Results: Twenty four PE and 25 controls were identified, with a global mean age of 2.9 years (range: 8 months to 14.3 years); 78 percent were < 5 years, with a significant difference between PE and controls [1.6 vs 3.3 years (p = 0.01)]. The mean duration of symptoms in PE patients before admission was 7 days (range: 2-21), and the most frequent symptoms were fever (100 percent) and cough (96 percent). In 15/24 cases a microorganism was identified being Streptococcus pneumoniae (n = 9) the most common. In 48 patients management was conservative and in 4 surgical procedures were required. The mean duration of hospitalization was significantly higher in the PE group vs controls group: 15 (range: 5-38) vs 9 days (range 3-16) (p < 0.01). A chest tube was inserted in 83 percent of children with EP compared with 36 percent in the control group (p = 0.002). There were no difference in number of days of oxygen use [6 vs 4.5 (p = 0.36)] or number of chest tubes per child [3 vs 2.5 (p = 0.29)]. No deaths were reported. Conclusion: PE in children represented an acute respiratory event associated with more prolonged hospitalization especially at younger ages; the majority of cases did not require surgical intervention.

[Clinical and epidemiological manifestations of parainfluenza infection in hospitalized children]. / Características clínicas y epidemiológicas de la infección por virus parainfluenza en niños hospitalizados.

BACKGROUND: Human parainfluenza viruses (hPIV) are a common cause of respiratory illness of children but published data on clinical characteristics of hPIV infection in South America is scarce. OBJECTIVE: To review the clinical presentation and epidemiological features of hPIV in a series of hospitalized children in Chile. PATIENTS AND METHODS: Retrospective review of clinical charts from all pediatric admissions with a diagnosis of respiratory disease (between January 2001 to December 2004) at the Catholic University Hospital, Santiago, Chile. Nasopharyngeal secretions were tested for hPIV in children admitted with suspected respiratory viral infections. RESULTS: A total of 3,043 respiratory admissions were recorded during the study period; 64 children (2.1%) were hPIV positive. Average age was 13 months (range: lm to 12y) and 77%> were younger than 2 years. HPIV-2 was the most common type identified (47%). A seasonal trend was noted for serotypes hPIV-2 and 3. Acute wheezing (40%o) and pneumonia (30%) were the most common clinical diagnosis in hPIV positive children and 17%> hPIV positive children (44%> for hPIV-1) were associated with laryngitis. All hPIV positive bronchiolitis were due to serotypes hPIV-2 and 3. CONCLUSION: hPIV can cause respiratory disease requiring hospitalization; serotypes hPIV-2 and 3 displayed a seasonal trend. Although hPIV is an uncommon cause of severe respiratory infecion requiring hospitalization in children, it should be considered in the differential diagnosis of laryngitis, bronchiolitis and pneumonia, especially in younger children.

Características clínicas y epidemiológicas de la infección por virus parainfluenza en niños hospitalizados / Clinical and epidemiological manifestations of parainfluenza infection in hospitalized children

Los virus parainfluenza del ser humano (VPIh) son patógenos importantes de enfermedad respiratoria en niños; pese a ello, existe escasa información publicada en Sudamérica dirigida a caracterizar esta infección. Objetivo: Describir las manifestaciones clínicas y epidemiológicas específicas de los VPIh en niños hospitalizados. Pacientes y Métodos: Se revisaron todas las hospitalizaciones respiratorias (HR) efectuadas en el Hospital de la Pontificia Universidad Católica, Santiago, Chile, durante el período 2001-2004 y sus respectivos estudios virales obtenidos de secreciones nasofaríngeas en aquellos con sospecha de infección viral. Resultados: Se identificaron 3.043 HR siendo 64 (2,1 por ciento) VPUrh La edad promedio fue 13 meses (rango: 1 m-12 a) siendo 77 por ciento) de edad inferior a dos años. VPIh-2 fue el serotipo prevalente (47 por ciento), observándose una tendencia estacional para los serotipos 2 y 3. Las presentaciones más frecuentes fueron sibilancias asociadas a virus (40 por cientoo) y neumonía (30 por ciento). Todas las bronquiolitis se presentaron asociadas a VPIh serotipos 2 y 3. Sólo 17 por ciento de los hospitalizados por VPIh+ (44 por ciento VPIh-1) desarrollaron laringitis. Conclusión: Virus parainfluenza humano puede ser responsable de HR en niños, mostrando una tendencia estacional VPIh-2 y el serotipo 3. Aunque son poco frecuentes como causa de HR, confirmamos su participación como etiología específica de laringitis, bronquiolitis y neumonía, especialmente en niños pequeños.

Background: Human parainfluenza viruses (hPIV) are a common cause of respiratory illness of children but published data on clinical characteristics of hPIV infection in South America is scarce. Objective: To review the clinical presentation and epidemiological features of hPIV in a series of hospitalized children in Chile. Patients and Methods: Retrospective review of clinical charts from all pediatric admissions with a diagnosis of respiratory disease (between January 2001 to December 2004) at the Catholic University Hospital, Santiago, Chile. Nasopharyngeal secretions were tested for hPIV in children admitted with suspected respiratory viral infections. Results: A total of 3,043 respiratory admissions were recorded during the study period; 64 children (2.1 percent) were hPIV positive. Average age was 13 months (range: lm to 12y) and 77 percent> were younger than 2 years. HPIV-2 was the most common type identified (47 percent). A seasonal trend was noted for serotypes hPIV-2 and 3. Acute wheezing (40 percento) and pneumonia (30 percent) were the most common clinical diagnosis in hPIV positive children and 17 percent> hPIV positive children (44 percent> for hPIV-1) were associated with laryngitis. All hPIV positive bronchiolitis were due to serotypes hPIV-2 and 3. Conclusion: hPIV can cause respiratory disease requiring hospitalization; serotypes hPIV-2 and 3 displayed a seasonal trend. Although hPIV is an uncommon cause of severe respiratory infecion requiring hospitalization in children, it should be considered in the differential diagnosis of laryngitis, bronchiolitis and pneumonia, especially in younger children.

[Empyema and pleural effusion in children]. / Empiema y efusión pleural en niños.

INTRODUCTION: Pleural empyema (PE) is a serious complication of community-acquired pneumonia (CAP). OBJECTIVES: To describe the clinical profile of hospitalized patients with PE in the pediatric ward of the Catholic University Hospital between 2000-2005. PATIENTS AND METHODS: Retrospectively, all pediatric admission due to CAP and pleural effusion (86 children) were identified. In 59 (70%) children > 1 thoracocentesis were performed. We considered PE as the presence in the pleural effusion of pus, and/or a positive gram strain and/ or positive culture, and/or a pH < 7.10. Children with effusions not meeting any criteria were used as controls. RESULTS: Twenty four PE and 25 controls were identified, with a global mean age of 2.9 years (range: 8 months to 14.3 years); 78% were < 5 years, with a significant difference between PE and controls [1.6 vs 3.3 years (p = 0.01)]. The mean duration of symptoms in PE patients before admission was 7 days (range: 2-21), and the most frequent symptoms were fever (100%) and cough (96%). In 15/24 cases a microorganism was identified being Streptococcus pneumoniae (n = 9) the most common. In 48 patients management was conservative and in 4 surgical procedures were required. The mean duration of hospitalization was significantly higher in the PE group vs controls group: 15 (range: 5-38) vs 9 days (range 3-16) (p < 0.01). A chest tube was inserted in 83% of children with EP compared with 36% in the control group (p = 0.002). There were no difference in number of days of oxygen use [6 vs 4.5 (p = 0.36)] or number of chest tubes per child [3 vs 2.5 (p = 0.29)]. No deaths were reported. CONCLUSION: PE in children represented an acute respiratory event associated with more prolonged hospitalization especially at younger ages; the majority of cases did not require surgical intervention.

Macrólidos en fibrosis quística: pasado, presente y futuro / Macrolides in cystic fibrosis

Introducción: La fibrosis quística (FQ) es una condición inflamatoria preferentemente neutrofílica que compromete el sistema respiratorio. Algunos autores han sugerido un beneficio discreto del uso de macrólidos como drogas anti-inflamatorias en determinadas circunstancias. Objetivo: Revisar los trabajos publicados en torno al uso de macrólidos en pacientes con FQ. Material y Métodos: Se realizó una búsqueda bibliográfica considerando ensayos clínicos originales indexados en el National Library of Medicine (MEDLINE/Pubmed) empleando las palabras: macrolides, azithromycin, immunomodulating, antiinflammatory, airway, cystic fibrosis and children. Resultados: Se identificaron seis ensayos clínicos que evaluaron los efectos de la azitromicina en niños y adultos con FQ. Tres de los ensayos incluyeron placebo, pero sólo dos incluyeron menores de 18 años. El antecedente de colonización crónica con P. aeruginosa no fue un criterio de selección exclusivo. En todos se observó algún beneficio tanto en VEF1 como CVF. Luego de descontinuar la azitromicina, los niveles de función pulmonar retornaron a su nivel basal. En general, la tolerancia fue adecuada sin claras diferencias con el placebo. Conclusiones: Existe un claro pero modesto beneficio del uso de azitromicina en niños con FQ, especialmente estando colonizados por P. aeruginosa; aunque esta casilibre de efectos adversos, aún faltan estudios que determinen sus efectos a largo plazo.

[Thyroid carcinoma as a cause of upper airway obstruction in children. Case report]. / Cáncer tiroideo: una causa infrecuente de obstrucción de vía aérea superior en niños. Caso clínico.

Upper airway obstruction (UAO) can be a severe medical condition with a high mortality in children. We report a 10 year-old girl with UAO due to papillary thyroid carcinoma. The study confirmed a thyroid cancer. The patient was referred to our centre for the evaluation of dyspnea and hoarseness. She was admitted in severe respiratory distress. Her chest X-ray revealed a critical narrowing of the cervical trachea and extensive infiltration of the lung with a miliary pattern; CT scan revealed a thyroid mass with bilateral pulmonary dissemination. An early surgical approach with total thyroidectomy and tracheotomy was performed. The study revealed a thyroid carcinoma. The patient was then referred to a specialized centre to receive radioiodine treatment [corrected] Recognition of thyroid carcinoma in children requires a high suspicion index. An early CT scan and fiberoptic assessment could show UAO in many unsuspected lesions.

Cáncer tiroideo: una causa infrecuente de obstrucción de vía aérea superior en niños: Caso clínico / Thyroid carcinoma as a cause of upper airway obstruction in children: Case report

Upper airway obstruction (UAO) can be a severe medical condition with a high mortality in children. We report a 10 year-old girl with UAO due to papillary thyroid carcinoma. The study confirmed a thyroid cancer. The patient was referred to our centre for the evaluation of dyspnea and hoarseness. She was admitted in severe respiratory distress. Her chest X-ray revealed a critical narrowing of the cervical trachea and extensive infiltration of the lung with a miliary pattern; CT scan revealed a thyroid mass with bilateral pulmonary dissemination. An early surgical approach with total thyroidectomy and tracheotomy was performed. The study revealed a thyroid carcinoma. The patient was then referred to a specialized centre to receive radioiodine treatment. Recognition of thyroid carcinoma in children requires a high suspicion index. An early CT scan and fiberoptic assessment could show UAO in many unsuspected lesions.

[Cystic fibrosis: facing patient transition from the pediatrician to the internist]. / Fibrosis quística: enfrentando la transición desde el pediatra hacia el internista.

The increased survival of patients with cystic fibrosis (CF) resulted in the appearance of new pulmonary and non-pulmonary complications. Even though subjects with CF present with inflammatory pulmonary changes at birth, several pathogens such as Staphyloccocus aureus, Haemophilus influenzae and Pseudomona aeruginosa contribute to the progression of pulmonary injury. Clinical presentations vary according to patient age; even though mild forms exist, patients with severe forms, develop respiratory insufficiency and end-stage disease at an early stage. Today, new diagnostic and therapeutic tools, increase the possibility of an early diagnosis and of greater survival. Successful management will depend on the timely selection of adequate antimicrobials, the use of pancreatic enzyme supplementation and early institution to respiratory physiotherapy. The transition from pediatric care to adult care must occur according to development of each patient. This timing must be flexible and there should be a constant communication and coordination within the different specialists in internal medicine. Thus, it is crucial to recognize the disease progression as a continuous process, giving the appropriate physiologic support and evaluating the needs of the patient and close relatives.

[Flu vaccine in children: state of the art]. / Vacuna anti-influenza en niños: estado del arte.

Influenza is an acute respiratory illness that year to year causes considerable morbidity and mortality. . All children, healthy or at high risk, are susceptible to this infection. Influenza vaccine seems to be effective in preventing influenza-like illness, laboratory-confirmed infection, and hospitalizations and deaths, demonstrating cost-effectiveness. Inactivated and live-attenuated vaccines have a similar efficacy profile. . Due to high influenza associated hospitalization rates in children, some countries have recommended incorporating influenza vaccination into the universal immunization program for healthy infants between 6-24 months of age. Considering that this public-health policy has been incorporated in Chile, local studies assessing its impact are needed.

Quiste laríngeo congénito: una rara causa de estridor en niños / Congenital laryngeal cyst: a rare cause of stridor in children

Introducción: Los quistes laríngeos congénitos (QLC) son una causa rara de estridor en niños. Objetivo: Describir las características clínicas del QLC como responsable de estridor atípico. Caso clínico: Una lactante sana fue evaluada por cuadro agudo de disfonía y estridor asociado a dificultad respiratoria progresiva en ausencia de pródromo respiratorio viral. La nasofibrolaríngoscopía demostró una masa en el ventrículo laríngeo y pliegue aritenoepiglótico izquierdo de 1 cm. La tomografía computada sugirió un QLC único, por lo que se procedió a marsupialización con resección de sus paredes. La evolución fue favorable, con controles posteriores hasta por 3 meses, observando una progresiva disminución del proceso inflamatorio. Conclusiones: Los QLC son una causa de estridor atípico que requieren alta sospecha. Se resalta la necesidad de considerar el estudio anatómico de la vía aérea en todo niño con estridor de curso infrecuente.

Fibrosis quística: enfrentando la transición desde el pediatra hacia el internista / Cystic fibrosis: facing patient transition from the pediatrician to the internist

The increased survival of patients with cystic fibrosis (CF) resulted in the appearance of new pulmonary and non-pulmonary complications. Even though subjects with CF present with inflammatory pulmonary changes at birth, several pathogens such as Staphyloccocus aureus, Haemophilus influenzae and Pseudomona aeruginosa contribute to the progression of pulmonary injury. Clinical presentations vary according to patient age; even though mild forms exist, patients with severe forms, develop respiratory insufficiency and end-stage disease at an early stage. Today, new diagnostic and therapeutic tools, increase the possibility of an early diagnosis and of greater survival. Successful management will depend on the timely selection of adequate antimicrobials, the use of pancreatic enzyme supplementation and early institution to respiratory physiotherapy. The transition from pediatric care to adult care must occur according to development of each patient. This timing must be flexible and there should be a constant communication and coordination within the different specialists in internal medicine. Thus, it is crucial to recognize the disease progression as a continuous process, giving the appropriate physiologic support and evaluating the needs of the patient and close relatives.