The role of viral diagnostic tests in respiratory tract infections: moving forward.

The increased knowledge on virology and the increased potential of their diagnostic has risen several relevant question about the role of an early viral diagnosis and potential early treatment on the management of respiratory tract infections (RTI). In order to further understand the role of viral diagnostic tests in the management of RTI, a panel of experts was convened to discuss about their potential role, beyond what had been agreed in Influenza. The objective of this panel was to define the plausible role of aetiologic viral diagnostic into clinical management; make recommendations on the potential expanded use of such tests in the future and define some gaps in the management of RTI. Molecular Infection Viral Diagnostic (mIVD) tests should be used in all adult patients admitted to Hospital with RTI, and in paediatric patients requiring admission or who would be referred to another hospital for more specialised care. The increased use of mIVD will not only reduce the inappropriate use of antibiotics so reducing the antibiotic microbe resistance, but also will improve the outcome of the patient if an aetiologic viral therapy can be warranted, saving resource requirements and improving patient flows. Implementing IVD testing in RTI has various organizational benefits as well, but expanding its use into clinical settings would need a cost-effectiveness strategy and budget impact assessment.

Dexamethasone does not reduce length of hospitalization or recurrent wheezing 1 year after early bronchiolitis.

AIM: It has been suggested that a 6-day dexamethasone course combined with adrenaline may significantly reduce the admission rate in outpatients. It has also been suggested that prednisolone may reduce recurrent wheezing. Our aim was to investigate whether treatment with steroids, especially high dose dexamethasone, is associated with the length of hospitalization or with recurrent wheezing. METHODS: A prospective-retrospective observational study was performed from January 2009 to December 2011 in a secondary care hospital. Eighty previously healthy patients aged 7-180 days who were hospitalized with a first episode of acute bronchiolitis (AB) were studied. AB treatment was at the attending physician's discretion, among those tested for AB with some benefit. Eligible drugs included bronchodilators and steroids. Primary short-term outcome studied was days of hospitalization. Primary long term outcome was "recurrent wheezing". RESULTS: Median length of hospitalization was 6 days for all groups. Patients treated with dexamethasone (1 mg/kg/day for 1 day, plus 0.6 mg/kg/day for 5 days) had an average length of hospitalization of 6.8 ± 3.1 (range, 4-20) days, those on prednisolone (prednisolone 1-2 mg/kg/day for 5 days) 7.0 ± 2.6 (range, 4-12) days and those with no steroids 6.6 ± 3.3 (3-21) days (no significant differences). The analysis showed no evidence of association of any management schedule with recurrent wheezing. After adjusting long-term outcome variables for potential confounders, comparisons remained no different. CONCLUSION: High dose dexamethasone or medium-dose prednisolone during AB provided no benefit in a short or long-term period in young, previously healthy hospitalized infants.

Asociación entre enfermedad celíaca y síndromede Noonan / Celiac disease and Noonan syndrome

Se aporta el caso de una niña con síndrome de Noonan, con hepatopatía y con miocardiopatía hipertrófica, a la que diagnosticó a los 20 meses de vida enfermedad celíaca. Existen pocas publicaciones de enfermedades autoinmunes asociadas al síndrome de Noonan, siendo éste el segundo caso publicado de asociación con enfermedad celíaca. Son necesarios más estudios para determinar si las alteraciones del sistema inmune, y en concreto la enfermedad celíaca, constituyen una característica más del síndrome o se trata de asociaciones casuales (AU)