Mineral Metabolism in Children: Interrelation between Vitamin D and FGF23.

Fibroblast growth factor 23 (FGF23) was identified at the turn of the century as the long-sought circulating phosphatonin in human pathology. Since then, several clinical and experimental studies have investigated the metabolism of FGF23 and revealed its relevant pathogenic role in various diseases. Most of these studies have been performed in adult individuals. However, the mineral metabolism of the child is, to a large extent, different from that of the adult because, in addition to bone remodeling, the child undergoes a specific process of endochondral ossification responsible for adequate mineralization of long bones' metaphysis and growth in height. Vitamin D metabolism is known to be deeply involved in these processes. FGF23 might have an influence on bones' growth as well as on the high and age-dependent serum phosphate concentrations found in infancy and childhood. However, the interaction between FGF23 and vitamin D in children is largely unknown. Thus, this review focuses on the following aspects of FGF23 metabolism in the pediatric age: circulating concentrations' reference values, as well as those of other major variables involved in mineral homeostasis, and the relationship with vitamin D metabolism in the neonatal period, in vitamin D deficiency, in chronic kidney disease (CKD) and in hypophosphatemic disorders.

Change on the Circulation of Respiratory Viruses and Pediatric Healthcare Utilization during the COVID-19 Pandemic in Asturias, Northern Spain.

(1) Background: The COVID-19 pandemic and the implementation of restrictions and nonpharmaceutical interventions (NPIs) changed the trends in respiratory viral circulation and the pattern in pediatric healthcare utilization; (2) Methods: A retrospective, multicenter observational study designed to analyze the impact of the pandemic on pediatric healthcare utilization and the viral circulation pattern in children in a region in Northern Spain was carried out. Viral diagnostics data from all nasal or pharyngeal swabs collected in children in Asturias during the periods of March 2018−September 2019 and March 2020−September 2021 were analyzed, as well as the number of pediatric hospitalizations and emergency visits; (3) Results: A total of 14,640 samples were collected during the pandemic period. Of these, at least one respiratory virus was detected in 2940 (20.1%) while 5568/10,298 samples were positive in the pre-pandemic period (54.1%); p < 0.001. The detection of both enveloped and non-enveloped viruses decreased among periods (p < 0.001). After week 14, 2020, enveloped viruses were no longer detected until one year later, while non-enveloped viruses continued to be detected in children. Overall, a mean of 4946.8 (95% CI 4519.1−5374.4) pediatric emergency visits per month during the period 2018−2019 as compared to 2496.5 (95% CI 2086.4−2906.5) for 2020−2021 occurred (p < 0.001). The mean of pediatric hospitalizations also significantly decreased between periods, as follows: 346.6 (95% CI 313−380.2) in 2018−2019 vs. 161.1 (95% CI 138.4−183.8); p < 0.001; (4) Conclusions: Our study showed a remarkably reduction in pediatric hospitalizations and emergency visits and a change in the pattern of viral circulation during the COVID-19 pandemic in Asturias. The usual seasonal respiratory viruses, namely influenza or RSV were nearly absent in the pediatric population during the pandemic.

Descripción clínica y epidemiológica de un brote grave de salmonelosis en una escuela infantil urbana / Clinical and epidemiologic description of a severe outbreak of Salmonellosis in an urban nursery school

Objetivos. Se describe clínica y epidemiológicamente unbrote de infección gastrointestinal por Salmonella entéricaser. (serotipo) Enteritidis, en una escuela infantil urbana, queconllevó elevada morbilidad e importante alarma social. La comunicación inmediata, así como el estudio adecuado del brote,en ambas vertientes, permitieron identificar el patógeno y establecer medidas de control en un plazo razonable de tiempo.Se discuten aspectos controvertidos como la indicación de antibioterapia o el momento de cierre del centro.Material y métodos. Se recogió retrospectivamente información clínica, analítica y epidemiológica, y se revisó la metodología y resultados del estudio del brote.Resultados. 57 niños (3-45 meses) de 92 asistentes al centro, fueron afectados y tuvieron confirmación microbiológica.Diarrea y fiebre fueron los principales síntomas. 74% acudieronal hospital, y 37% ingresaron, (estancia media 3,3 días). Fueronfactores asociados al ingreso: deshidratación, elevación significativa de reactantes de fase aguda y coagulopatía. 12 recibieroncefotaxima parenteral. Se registraron 2 complicaciones: 1 bacteriemia y 1 reingreso. La sospecha inicial del origen del brotefueron los alimentos, pero el análisis de las muestras testigofue negativo. 5 trabajadores fueron positivos (2 sintomáticos).Vigilancia Epidemiológica concluyó que el origen probable delbrote fue un portador asintomático y la manipulación incorrectade pañales. El centro permaneció cerrado 8 días. Se realizaronmedidas de limpieza y desinfección, instrucción sobre cambio depañales y seguimiento de portadores.Conclusiones. La agrupación en tiempo y espacio de casos debe ser notificada inmediatamente para el control precozdel brote. Los niños pueden presentar formas graves de gastroenteritis por Salmonella. (AU)

Objectives. We describe clinically and epidemiologically anoutbreak of gastrointestinal infection by Salmonella entericaser. (serotype) Enteritidis in an urban infant school, which ledto high morbidity and significant social alarm. The immediatecommunication, as well as the adequate study of the outbreak, inboth aspects, allowed identifying the pathogen and establishingcontrol measures in a reasonable period of time. Controversialaspects such as the indication of antibiotherapy or the momentof closing the center are discussed.Methods. We retrospectively collected clinical, analyticaland epidemiological information and we reviewed themethodology of the outbreak study and its results.Results. A total of 57 children (3-45 months), wereaffected and had microbiological confirmation. Diarrhea andfever were the main symptoms. 74% went to the hospital and37% were admitted (mean stay 3.3 days). Factors associatedwith admission were: dehydration, significant elevation ofacute phase reactants and coagulopathy. Twelve patientsreceived parenteral cefotaxime. There were 2 complications:1 bacteremia and 1 readmission. The initial suspicion ofthe origin of the outbreak was food, but the analysis of thecontrol samples was negative. Five workers were positive (2symptomatic). Epidemiologic Surveillance concluded that theprobable origin of the outbreak was an asymptomatic carrierand improper diapers handling. The center was closed for 8days. Cleaning and disinfection measures were carried out, aswell as instruction on diaper changing, and the carriers werefollowedConclusions. Clustering in time and space of cases shouldbe reported immediately for early control of the outbreak.Children may present severe forms of Salmonella gastroenteritis (AU)