Combining different bacteria in vaccine formulations enhances the chance for antiviral cross-reactive immunity: a detailed in silico analysis for influenza A virus.

Bacteria are well known to provide heterologous immunity against viral infections through various mechanisms including the induction of innate trained immunity and adaptive cross-reactive immunity. Cross-reactive immunity from bacteria to viruses is responsible for long-term protection and yet its role has been downplayed due the difficulty of determining antigen-specific responses. Here, we carried out a systematic evaluation of the potential cross-reactive immunity from selected bacteria known to induce heterologous immunity against various viruses causing recurrent respiratory infections. The bacteria selected in this work were Bacillus Calmette Guerin and those included in the poly-bacterial preparation MV130: Streptococcus pneumoniae, Staphylococcus aureus, Staphylococcus epidermidis, Klebisella pneumoniae, Branhamella catarrhalis and Haemophilus influenzae. The virus included influenza A and B viruses, human rhinovirus A, B and C, respiratory syncytial virus A and B and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Through BLAST searches, we first identified the shared peptidome space (identity ≥ 80%, in at least 8 residues) between bacteria and viruses, and subsequently predicted T and B cell epitopes within shared peptides. Interestingly, the potential epitope spaces shared between bacteria in MV130 and viruses are non-overlapping. Hence, combining diverse bacteria can enhance cross-reactive immunity. We next analyzed in detail the cross-reactive T and B cell epitopes between MV130 and influenza A virus. We found that MV130 contains numerous cross-reactive T cell epitopes with high population protection coverage and potentially neutralizing B cell epitopes recognizing hemagglutinin and matrix protein 2. These results contribute to explain the immune enhancing properties of MV130 observed in the clinic against respiratory viral infections.

Corrigendum: Combining different bacteria in vaccine formulations enhances the chance for antiviral cross-reactive immunity: a detailed in silico analysis for influenza A virus.

[This corrects the article DOI: 10.3389/fimmu.2023.1235053.].

Evolución y características de los ingresos por COVID-19 pediátricos en un hospital terciario

Introducción. La mayoría de infecciones por SARS-CoV2 en población pediátrica cursan asintomáticas o con síntomas leves, con porcentaje mínimo de casos graves descritos como síndrome inflamatorio multisistémico asociado al SARS-CoV2 (SIM-PEDs). El objetivo fue describir las características clínico-epidemiológicas de aquellos pacientes pediátricos ingresados con diagnóstico confirmado de SARS-CoV2, y las posibles diferencias de la enfermedad considerando dos períodos epidemiológicos. Material y métodos. Estudio retrospectivo observacional de pacientes pediátricos ingresados con diagnóstico de COVID-19, de un hospital terciario. Se recogieron de forma consecutiva, entre marzo de 2020 hasta febrero 2022, analizando datos demográficos, clínicos, pruebas complementarias, tratamiento administrado y evolución. Resultados. Se incluyeron 69 pacientes, clasificándose en 6 grupos según diagnóstico. Los pacientes con neumonía asociaban mayor hipoxemia, mayor edad y eran predominantemente varones (p<0.01), con respecto al grupo de infecciones respiratorias sin condensación. SIM-PEDs fueron pacientes más graves, con afectación analítica marcada y mayor ingreso en UCIP. Durante el 2º periodo se observa una tendencia a la disminución de la infección respiratoria (69% al 47%), menor estancia hospitalaria (de 4 a 3 días), y aumento de los ingresos por otra patología (7,7% al 30,6%). Conclusiones. Los cuadros clínicos de COVID-19 más frecuentes en niños son respiratorios leves-moderados con buena evolución. Hay una tendencia a menor duración de estancia hospitalaria y aumento de ingresos por otra patología en pacientes asintomáticos en el segundo periodo. SIM-PEDs es otra forma de expresión de infección por SARS-COV2 de mayor gravedad, pero habitualmente con buen pronóstico tras diagnóstico precoz y requiriendo frecuentemente ingreso en UCIP. (provisto por Infomedic International)

Introduction. Most SARS-CoV2 infections in pediatric population are asymptomatic or have mild symptoms, with a small percentage of severe cases described as SARS-CoV2-associated multisystem inflammatory syndrome (MIS-C). The objective was to describe the clinical-epidemiological characteristics of those pediatric patients admitted with a SARS-CoV2 confirmed diagnosis, and the possible differences in the disease considering two epidemiological periods. Methods. Observational retrospective study of pediatric patients admitted with a diagnosis of COVID-19, from a tertiary hospital. They were collected consecutively, between March 2020 and February 2022, analyzing demographic and clinical data, complementary tests, administered treatment and evolution. Results. 69 patients were included, classified into 6 groups according to diagnosis. Patients with pneumonia associated greater hypoxemia, older age and were predominantly male (p<0.01), with respect to the group of respiratory infections without condensation. MIS-C were more severe patients, with marked analytic involvement and greater admission to the PICU. During the 2nd period, there was a trend towards a decrease in respiratory infection (69% to 47%), a shorter hospital stays (4 to 3 days), and an increase in admissions for another pathology (7.7% to 30,6%). Discussion. The most frequent clinical manifestations of COVID-19 in children are mild-moderate respiratory symptoms with a good prognosis. There is a trend towards a shorter length of hospital stay and an increase in admissions for another pathology in asymptomatic patients in the second period. MIS-C is another form of expression of SARS-COV2 infection of greater severity, but usually with a good prognosis after early diagnosis and frequently requiring PICU admission. (provided by Infomedic International)

Longitudinal survey of humoral and cellular response to SARS-CoV-2 infection in children.

BACKGROUND: Data regarding humoral and cellular response against SARS-CoV-2 in children are scarce. We analysed seroconversion rate, decrease of anti-RBD IgG antibodies over time and T-cell response in paediatric patients who suffered COVID-19. METHODS: Longitudinal study of paediatric patients COVID-19 diagnosed by positive molecular assay in nasopharyngeal swabs. Blood samples were drawn 1-2 months and 6-7 months after acute infection. Anti-RBD IgG were determined using the Alinity® SARS-CoV-2 IgG II Quant assay (Abbott). Cellular immune response was analysed by T-SPOT® SARS-CoV-2 assay kit (Oxford Immunotec Ltd.). RESULTS: 27/39 (69,2%) patients seroconverted. Despite a significant decrease in antibody levels over time (p < 0,01), no children seroreverted between first and second visits. Only 6/16 (37,2%) children under 6 years-old were seropositive compared to 21/23 (91,3%) over 6 years-old (p < 0,01). Highest antibody levels were found in seropositive younger children (p = 0,036). Thirteen (33,3%) children showed T-cell response. Among participants showing humoral response, no cellular response was detected in 14 (51,9%). CONCLUSIONS: Anti-RBD IgG antibodies persistence at 6-7-months after SARS-CoV-2 infection was observed. A different IgG response was found depending on age. As measured by T-SPOT, most patients did not display cellular response 6-7 months after infection.

A Prospective Study of the Serological, Clinical, and Epidemiological Features of a SARS-CoV-2 Positive Pediatric Cohort.

Background: SARS-CoV-2 was a global pandemic. Children develop a mild disease and may have a different rate of seroconversion compared to adults. The objective was to determine the number of seronegative patients in a pediatric cohort. We also reviewed the clinical−epidemiological features associated with seroconversion. Methods: A multicenter prospective observational study during September−November 2020, of COVID-19, confirmed by reverse transcription-polymerase chain reaction. Data were obtained 4−8 weeks after diagnosis. Blood samples were collected to investigate the humoral response, using three different serological methods. Results: A total of 111 patients were included (98 symptomatic), 8 were admitted to hospital, none required an Intensive Care Unit visit. Median age: 88 months (IQR: 24−149). Median time between diagnosis and serological test: 37 days (IQR: 34−44). A total of 19 patients were non-seroconverters when using three serological techniques (17.1%; 95% CI: 10.6−25.4); most were aged 2−10 years (35%, p < 0.05). Univariate analysis yielded a lower rate of seroconversion when COVID-19 confirmation was not present amongst household contacts (51.7%; p < 0.05). Conclusions: There was a high proportion of non-seroconverters. This is more commonly encountered in childhood than in adults. Most seronegative patients were in the group aged 2−10 years, and when COVID-19 was not documented in household contacts. Most developed a mild disease. Frequently, children were not the index case within the family.

Predictors of Response to Exclusive Enteral Nutrition in Newly Diagnosed Crohn´s Disease in Children: PRESENCE Study from SEGHNP.

Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014-2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6-8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn's Disease activity index [wPCDAI] < 12.5). Faecal calprotectin (FC) levels (µg/g) decreased significantly after EEN (830 [IQR 500-1800] to 256 [IQR 120-585] p < 0.0001). Patients with wPCDAI ≤ 57.5, FC < 500 µg/g, CRP >15 mg/L and ileal involvement tended to respond better to EEN. EEN administered for 6-8 weeks is effective for inducing clinical remission. Due to the high response rate in our series, EEN should be used as the first-line therapy in luminal paediatric Crohn's disease regardless of the location of disease and disease activity.

Blood lead in children and associations with trace elements and sociodemographic factors.

BACKGROUND: No safe blood lead concentration in children has been identified. Lead can affect nearly every system in the body and is especially harmful to the developing central nervous system of children. The aim of this study is to analyze blood lead in a population of children and its association with sociodemographic variables, biochemical parameters, copper, iron, selenium and zinc. METHODS: We recruited 155 children (86 boys and 69 girls) with a mean age of 7.3 (SD:4.1). Blood lead and serum selenium concentrations were measured by electrothermal atomic absorption spectrometry. Serum copper and zinc concentrations were measured by flame atomic absorption spectrometry. Serum iron levels were determined by colorimetric assay. A risk exposure questionnaire for lead was administered to the participants. RESULTS: The median blood lead level was 1.1 (IQR 0.7-1.6) µg/dL. Regarding risk exposure factors, the youngest children (<2 years) who played outdoors presented a median blood lead concentration of 1.1 µg/dL IQR: 0.48-1.48, compared to the median of 0.3 µg/dL IQR:0.2-0.48 in the children who stated they played at home (p = 0.024). Significant differences were also found when taking into account those parents who smoked (median 1.3 IQR 0.8-1.9 µg/dL vs 0.9 IQR 0.5-1.4 µg/dL of non-smokers, p = 0.002). Children who drank tap water had higher blood lead levels (median 1.2 IQR 0.7-1.6 µg/dL) than those who drank bottled water (median 0.7 IQR 0.2-1.3 µg/dL p = 0.014). In addition, children whose mothers had not finished school had higher blood lead levels (median 1.7 IQR 1.2-2.3 µg/dL) than those whose mothers had finished school (median 1.2 IQR 0.7-1.7 µg/dL) and those whose mothers had gone to university (median 0.9 IQR 0.5-1.4 µg/dL) p = 0.034. In the multivariate lineal regression analysis we continue to observe the association between mother's higher level of education and lower blood levels (p = 0.04) and the interaction between age and outdoor play (p = 0.0145). CONCLUSIONS: In spite of the decline in blood lead concentrations, associated risk factors continue to exist in vulnerable populations such as children.

[Hospital emergency room diagnosis of acute appendicitis in patients aged 2 to 20 years: the INFURG-SEMES score from the emergency infections study of the Spanish Society of Emergency Medicine]. / Escala INFURG-SEMES para el diagnóstico de apendicitis aguda en los pacientes de 2 a 20 años atendidos en los servicios de urgencias hospitalarios.

OBJECTIVES: To develop the INFURG-SEMES scale (based on the emergency infections study of the Spanish Society of Emergency Medicine) using clinical and laboratory data to diagnose acute appendicitis (AA) in patients aged 2 to 20 years who were evaluated in hospital emergency departments and to compare its diagnostic yield to that of the Alvarado score. MATERIAL AND METHODS: Prospective observational cohort study enrolling consecutive patients between the ages of 2 and 20 years who came to 4 hospital emergency departments with abdominal pain suggestive of AA and of less than 72 hours' duration. We collected demographic, clinical, analytic (white blood cell count, differential counts, and C-reactive protein [CRP] levels), and radiographic data (ultrasound and/or computed tomography scans). We also recorded surgical data if pertinent. The main outcome was a diagnosis of AA within 14 days of the index visit. RESULTS: We included 331 patients with a mean (SD) age of 11.8 (3.8) years; 175 (52.9%) were male. The final diagnosis was AA in 116 cases (35.0%). The INFURG-SEMES scale included the following predictors: male sex, right quadrant pain (right iliac fossa) on examination, pain on percussion, pain on walking, and elevated neutrophil count and CRP level. The areas under the receiver operating characteristic curves for the INFURG-SEMES scale and the Alvarado score, respectively, were 0.84 (95% CI, 0.79-0.88) and 0.77 (95% CI, 0.72-0.82). The difference was statistically significant (P=.002). CONCLUSION: The INFURG-SEMES scale may prove useful for diagnosing AA in patients aged between 2 and 20 years evaluated for abdominal pain in hospital emergency departments. The INFURG-SEMES score showed greater discrimination than the Alvarado score.

OBJETIVO: Derivar una escala clínico-analítica diagnóstica de apendicitis aguda (AA) en pacientes entre 2 y 20 años atendidos por dolor abdominal con sospecha de AA en servicios de urgencias hospitalarios (SUH), y comparar su capacidad diagnóstica con la Escala de Alvarado (EA). METODO: Estudio observacional de cohorte prospectivo que incluyó de forma consecutiva pacientes entre 2 y 20 años con dolor abdominal sospechoso de AA de menos de 72 horas de evolución atendidos en 4 SUH españoles entre junio y diciembre de 2014. Se recogieron datos demográficos, clínicos, analíticos (recuento leucocitario, fórmula y proteína C reactiva) y radiológicos (ecografía y/o TC) y, si procedía, quirúrgicos. La variable resultado principal fue el diagnóstico final de AA en los 14 días desde la visita índice. RESULTADOS: Se incluyeron 331 pacientes con edad media de 11,8 (DE 3,8) años, siendo 175 (52,9%) hombres. Ciento dieciséis (35,0%) tuvieron diagnóstico final de AA. La escala INFURG-SEMES incluye sexo masculino, dolor en fosa ilíaca derecha a la exploración, dolor a la percusión, dolor al caminar, presencia de neutrofilia y proteína C reactiva elevada. El área bajo la curva (ABC) de la característica operativa del receptor (COR) de dicha escala fue 0,84 (IC 95% 0,79-0,88) y para la EA 0,77 (IC95% 0,72-0,82) siendo la diferencia estadísticamente significativa (p = 0,002). CONCLUSIONES: La escala INFURG-SEMES podría ser una herramienta de ayuda para el diagnóstico de AA en los pacientes entre 2 y 20 años atendidos con dolor abdominal sospechoso de apendicitis en los SUH, y ha mostrado una mayor capacidad discriminativa que la EA.

Escala INFURG-SEMES para el diagnóstico de apendicitis aguda en los pacientes de 2 a 20 años atendidos en los servicios de urgencias hospitalarios / Hospital emergency room diagnosis of acute appendicitis in patients aged 2 to 20 years: the INFURG-SEMES score from the emergency infections study of the Spanish Society of Emergency Medicine

Objetivo. Derivar una escala clínico-analítica diagnóstica de apendicitis aguda (AA) en pacientes entre 2 y 20 años atendidos por dolor abdominal con sospecha de AA en servicios de urgencias hospitalarios (SUH), y comparar su capacidad diagnóstica con la Escala de Alvarado (EA). Métodos. Estudio observacional de cohorte prospectivo que incluyó de forma consecutiva pacientes entre 2 y 20 años con dolor abdominal sospechoso de AA de menos de 72 horas de evolución atendidos en 4 SUH españoles entre junio y diciembre de 2014. Se recogieron datos demográficos, clínicos, analíticos (recuento leucocitario, fórmula y proteína C reactiva) y radiológicos (ecografía y/o TC) y, si procedía, quirúrgicos. La variable resultado principal fue el diagnóstico final de AA en los 14 días desde la visita índice. Resultados. Se incluyeron 331 pacientes con edad media de 11,8 (DE 3,8) años, siendo 175 (52,9%) hombres. Ciento dieciséis (35,0%) tuvieron diagnóstico final de AA. La escala INFURG-SEMES incluye sexo masculino, dolor en fosa ilíaca derecha a la exploración, dolor a la percusión, dolor al caminar, presencia de neutrofilia y proteína C reactiva elevada. El área bajo la curva (ABC) de la característica operativa del receptor (COR) de dicha escala fue 0,84 (IC 95% 0,79-0,88) y para la EA 0,77 (IC95% 0,72-0,82) siendo la diferencia estadísticamente significativa (p = 0,002). Conclusiones. La escala INFURG-SEMES podría ser una herramienta de ayuda para el diagnóstico de AA en los pacientes entre 2 y 20 años atendidos con dolor abdominal sospechoso de apendicitis en los SUH, y ha mostrado una mayor capacidad discriminativa que la EA (AU)

Objectives. To develop the INFURG-SEMES scale (based on the emergency infections study of the Spanish Society of Emergency Medicine) using clinical and laboratory data to diagnose acute appendicitis (AA) in patients aged 2 to 20 years who were evaluated in hospital emergency departments and to compare its diagnostic yield to that of the Alvarado score. Methods. Prospective observational cohort study enrolling consecutive patients between the ages of 2 and 20 years who came to 4 hospital emergency departments with abdominal pain suggestive of AA and of less than 72 hours’ duration. We collected demographic, clinical, analytic (white blood cell count, differential counts, and C-reactive protein [CRP] levels), and radiographic data (ultrasound and/or computed tomography scans). We also recorded surgical data if pertinent. The main outcome was a diagnosis of AA within 14 days of the index visit. Results. We included 331 patients with a mean (SD) age of 11.8 (3.8) years; 175 (52.9%) were male. The final diagnosis was AA in 116 cases (35.0%). The INFURG-SEMES scale included the following predictors: male sex, right quadrant pain (right iliac fossa) on examination, pain on percussion, pain on walking, and elevated neutrophil count and CRP level. The areas under the receiver operating characteristic curves for the INFURG-SEMES scale and the Alvarado score, respectively, were 0.84 (95% CI, 0.79-0.88) and 0.77 (95% CI, 0.72-0.82). The difference was statistically significant (P=.002). Conclusions. The INFURG-SEMES scale may prove useful for diagnosing AA in patients aged between 2 and 20 years evaluated for abdominal pain in hospital emergency departments. The INFURG-SEMES score showed greater discrimination than the Alvarado score (AU)

Relationship between serum selenium, sociodemographic variables, other trace elements and lipid profile in an adult Spanish population.

INTRODUCTION: Several studies have shown an inverse relationship between selenium status and cardiovascular health, although epidemiologic evidence yielded by the randomized trials did not find a beneficial effect of selenium administration. The aim of this study was to analyze the association between serum selenium levels and lipid profile adjusted by age, sex and other associated factors among a general adult population in Spain. MATERIALS AND METHODS: We recruited 372 hospital employee volunteers (60 men and 312 women) with a mean age of 47 (SD: 10.9), whom were given a standardized questionnaire. Serum selenium concentration was measured by electrothermal atomization atomic absorption spectrometry. Serum copper and zinc concentrations were measured using flame atomic absorption spectrometry. RESULTS: The mean of serum selenium was 79.5µg/L (SD: 11.7) with no sex-dependent differences. In the multivariate linear regression analysis, the associated factors with the mean levels of selenium were: age (ß=0.223; CI 95%: 0.101-0.345), p<0.001; widowhood (ß=-9.668; CI 95%: -17.234 to -2.102), p=0.012; calcium supplements (ß=3.949; CI 95%: 0.059-7.838), p=0.047; zinc (ß=0.126; CI 95%: 0.013-0.238), p=0.028 and glucose (ß=0.172; CI 95%: 0.062- 0.281), p=0.002; Participants with serum selenium≥79.5µg/L were 1.98 (OR=1.98; CI 95% 1.17-3.35; p=0.011) and 2.04 times (OR=2.04; CI 95% 1.06-3.97; p=0.034) more likely to have cholesterol ≥200mg/dL and LDL-c ≥100mg/dL respectively than those with serum selenium <79.5µg/L. CONCLUSIONS: Higher selenium was positively associated with increased total and LDL cholesterol but not with HDL-c and triglycerides. More studies are needed in order to confirm the lower serum selenium findings in widows.

[Economic Appraisal of the Impact of the Ban on the Use of Lead in Gasoline on the Intellectual Quotient of 7-8 Years Old in the Community of Madrid]. / Evaluación económica del impacto de la prohibición de plomo en las gasolinas en el cociente intelectual de los niños de 7 y 8 años de la Comunidad de Madrid.

BACKGROUND: The repercussions on health of public policies are hard to assess from an economic point of view, which is why this is rarely done. The purpose of this study was to financially quantify the benefits of reducing blood lead levels in children aged 7-8 years in the Community of Madrid (Spain) as a result of the ban on the use of lead in gasoline. METHODS: The decrease the intellectual quotient (IQ) points was calculated through two studies on children aged 7-8 years according to their blood lead levels. A geometric mean of 3.8 µg/dl was obtained in the 1995 study and of 0.9 µg/dl in the 2010 study. The net increase in IQ was measured in terms of productivity gained throughout the working life as per the methods of Schwartz and Salkever. RESULTS: The decrease in blood lead levels in these children prevented a loss of between 135,391 and 144,153 IQ points; the current economic valuation of these points in terms of the productivity gained throughout the working life of this cohort of children was estimated to fall within the €626.4m- €865.4m range (2009). CONCLUSIONS: The figures of the economic benefits derived from the decision to ban leaded gasoline are very high.

Evaluación económica del impacto de la prohibición de plomo en las gasolinas en el cociente intelectual de los niños de 7 y 8 años de la Comunidad de Madrid / Economic vappraisal of the impact of the ban on the use of lead in gasolina on the intellectural quotient of 7-8 years old in the Community of Madrid

Fundamentos: la evaluación económica de las repercusiones sanitarias de las políticas públicas es difícil y escasa. El objetivo del presente estudio fue cuantificar monetariamente los beneficios de la reducción del plomo en la sangre de los niños de 7-8 años en la Comunidad de Madrid (España), derivada de la prohibición del plomo en las gasolinas. Métodos: se calculó la disminución de puntos de cociente intelectual (CI), utilizando dos estudios realizados en niños de 7 a 8 años según los valores de plomo en sangre que presentaban: media geométrica de 3,8 μg/dL en 1995 y 0,9 μg/dL en 2010. La mejoría neta de CI se midió en términos de capacidad de producción ganada a lo largo de la vida laboral, siguiendo los métodos de Schwartz y Salkiver. Resultados: la reducción de los niveles de plomo en sangre de estos niños evitó perder entre 135.391 y 144.153 puntos de CI. La valoración económica actual de estos puntos en términos de capacidad de producción ganada a lo largo de la vida laboral de estos sujetos se estimó en un rango entre 626,4 y 865,4 millones de euros (valor 2009). Conclusiones: las cifras de beneficios económicos encontradas derivadas de la medida de prohibición de uso de plomo en las gasolinas son importantes en términos sociales (AU)

Background: The repercussions on health of public policies are hard to assess from an economic point of view, which is why this is rarely done. The purpose of this study was to financially quantify the benefits of reducing blood lead levels in children aged 7-8 years in the Community of Madrid (Spain) as a result of the ban on the use of lead in gasoline. Methods: the decrease the intellectual quotient (IQ) points was calculated through two studies on children aged 7-8 years according to their blood lead levels. A geometric mean of 3.8 μg/dl was obtained in the 1995 study and of 0.9 μg/dl in the 2010 study. The net increase in IQ was measured in terms of productivity gained throughout the working life as per the methods of Schwartz and Salkever. Results: the decrease in blood lead levels in these children prevented a loss of between 135,391 and 144,153 IQ points; the current economic valuation of these points in terms of the productivity gained throughout the working life of this cohort of children was estimated to fall within the €626.4m-€865.4m range (2009). Conclusions: the figures of the economic benefits derived from the decision to ban leaded gasoline are very high (AU)

Consensus document on the prevention of methylmercury exposure in Spain: Study group for the prevention of Me-Hg exposure in Spain (GEPREM-Hg).

The beneficial effects of fish consumption in both children and adults are well known. However, the intake of methylmercury, mainly from contaminated fish and shellfish, can have adverse health effects. The study group on the prevention of exposure to methylmercury (GEPREM-Hg), made up of representatives from different Spanish scientific societies, has prepared a consensus document in a question and answer format, containing the group's main conclusions, recommendations and proposals. The objective of the document is to provide broader knowledge of factors associated with methylmercury exposure, its possible effects on health amongst the Spanish population, methods of analysis, interpretation of the results and economic costs, and to then set recommendations for fish and shellfish consumption. The group sees the merit of all initiatives aimed at reducing or prohibiting the use of mercury as well as the need to be aware of the results of contaminant analyses performed on fish and shellfish marketed in Spain. In addition, the group believes that biomonitoring systems should be set up in order to follow the evolution of methylmercury exposure in children and adults and perform studies designed to learn more about the possible health effects of concentrations found in the Spanish population, taking into account the lifestyle, eating patterns and the Mediterranean diet.

Oropharyngeal dysphagia, an underestimated disorder in pediatrics.

Oropharyngeal dysphagia is a rather frequent clinical entity in patients with neurological problems that can lead to serious complications such as aspiration pneumonia and other disorders like dehydration or malnutrition due to feeding difficulties. It should be suspected in children with splitting of food intake or prolonged feeding, coughing or choking during feeding, continuous drooling or repeated respiratory symptoms. For the diagnosis, apart from the examination of swallowing, additional tests can be run like the water-swallowing test, the viscosity-volume test (which determines what kind of texture and how much volume the patient is able to tolerate), a fiberoptic endoscopy of swallowing or a videofluoroscopic swallow study, which is the gold standard for the study of swallowing disorders.It requires a multidisciplinary approach to guarantee an adequate intake of fluids and nutrients with minimal risk of aspiration. If these two conditions cannot be met, a gastrostomy feeding may be necessary.

Disfagia orofaríngea, un trastorno infravalorado en pediatría / Oropharyngeal dysphagia, an underestimated disorder in pediatrics

La disfagia orofaríngea es una entidad clínica bastante frecuente en pacientes con problemas neurológicos, que puede conllevar complicaciones graves como las neumonías aspirativas y otras alteraciones como deshidratación o desnutrición por dificultades para la alimentación. Debe sospecharse en niños con fraccionamiento de la toma o ingestas prolongadas, tos o atragantamientos asociados a la alimentación, babeo continuo o sintomatología respiratoria de repetición. Para su diagnóstico, además de la exploración de la deglución, pueden hacerse pruebas complementarias como la prueba de deglución del agua, la de viscosidad-volumen (determina qué tipo de textura y cuánto volumen puede tolerar el paciente), la fibroendoscopia de la deglución y la videofluoroscopia (el gold estándar para el estudio de los trastornos de la deglución). Requiere un abordaje multidisciplinar para asegurar un adecuado aporte oral de líquido y nutrientes, con mínimo riesgo de aspiración. Si estas dos condiciones no son posibles puede ser necesaria la alimentación por gastrostomía

Oropharyngeal dysphagia is a rather frequent clinical entity in patients with neurological problems that can lead to serious complications such as aspiration pneumonia and other disorders like dehydration or malnutrition due to feeding difficulties. It should be suspected in children with splitting of food intake or prolonged feeding, coughing or choking during feeding, continuous drooling or repeated respiratory symptoms. For the diagnosis, apart from the examination of swallowing, additional tests can be run like the water-swallowing test, the viscosity-volume test (which determines what kind of texture and how much volume the patient is able to tolerate), a fiberoptic endoscopy of swallowing or a videofluoroscopic swallow study, which is the gold standard for the study of swallowing disorders. It requires a multidisciplinary approach to guarantee an adequate intake of fluids and nutrients with minimal risk of aspiration. If these two conditions cannot be met, a gastrostomy feeding may be necessary

Metilmercurio: Recomendaciones existentes; métodos de análisis e interpretación de resultados; evaluación económica / Methylmercury: existing recommendations; methods of analysing and interpreting the results; economic evaluation

Los efectos beneficiosos del consumo de pescado son bien reconocidos. Sin embargo, existe preocupación a nivel mundial sobre los niveles de metilmercurio en el pescado, por lo que muchos países como Estados Unidos, Australia, Nueza Zelanda, Canadá y muchos países europeos han realizado recomendaciones de consumo de pescado a la población , especialmente a los grupos vulnerables con el fin de reducir la ingesta de metilmercurio. La sangre y el pelo son las mejores muestras biológicas para medir el metilmercurio. El método de análisis más empleado ha sido la espectroscopia de absorción atómica con la técnica del vapor frío, aunque existen también métodos directos que se basan en la descomposición térmica de la muestra. En los últimos años han aumentado los laboratorios que miden el mercurio por espectrometría de masas con plasma acoplado por inducción. Además, se puede diferenciar las distintas especies de mercurio acoplando métodos de separación cromatográficos. Es necesario que los laboratorios que analizan mercurio en muestras biológicas participen en programas de garantía externa de la calidad. Aunque se logre reducir las emisiones de mercurio, el mercurio del medio ambiente altodavía puede permanecer muchos años, por lo que es fundamental el consejo dietético para disminuir la exposición. No es aconsejable el uso de terapia quelante con fines diagnósticos o en pacientes asintomáticos. Es preciso proponer medidas de salud pública encaminadas a la disminución de la exposición al mercurio y que se evalúe también los beneficios de las mismas desde el punto de vista económico y social (AU)

The beneficial effects of fish consumption are well-known. Nevertheless, there is worldwide concern regard methylmercury concentrations in fish, which is why many countries such as the United States, Australia, New Zealand, Canada and numerous European countries have made fish consumption recommendations for their populations, particularly vulnerable groups, in order to México methylmercury intake. Blood and hair are the best biological samples for measuring methylmercury. The most widely-used method to analyse ethylmercury is cold vapor atomic absorption spectrometry, although there are also direct methods based on the thermal decomposition of the sample. In recent years, the number of laboratories that measure mercury by inductively coupled plasma mass spectrometry has increased. In addition, the different kinds of mercury can be distinguished by coupling chromatography methods of separation. Laboratories that analyse mercury in biological samples need to participate in external quality control programmes. Even if mercury emissions are reduced, mercury may remain in the environment for many years, so dietary recommendations are fundamental in order to reduce exposure. It is necessary to propose public health measures aimed at decreasing mercury exposure and to evaluate the benefits of such measures from the economic and social standpoints (AU)

Documento de consenso sobre la prevención de la exposición al metilmercurio en España / Consensus document on the prevention of exposure to methylmercuty in Spain

Los efectos beneficiosos del consumo de pescado tanto en niños como en adultos han sido bien reconocidos. Sin embargo, la ingesta de metilmercurio principalmente a través del pescado y marisco contaminado puede producir efectos adversos en la salud. El grupo de estudio para la prevención de la exposición al metilmercurio (GEPREM-Hg), constituido por representantes de diferentessociedades científicas españolas, ha elaborado un documento de consenso donde se recogen en forma de preguntas y respuestas las principales conclusiones, recomendaciones y propuestas planteadas en el grupo. El objetivo del documento es profundizar en el conocimiento de los factores asociados a la exposición al metilmercurio, los posibles efectos sobre la salud en la población española, los métodos de análisis, la interpretación de los resultados, el coste económico y establecer finalmente recomendaciones de consumo de pescados y mariscos. El grupo considera acertadas todas las iniciativas encaminadas a reducir o prohibir el uso del mercurio y la necesidad de conocer los resultados de los análisis de contaminantes que se realizan en los pescados y mariscos que se comercializan en España. Además, opina que se deberían establecer sistemas de biomonitorización para conocer la evolución de la exposición al metilmercurio en niños y adultos y realizar estudios diseñados para conocer los posibles efectos sobre la salud de las concentraciones halladas en la población española, teniendo en cuenta el estilo de vida, los patrones de consumo alimentarios y la dieta mediterránea (AU)

The beneficial effects of fish consumption in both children and adults are well known. However, the intake of methylmercury, mainly from contaminated fish and shellfish, can have adverse health effects. The study group on the prevention of exposure to methylmercury (GEPREM-Hg), made up of representatives from different Spanish scientific societies, has prepared a consensus document in a question and answer format, containing the group’s main conclusions, recommendations and proposals. The objective of the document is to provide broader knowledge of factors associated with methylmercury exposure, its possible effects on health among the Spanish population, methods of analysis, interpretation of the results and economic costs, and to then set recommendations for fish and shellfish consumption. The group sees the merit of all initiatives aimed at reducing or prohibiting the use of mercury as well as the need to be aware of the results of contaminant analyses performed on fish and shellfish marketed in Spain. In addition, the group believes that biomonitoring systems should be set up in order to follow the evolution of methylmercury exposure in children and adults and perform studies designed to learn more about the possible health effects of concentrations found in the Spanish population, ta combusking into account the lifestyle, eating patterns and the Mediterranean diet (AU)

Documento de consenso sobre la prevención de la exposición al metilmercurio en España / Consensus document on the prevention of exposure to methylmercury in Spain

Los efectos beneficiosos del consumo de pescado tanto en niños como en adultos han sido bien reconocidos. Sin embargo, la ingesta de metilmercurio principalmente a través del pescado y marisco contaminado puede producir efectos adversos en la salud. El grupo de estudio para la prevención de la exposición al metilmercurio (GEPREM-Hg), constituido por representantes de diferentes sociedades científicas españolas, ha elaborado un documento de consenso donde se recogen en forma de preguntas y respuestas las principales conclusiones, recomendaciones y propuestas planteadas en el grupo. El objetivo del documento es profundizar en el conocimiento de los factores asociados a la exposición almetilmercurio, los posibles efectos sobre la salud en la población española, los métodos de análisis, la interpretación de los resultados, el coste económico y establecer finalmente recomendaciones de consumo de pescados y mariscos. El grupo considera acertadas todas las iniciativas encaminadas a reducir o prohibir el uso del mercurio y la necesidad de conocer los resultados de los análisis de contaminantes que se realizan en los pescados y mariscos que se comercializan en España. Además, opina que se deberían establecer sistemas de biomonitorización para conocer la evolución de la exposicional metilmercurio en niños y adultos y realizar estudios diseñados para conocer los posibles efectos sobre la salud de las concentraciones halladas en la población española, teniendo en cuenta el estilo de vida, los patrones de consumo alimentarios y la dieta mediterránea (AU)

The beneficial effects of fish consumption in both children and adults are well known. However, the intake of methyl mercury, mainly from contaminated fish and shellfish, can have adverse health effects. The study group on the prevention of exposure to methyl mercury (GEPREM-Hg), made up of representatives from different Spanish scientific societies, has prepared a consensus document in a question and answer format, containing the group's main conclusions, recommendations and proposals. The objective of the document is to provide broader knowledge of factors associated with methyl mercury exposure, its possible effects on health among the Spanish population, methods of analysis, interpretation of the results and economic costs, and to then set recommendations for fish and shellfish consumption. The group sees the merit of all initiatives aimed at reducing or prohibiting the use of mercury as well as the need to be aware of the results of contaminant analyses performed on fish and shellfish marketed in Spain. In addition, the group believes that biomonitoring systems should be set up in order to follow the evolution of methyl mercury exposure in children and adults and perform studies designed to learn more about the possible health effects of concentrations found in the Spanish population, taking into account the lifestyle, eating patterns and the Mediterranean diet (AU)