Utilidad del CANs SCORE para valoración clínica del estado nutricional del recién nacido de término / Utility of the CANs SCORE for clinical assessment of the nutritional the new born status of

Se conoce que la Desnutrición Fetal predispone a una mayor morbimortalidad perinatal, secundaria a sufrimiento fetal, aspiración de meconio, asfixia, hipoglucemia neonatal y síndrome de hiperviscosidad. También se asocia, a medio-largo plazo, a un mayor riesgo en comparación con la población general de presentar trastornos neurológicos o mentales (trastornos cognitivos y del aprendizaje), complicaciones endocrinológicas, metabólicas y cardiovasculares, por lo que sería conveniente identificar a estos recién nacidos precozmente, para promover una vigilancia e intervención adecuadas. Objetivo: demostrar la utilidad de la Evaluación Clínica Neonatal utilizando el CANs SCORE (Evaluación Clínica del Estado Nutricional), desarrollado y publicado por Mettcoff en 1994. Métodos: se realizó un estudio piloto transversal de marzo a junio de 2018, en el Hospital "Cochabamba", de nivel II, seleccionando 50 recién nacidos a término que presentasen signos clínicos para desnutrición según la escala de Mettcoff. Se realizaron mediciones antropométricas completas y exámenes de parámetros de laboratorio relacionados. Se utilizaron comparaciones de medias y correlaciones con valores del score-Z calculado mediante la herramienta Intergrowth- 21st, para evaluar los datos. Resultados: se encontraron diferencias estadísticamente significativas entre los parámetros antropométricos básicos evaluados como peso, talla, perímetro cefálico. Además, la evaluación mediante la escala de Mettcoff permitió la detección de DESNUTRICIÓN FETAL en recién nacidos que de otra manera se clasificarían como de peso adecuado para la Edad Gestacional (AEG). En el laboratorio los hallazgos fueron: disminución o aumento de las concentraciones de algunos de los parámetros bioquímicos evaluados; los más llamativos fueron la disminución de los niveles de albúmina sérica; también disminución de las concentraciones de calcio en más del 90% de la población estudiada y una elevación sistemática de los valores de creatinina en la mayoría, 80% de los casos. Conclusiones: el puntaje CANs es una herramienta clínica útil, sencilla y de fácil aplicación que permite identificar con mayor precisión el grado de desnutrición en recién nacidos y podría validarse estadísticamente en series más amplias y estudios sistemáticos.

It is known that Fetal Malnutrition predisposes to greater perinatal morbidity and mortality, secondary to fetal distress, meconium aspiration, asphyxia, neonatal hypoglycemia and hyperviscosity syndrome. It is also associated, in the medium-long term, with a higher risk compared to the general population of presenting neurological or mental disorders (cognitive and learning disorders), endocrinological, metabolic and cardiovascular complications, so it would be convenient to identify these newborns with DF early in life to promote appropriate surveillance and intervention. Objective:to demonstrate the usefulness of the Neonatal Clinical Assessment using the CANs SCORE (Clinical Assessment of Nutritional Status), developed and published by Mettcoff in 1994. Methods: a transversal pilot study was carried out from March to June 2018, in the second level Hospital "Cochabamba" , selecting 50 term neonates who had a positive score for malnutrition according to the Mettcoff scale. Complete anthropometric measurements and examinations of related laboratory parameters were performed. Comparisons of means and correlations were used to evaluate the data with Z-score values calculated using the Intergrowth -21st toolª. Results: statistically significant differences were found between the basic anthropometric parameters as weight, height, head circumference evaluated. Furthermore, the evaluation using the Mettcoff scale allowed the detection of FETAL MALNUTRITION in newborns who are otherwise classified as having adequate weight for Gestational Age (AEG). In the laboratory, the main findings were: decreased or increased concentrations of some of the biochemical parameters evaluated: the most striking findings being decreased serum albumin levels; also decreased calcium concentrations in 100% of the studied population and a systematic elevation of creatinine values in most of 90% of cases. Conclusions: the CANs score is a useful, simple and easy-to-apply clinical tool that allows the degree of malnutrition in Newborns to be identified with greater precision and it could be statistically validated in larger series and systematic studies.

Optimized germinated soybean/cornstarch extrudate and its in vitro fermentation with human inoculum.

The aim of this work was to optimise a soybean/cornstarch extrudate by adjusting a central composite design and to maximise a product with a high protein and resistant starch (RS) content by evaluating the indigestible fractions through in vitro colonic fermentation and production of short-chain fatty acids (SCFAs) with potential health benefits. According to the response surface analysis and RS maximisation results, an optimisation of the independent variables was obtained as follows: 32.5% feed moisture, 144 °C extrusion temperature and a proportion of 44% germinated soybean flour and 56% cornstarch. A product with a 2.11% expansion index, 6.25 N hardness, a glycaemic index of 49 and 12% resistant starch was obtained. The optimised extrudate showed a 36% indigestible fraction and high fermentability with respect to that of the lactulose control. Furthermore, the decrease in pH was inversely proportional to the production of SCFAs and the volume of gas generated. Acetic, propionic, and butyric acids were produced at a molar ratio of 62:27:11, while the highest SCFA concentrations were found 48 h after incubation. The RS of the optimised extruder was a viable substrate for in vitro colonic fermentation, suggesting that it is a good food source to produce SCFAs, which could exert an effect on the regulation of lipid and glucose metabolism.

Optimal germination condition impacts on the antioxidant activity and phenolic acids profile in pigmented desi chickpea (Cicer arietinum L.) seeds.

Legume sprouts are considered natural, healthy products that provide a source of bioactive compounds to fight against chronic diseases. This study aims to identify the optimal germination temperature (GT) and germination time (Gt) to maximize total phenolic and flavonoid contents (TPC, FC), and antioxidant activity (AoxA) of desi chickpea. Response surface methodology was used as an optimization tool. An experimental design with two factors (GT and Gt) and five levels was used (13 treatments). The sprouts from each treatment were lyophilized, tempered, and milled to obtain germinated chickpea flours (GCF). To predict the phytochemicals composition and AoxA in GCF, regression models were developed. Maximum TPC, FC, and AoxA were attained during germination 33.7 °C for 171 h. Optimized germinated chickpea flour produced applying the optimal germination conditions resulted in an increase of protein and total dietary fibre content, TPC, FC, phenolic acids profile, and AoxA. Germination at optimal conditions also increased the level of coumaric, ferulic, synapic, ellagic, and syringic acids. This study demonstrated that germination carried out under optimal conditions enhanced the nutraceutical value of desi chickpea seeds.

[Eslicarbazepine in patients with hipercholesterolemia associated to carbamazepine and oxcarbacepine]. / Eslicarbacepina en pacientes con hipercolesterolemia asociada a carbamacepina y oxcarbacepina.

TITLE: Eslicarbacepina en pacientes con hipercolesterolemia asociada a carbamacepina y oxcarbacepina.

Evaluation of non-aqueous capillary zone electrophoresis for the determination of histamine H2 receptor antagonists in pharmaceuticals.

A new non-aqueous capillary electrophoresis method is proposed for the separation and simultaneous determination of cimetidine, ranitidine, roxatidine, nizatidine and famotidine by using a 30-cm long × 75 µm i.d. fused silica capillary and UV detection at 214 nm. Using a temperature of 25°C, an applied voltage of 15 kV, and a background electrolyte consisting of methanol containing 10 mM ammonium acetate and 0.2% acetic acid allowed the analytes to be separated in less than 4 min. The limits of detection obtained ranged from 7 and 17 µg L(-1). The proposed method was successfully used to determine the analytes in pharmaceutical preparations and its results were checked against an HPLC method.

Neuroanatomía de las decisiones financieras / Neuroanatomy of financial decisions

Introducción: La neuroeconomía es una nueva disciplina que estudia los procesos cerebrales de toma de decisiones, fundamentalmente económicas y que ha adquirido un importante avance en los últimos años con el desarrollo de las modernas técnicas de neuroimagen, como la resonancia magnética cerebral funcional. Este artículo realiza una revisión de la bibliografía sobre los diferentes mecanismos neurológicos implicados en la toma de decisiones financieras, las estructuras cerebrales involucradas y las enfermedades que pueden afectarlos. Fuentes: Realizamos una revisión no sistemática de la literatura, tanto en fuentes de información primaria (PubMed) como de información secundaria (Tripdatabase y Cochrane Library). También se utilizó bibliografía cedida por la Asociación Española de Neuroeconomía. Desarrollo:Los sistemas de recompensa cerebral y de aversión a la pérdida suponen un equilibrio que hará que optemos por una u otra decisión. En este equilibrio en el que la dopamina desempeña un papel primordial, se han visto involucradas varias estructuras cerebrales como la amígdala, la ínsula, la corteza prefrontal medial, las cortezas cinguladas anterior y posterior, el núcleo accumbens y el área tegmental ventral. Su alteración supone la producción de conductas financieras inapropiadas como tienen lugar en enfermedades tan frecuentes como la depresión, la manía, el alcoholismo, la ludopatía o diversos trastornos del control de impulsos.Conclusiones: Los neurólogos deberíamos definir nuestro papel en esta ciencia pluridisciplinar, dada la posición de privilegio de nuestra especialidad para estudiar el funcionamiento cerebral, y al más que posible crecimiento que se espera que la neuroeconomía adquiera en un futuro cercano (AU)

Introduction: Neuroeconomics is a new science that studies the brain processes involved in taking decisions, particularly related to economy and it has experienced an important advancein the recent years due to the development of the new neuroimaging techniques, basically functional magnetic resonance imaging. The aim of this paper it to carry out a review of theliterature on the different neurological mechanisms involved in taking financial decisions, the concerned brain structures and the diseases that can affect them. Sources: We made a non systematic review of the literature in primary (PubMed) and secondary(Tripdatabase and Cochrane Library) bibliographic databases. We also used bibliography given by the Asociación Espa˜nola de Neuroeconomía.Development: Brain reward and loss aversion systems suppose a balance that makes us take one or another decision. Dopamine plays an important role on it and several brain structureshave been involved in this balance such as the amygdale, the insula, the medial prefrontal cortex, the anterior and posterior cingulated cortex, the accumbens nucleus and the ventraltegmental area. The alteration of this balance may produce inappropriate financial behaviors what may occur in common diseases including depression, mania, alcoholism, gambling andseveral impulse control disorders.Conclusions: Neurologists should define our role in this interdisciplinary field due to the privileged position of our specialty to study how the brain works and due to the potential growingof this science in the near future (AU)

Neuroanatomy of financial decisions.

INTRODUCTION: Neuroeconomics is a new science that studies the brain processes involved in taking decisions, particularly related to economy and it has experienced an important advance in the recent years due to the development of the new neuroimaging techniques, basically functional magnetic resonance imaging. The aim of this paper it to carry out a review of the literature on the different neurological mechanisms involved in taking financial decisions, the concerned brain structures and the diseases that can affect them. SOURCES: We made a non systematic review of the literature in primary (PubMed) and secondary (Tripdatabase and Cochrane Library) bibliographic databases. We also used bibliography given by the Asociación Española de Neuroeconomía. DEVELOPMENT: Brain reward and loss aversion systems suppose a balance that makes us take one or another decision. Dopamine plays an important role on it and several brain structures have been involved in this balance such as the amygdale, the insula, the medial prefrontal cortex, the anterior and posterior cingulated cortex, the accumbens nucleus and the ventral tegmental area. The alteration of this balance may produce inappropriate financial behaviors what may occur in common diseases including depression, mania, alcoholism, gambling and several impulse control disorders. CONCLUSIONS: Neurologists should define our role in this interdisciplinary field due to the privileged position of our specialty to study how the brain works and due to the potential growing of this science in the near future.

Oxcarbazepine monotherapy in carbamazepine-unresponsive trigeminal neuralgia.

The objective of this prospective open-label study was to evaluate the efficacy and tolerability of oxcarbazepine in trigeminal neuralgia (TN) unresponsive to treatment with the standard antiepileptic drug, carbamazepine. Thirty-five patients with idiopathic TN, who underwent treatment with oxcarbazepine monotherapy for at least 12 weeks, were studied. Pain was assessed using mean pain frequency, responder rate, pain-free patients and clinical global impression. The mean maintenance dose was 773.7 mg/day. There was a significant decrease in the mean of the main scores following 12 weeks of treatment (p<0.05) compared with baseline. Oxcarbazepine was effective from the first month of treatment. There was a significant reduction in pain frequency, leading to improvements in patient satisfaction. In general, oxcarbazepine was well tolerated. Oxcarbazepine appears to be an important alternative therapeutic approach for patients affected by TN. This study adds to the existing literature arriving at the same findings.

[Zonisamide in refractory essential tremor]. / Zonisamida en el temblor esencial refractario.

INTRODUCTION: Essential tremor is one of the most frequent movement disorders. It is characterized by postural and action tremor that may affect different regions of the body. Among current treatments propranolol and primidone are included. However, these two drugs have demonstrated a limited efficacy and several adverse events. Additionally, they are contraindicated in patients with cardiac insufficiency and several respiratory diseases. New antiepileptic drugs are revealing as a possibility in the treatment of this disease. AIM. To evaluate efficacy and tolerability of zonisamide in the treatment of essential tremor. PATIENTS AND METHODS: We perform a retrospective study about 13 patients with essential tremor refractory to an average of 2.8 drugs. Age, sex, zonisamide dosage, adverse events, duration and response to the treatment before and after the treatment were collected and analysed. Average zonisamide dosage was 215 mg/day and average duration of the treatment was 121 days. RESULTS: Nine of 13 patients included in our study experienced a good response. A positive response was understood as a decrease on the limitation of daily activities and an improvement on neurological examination. Zonisamide was well tolerated and no patient abandoned the study for this reason. CONCLUSIONS: Our data suggest that zonisamide is effective and well tolerated in the treatment of essential tremor. Placebo-controlled and bigger studies are warranted to confirm these results.

Zonisamida en el temblor esencial refractario / Zonisamide in refractory essential tremor

El temblor esencial es uno de los trastornos del movimiento más frecuentes, que se caracteriza portemblor postural y de acción, y que puede afectar a distintas regiones del cuerpo. Entre los tratamientos actualmente utilizados se incluyen el propranolol y la primidona. Sin embargo, estos dos fármacos han demostrado una utilidad limitada y marcados efectos secundarios. Además, están contraindicados en pacientes con insuficiencia cardíaca y algunos problemas pulmonares. Los nuevos fármacos antiepilépticos se están revelando como una posibilidad en el tratamiento de esta enfermedad. Objetivo. Evaluar la eficacia y la tolerabilidad de la zonisamida en el tratamiento del temblor esencial. Pacientes y métodos.Se evalúan trece pacientes con temblor esencial refractarios a una media de 2,8 tratamientos de un modo retrospectivo. Se recogierony evaluaron la edad, el sexo, la dosis de zonisamida, los efectos secundarios, la duración y la respuesta al tratamiento. La dosis media utilizada fue de 215 mg/día, y la duración media de seguimiento, de 121 días. Resultados. Nueve de los 13 pacientes experimentaron una buena respuesta clínica, entendida como una menor limitación para llevar a cabo sus actividadesdiarias y/o una mejoría objetiva en la exploración física. Los efectos secundarios fueron leves y ningún paciente abandonó el estudio por este motivo. Conclusiones. Los datos obtenidos sugieren que la zonisamida es eficaz y bien tolerada en eltratamiento del temblor esencial. Son necesarios estudios controlados con placebo y con mayor número de pacientes para confirmar estos resultados

Essential tremor is one of the most frequent movement disorders. It is characterized by postural andaction tremor that may affect different regions of the body. Among current treatments propranolol and primidone are included. However, these two drugs have demonstrated a limited efficacy and several adverse events. Additionally, they are contraindicatedin patients with cardiac insufficiency and several respiratory diseases. New antiepileptic drugs are revealing as a possibility in the treatment of this disease. Aim. To evaluate efficacy and tolerability of zonisamide in the treatment of essentialtremor. Patients and methods. We perform a retrospective study about 13 patients with essential tremor refractory to an average of 2.8 drugs. Age, sex, zonisamide dosage, adverse events, duration and response to the treatment before and after the treatment were collected and analysed. Average zonisamide dosage was 215 mg/day and average duration of the treatmentwas 121 days. Results. Nine of 13 patients included in our study experienced a good response. A positive response was understood as a decrease on the limitation of daily activities and an improvement on neurological examination. Zonisamide was well tolerated and no patient abandoned the study for this reason. Conclusions. Our data suggest that zonisamide iseffective and well tolerated in the treatment of essential tremor. Placebo-controlled and bigger studies are warranted to confirm these results

Topiramato en el temblor esencial refractario / Topiramate in refractory essential tremor

No disponible

Nutritional properties of quality protein maize and chickpea extruded based weaning food.

Malnutrition is one of the major causes of morbidity and mortality among young children in most of the developing countries. To minimize the adversities of malnutrition, low-cost infant supplementary foods have been developed and are being supplied to the needy through state-sponsored nutrition intervention programmers. The present study had two objectives: to determine the best combination of nixtamalized extruded quality protein maize (NEMF) and extruded chickpea (ECF) flours for producing a weaning food, and to evaluate the nutritional properties of the optimized NEMF/ECF mixture and the weaning food. The NEMF and ECF were produced applying combinations of extrusion temperature/screw speed of 79.4 degrees C/73.5 rpm, and 150.5 degrees C/190.5 rpm, respectively. Response surface methodology was applied to determine the optimum combination NEMF/ECF; the experimental design generated 11 assays. Mixtures from each assay were evaluated for true protein (TP) and available lysine (AL). Each one of 11 mixtures were used for preparing 11 weaning foods which were sensory evaluated for acceptability (A). The best combination of NEMF/ECF for producing a weaning food was NEMF = 21.2%/ ECF = 78.8 %. This mixture had a global desirability (D) of 0.93; it contained 20.07% proteins (DM), 5.70% lipids (DM), and 71.14% carbohydrates (DM); its essential amino acids (EAA) profile satisfactorily covered the EAA requirements for children 2-5 years old, except for Trp. The weaning food prepared with the optimized mixture had high protein quality and digestibility and could be used to support the growth of infants.

[Topiramate in comorbid disorders: epilepsy and migraine]. / Topiramato en enfermedades comórbidas: epilepsia y migraña.

INTRODUCTION: With relative frequency epilepsy and migraine are associated in a same patient. Some times it is difficult to distinguish an attack of others. Reason why it would be of utility to have a treatment effective in both pathologies. It is tried to study in patients with this comorbidity, how of effective it is a drug indicated in the two pathologies, as it is topiramate. PATIENTS AND METHODS: An observational, longitudinal and prospective study is made, where 15 patients are recruited with this association, and which they were treated with topiramate. They are revaluated at three and six months of treatment. RESULTS: Significant differences are obtained (p < 0.05) in all the studied variables (severity and duration of the migraine attacks and frequency of the migraine and epileptic attacks), with a medium dose of 100 mg/day of topiramate, at the end of the study. Not serious adverse effects were observed. CONCLUSIONS: Topiramate in monotherapy seems to be a suitable treatment in patients who undergo epileptic and migrainous attacks jointly.

Topiramato en enfermedades comórbidas: epilepsia y migraña / Topiramate in comorbid disorders: epilepsy and migraine

Introducción. Con relativa frecuencia la epilepsia y lamigraña se ven asociadas en un mismo paciente. Algunas veces esdifícil distinguir unas crisis de otras. Por tanto, sería de utilidadposeer un tratamiento que fuera eficaz en ambas patologías. Sepretende estudiar la eficacia del topiramato en el tratamiento delos pacientes que padecen epilepsia y migraña. Pacientes y métodos.Se realiza un estudio observacional, longitudinal y prospectivo,donde se recoge la frecuencia de las crisis, tanto de migrañacomo epilépticas, en una serie de 15 pacientes con dicha comorbilidad,tratados con topiramato. Se reevalúan a los tres y seis mesesde tratamiento. Resultados. Se obtienen diferencias significativas(p < 0,05) en todas las variables estudiadas (intensidad y duraciónde las crisis migrañosas y frecuencia de crisis migrañosas y epilépticas),con una dosis mediana de topiramato de 100 mg/día al finalizarel estudio. No se observaron efectos adversos graves. Conclusiones.El topiramato en monoterapia parece ser un tratamientoefectivo en pacientes que sufren conjuntamente crisis epilépticas ymigrañosas

Introduction. With relative frequency epilepsy and migraine are associated in a same patient. Some times it isdifficult to distinguish an attack of others. Reason why it would be of utility to have a treatment effective in both pathologies.It is tried to study in patients with this comorbidity, how of effective it is a drug indicated in the two pathologies, as it istopiramate. Patients and methods. An observational, longitudinal and prospective study is made, where 15 patients arerecruited with this association, and which they were treated with topiramate. They are revaluated at three and six months oftreatment. Results. Significant differences are obtained (p < 0.05) in all the studied variables (severity and duration of themigraine attacks and frequency of the migraine and epileptic attacks), with a medium dose of 100 mg/day of topiramate, at theend of the study. Not serious adverse effects were observed. Conclusions. Topiramate in monotherapy seems to be a suitabletreatment in patients who undergo epileptic and migrainous attacks jointly

Determination of ibuprofen and tetrazepam in human urine by micellar electrokinetic capillary chromatography.

A new micellar electrokinetic capillary chromatography method (MEKC) is proposed for the determination of ibuprofen and tetrazepam in human urine samples over a concentration range of therapeutic interest. A fused silica capillary (60 cm x 75 microm) is used. Ibuprofen and tetrazepam are detected via UV detection at 220 and 228 nm, respectively. Separation is performed at 25 degrees C and at a separation voltage of 30 kV, with 15 mM borate buffer (pH 10.2) containing 40 mM sodium dodecylsulfate as the electrolyte solution. Under these conditions the analytes were separated in <11 min. Sulfamethazine is used as an internal standard. Prior to determination, the samples are purified and enriched by means of an extraction-preconcentration step with a preconditioned C18 cartridge and by eluting the compounds with methanol. Good linearity, accuracy, precision, robustness and solution stability were achieved for the technique. Detection limits of 200 microg L(-1) for ibuprofen and 300 microg L(-1) for tetrazepam were obtained. These analytes were then determined in real urine using the technique.

[Fiberoptic bronchoscopy in childhood endobronchial tuberculosis]. / Fibrobroncoscopia en la tuberculosis endobronquial.

BACKGROUND: Endobronchial tuberculosis is a classical manifestation of primary tuberculosis in childhood. Fiberoptic bronchoscopy (FB) is an ancillary diagnostic tool, but its utility and indications are not well established. OBJECTIVES: To analyze the FB performed over 11 years (1992-2003) in children with a diagnosis of tuberculosis and to review the literature. A further aim was to establish the current usefulness of FB in children with tuberculosis and propose criteria to determine the indications for FB in this population. METHODS: We report a retrospective series (n 5 16). FB was indicated in children who showed any of the following findings in chest roentgenogram: a) persistent parenchymal consolidation; b) lymphadenopathy and consolidation; c) hyperinsufflation (emphysema); d) atelectasias, and e) airway narrowing caused by lymphadenopathies. Published series on the topic were reviewed and six studies were suitable for comparison with our own. RESULTS: Endobronchial tuberculosis was found in seven children (43 %) and extrinsic compression was found in three (18 %). The microbiological results obtained from FB samples were not superior to those obtained from classical diagnostic methods. The sensitivity of the proposed criteria for suspicion of endobronchial tuberculosis was 71 %. Endoscopic findings justified a change in therapy in 50 % of the children (addition of corticoids or surgery) and this percentage was similar to that reported in other series. CONCLUSIONS: FB does not usually improve microbiological diagnosis of tuberculosis but can be useful when choosing the most appropriate therapy in children with suspected endobronchial tuberculosis. In some cases, computed tomography may make FB unnecessary, but in others this procedure can be therapeutic (obstruction due to caseum, atelectasias). Establishing the indications for FB in childhood tuberculosis is difficult, but the proposed criteria may be an acceptable guide to identifying which patients could benefit most from this procedure. Not all children with endobronchial tuberculosis require corticoids.

Fibrobroncoscopia en la tuberculosis endobronquial / Fiberoptic bronchoscopy in childhood endobronchial tuberculosis

La tuberculosis endobronquial (TBE) es una manifestación típica de la tuberculosis primaria infantil. La fibrobroncoscopia es una técnica que ayuda a su diagnóstico, pero ni su utilidad ni sus indicaciones están claramente definidas. Objetivos Analizar las fibrobroncoscopias llevadas a cabo a lo largo de 11 años (1992-2003) en niños con diagnóstico de tuberculosis, y realizar una revisión de la literatura especializada. Intentar establecer la utilidad actual de la fibrobroncoscopia en la tuberculosis infantil, y proponer unos criterios para determinar la indicación de esta técnica en estos niños. Métodos Se presenta una serie retrospectiva de 16 pacientes. Se indicó fibrobroncoscopia a los niños que presentaban en la radiografía de tórax: a) consolidación parenquimatosa persistente; b) adenopatía y consolidación; c) hiperinsuflación (enfisema); d) atelectasia, o e) estrechamiento de las vías respiratorias por adenopatías. Se revisaron las series publicadas sobre este tema, rescatándose 6 con valor para la comparación con la nuestra. Resultados Se encontró TBE en 7 niños (43 por ciento) y en tres (18 por ciento) compresión exclusivamente extrínseca. Los resultados de la microbiología a través de la fibrobroncoscopia no mejoraron a los métodos diagnósticos clásicos. La sensibilidad de los criterios radiológicos utilizados para sospechar TBE fue del 71 por ciento. Los hallazgos endoscópicos justificaron un cambio en el tratamiento en el 50 por ciento de los niños (adición de corticoides o cirugía), cifra similar a otras series. Conclusiones La fibrobroncoscopia no suele mejorar el diagnóstico microbiológico de la tuberculosis, pero es una herramienta útil en nuestro medio para decidir el tratamiento más adecuado de los niños con sospecha de TBE. En algunos casos, la tomografía computarizada (TC) puede hacerla innecesaria, pero en otros la fibrobroncoscopia puede ser, además, terapéutica (obstrucción por caseum, atelectasias). Es difícil establecer indicaciones de fibrobroncoscopia en casos de tuberculosis infantil, pero los criterios propuestos pueden ser una guía aceptable para determinar qué pacientes se beneficiarían más. No todos los niños con TBE necesitan corticoides (AU)

Bacteriemia por Salmonella no typhi en niños: revisión de 11 años / Non-typhi salmonella bacteremia in children: an 11-year review

Objetivos: Revisar los aspectos clínicos y bacteriológicos de los pacientes pediátricos con bacteriemia por Salmonella no typhi (SNT).Métodos Se revisaron las historias clínicas de niños menores de 14 años con hemocultivo positivo para SNT en un hospital de referencia de Madrid durante los últimos 11 años. Resultados: Se diagnosticaron un total de 29 casos de bacteriemia por SNT y fueron analizados 27 de ellos. La edad media fue de 11,1 meses (rango de 3 días a 11 años); 46 por ciento eran menores de un año. Once niños (41 por ciento) tenían una enfermedad de base. Éstas incluían 7 inmunodeficiencias (3 pacientes oncológicos, uno con déficit de IgA-IgG2, uno con enfermedad granulomatosa crónica, uno con infección por virus de la inmunodeficiencia humana (VIH) y uno con lupus eritematoso sistémico en tratamiento con corticoides), tres enfermedades hepáticas y una encefalopatía hipóxico-isquémica. Las manifestaciones clínicas en la primera visita fueron: fiebre superior a 39 °C (86 por ciento), diarrea (66 por ciento), y vómitos (37 por ciento). Dos pacientes presentaron bacteriemia oculta. Tres niños (11 por ciento) requirieron cuidados intensivos por sepsis grave. Cinco pacientes presentaron infecciones extraintestinales focales: 2 artritis, 1 osteomielitis, 1 infección del tracto urinario y 1 neumonía. Ninguno de los niños presentó meningitis o falleció como consecuencia de la infección por Salmonella. Los serogrupos más frecuentemente aislados fueron Salmonella D9 y B4-5 (38 por ciento cada una). Once cepas (38 por ciento) fueron resistentes a amoxicilina y 5 (17 por ciento) resistentes a cotrimoxazol. Sólo un paciente desarrolló bacteriemia persistente. Todos los niños se recuperaron completamente sin complicaciones. Conclusiones: La bacteriemia por SNT es una entidad infrecuente pero debe ser considerada en lactantes y niños inmunocomprometidos. Aunque pueden existir complicaciones focales, estos niños suelen recuperarse completamente con tratamiento antimicrobiano apropiado (AU)

[Non-typhi Salmonella bacteremia in children: an 11-year review]. / Bacteriemia por Salmonella no typhi en niños: revisión de 11 años.

OBJECTIVES: To review the clinical and bacteriological features of pediatric patients with non-typhi Salmonella (NTS) bacteremia. METHODS: We reviewed the medical records of children aged less than 14 years with culture-proven NTS bacteremia in the previous 11 years in a referral hospital in Madrid, Spain. RESULTS: A total of 29 cases of NTS bacteremia were diagnosed. Of these, 27 were used for study purposes. The mean age was 11.1 months (range: 3 days to 11 years); 48% were infants aged < 1 year. Eleven children (41%) had an underlying disease. These included immunodeficiency in seven (malignant disease in three, IgA-IgG2 deficit in one, chronic granulomatous disease in one, HIV infection in one, and systemic lupus erythematosus in one patient on steroid treatment), liver disease in three, and hypoxic-ischemic encephalopathy in one. Clinical manifestations at the initial visit included: fever > 39 C (85%), diarrhea (67%), and vomiting (37%). Seven patients had occult bacteremia. Three children (11 %) required intensive care management for severe sepsis. Five patients presented extraintestinal focal infections: arthritis in two, osteomyelitis in one, urinary tract infection in one, and pneumonia in one. None of the children had meningitis or died as a result of NTS infection. The most common serogroups isolated were Salmonella D9, and B4-5 (38% each). Eleven strains (38%) were resistant to amoxicillin and five (17%) were resistant to cotrimoxazole. Only one patient developed persistent bacteremia. All the children made a complete recovery without further complications. CONCLUSIONS: NTS bacteremia is an uncommon entity but it should be considered in infants and immunocompromised children. Although focal complications may occur, the usual outcome with appropriate antimicrobial treatment is a full recovery.