Caracterización clínica-epidemiológica de las hospitalizaciones pediátricas por virus Influenza estacional antes y después de la introducción de la vacuna en niños / Clinical-epidemiologic characteristics of pediatric hospitalizations for seasonal influenza virus

Objetivo: Evaluar el impacto de la indicación ministerial de la vacunación contra Influenza a lactantes sanos entre 6 y 24 meses iniciada en el año 2006. Material y método: Revisión retrospectiva de fichas clínicas de pacientes hospitalizados por infección respiratoria causada por virus Influenza entre enero 2004 y diciembre 2007 en el Hospital Roberto del Río. Todos los casos fueron confirmados mediante inmunofluorescencia viral positiva para Influenza A o B. Resultados: De un total de 224 pacientes, 122 corresponden al período prevacuna (años 2004-2005) y 102 al postvacuna (años 2006-2007). La tasa de hospitalización fue similar para todos los años estudiados. Durante el período postvacuna recibieron vacunación solo 4 de los 102 pacientes, el 68 por ciento de los no vacunados se encontraban al momento de la campaña ministerial fuera del rango etario con indicación de vacunación. El 70 por ciento de los hospitalizados corresponden a pacientes menores de 2 años en ambos grupos. No se registró diferencia estadísticamente significativa en sexo, días de hospitalización, requerimientos de oxígeno, ingreso a UCI ni necesidad de ventilación mecánica invasiva. Un 75 por ciento de los hospitalizados corresponde a pacientes sin comorbilidad. Se evidencia un cambio en el patrón estacional de las infecciones por Influenza luego de la introducción de la vacuna manteniéndose éstas presentes a lo largo de todo el año. Conclusiones: No existe una disminución en la tasa de hospitalización ni cambios en las características clínicas de los pacientes hospitalizados luego de la introducción de la vacuna. Si se evidencia un cambio en la distribución estacional con un aplanamiento de la curva a diferencia de la clásica presentación en brote descrita en la literatura y observada en nuestro país previo a esta medida.

Objective: To evaluate the impact of the ministerial statement of vaccination against influenza in healthy infants in the age group of 6 and 24 months since 2006. Material and Methods: Retrospective review of medical records of patients hospitalized due to respiratory infection caused by influenza virus between January 2004 and December 2007 at the Hospital Roberto del Río. All cases were confirmed by positive immunofluorescence for influenza virus A or B. Results: Of a total of 224 patients, 122 are from the pre-vaccination period (2004-2005) and 102 from post vaccination period (2006-2007). The hospitalization rate was similar during the study time course. During the post vaccination period only 4 of 102 patients received vaccination, meanwhile 68 percent of them were out of age requirements for the vaccination ministerial campaign. 70 percent of hospitalized patients are younger than 2 years in both groups. There were not significant differences in sex, hospital stay, oxygen requirements, ICU admission or in the need of invasive mechanical ventilation. 75 percent of hospitalized patients did not exhibit comorbility. These results show a change in the seasonal pattern of influenza infections after the vaccine introduction that remains all over the years. Conclusions: There is not a decrease in the hospitalization rate or a change in the clinical characteristics of hospitalized patients after the vaccine introduction. There is a clear change in the seasonal distribution with a curve flattening, unlike the classic outbreak presentation described in literature and observed in our country prior to this program.

[Assessment of disease control among asthmatic adolescents]. / Control de asma en adolescentes.

BACKGROUND: The clinical assessment of asthma control is fundamental to evaluate the results of treatment. The Asthma Control Test (ACT) is a questionnaire with five scored items, that differentiates between a well controlled or uncontrolled asthma. It has a Spanish version and has been applied in different countries. AIM: To assess asthma control using the ACT and compare it with the clinical assessment of specialists in a group of pediatric patients. MATERIAL AND METHODS: The ACT was applied to 220 adolescents aged 12 to 17 years, 54% males, with persistent asthma, attended at a respiratory disease unit of a pediatric hospital. The concordance between ACT results and the assessment of specialists was also evaluated. RESULTS: According to ACT and specialists, asthma was controlled in 54% and 63% of patients, respectively. There was a weak concordance between ACT and specialists assessment (Kappa index: 0.27; 95% confidence intervals: 0.14-0.4). The degree of asthma control decreased along with increasing severity of the disease (chi2 = 10.128, p =0.001). CONCLUSIONS: Half of the evaluated asthmatic adolescents do not have an adequate control of their disease. Severity of the disease is inversely related to the degree of control.

Control de asma en adolescentes / Assessment of disease control among asthmatic adolescents

Background: The clinical assessment of asthma control is fundamental to evaluate the results of treatment. The Asthma Control Test (ACT) is a questionnaire with five scored items, that differentiates between a well controlled or uncontrolled asthma. It has a Spanish version and has been applied in different countries. Aim: To assess asthma control using the ACT and compare it with the clinical assessment of specialists in a group of pediatric patients. Material and methods: The ACT was applied to 220 adolescents aged 12 to 17 years, 54 percent males, with persistent asthma, attended at a respiratory disease unit of a pediatric hospital. The concordance between ACT results and the assessment of specialists was also evaluated. Results: According to ACT and specialists, asthma was controlled in 54 percent and 63 percent of patients, respectively. There was a weak concordance between ACT and specialists assessment (Kappa index: 0.27; 95 percent confidence intervals: 0.14-0.4). The degree of asthma control decreased along with increasing severity of the disease ( percentz = 10.128, p =0.001). Conclusions: Half of the evaluated asthmatic adolescents do not have an adequate control of their disease. Severity of the disease is inversely related to the degree of control

[Usefulness of C-reactive protein for the diagnosis of bacterial infections in children. A review]. / Existen bases para el uso de la proteína C reactiva en la detección de infecciones bacterianas en niños?

Although C-Reactive protein (CRP) was described more than 70 years ago and it still is commonly used in practice, studies exploring its usefulness persist while some propose its replacement by other inflammatory acute-phase-mediators. The aim of this clinical review is to answer the question if CRP measurement warrant clinical decisions for febrile children because it discriminates between bacterial from non bacterial etiologies. We made a systematic search by means of MEDLINE, SciELO and LILACS with the following MESH terms: "C-reactive protein", "bacterial", "infection", "children", "diagnosis" or "detection", besides the Haynes selector for articles on diagnosis, between 1950 and 2004. Selection data extraction and critical appraisal were independently made by the two authors, following standard criteria. We selected 7 primary articles, 3 clinical reviews and two randomized clinical trials. There was no disagreement between reviewers. Only one of the clinical reviews followed standard guidelines; two reviews concluded that no isolated CRP values would warrant to make decisions on starting or withholding antimicrobial therapy in febrile children. All primary articles showed methodological flaws in basic validity criteria. Both randomized clinical trials showed that CRP results did not change either doctor's decisions about antimicrobial prescriptions nor the studied patients' prognosis. We did not find evidences that could warrant the use of CRP for the defined problem in Pediatrics. Main problems affecting validity of studies on CRP as diagnostic resource are the lack of laboratory methods uniformity--including the gold standard make up--the heterogeneity of cut off points, clinical spectrum inappropriateness of study groups as well as the resulting diversity of the fixed indexes values. Moreover, no validation of this test in children population has been made so far.