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.

Risk factors and bronchopulmonary dysplasia severity: data from the Spanish Bronchopulmonary Dysplasia Research Network.

GEIDIS is a national-based research-net registry of patients with bronchopulmonary dysplasia (BPD) from public and private Spanish hospitals. It was created to provide data on the clinical characterization and follow-up of infants with BPD until adulthood. The purpose of this observational study was to analyze the characteristics and the impact of perinatal risk factors on BPD severity. The study included 1755 preterm patients diagnosed with BPD. Of the total sample, 90.6% (n = 1591) were less than 30 weeks of gestation. The median gestational age was 27.1 weeks (25.8-28.5) and median birth weight 885 g (740-1,070 g). A total of 52.5% (n = 922) were classified as mild (type 1), 25.3% (n = 444) were moderate (type 2), and 22.2% (n = 389) were severe BPD (type 3). In patients born at under 30 weeks' gestation, most pre-and postnatal risk factors for type 2/3 BPD were associated with the length of exposure to mechanical ventilation (MV). Independent prenatal risk factors were male gender, oligohydramnios, and intrauterine growth restriction. Postnatal risk factors included the need for FiO2 of > 0.30 in the delivery room, nosocomial pneumonia, and the length of exposure to MV. Conclusion: In this national-based research-net registry of BPD patients, the length of MV is the most important risk factor associated with type 2/3 BPD. Among type 3 BPD patients, those who required an FiO2 > .30 at 36 weeks' postmenstrual age had a higher morbidity, during hospitalization and at discharge, compared to those with nasal positive pressure but FiO2 < .30. What is Known: • BPD is a highly complex multifactorial disease associated with preterm birth. What is New: • The length of exposure to mechanical ventilation is the most important postnatal risk factor associated to bronchopulmonary severity which modulate the effect of most pre and postnatal risk factors. • Among patients with BPD, the requirement for FiO2 >.30% at 36 weeks of postmenstrual age is associated with greater morbidity during hospitalization and at discharge.

The relationship between allergic diseases and internalising and externalising behaviours in Spanish children: A cross-sectional study.

INTRODUCTION AND OBJECTIVES: The relationship between allergic diseases and behavioural disorders is still unclear. The objective of this study was to describe and compare children's behaviour (internalising and externalising) across a sample of children aged 6-11 years with and without allergic diseases. MATERIALS AND METHODS: This was a cross-sectional observational case-control study. A survey to 366 families (194 allergic cases and 172 controls), including a child behaviour checklist (CBCL) and a socio-demographic questionnaire with questions related to family, school education, health conditions and allergy symptoms, was administered. RESULTS: Children with a diagnosis of allergy showed higher scores in the overall CBCL score (standardised mean differences [SMD] = 0.47; confidence intervals [CI]: 0.26-0.68) and in the internalising and externalising factors (SMD = 0.52 and SMD = 0.36, respectively) than non-allergic children. Odds ratio (OR) analyses showed a higher risk (OR = 2.76; 95% CI [1.61 to 4.72]) of developing a behavioural difficulty in children diagnosed with allergies. Age and level of asthma appear as modulatory variables. CONCLUSIONS: Children aged 6-11 years diagnosed with allergies showed larger behavioural problems than non-allergic children, especially in the case of internalising behaviours. These findings suggest the importance of attending to them and treating them in the early stages of diagnosis to avoid future psychological disorders.

The relationship between allergic diseases and internalising and externalising behaviours in Spanish children: A cross-sectional study

Introduction and objectives: The relationship between allergic diseases and behavioural disorders is still unclear. The objective of this study was to describe and compare children’s behaviour (internalising and externalising) across a sample of children aged 6–11 years with and without allergic diseases. Materials and methods: This was a cross-sectional observational case-control study. A survey to 366 families (194 allergic cases and 172 controls), including a child behaviour checklist (CBCL) and a socio-demographic questionnaire with questions related to family, school education, health conditions and allergy symptoms, was administered. Results: Children with a diagnosis of allergy showed higher scores in the overall CBCL score (standardised mean differences [SMD] = 0.47; confidence intervals [CI]: 0.26–0.68) and in the internalising and externalising factors (SMD = 0.52 and SMD = 0.36, respectively) than non-allergic children. Odds ratio (OR) analyses showed a higher risk (OR = 2.76; 95% CI [1.61 to 4.72]) of developing a behavioural difficulty in children diagnosed with allergies. Age and level of asthma appear as modulatory variables. Conclusions: Children aged 6–11 years diagnosed with allergies showed larger behavioural problems than non-allergic children, especially in the case of internalising behaviours. These findings suggest the importance of attending to them and treating them in the early stages of diagnosis to avoid future psychological disorders (AU)

Respiratory outcomes of "new" bronchopulmonary dysplasia in adolescents: A multicenter study.

OBJECTIVE: Long-term respiratory consequences of bronchopulmonary dysplasia (BPD) in preterm infants born in the post-surfactant era ("new" BPD) remain partially unknown. The present study aimed to evaluate the respiratory outcomes of "new" BPD in adolescents who were born preterm. METHODS: This multicenter, cross-sectional study included 286 adolescents born between 2003 and 2005 (mean age: 14.2 years); among them, 184 and 102 were born extremely preterm (EP; <28 weeks' gestation) and moderate-late preterm (32 to <37 weeks' gestation), respectively. Among EP adolescents, 92 had BPD, and 92 did not. All participants underwent lung function tests, skin prick testing, and questionnaires on asthma symptoms and quality of life. RESULTS: EP adolescents with BPD had significantly lower forced expiratory volume in 1 s (FEV1 ), forced vital capacity (FVC), FEV1 /FVC ratio, and forced expiratory flow between 25% and 75% of FVC than other included adolescents. FEV1 /FVC ratios were below the lower limit of normal (z-score <-1.645) in 30.4% of EP adolescents with BPD, 13.0% of EP adolescents without BPD, and 11.8% of adolescents who were born moderate-late preterm. Bronchodilator response and air-trapping were significantly higher in BPD adolescents than in other adolescents. Diffusion capacity was significantly lower in EP adolescents than in moderate-late preterm adolescents. Asthma symptoms and quality-of-life scores were similar among groups. CONCLUSION: EP adolescents with "new" BPD had poorer pulmonary function than EP adolescents without BPD or moderate-late preterm adolescents. Further studies are needed to determine whether "new" BPD is associated with early-onset chronic obstructive pulmonary disease in adulthood.

Enfermedad tuberculosa en población pediátrica en Madrid en los últimos 26 años / Tuberculosis in the paediatric population of Madrid in the last 26 years

INTRODUCCIÓN: La tuberculosis (TB) continúa siendo un problema de salud pública grave. En la edad pediátrica existe gran dificultad para obtener un diagnóstico de certeza. La principal forma de presentación es la pulmonar, con mayor riesgo de formas graves y extrapulmonares en menores de 2 años. El objetivo del estudio es describir la TB en población pediátrica en nuestro medio en los últimos años. PACIENTES Y MÉTODOS: Estudio retrospectivo de TB diagnosticadas en 2 hospitales de la Comunidad de Madrid durante 26 años (1991-2017). Se analizan variables epidemiológicas, clínicas, pruebas complementarias y tratamientos recibidos. RESULTADOS: Se incluyeron 170 niños. Las 2 franjas de edad más afectadas son la lactancia y la adolescencia. Población inmigrante: 42,9% (Sudamérica y Marruecos). Los principales motivos de consulta fueron contacto con TB (20,6%) y fiebre (15,3%). Al diagnóstico, el 61,8% refería ambiente epidémico. El 30,6% estaba asintomático. El Mantoux fue positivo en el 92,2% de los pacientes y el IGRA fue positivo en el 70,6% de casos realizados. Se halló enfermedad pulmonar en el 91,8% vs. afectación extrapulmonar en el 8,2% de los niños. El cultivo fue positivo en el 36,9% de muestras de jugo gástrico y se aislaron 3 cepas resistentes a isoniacida. Todos los pacientes seguidos curaron sin secuela, salvo uno que falleció. CONCLUSIONES: La afectación pulmonar continúa siendo la forma de presentación más frecuente de TB en pediatría. El diagnóstico de presunción (clínica compatible con Mantoux positivo o radiografía patológica) es el más habitual. Es importante realizar estudio de contactos como medida de control de enfermedad tuberculosa

INTRODUCTION: Tuberculosis (TB) continues to be a serious public health problem and establishing a definitive diagnosis among children is extremely challenging. Pulmonary tuberculosis is the most prevalent form, with children under the age of 2 years being at greatest risk of severe and disseminated forms. The aim of this study was to describe TB among children in Spain in recent years. PATIENTS AND METHODS: A retrospective study of paediatric patients diagnosed with TB in two hospitals of the Community of Madrid over a 26-year period (1991-2017). Epidemiological and clinical variables, additional tests and treatments received were analysed. RESULTS: 170 children were included. The two most-affected age groups were infancy and adolescence. 42.9% of patients were immigrant children (South-America or Morocco). The main reasons for consultation were TB contact (20.6%) and fever (15.3%). At diagnosis, 61.8% of cases referred an epidemic environment, and 30.6% were asymptomatic. The Mantoux tuberculin skin test was positive in 92.2% of patients and IGRA was positive in 70.6%. Pulmonary TB was identified in 91.8% of children vs. 8.2% with extrapulmonary forms. Gastric juice culture was positive in 36.9% of cases and three strains resistant to isoniazid were isolated. All patients were cured without complications except one who died. CONCLUSIONS: Pulmonary TB continues to be the most prevalent form among children and presumptive diagnosis (symptoms consistent with positive Mantoux test or suggestive X-ray) is the most common form of diagnosis. It is important to conduct a contact investigation in order to control the spread of TB

Tuberculosis in the paediatric population of Madrid in the last 26 years. / Enfermedad tuberculosa en población pediátrica en Madrid en los últimos 26 años.

INTRODUCTION: Tuberculosis (TB) continues to be a serious public health problem and establishing a definitive diagnosis among children is extremely challenging. Pulmonary tuberculosis is the most prevalent form, with children under the age of 2 years being at greatest risk of severe and disseminated forms. The aim of this study was to describe TB among children in Spain in recent years. PATIENTS AND METHODS: A retrospective study of paediatric patients diagnosed with TB in two hospitals of the Community of Madrid over a 26-year period (1991-2017). Epidemiological and clinical variables, additional tests and treatments received were analysed. RESULTS: 170 children were included. The two most-affected age groups were infancy and adolescence. 42.9% of patients were immigrant children (South-America or Morocco). The main reasons for consultation were TB contact (20.6%) and fever (15.3%). At diagnosis, 61.8% of cases referred an epidemic environment, and 30.6% were asymptomatic. The Mantoux tuberculin skin test was positive in 92.2% of patients and IGRA was positive in 70.6%. Pulmonary TB was identified in 91.8% of children vs. 8.2% with extrapulmonary forms. Gastric juice culture was positive in 36.9% of cases and three strains resistant to isoniazid were isolated. All patients were cured without complications except one who died. CONCLUSIONS: Pulmonary TB continues to be the most prevalent form among children and presumptive diagnosis (symptoms consistent with positive Mantoux test or suggestive X-ray) is the most common form of diagnosis. It is important to conduct a contact investigation in order to control the spread of TB.

GEMA 4.0. Spanish Guigeline on the Management of Asthma

No disponible

Validación de un cuestionario en castellano sobre conocimientos de asma en profesores / Validation of a Questionnaire in Spanish on Asthma Knowledge in Teachers

Objetivo: Evaluar la fiabilidad y la validez de la versión en castellano del cuestionario NewCastle Asthma Knowledge Questionnaire (NAKQ) para la determinación de conocimientos sobre asma en profesores. Métodos: Diseño y muestra: estudio observacional, transversal, en centros educativos de A Coruña con segundo ciclo de educación infantil, primaria y/o secundaria obligatoria. Los centros se seleccionaron mediante muestreo aleatorizado, estratificado según titularidad y nivel educativo (24 centros, 864 profesores). Contestaron 537 (62,1%) docentes (precisión, ± 4%, seguridad, 95%). Mediciones: Edad, sexo, formación académica, experiencia docente, antecedentes personales/familiares de asma, cuestionario NAKQ. Análisis: Evaluación de consistencia interna (alfa de Cronbach). La validez concurrente se determinó comparando la puntuación en docentes asmáticos o con familiares asmáticos y docentes sin contacto con el asma. Se evaluó la fiabilidad test-retest en 2 centros seleccionados aleatoriamente, mediante índice Kappa, metodología de Bland-Altman y el coeficiente de correlación intraclase. Resultados: La puntuación media del cuestionario NAKQ fue 15,7 ± 5,3 (mediana 17), contestando correctamente el 50,6% de ítems. El coeficiente alfa de Cronbach fue 0,824 (IC 95%: 0,802-0,845). La puntuación NAKQ fue mayor en asmáticos o con familiares próximos asmáticos (17,7 ± 3,3) que en docentes con familiares lejanos asmáticos (16,1 ± 5,4) y docentes sin contacto próximo con el asma (15,1 ± 5,6; p < 0,001). En el análisis test-retest (Kappa 0,33 a 1) no hubo diferencias entre la puntuación NAKQ en la primera y la segunda cumplimentación (diferencia media, 0,3 ± 2,3; coeficiente de correlación intraclase, 0,863). Conclusiones: Las puntuaciones obtenidas con la versión española del NAKQ en profesores de centros escolares españoles son fiables y válidas para medir su grado de conocimiento de asma

Objective: To evaluate the reliability and validity of the Spanish version of the NewCastle Asthma Knowledge Questionnaire (NAKQ) for determining asthma knowledge in teachers. Methods: Design and sample: A cross-sectional observational study in educational centers of A Coruna˜ providing preschool, primary school and/or compulsory secondary education. Centers were selected by random sampling, stratified by ownership and educational level (24 centers, 864 teachers). A total of 537 (62.1%) teachers responded (precision, ± 4%, confidence, 95%). Measurements: Age, sex, academic training, teaching experience, personal/family history of asthma, NAKQ. Analysis: Evaluation of internal consistency (Cronbach’s alpha). Concurrent validity was determined by comparing scores of asthmatic teachers or with asthmatic relatives with teachers with no contact with asthma. Test-retest reliability was evaluated in two randomly selected centers by the kappa index, BlandAltman method and intraclass correlation coefficient. Results: Mean score on the NAKQ was 15.7 ± 5.3 (median 17), correctly answering 50.6% of items. Cronbach’s alpha coefficient was 0.824 (95% CI: 0.802-0.845). NAKQ score washigher inasthmatic teachers or with close asthmatic relatives (17.7 ± 3.3) than in teachers with distant asthmatic relatives (16.1 ± 5.4) and teachers without close contact with asthma (15.1 ± 5.6; P < 0.001). In the test-retest analysis (kappa 0.33-1), there were no differences in NAKQ score between the first and second completion (mean difference, 0.3 ± 2.3; intraclass correlation coefficient, 0.863). Conclusions: Scores obtained with the Spanish version of the NAKQ in teachers of Spanish school centers are reliable and valid to measure their degree of asthma knowledge

Validation of a questionnaire in Spanish on asthma knowledge in teachers.

OBJECTIVE: To evaluate the reliability and validity of the Spanish version of the NewCastle Asthma Knowledge Questionnaire (NAKQ) for determining asthma knowledge in teachers. DESIGN AND SAMPLE: A cross-sectional observational study in educational centers of A Coruña providing preschool, primary school and/or compulsory secondary education. Centers were selected by random sampling, stratified by ownership and educational level (24centers, 864teachers). A total of 537 (62.1%) teachers responded (precision, ±4%, confidence, 95%). MEASUREMENTS: Age, sex, academic training, teaching experience, personal/family history of asthma, NAKQ. ANALYSIS: Evaluation of internal consistency (Cronbach's alpha). Concurrent validity was determined by comparing scores of asthmatic teachers or with asthmatic relatives with teachers with no contact with asthma. Test-retest reliability was evaluated in two randomly selected centers by the kappa index, Bland-Altman method and intraclass correlation coefficient. RESULTS: Mean score on the NAKQ was 15.7±5.3 (median 17), correctly answering 50.6% of items. Cronbach's alpha coefficient was 0.824 (95%CI: 0.802-0.845). NAKQ score was higher in asthmatic teachers or with close asthmatic relatives (17.7±3.3) than in teachers with distant asthmatic relatives (16.1±5.4) and teachers without close contact with asthma (15.1±5.6; P<0.001). In the test-retest analysis (kappa 0.33-1), there were no differences in NAKQ score between the first and second completion (mean difference, 0.3±2.3; intraclass correlation coefficient, 0.863). CONCLUSIONS: Scores obtained with the Spanish version of the NAKQ in teachers of Spanish school centers are reliable and valid to measure their degree of asthma knowledge.

Prevalencia de síntomas de asma en los niños y adolescentes de la Comunidad Autónoma de Galicia (España) y sus variaciones geográficas / Prevalence and Geographic Variations in Asthma Symptoms in Children and Adolescents in Galicia (Spain)

Objetivos: Determinar la prevalencia y variaciones geográficas de síntomas relacionados con asma enniños y adolescentes gallegos.Población y métodos: Estudio transversal según la metodología ISAAC (Internacional Study of Asthmaand Allergies in Childhood) mediante cuestionario escrito distribuido en el medio escolar. Se incluyeron10.371 niños de 6-7 años y 10.372 adolescentes de 13-14 años de todas las Áreas Sanitarias de Galicia. Seanalizaron las variaciones geográficas mediante un modelo de regresión logística.Resultados: Las sibilancias en los últimos 12 meses oscilaron en los pequeños, del 11,4 (Santiago) al 15,7%(Vigo) y en los adolescentes del 8,8 (Ourense) al 18,8% (Vigo). Según el género se observó una mayorfrecuencia en varones de 6-7 años (p < 0,001) y con tendencia a la significación estadística en las chicasde 13-14 años (p = 0,08). El riesgo (Odds ratio [OR]) de sibilancias en los últimos 12 meses, en el área demayor prevalencia con respecto a la de menor, fue 1,45 (intervalo de confianza [IC] del 95%: 1,12-1,88)en niños y 2,39 (IC 95%: 1,82-3,13) en adolescentes. La prevalencia de asma estimada para Galicia fue de13,6% en niños y 12,2% en adolescentes.Conclusiones: La prevalencia de sibilancias en los últimos 12 meses en las diferentes áreas gallegas essensiblemente superior al resto de ciudades españolas participantes en el ISAAC en los pequeños, siendomuy similar en los adolescentes, salvo en Vigo donde es sensiblemente superior. Encontramos un patróngeográficomuydefinido en los adolescentes, siendo mayores las prevalencias en la costa que en el interior(AU)

Objectives: To determine the prevalence and geographic variations of the symptoms associated withasthma in Galician children and adolescents.Population and methods: A cross-sectional epidemiological study following ISAAC (International Studyof Asthma and Allergies in Childhood) methodology, and using a written questionnaire distributed inschools. The study sample included 10,371 6-7 year-old children and 10,372 13-14 year-old adolescents,all of them from Galician Health Areas. A logistic regression model was used to analyse geographic variations. Results: In the 6-7 year-old group, wheezing in the last 12 months varied from 11.4% (Santiago) to 15.7%(Vigo) and in the adolescents varied from 8.8% (Ourense) to 18.8% (Vigo). The distribution by gender showeda predominant significance in 6-7 year-old males (P < .001), and near to be statistically significant in 13-14year-old females (P = .08). The risk (odds ratio [OR]) of wheezing in the last 12 months in the area withhighest prevalence in comparison with the area of lowest prevalence was 1.45 (95% Confidence Interval[CI], 1.12-1.88) for children and 2.39 (95% CI, 1.82-3.13) for adolescents. The estimated prevalence of asthmain the Autonomous Community of Galicia was 13.6% in younger children and 12.2% in adolescents.Conclusions: The prevalence of wheezing in the last 12 months in the different areas of Galicia is considerablyhigher than the rest of Spanish ISAAC cities in the 6-7 years group and very similar in the 13-14 yearsgroup, except in Vigo where it is considerably higher. We found a clearly defined geographic pattern inthe adolescent group, with higher prevalences in coastal areas than in the interior(AU)

Prevalence and geographic variations in asthma symptoms in children and adolescents in Galicia (Spain).

OBJECTIVES: To determine the prevalence and geographic variations of the symptoms associated with asthma in Galician children and adolescents. POPULATION AND METHODS: A cross-sectional epidemiological study following ISAAC (International Study of Asthma and Allergies in Childhood) methodology, and using a written questionnaire distributed in schools. The study sample included 10,371 6-7 year-old children and 10,372 13-14 year-old adolescents, all of them from Galician Health Areas. A logistic regression model was used to analyse geographic variations. RESULTS: In the 6-7 year-old group, wheezing in the last 12 months varied from 11.4% (Santiago) to 15.7% (Vigo) and in the adolescents varied from 8.8% (Ourense) to 18.8% (Vigo). The distribution by gender showed a predominant significance in 6-7 year-old males (P<.001), and near to be statistically significant in 13-14 year-old females (P=.08). The risk (odds ratio [OR]) of wheezing in the last 12 months in the area with highest prevalence in comparison with the area of lowest prevalence was 1.45 (95% Confidence Interval [CI], 1.12-1.88) for children and 2.39 (95% CI, 1.82-3.13) for adolescents. The estimated prevalence of asthma in the Autonomous Community of Galicia was 13.6% in younger children and 12.2% in adolescents. CONCLUSIONS: The prevalence of wheezing in the last 12 months in the different areas of Galicia is considerably higher than the rest of Spanish ISAAC cities in the 6-7 years group and very similar in the 13-14 years group, except in Vigo where it is considerably higher. We found a clearly defined geographic pattern in the adolescent group, with higher prevalences in coastal areas than in the interior.