Lower tract respiratory infection in children younger than 5 years of age and adverse pregnancy outcomes related to household air pollution in Bariloche (Argentina) and Temuco (Chile).

The main objective of this study was to evaluate the association between household air pollution with lower tract respiratory infection (LRTI) in children younger than 5 years old and adverse pregnancy outcomes. This retrospective cohort study took place in two cities in Patagonia. Using systemic random sampling, we selected households in which at least one child <5 years had lived and/or a child had been born alive or stillborn. Trained interviewers administered the questionnaire. We included 926 households with 695 pregnancies and 1074 children. Household cooking was conducted indoors in ventilated rooms and the use of wood as the principal fuel for cooking was lower in Temuco (13% vs. 17%). In exposed to biomass fuel use, the adjusted OR for LRTI was 1.87 (95% CI 0.98-3.55; P = 0.056) in Temuco and 1.12 (95% CI 0.61-2.05; P = 0.716) in Bariloche. For perinatal morbidity, the OR was 3.11 (95% CI 0.86-11.32; P = 0.084) and 1.41 (95% CI 0.50-3.97; P = 0.518), respectively. However, none of the effects were statistically significant (P > 0.05). The use of biomass fuel to cook in traditional cookstoves in ventilated dwellings may increase the risk of perinatal morbidity and LRTI.

Pulmonary involvement of systemic lupus erythematosus: analysis of 90 necropsies.

Pleuropulmonary manifestations of systemic lupus erythematosus (SLE) have been reported to be of variable prevalence, depending on the diagnostic methods used. The objective of this study was to determine the anatomopathological prevalence and the nature of lung involvement associated with SLE and to define if there were differences in the grade and type of pulmonary involvement in patients who had died at different time periods, before or after 1996. Complete autopsy studies of 90 patients with SLE diagnosis carried out between 1958 and 2006 and their clinical records were studied. All patients fulfilled the American College of Rheumathology (ACR) diagnostic criteria for SLE. Two groups of patients were analyzed: patients who had died before 1996 and those deceased in 1996-2006. Some pleuropulmonary involvement was detected in 97.8% of the autopsies. The most frequent findings were pleuritis (77.8%), bacterial infections (57.8%), primary and secondary alveolar haemorrhages (25.6%), followed by distal airway alterations (21.1%), opportunistic infections (14.4%) and pulmonary thromboembolism (7.8%), both acute and chronic. No cases of acute or chronic lupus pneumonitis were found. Opportunistic lung infections were invasive aspergillosis, disseminated strongyloidiasis, mucormicosis and Pneumocystis carinii. Only three of 23 patients with alveolar haemorrhage showed capillaritis. The four patients with primary pulmonary hypertension (PHT) had plexiform lesions. Deceased patients' age at death (46.09 +/- 11.01 vs 30.3 +/- 11.5 years, P < 0.0001) as well as survival time from diagnosis date (11.8 +/- 11.2 vs 4.4 +/- 4.9 years, P < 0.0001) in the second time period evaluated were significantly higher. However, there were no statistically significant differences in the prevalence of any of the pulmonary manifestations. Sepsis was considered the major cause of death without significant differences in both groups. Our results show that pulmonary manifestations directly caused by systemic lupus erythematosus are very uncommon and that their prevalence has not changed in the past 10 years. Pulmonary infection is still the most frequent affection, and it is an important cause of death in patients with lupus.

Síndrome del QT largo en Pediatría: aspectos genéticos y opciones terapéuticas / Long QT síndrome in pediatrics: genetic aspects and therapeutic options

El síndrome de QT largo (LQTS) es una entidad heterogénea, tanto clínica como genéticamente, caracterizada por el aumento del intervalo QT en el ECG. Su potencial letalidad le confiere una especial importancia en pacientes pediátricos, siendo importancia en pacientes pediátricos, siendo importante su identificación. Este artículo pretende revisar las diferentes variantes conocidas del síndrome del QT largo congénito, repasar las causas más frecuentes así como los distintos tratamientos utilizados hasta la fecha, los nuevos avances y posibles futuras estrategias en el síndrome de QT largo y en las torsades de pointes (AU)

The long QT syndrome (LQTS) is a clinically and genetically heterogeneous disease characterized by the increase of the QT interval in the ECG. Its potential lethality makes it have special importance in pediatric patients, its identification being important. This article aims to review the different known variants of the congenital long QT syndrome, review its most frequent causes and different treatments used up to date, the new advances and possible future strategies in the long QT syndrome and in the torsades de pointes (AU)

Crecimiento intrauterino retardado: del diagnóstico prenatal a la edad adulta / Retarded intrauterine growth: from prenatal diagnosis to adult age

No disponible

Enfermedad de von Willebrand: a propósito de un estudio familiar / Von Willebrans Disease: a family study

Se presente una familia con tres miembros afectados de la enfermedad de von Willebrand, que es la diátesis hemorrágica más frecuente, con una incidencia del 1% de la población. El padre y do de los hijos padecían la enfermedad con diferente grado de expresión clínica. Se revisan las bases fisiopatologías de la enfermedad, sus distintas variantes y las pautas terapéuticas actualmente recomendadas en cada una de ellas (AU)

A family with three members affected by von Willebrand disease, which is the most frequent hemorrhagic diathesis with an incidence of 1% of the population, is presented. The father and two of the children suffer the disease with different grade of clinical expression. The physiopathological bases of the disease in their different variants and the therapeutic regimes presently recommended in each one of them are reviewed (AU)

Adenitis cervical por Micobacterium scrofulaceum / No disponible

La incidencia de adenitis cervical por micobacterias atípicas ha aumentado en los últimos años, especialmente por el complejo Micobacterium avium-intracellulare y Micobacterium scrofulaceum. Presentamos dos casos clínicos de dos niñas con adenopatía submandibular unilateral de más de 2 semanas de evolución. En ambos casos se inició un ciclo antibiótico con amoxicilina-ácido clavulánico sin objetivarse mejoría. En su evolución ambas pacientes desarrollaron una adenitis cervical supurada. El hemograma, las serología y la radiografía de tórax, no aportaron datos de interés. El Mantoux fue positivo; de 8 y 12 mm, respectivamente. En el estudio microbiológico de las adenitis se obtuvo tinción de ziehl-auramina positiva y en el cultivo de micobacterias crecieron colonias de Micobacterium scrofulaceum. Ambos casos recidivaron tras una cirugía parcial inicial. Finalmente se trataron mediante extirpación quirúrgica de todos los ganglios afectados, añadiendo en una de las pacientes tratamiento antibiótico (AU)

The incidence of cervical adenitis caused by atypical mycobacteria has increased in recent years, especially due to the Mycobacterium avium-intracellulare complex and Mycobacterium scrofulaceum. We present two clinical cases of two female children with unilateral submandibular adenopathy having more than 2 week´s evolution. In both cases, an antibiotic cycle was initiate with amoxicillin-clavulanic acid without observing improvement. In their course, both patients developed supurative cervical adenitis. The complete blood count, serologies and chest X-ray did not provide any data of interest. Mantoux was positive: from 8 and 12 mm respectively. Zichl-auramine staining was positive in the microbiologic study of adenitis and Mycobacterium scrofulaceum colonies grew in mycobacteria culture. Both cases reoccurred after initial partial surgery. Finally, they were treated with surgical excision of all the lymph nodes involved, adding antibiotic medical treatment in one of the patients (AU)

[Non-invasive mechanical ventilation as treatment for severe pneumonia in an HIV positive patient]. / Ventilacion mecanica no invasiva como tratamiento de la neumonia severa en un paciente con serologia HIV positiva.

A 27 year-old HIV+ patient was admitted to the hospital for probable Pneumocystis carinii pneumonia (PCP). He was severely dyspneic, with respiratory rate of 44 x min and accessory respiratory muscle contraction. The alveolar-arterial quotient was 0.35. Ventilation by BiPAP was applied during 12 hours. After BiPAP a/AO2 was O.42, with amelioration of dyspnea, decrease of respiratory rate (25 x min) and without using of accessory respiratory muscles. No complications occurred. At the end of hospital stay a/AO2 was 0.68. CPAP application but not BiPAP has been reported in PCP. Our patient showed evident improvement after BiPAP, suggesting that this method of ventilation is useful and should be incorporated to the routine management of these patients.