Estudio comparativo entre un test de antígeno y la prueba de la reacción en cadena de la polimerasa en tiempo real (RT-PCR) para el diagnóstico de infección por COVID-19 en pediatría / Comparative study between an antigen test and the reverse transcription-polymerase chain reaction (RT-PCR) test for the diagnosis of COVID-19 in pediatrics

Introducción. La pandemia por COVID-19 ha puesto de manifiesto la necesidad de pruebas diagnósticas rápidas. La prueba de referencia es la reacción en cadena de la polimerasa en tiempo real (RT-PCR). Requiere un equipo y personal capacitado, y su resultado puede llevar un tiempo de espera prolongado. El sistema BD Veritor® es el método rápido cromatográfico utilizado para la detección del antígeno del coronavirus de tipo 2 del síndrome respiratorio agudo grave, en individuos sintomáticos. El objetivo primario del siguiente trabajo es evaluar sensibilidad y especificidad del test de antígeno (TA) comparadas con la RT-PCR en población pediátrica. Población y métodos. Estudio prospectivo, de prueba diagnóstica. Se incluyó a todo menor de 17 años en los primeros 5 días de inicio de síntomas, que consultó desde julio de 2021 hasta febrero de 2022. Se calculó un mínimo de 300 muestras para lograr una precisión de ± 8,76 % y de ± 3,68 % para sensibilidad y especificidad respectivamente. Se analizaron en paralelo las muestras por ambas metodologías. Resultados. De 316 muestras pareadas, 33 fueron positivas por ambos métodos; 6 fueron positivas solo por RT-PCR. La especificidad del TA fue del 100 %; la sensibilidad, del 84,6 %, con un valor predictivo positivo y negativo del 100 % y del 98 % respectivamente. Conclusiones. El TA demostró ser útil en el diagnóstico de pacientes pediátricos con COVID-19 en los primeros 5 días de inicio de síntomas, aunque aquellos con TA negativo y alta sospecha clínica deberían confirmar su resultado con la RT-PCR.

Introduction. The COVID-19 pandemic has brought to light the need for rapid diagnostic tests. The gold standard test is reverse transcription-polymerase chain reaction (RT-PCR). RT-PCR requires equipment and trained personnel, and results may take a long waiting time. The BD Veritor® System is a rapid chromatographic method used for the detection of severe acute respiratory syndrome coronavirus 2 antigen in symptomatic individuals. The primary objective of this study is to assess the sensitivity and specificity of the antigen test (AT) compared to the RT-PCR in the pediatric population. Population and methods. Prospective study with a diagnostic test. All children younger than 17 years in the first 5 days of symptom onset, who consulted between July 2021 and February 2022, were included. A minimum of 300 specimens was estimated to achieve an accuracy of ±8.76% and ±3.68% for sensitivity and specificity, respectively. Specimens were analyzed in parallel using both methodologies. Results. Of 316 paired samples, 33 were positive by both methods; 6 were positive only by RT-PCR. The specificity of the AT was 100%; sensitivity was 84.6%, with a positive and negative predictive value of 100% and 98%, respectively. Conclusions. The AT proved to be useful in the diagnosis of pediatric patients with COVID-19 in the first 5 days of symptom onset, although those with a negative AT and high clinical suspicion should confirm their result with a RT-PCR.

Pubertad precoz y pubertad rápidamente progresiva durante el confinamiento por la pandemia por COVID-19 / Rapidly progressive precocious puberty during the COVID-19 lockdown

Introducción. Durante la pandemia por COVID-19, observamos un aumento de consultas por pubertad precoz (PP). Nuestro objetivo fue determinar la frecuencia de PP y su progresión antes y durante la pandemia. Métodos. Estudio retrospectivo, observacional y analítico. Se evaluaron las historias clínicas de los pacientes que consultaron en Endocrinología Infantil entre abril de 2018 y marzo de 2021. Se analizaron las consultas por sospecha de PP durante la pandemia (período 3) y se compararon con 2 años previos (períodos 1 y 2). Se recolectaron datos clínicos y estudios complementarios de la evaluación inicial y su progresión. Resultados. Se analizaron 5151 consultas. Se observó un aumento de consultas por sospecha de PP durante el período 3 (21 % vs.10 % y 11 %, p <0,001). Los pacientes que consultaron por sospecha de PP durante el período 3 aumentaron 2,3 veces (80 vs. 29 y 31, p <0,001). El 95 % fueron niñas; esa población fue analizada. Se incluyeron 132 pacientes que fueron similares en edad, peso, talla, edad ósea y determinaciones hormonales en los 3 períodos. En el período 3, se observó un menor índice de masa corporal, mayor porcentaje de estadio mamario Tanner 3-4 y mayor longitud uterina. Se indicó tratamiento al diagnóstico en el 26 % de los casos. En el resto, se controló su evolución. Durante el seguimiento, se observó una evolución rápidamente progresiva con mayor frecuencia durante el período 3 (47 % vs. 8 % vs. 13 %; p: 0,02). Conclusiones. Evidenciamos un aumento de la PP y una evolución rápidamente progresiva en niñas durante la pandemia.

Introduction. During the COVID-19 pandemic, an increase in consultations for precocious puberty (PP) was observed. Our objective was to determine the frequency of PP and its progression before and during the pandemic. Methods. Retrospective, observational, analytical study. The medical records of patients who consulted with the Department of Pediatric Endocrinology between April 2018 and March 2021 were assessed. Consultations for suspected PP during the pandemic (period 3) were analyzed and compared to the 2 previous years (periods 1 and 2). Clinical data and ancillary tests done in the initial assessment and PP progression information were collected. Results. Data from 5151 consultations were analyzed. An increase in consultations for suspected PP was observed during period 3 (21% versus 10% and 11%, p < 0.001). Patients who consulted for suspected PP during period 3 increased 2.3-fold (80 versus 29 and 31, p < 0.001). In total, 95% were female; this was the population analyzed. We included 132 patients with similar age, weight, height, bone age, and hormonal characteristics in the 3 periods. During period 3, a lower body mass index, a higher percentage of Tanner breast stage 3­4, and a greater uterine length were observed. Treatment was indicated upon diagnosis in 26% of the cases. In the rest, their evolution was monitored. During follow-up, a rapidly progressive course was observed more frequently in period 3 (47% versus 8% versus 13%, p: 0.02). Conclusions. We observed an increase in PP and a rapidly progressive evolution in girls during the pandemic.

Comparative study between an antigen test and the reverse transcription-polymerase chain reaction (RT-PCR) test for the diagnosis of COVID-19 in pediatrics. / Estudio comparativo entre un test de antígeno y la prueba de la reacción en cadena de la polimerasa en tiempo real (RT-PCR) para el diagnóstico de infección por COVID-19 en pediatría.

Introduction. The COVID-19 pandemic has brought to light the need for rapid diagnostic tests. The gold standard test is reverse transcription-polymerase chain reaction (RT-PCR). RT-PCR requires equipment and trained personnel, and results may take a long waiting time. The BD Veritor® System is a rapid chromatographic method used for the detection of severe acute respiratory syndrome coronavirus 2 antigen in symptomatic individuals. The primary objective of this study is to assess the sensitivity and specificity of the antigen test (AT) compared to the RT-PCR in the pediatric population. Population and methods. Prospective study with a diagnostic test. All children younger than 17 years in the first 5 days of symptom onset, who consulted between July 2021 and February 2022, were included. A minimum of 300 specimens was estimated to achieve an accuracy of ±8.76% and ±3.68% for sensitivity and specificity, respectively. Specimens were analyzed in parallel using both methodologies. Results. Of 316 paired samples, 33 were positive by both methods; 6 were positive only by RT-PCR. The specificity of the AT was 100%; sensitivity was 84.6%, with a positive and negative predictive value of 100% and 98%, respectively. Conclusions. The AT proved to be useful in the diagnosis of pediatric patients with COVID-19 in the first 5 days of symptom onset, although those with a negative AT and high clinical suspicion should confirm their result with a RT-PCR. Clinical trial registration: PRIISA.BA - Record number: 4912 - Date of registration: 07/07/2021.

Introducción. La pandemia por COVID-19 ha puesto de manifiesto la necesidad de pruebas diagnósticas rápidas. La prueba de referencia es la reacción en cadena de la polimerasa en tiempo real (RT-PCR). Requiere un equipo y personal capacitado, y su resultado puede llevar un tiempo de espera prolongado. El sistema BD Veritor® es el método rápido cromatográfico utilizado para la detección del antígeno del coronavirus de tipo 2 del síndrome respiratorio agudo grave, en individuos sintomáticos. El objetivo primario del siguiente trabajo es evaluar sensibilidad y especificidad del test de antígeno (TA) comparadas con la RT-PCR en población pediátrica. Población y métodos. Estudio prospectivo, de prueba diagnóstica. Se incluyó a todo menor de 17 años en los primeros 5 días de inicio de síntomas, que consultó desde julio de 2021 hasta febrero de 2022. Se calculó un mínimo de 300 muestras para lograr una precisión de ± 8,76 % y de ± 3,68 % para sensibilidad y especificidad respectivamente. Se analizaron en paralelo las muestras por ambas metodologías. Resultados. De 316 muestras pareadas, 33 fueron positivas por ambos métodos; 6 fueron positivas solo por RT-PCR. La especificidad del TA fue del 100 %; la sensibilidad, del 84,6 %, con un valor predictivo positivo y negativo del 100 % y del 98 % respectivamente. Conclusiones. El TA demostró ser útil en el diagnóstico de pacientes pediátricos con COVID-19 en los primeros 5 días de inicio de síntomas, aunque aquellos con TA negativo y alta sospecha clínica deberían confirmar su resultado con la RT-PCR. Registro de ensayos clínicos: PRIISA.BA ­ Número de registro: 4912 ­ Fecha de inscripción: 07/07/2021.

Rapidly progressive precocious puberty during the COVID-19 lockdown. / Pubertad precoz y pubertad rápidamente progresiva durante el confinamiento por la pandemia por COVID-19.

Introduction. During the COVID-19 pandemic, an increase in consultations for precocious puberty (PP) was observed. Our objective was to determine the frequency of PP and its progression before and during the pandemic. Methods. Retrospective, observational, analytical study. The medical records of patients who consulted with the Department of Pediatric Endocrinology between April 2018 and March 2021 were assessed. Consultations for suspected PP during the pandemic (period 3) were analyzed and compared to the 2 previous years (periods 1 and 2). Clinical data and ancillary tests done in the initial assessment and PP progression information were collected. Results. Data from 5151 consultations were analyzed. An increase in consultations for suspected PP was observed during period 3 (21% versus 10% and 11%, p < 0.001). Patients who consulted for suspected PP during period 3 increased 2.3-fold (80 versus 29 and 31, p < 0.001). In total, 95% were female; this was the population analyzed. We included 132 patients with similar age, weight, height, bone age, and hormonal characteristics in the 3 periods. During period 3, a lower body mass index, a higher percentage of Tanner breast stage 3-4, and a greater uterine length were observed. Treatment was indicated upon diagnosis in 26% of the cases. In the rest, their evolution was monitored. During follow-up, a rapidly progressive course was observed more frequently in period 3 (47% versus 8% versus 13%, p: 0.02). Conclusions. We observed an increase in PP and a rapidly progressive evolution in girls during the pandemic.

Introducción. Durante la pandemia por COVID-19, observamos un aumento de consultas por pubertad precoz (PP). Nuestro objetivo fue determinar la frecuencia de PP y su progresión antes y durante la pandemia. Métodos. Estudio retrospectivo, observacional y analítico. Se evaluaron las historias clínicas de los pacientes que consultaron en Endocrinología Infantil entre abril de 2018 y marzo de 2021. Se analizaron las consultas por sospecha de PP durante la pandemia (período 3) y se compararon con 2 años previos (períodos 1 y 2). Se recolectaron datos clínicos y estudios complementarios de la evaluación inicial y su progresión. Resultados. Se analizaron 5151 consultas. Se observó un aumento de consultas por sospecha de PP durante el período 3 (21 % vs.10 % y 11 %, p <0,001). Los pacientes que consultaron por sospecha de PP durante el período 3 aumentaron 2,3 veces (80 vs. 29 y 31, p <0,001). El 95 % fueron niñas; esa población fue analizada. Se incluyeron 132 pacientes que fueron similares en edad, peso, talla, edad ósea y determinaciones hormonales en los 3 períodos. En el período 3, se observó un menor índice de masa corporal, mayor porcentaje de estadio mamario Tanner 3-4 y mayor longitud uterina. Se indicó tratamiento al diagnóstico en el 26 % de los casos. En el resto, se controló su evolución. Durante el seguimiento, se observó una evolución rápidamente progresiva con mayor frecuencia durante el período 3 (47 % vs. 8 % vs. 13 %; p: 0,02). Conclusiones. Evidenciamos un aumento de la PP y una evolución rápidamente progresiva en niñas durante la pandemia.

Inhaloterapia: recomendaciones para Argentina 2021 / Inhalotherapy: recommendations for Argentina 2021

Resumen En las últimas décadas ha habido un importante desarrollo de dispositivos inhalados (DI) que permiten aumentar la eficacia de las drogas y disminuir los eventos adversos. Su correcto uso es de fundamental importancia para el control de las enfermedades respiratorias obstructivas. En la Argentina no existen recomendaciones locales sobre el uso de los DI. Se revisó la base biofísica, indicación, ventajas y limitaciones, técnica de correcto uso, errores frecuentes, mantenimiento y limpieza de cada DI. El uso de nebulizaciones ha quedado restringido a la administración de drogas que no están disponibles en otros DI (ejemplo: tratamiento de fibrosis quística), o ante la falla de los otros DI. No deben ser usados durante la pandemia de SARS-CoV2. Los inhaladores de dosis medida (aerosol) deben ser indicados siempre con aerocámaras (AC), las que reducen la incidencia de eventos adversos y aumentan el depósito de la droga en el pulmón. Son los dispositivos de elección junto a los inhaladores de polvo seco. Los aerosoles se deben usar en pacientes que no generan flujos inspiratorios altos. Los inhaladores de polvo seco deben recomendarse en aquellos que pueden realizar flujos inspiratorios enérgicos. Se revisaron los diferentes DI en fibrosis quística y en pacientes con asistencia respiratoria mecánica. La elección del DI dependerá de varios factores: situación clínica, edad, experiencia previa, preferencia del paciente, disponibilidad de la droga y entrenamiento alcanzado con el correcto uso.

Abstract Last decades, a broad spectrum of inhaled devices (ID) had been developed to enhance efficacy and reduce adverse events. The correct use of IDs is a critical issue for controlling obstructive respiratory diseases. There is no recommendation on inhalation therapy in Argentina. This document aims to issue local recommendations about the prescription of IDs. Each device was reviewed regarding biophysical laws, indication, strength, limitations, correct technique of use, frequent mistakes, and device cleaning and maintenance. Nebulization should be restricted to drugs that are not available in other IDs (for example, for treatment of cystic fibrosis) or where other devices fail. Nebulization is not recommended during the SARS-CoV2 pandemic. A metered-dose inhaler must always be used with an aerochamber. Aerochambers reduce the incidence of adverse events and improve lung deposition. Metered-dose inhalers must be prescribed to patients who cannot generate a high inspiratory flow and dry powders to those who can generate an energetic inspiratory flow. We reviewed the use of different IDs in patients with cystic fibrosis and under mechanical ventilation. The individual choice of an ID will be based on several variables like clinical status, age, previous experience, patient preference, drug availability, and correct use of the device.

[Inhalotherapy: Recommendations for Argentina 2021]. / Inhaloterapia: Recomendaciones para Argentina 2021.

Last decades, a broad spectrum of inhaled devices (ID) had been developed to enhance efficacy and reduce adverse events. The correct use of IDs is a critical issue for controlling obstructive respiratory diseases. There is no recommendation on inhalation therapy in Argentina. This document aims to issue local recommendations about the prescription of IDs. Each device was reviewed regarding biophysical laws, indication, strength, limitations, correct technique of use, frequent mistakes, and device cleaning and maintenance. Nebulization should be restricted to drugs that are not available in other IDs (for example, for treatment of cystic fibrosis) or where other devices fail. Nebulization is not recommended during the SARS-CoV2 pandemic. A metered-dose inhaler must always be used with an aerochamber. Aerochambers reduce the incidence of adverse events and improve lung deposition. Metered-dose inhalers must be prescribed to patients who cannot generate a high inspiratory flow and dry powders to those who can generate an energetic inspiratory flow. We reviewed the use of different IDs in patients with cystic fibrosis and under mechanical ventilation. The individual choice of an ID will be based on several variables like clinical status, age, previous experience, patient preference, drug availability, and correct use of the device.

En las últimas décadas ha habido un importante desarrollo de dispositivos inhalados (DI) que permiten aumentar la eficacia de las drogas y disminuir los eventos adversos. Su correcto uso es de fundamental importancia para el control de las enfermedades respiratorias obstructivas. En la Argentina no existen recomendaciones locales sobre el uso de los DI. Se revisó la base biofísica, indicación, ventajas y limitaciones, técnica de correcto uso, errores frecuentes, mantenimiento y limpieza de cada DI. El uso de nebulizaciones ha quedado restringido a la administración de drogas que no están disponibles en otros DI (ejemplo: tratamiento de fibrosis quística), o ante la falla de los otros DI. No deben ser usados durante la pandemia de SARS-CoV2. Los inhaladores de dosis medida (aerosol) deben ser indicados siempre con aerocámaras (AC), las que reducen la incidencia de eventos adversos y aumentan el depósito de la droga en el pulmón. Son los dispositivos de elección junto a los inhaladores de polvo seco. Los aerosoles se deben usar en pacientes que no generan flujos inspiratorios altos. Los inhaladores de polvo seco deben recomendarse en aquellos que pueden realizar flujos inspiratorios enérgicos. Se revisaron los diferentes DI en fibrosis quística y en pacientes con asistencia respiratoria mecánica. La elección del DI dependerá de varios factores: situación clínica, edad, experiencia previa, preferencia del paciente, disponibilidad de la droga y entrenamiento alcanzado con el correcto uso.

[Epignathus, the importance of prenatal diagnosis and interdisciplinary work: A case report]. / Teratoma oral: la importancia del diagnóstico prenatal y el trabajo interdisciplinario: un caso clínico.

Thanks to technological advances, it has been possible to carry out the prenatal diagnosis of different life-threatening congenital malformations. Among these, oral teratoma, or epignathus, is a rare form of congenital teratoma within those located in the head and neck. They are generally benign and comprise 4 % of neonatal teratomas. From the development of the EXIT technique (ex utero intrapartum treatment), which has been implemented since the 90's to support fetal circulation until the newborn's airway is secured, it is possible to plan a multidisciplinary management strategy that enables the correct approach of these pathologies. We present a case of giant epignathus in a 35-week gestation female patient, whose airway was secured using the EXIT technique, and follow up.

Gracias al avance de la tecnología, es posible realizar el diagnóstico prenatal de distintas malformaciones congénitas que ponen en riesgo la vida del recién nacido. Entre estas, el teratoma oral o epignathus es una forma poco frecuente de teratoma congénito entre los que se localizan en cabeza y cuello. Suelen ser benignos y abarcan el 4 % de los teratomas neonatales. A partir del desarrollo de la técnica de tratamiento intraparto extraútero (EXIT, por su sigla en inglés), que se implementó en los años 90 para mantener la circulación fetal hasta asegurar la vía aérea del recién nacido, se logra planificar una estrategia de manejo multidisciplinario que permite el abordaje correcto de estas patologías. Se presenta un caso de teratoma oral gigante en una paciente de sexo femenino de 35 semanas de gestación, en quien se aplicó la técnica EXIT, y su evolución posterior.

Teratoma oral: la importancia del diagnóstico prenatal y el trabajo interdisciplinario: un caso clínico / Epignathus, the importance of prenatal diagnosis and interdisciplinary work: A case report

Gracias al avance de la tecnología, es posible realizar el diagnóstico prenatal de distintas malformaciones congénitas que ponen en riesgo la vida del recién nacido. Entre estas, el teratoma oral o epignathus es una forma poco frecuente de teratoma congénito entre los que se localizan en cabeza y cuello. Suelen ser benignos y abarcan el 4 % de los teratomas neonatales.A partir del desarrollo de la técnica de tratamiento intraparto extraútero (EXIT, por su sigla en inglés), que se implementó en los años 90 para mantener la circulación fetal hasta asegurar la vía aérea del recién nacido, se logra planificar una estrategia de manejo multidisciplinario que permite el abordaje correcto de estas patologías. Se presenta un caso de teratoma oral gigante en una paciente de sexo femenino de 35 semanas de gestación, en quien se aplicó la técnica EXIT, y su evolución posterior.

Thanks to technological advances, it has been possible to carry out the prenatal diagnosis of different life-threatening congenital malformations. Among these, oral teratoma, or epignathus, is a rare form of congenital teratoma within those located in the head and neck. They are generally benign and comprise 4 % of neonatal teratomas. From the development of the EXIT technique (ex utero intrapartum treatment), which has been implemented since the 90's to support fetal circulation until the newborn's airway is secured, it is possible to plan a multidisciplinary management strategy that enables the correct approach of these pathologies.We present a case of giant epignathus in a 35-week gestation female patient, whose airway was secured using the EXIT technique, and follow up.

Direct costs and clinical impact of adenovirus genotype 8 conjunctivitis outbreak in a neonatology unit.

OBJECTIVE: To report a conjunctivitis outbreak in a neonatology intensive care unit (NICU) and determine the associated economic impact. DESIGN: Prospective observational study. SETTING: Centro de Educación Médica e Investigaciones Clínicas (CEMIC) University Hospital, a private, tertiary-care healthcare institution in Buenos Aires, Argentina. PARTICIPANTS: The study included 52 NICU neonates and 59 NICU-related healthcare workers (HCWs) from CEMIC hospital. METHODS: Neonates and HCWs were swabbed for real-time polymerase chain reaction (PCR) testing, viral culture, and typing by sequencing. Infection control measures, structural and logistic changes were implemented. Billing records were analyzed to determine costs. RESULTS: From January 30 to April 28, 2018, 52 neonates were hospitalized in the NICU. Among them, 14 of 52 (21%) had bilateral conjunctivitis with pseudomembranes. Symptomatic neonates and HCWs were HAdV-D8 positive. Ophthalmological symptoms had a median duration of 18 days (IQR, 13-24.5). PCR positivity and infectious range had a median duration of 18.5 days. As part of containment measures, the NICU and the high-risk pregnancy unit were closed to new patients. The NICU was divided into 2 areas for symptomatic and asymptomatic patients; a new room was assigned for the general nursery, and all deliveries from the high-risk pregnancy unit were redirected to other hospitals. The outbreak cost the hospital US$205,000: implementation of a new nursery room and extra salaries cost US$30,350 and estimated productivity loss during 1 month cost US$175,000. CONCLUSIONS: Laboratory diagnosis confirmed the cause of this outbreak as HAdV-D8. The immediate adoption and reinforcement of rigorous infection control measures limited the nosocomial viral spread. This outbreak represented a serious institutional problem, causing morbidity, significant economic loss, and absenteeism.

Respiratory pathogens in infants less than two months old hospitalized with acute respiratory infection.

Lower acute respiratory infections (ARI) are a frequent cause of morbidity and mortality in infants, respiratory viruses being the major causative agents. The aim of this work was to determine the respiratory pathogen frequency, the clinical characteristics and the outcome in infants <2 months old hospitalized with ARI. A retrospective study was performed during a five-year period (2008-2011, 2014-2016). Respiratory viruses and atypical bacteria were studied using the FilmArray-Respiratory Panel. Demographic and clinical characteristics, hospitalization course and outcomes were evaluated. Of the 137 infants <2 months old hospitalized with ARI studied, a 94.9% positivity rate as determined in 117 infants with community-acquired infection and 20.0% in 20 infants who acquired the infection during their birth hospitalization in the neonatal intensive care units (NICU) (nosocomial ARI) (p<0.001). In infants with community-acquired infection, Respiratory syncytial virus (RSV) (52.1%) and Rhinovirus/Enterovirus (RV/EV) (41.0%) were the most frequent detected pathogens. Coinfections were determined in one quarter of the infants, RSV-RV/EV being the most frequent combination. In infants with nosocomial infection, RV/EV, RSV or Parainfluenza-3 were detected as single pathogens. Most infants with community-acquired infection presented lower ARI (81.2%) while most infants in the NICU had upper ARI (55.0%). The median length of stay (LOS) in infants with community-acquired ARI was 4 days (IQR: 2-6). Positive infants with nosocomial infection had longer median LOS (71 days [IQR:42-99]) compared to negative infants (58 days [IQR: 49-71]) (p=0.507). Respiratory viruses were detected as the major causative agents of community-acquired infection in hospitalized infants <2-months old, RSV and RV/EV being the most frequently detected. Although a low pathogen positivity rate was observed in infants with nosocomial infection, they may prolong the LOS.

Nosocomial Transmission and Genetic Diversity of Rhinovirus in a Neonatal Intensive Care Unit.

Rhinoviruses were detected as sole pathogens in 6 preterm infants who developed severe respiratory infections while hospitalized in a neonatal intensive care unit. We confirmed 2 nosocomial rhinovirus transmission episodes and describe the genetic diversity of rhinovirus strains that circulated simultaneously during a winter season.

[Publication of abstracts presented at the National Pediatric Research Meetings of the Argentine Society of Pediatrics: Related factors]. / Publicación de trabajos presentados en los Encuentros Nacionales de Investigación Pediátrica de la Sociedad Argentina de Pediatría: factores involucrados.

OBJECTIVE: To estimate the proportion of abstracts presented at National Pediatric Research Meetings that are fully-published and describe their design and factors that influence nonpublication. METHODS: Descriptive and analytical study including all abstracts presented at National Pediatric Research Meetings (1998-2011). One author per study was identified and asked to complete a survey on its design, publication and factors associated with non-publication. RESULTS: Out of 746 abstracts that were submitted, the authors of 522 (70%) completed the survey. Among these, 84.3% were observational studies and 15.7%, experimental; 34% had received funding. Two hundred and seventeen abstracts were published subsequently (41.5%, 95% confidence interval [CI]: 37.3-45.9). Funded studies had better chances of being published (odds ratio [OR]: 2, 95% CI: 1.4-2.9, p 〈 0.001). Lack of time, insufficient sample size, and problems with funding were referred as the most common reasons for failure to publish. CONCLUSIONS: Among allabstracts presented at National Pediatric Research Meetings, 41.5% were fully published. Lack of time was the most common reason for unpublished studies.

OBJETIVOS: Estimar la proporción de trabajos presentados en Encuentros Nacionales de Investigación Pediátrica que posteriormente fueron publicados en forma completa; describir sus diseños y factores involucrados con la no publicación. MÉTODOS: Estudio descriptivo y analítico, que incluyó todos los trabajos presentados en Encuentros N acionales de Investigación Pediátrica (1998-2011). Se identificó un investigador por estudio y se lo encuestó sobre el diseño, la publicación y los factores asociados a la no publicación. RESULTADOS: Sobre 746 trabajos presentados, respondieron la encuesta los autores de 522 (70%). El 84,3% eran estudios observacionales y 15,7%, experimentales; 34% recibieron financiación. Fueron publicados posteriormente 217 trabajos (41,5%, IC 95%: 37,3-45,9). Aquellos con financiación tuvieron mayor probabilidad de publicarse (OR 2; IC 95%: 1,4-2,9; p 〈 0,001). Las causas de no publicación más frecuentes fueron la falta de tiempo, el tamaño muestral insuficiente y la dificultad con el financiamiento. CONCLUSIONES: El 41,5% de trabajos presentados en Encuentros Nacionales de Investigación Pediátrica alcanzaron la publicaciónen texto completo. La falta de tiempo fue la principal causa para no hacerlo.

Incidence of viral respiratory infections in a prospective cohort of outpatient and hospitalized children aged ≤5 years and its associated cost in Buenos Aires, Argentina.

BACKGROUND: Although information about the incidence of viral respiratory illnesses and their associated cost can help health officials explore the value of interventions, data are limited from middle-income countries. METHODS: During 2008-2010, we conducted a prospective cohort study and followed ~1,800 Argentinian children aged ≤5 years to identify those children who were hospitalized or who sought care at an emergency room with any acute respiratory infection sign or symptom (e.g., rhinorrhea, cough, wheezing, tachypnea, retractions, or cyanosis). Respiratory samples were obtained for respiratory syncytial virus, influenza, parainfluenza, adenovirus, and metapneumovirus testing by immunofluorescence and for rhinovirus by real-time reverse transcription polymerase chain reaction. RESULTS: The incidence of respiratory syncytial virus (24/1000 children-years), human metapneumovirus (8/1000 children-years), and influenza (8/1000 children-years) illnesses was highest among hospitalized children aged <6 months and decreased among older children. In contrast, the incidence of rhinovirus was highest (12/1000 children-years) among those aged 6-23 months. In the emergency room, the incidence of rhinovirus was 459; respiratory syncytial virus 352; influenza 185; parainfluenza 177; metapneumovirus 130; and adenovirus 73/1,000 children-years. The total cost of hospitalization was a median of US$529 (Interquartile range, US$362-789). CONCLUSIONS: Our findings indicate that respiratory viruses, in particular rhinovirus, respiratory syncytial virus, metapneumovirus, and influenza may be associated with severe illness causing substantial economic burden.

Assessment of quality of life before and after an adenotonsillectomy among children with hypertrophic tonsils and/or adenoids.

INTRODUCTION: Adenotonsillectomy is the most common surgical procedure in otolaryngology.The main indication for this procedure is upper airway obstruction associated with hypertrophic tonsils and/or adenoids. OBJECTIVES: To describe the differences in quality of life before and after an adenoidectomy and/or tonsillectomy and compare it with that of healthy children. POPULATION AND METHODS: All children aged 1 to 17 years old hospitalized for an elective surgery between July 2012 and April 2014 were enrolled.They were compared to a control group of children in the same age range. The survey used was validated in Spanish (OSA-18) and has been especially designed to establish a relationship between obstructive sleep apnea and quality of life in pediatrics. RESULTS: Eighty-five surgery patients and 100 healthy control children were assessed. The impact on quality of life was mild in 37.6% of children, moderate in 32.9%, and severe in 29.4%,while it was mild for 96% of the control group.The average±SD of the total pre-surgery score was 67.5±20.3 (95% confidence interval [CI]:63.13-71.88). The average post-surgery scores were 37.9±21.4 (95% CI: 33.24-42.48) and 37.25±23.9 (95% CI: 32.19-42.33) at 3 and 6 months,respectively (p<0.001). The average score for the control group was 31.2±13.2 (95% CI: 28.6-33.8) and was significantly different from the post-surgery groups (p=0.03). CONCLUSIONS: Quality of life was reduced in children with a surgical indication for symptomatic adenotonsillar hypertrophy, while it was significantly improved after the surgery.

Evaluación de la calidad de vida antes y después de la adenotonsilectomía en niños con hipertrofia de amígdalas y/o adenoides / Assessment of quality of life before and after an adenotonsillectomy among children with hypertrophic tonsils and/or adenoids

Introducción. La adenoamigdalectomía es la intervención más frecuente en otorrinolaringología. La principal indicación son las alteraciones obstructivas de la vía aérea superior asociadas con hipertrofia de amígdalas y/o adenoides. Objetivos. Describir las diferencias en la calidad de vida antes y después de la adenoidectomía y/o amigdalectomía y en comparación con un grupo de niños sanos. Población y métodos. Se enrolaron niños de entre 1 y 17 años de edad internados para cirugía programada entre julio de 2012 y abril de 2014. Se comparó con un grupo control de niños de la misma edad. Se utilizó una encuesta validada en el idioma español (OSA-18), especialmente diseñada para relacionar apneas obstructivas del sueño con calidad de vida, en pediatría. Resultados. Se evaluaron 85 pacientes quirúrgicos y 100 niños sanos del grupo control. Se halló un impacto sobre la calidad de vida leve en 37,6% de niños, moderado en 32,9% y grave en 29,4%, mientras que en el grupo control fue leve en el 96%. El promedio ± DE de puntaje prequirúrgico total fue de 67,5 ± 20,3 (IC 95% 63,13-71,88). Los promedios posquirúrgicos fueron 37,9 ± 21,4 (IC 95% 33,24-42,48) y 37,25 ± 23,9 (IC 95% 32,19-42,33) a los 3 y 6 meses, respectivamente (p < 0,001). El puntaje promedio en el grupo control fue 31,2 ± 13,2 (IC 95% 28,6-33,8) y difirió significativamente con los grupos posquirúrgicos (p= 0,03). Conclusiones. Se observó una disminución de calidad de vida en niños con indicación quirúrgica por hipertrofia adenoamigdalina sintomática y un beneficio significativo sobre esta luego de la intervención.(AU)

.(AU)

Evaluación de la calidad de vida antes y después de la adenotonsilectomía en niños con hipertrofia de amígdalas y/o adenoides / Assessment of quality of life before and after an adenotonsillectomy among children with hypertrophic tonsils and/or adenoids

Introducción. La adenoamigdalectomía es la intervención más frecuente en otorrinolaringología. La principal indicación son las alteraciones obstructivas de la vía aérea superior asociadas con hipertrofia de amígdalas y/o adenoides. Objetivos. Describir las diferencias en la calidad de vida antes y después de la adenoidectomía y/o amigdalectomía y en comparación con un grupo de niños sanos. Población y métodos. Se enrolaron niños de entre 1 y 17 años de edad internados para cirugía programada entre julio de 2012 y abril de 2014. Se comparó con un grupo control de niños de la misma edad. Se utilizó una encuesta validada en el idioma español (OSA-18), especialmente diseñada para relacionar apneas obstructivas del sueño con calidad de vida, en pediatría. Resultados. Se evaluaron 85 pacientes quirúrgicos y 100 niños sanos del grupo control. Se halló un impacto sobre la calidad de vida leve en 37,6% de niños, moderado en 32,9% y grave en 29,4%, mientras que en el grupo control fue leve en el 96%. El promedio ± DE de puntaje prequirúrgico total fue de 67,5 ± 20,3 (IC 95% 63,13-71,88). Los promedios posquirúrgicos fueron 37,9 ± 21,4 (IC 95% 33,24-42,48) y 37,25 ± 23,9 (IC 95% 32,19-42,33) a los 3 y 6 meses, respectivamente (p < 0,001). El puntaje promedio en el grupo control fue 31,2 ± 13,2 (IC 95% 28,6-33,8) y difirió significativamente con los grupos posquirúrgicos (p= 0,03). Conclusiones. Se observó una disminución de calidad de vida en niños con indicación quirúrgica por hipertrofia adenoamigdalina sintomática y un beneficio significativo sobre esta luego de la intervención.(AU)

.(AU)

Evaluación de la calidad de vida antes y después de la adenotonsilectomía en niños con hipertrofia de amígdalas y/o adenoides / Assessment of quality of life before and after an adenotonsillectomy among children with hypertrophic tonsils and/or adenoids

Introducción. La adenoamigdalectomía es la intervención más frecuente en otorrinolaringología. La principal indicación son las alteraciones obstructivas de la vía aérea superior asociadas con hipertrofia de amígdalas y/o adenoides. Objetivos. Describir las diferencias en la calidad de vida antes y después de la adenoidectomía y/o amigdalectomía y en comparación con un grupo de niños sanos. Población y métodos. Se enrolaron niños de entre 1 y 17 años de edad internados para cirugía programada entre julio de 2012 y abril de 2014. Se comparó con un grupo control de niños de la misma edad. Se utilizó una encuesta validada en el idioma español (OSA-18), especialmente diseñada para relacionar apneas obstructivas del sueño con calidad de vida, en pediatría. Resultados. Se evaluaron 85 pacientes quirúrgicos y 100 niños sanos del grupo control. Se halló un impacto sobre la calidad de vida leve en 37,6 % de niños, moderado en 32,9 % y grave en 29,4 %, mientras que en el grupo control fue leve en el 96 %. El promedio ± DE de puntaje prequirúrgico total fue de 67,5 ± 20,3 (IC 95 % 63,13-71,88). Los promedios posquirúrgicos fueron 37,9 ± 21,4 (IC 95 % 33,24-42,48) y 37,25 ± 23,9 (IC 95 % 32,19-42,33) a los 3 y 6 meses, respectivamente (p < 0,001). El puntaje promedio en el grupo control fue 31,2 ± 13,2 (IC 95 % 28,6-33,8) y difirió significativamente con los grupos posquirúrgicos (p= 0,03). Conclusiones. Se observó una disminución de calidad de vida en niños con indicación quirúrgica por hipertrofia adenoamigdalina sintomática y un beneficio significativo sobre esta luego de la intervención.

Introduction. Adenotonsillectomy is the most common surgical procedure in otolaryngology. The main indication for this procedure is upper airway obstruction associated with hypertrophic tonsils and/or adenoids.Objectives. To describe the differences in quality of life before and after an adenoidectomy and/or tonsillectomy and compare it with that of healthy children.Population and Methods. All children aged 1 to 17 years old hospitalized for an elective surgery between July 2012 and April 2014 were enrolled. They were compared to a control group of children in the same age range. The survey used was validated in Spanish (OSA-18) and has been especially designed to establish a relationship between obstructive sleep apnea and quality of life in pediatrics. Results. Eighty-five surgery patients and 100 healthy control children were assessed. The impact on quality of life was mild in 37.6 % of children, moderate in 32.9 %, and severe in 29.4 %, while it was mild for 96 % of the control group.The average ± SD of the total pre-surgery score was 67.5 ± 20.3 (95 % confidence interval [CI]: 63.13-71.88). The average post-surgery scores were 37.9 ± 21.4 (95 % CI: 33.24-42.48) and 37.25 ± 23.9 (95 % CI: 32.19-42.33) at 3 and 6 months, respectively (p < 0.001). The average score for the control group was 31.2 ± 13.2 (95 % CI: 28.6-33.8) and was significantly different from the post-surgery groups (p = 0.03). Conclusions. Quality of life was reduced in children with a surgical indication for symptomatic adenotonsillar hypertrophy, while it was significantly improved after the surgery.

Assessment of quality of life before and after an adenotonsillectomy among children with hypertrophic tonsils and/or adenoids. / Assessment of quality of life before and after an adenotonsillectomy among children with hypertrophic tonsils and/or adenoids.

INTRODUCTION: Adenotonsillectomy is the most common surgical procedure in otolaryngology.The main indication for this procedure is upper airway obstruction associated with hypertrophic tonsils and/or adenoids. OBJECTIVES: To describe the differences in quality of life before and after an adenoidectomy and/or tonsillectomy and compare it with that of healthy children. POPULATION AND METHODS: All children aged 1 to 17 years old hospitalized for an elective surgery between July 2012 and April 2014 were enrolled.They were compared to a control group of children in the same age range. The survey used was validated in Spanish (OSA-18) and has been especially designed to establish a relationship between obstructive sleep apnea and quality of life in pediatrics. RESULTS: Eighty-five surgery patients and 100 healthy control children were assessed. The impact on quality of life was mild in 37.6

of children, moderate in 32.9

, and severe in 29.4

,while it was mild for 96

of the control group.The average±SD of the total pre-surgery score was 67.5±20.3 (95

confidence interval [CI]:63.13-71.88). The average post-surgery scores were 37.9±21.4 (95

CI: 33.24-42.48) and 37.25±23.9 (95

CI: 32.19-42.33) at 3 and 6 months,respectively (p<0.001). The average score for the control group was 31.2±13.2 (95

CI: 28.6-33.8) and was significantly different from the post-surgery groups (p=0.03). CONCLUSIONS: Quality of life was reduced in children with a surgical indication for symptomatic adenotonsillar hypertrophy, while it was significantly improved after the surgery.