Association between oronasopharyngeal abnormalities and malocclusion in Northeastern Brazilian preschoolers

Abstract Objective: Evidence is contradictory regarding the association between oronasopharyngeal abnormalities and malocclusion. The aim of the present study was to assess the association between oronasopharyngeal abnormalities and malocclusion (anterior open bite and posterior crossbite) in preschoolers. Methods: A cross-sectional study was conducted with a representative sample of 732 preschoolers aged 3-5 years old selected randomly from private and public preschools. Anterior open bite (AOB) and posterior crossbite (PC) were evaluated through a clinical exam. Parents/caregivers answered a questionnaire addressing sociodemographic indicators and oronasopharyngeal issues. Statistical analysis involved descriptive analysis and Poisson regression (p < 0.05). Results: The prevalences of AOB and PC were 21.0% and 11.6%, respectively. Being three years old (PR = 1.244; 95% CI = 1.110-1.394; p < 0.001), being four years old (PR = 1.144; 95% CI = 1.110 - 1.394; p = 0.015), absence of allergy (PR = 1.158; 95% CI = 1.057 - 1.269; p = 0.002), not having undergone nose surgery (PR = 1.152; 95% CI = 1.041 - 1.275; p = 0.006) and having a sore throat more than five times in the same year (PR = 1.118; 95% CI = 1.011 - 1.237; p = 0.030) were significantly associated with AOB. The absence of asthma (PR = 1.082; 95% CI = 1.012 - 1.156; p = 0.020), not having undergone throat surgery (PR = 1.112; 95% CI = 1.068 - 1.158; p < 0.001) and not having undergone nose surgery (PR = 1.114; 95% CI = 1.069 - 1.160; p < 0.001) remained associated with PC. Conclusion: Significant associations were found between oronasopharyngeal-reported abnormalities and the presence of AOB and PC in preschoolers.

resumo Introdução: não há consenso na literatura quanto à associação entre alterações oronasofaríngeas e as más oclusões. Objetivo: o objetivo do presente estudo foi avaliar a associação entre as alterações oronasofaríngeas e as más oclusões (mordida aberta anterior e mordida cruzada posterior) em pré-escolares. Métodos: um estudo transversal foi conduzido com uma amostra representativa de 732 pré-escolares com 3 a 5 anos de idade, aleatoriamente selecionados em pré-escolas privadas e públicas. A mordida aberta anterior (MAA) e a mordida cruzada posterior (MCP) foram avaliadas a partir de exames clínicos. Pais/cuidadores responderam a um questionário relativo a indicadores sociodemográficos e problemas oronasofaríngeos. A análise estatística envolveu análise descritiva e regressão de Poisson (p < 0,05). Resultados: as prevalências de MAA e MCP foram de 21,0% e 11,6%, respectivamente. Ter três anos de idade (RP = 1,244; IC = 1,110 - 1,394; p < 0,001, considerando-se RP = Razões de Prevalência e IC = Intervalo de Confiança 95%), ter quatro anos de idade (RP = 1,144; IC = 1,110 - 1,394; p = 0,015), ausência de alergia (RP = 1,158; IC = 1,057 - 1,269; p = 0,002), não ter se submetido a cirurgias do nariz (RP = 1,152; IC = 1,041 - 1,275; p = 0,006) e ter tido dor de garganta mais de cinco vezes no mesmo ano (RP = 1,118; IC = 1,011 - 1,237; p = 0,030) foram significativamente associados com MAA. Ausência de asma (RP = 1,082; IC = 1,012 - 1,156; p = 0,020), não ter realizado adenoidectomia (RP = 1,112; IC = 1,068 - 1,158; p < 0,001) e não ter se submetido a cirurgias do nariz (RP = 1,114; IC = 1,069 - 1,160; p < 0,001) permaneceram associados à MCP. Conclusão: associações significativas foram encontradas entre as alterações oronasofaríngeas relatadas e a presença de MAA e MCP em pré-escolares.

Influenza: evolución a cuatro años de la pandemia: Hospital Nacional Profesor Alejandro Posadas, Argentina / Influenza: A four-year evolution of the pandemic: Prof. Alejandro Posadas National Hospital, Argentina

En el Hospital Nacional Profesor Alejandro Posadas se estudiaron la incidencia de influenza, las características de casos y tipos y subtipos de virus circulantes de enero a agosto de 2013 inclusive, semanas epidemiológicas (SE) 1-35, y se compararon con los años 2009-2012. De fin de mayo a agosto inclusive de 2013 (SE 18 a 35) se observó un aumento del porcentaje de consulta por enfermedades respiratorias, enfermedad tipo influenza e internación por neumonía y se diagnosticaron 207 casos: 153 influenza A (FLU-A)(H1N1pdm09), 46 A(H3), ocho A(sin subtipificar). La mayor frecuencia fue en menores de 5 años, seguida por el grupo de 60 a 64.La chance de tener la enfermedad fue tres veces mayor en el grupo de 40-64 años versus 15-39 o > 64 años. La letalidad, que aumentó con la edad, fue de 7.2% y la chance de morir fue seis veces mayor en los > 64 años. El porcentaje de vacunación entre los casos fue11.6%. Ninguno de los fallecidos estaba vacunado. Luego de la pandemia de 2009 el porcentaje de consultas anuales disminuyó hasta 2012, con un aumento en el período invernal de 2013 de 52.0% con respecto a 2012. La circulación viral en 2013 fue más temprana que en los años anteriores. En 2009 y 2013 la mayor circulación fue FLU-A (H1N1pdm), en 2011 FLU-A(H3) y en 2010 y 2012 FLU-A(H3) y FLU-B.

As from January to August 2013, epidemiological weeks 1-35 (EW), Influenza incidence, case characteristics, types and subtypes of circulating influenza virus in the Nacional Profesor Alejandro Posadas Hospital were studied, and were compared to incidences during 2009-2012. From late May to the end of August 2013 (EW18-35), an increase was observed in the proportion of patients' visits for respiratory disease, influenza-like illness and hospitalizations due to pneumonia; of 207 cases diagnosed with influenza A virus, 153 were infected by H1N1pdm09, 46 by H3, and eight without subtype. The highest proportion of cases was found in children under five years of age, followed by the group 60-64.The chances of having the illness were three times greater among the group 40-64 years old compared to 15-39 or those older than 64. Mortality, which increased with age, was 7.2%, and the odds of death were six times higher among those older than 64. Vaccination rate among the cases was 11.6%. None of the fatal cases had received the vaccine. After the 2009 pandemic, the proportions of annual patients´ visits decreased until 2012; in 2013, an increase of 52.0% during the winter period compared to 2012. The viral circulation started earlier in 2013 compared to previous years. FLU-A(H1N1pdm) was the predominant circulating virus in 2009 and 2013, FLU-A(H3) in 2011, FLU-A(H3) and FLU-B in both 2010 and 2012.

Case-case-control study of risk factors for nasopharyngeal colonization with methicillin-resistant Staphylococcus aureus in a medical-surgical intensive care unit

Nasopharyngeal colonization with methicillin-resistant Staphylococcus aureus (MRSA) often precedes the development of nosocomial infections. In order to identify risk factors for MRSA colonization, we conducted a case-case-control study, enrolling 122 patients admitted to a medical-surgical intensive care unit (ICU). All patients had been screened for nasopharyngeal colonization with S. aureus upon admission and weekly thereafter. Two case-control studies were performed, using as cases patients who acquired colonization with MRSA and methicillin-susceptible S. aureus (MSSA), respectively. For both studies, patients in whom colonization was not detected during ICU stay were selected as control subjects. Several potential risk factors were assessed in univariate and multivariable (logistic regression) analysis. MRSA and MSSA were recovered from nasopharyngeal samples from 27 and 10 patients, respectively. Independent risk factors for MRSA colonization were: length-of-stay in the ICU (Odds Ratio [OR]=1.12, 95 percentConfidence Interval[CI]=1.06-1.19, p<0.001) and use of ciprofloxacin (OR=5.05, 95 percentCI=1.38-21.90, p=0.015). The use of levofloxacin had a protective effect (OR=0.08, 95 percentCI=0.01-0.55, p=0.01). Colonization with MSSA was positively associated with central nervous system disease (OR=7.45, 95 percentCI=1.33-41.74, p=0.02) and negatively associated with age (OR=0.94, 95 percentCI=0.90-0.99, p=0.01). In conclusion, our study suggests a role for both cross-transmission and selective pressure of antimicrobials in the spread of MRSA.

Nasopharyngeal colonization with Streptococcus pneumoniae in children infected with human immunodeficiency virus

OBJECTIVE: To determine the prevalence of pneumococcus colonization among HIV-infected outpatients aged 0 to 18 years. To determine the resistance to penicillin of the microorganisms observed, to identify their serotypes, and to determine whether there are associations between known risk factors and colonization in this group. MATERIAL AND METHOD: This was an observational and cross-sectional study in which nasopharynx swabs were collected from 112 children on the occasion of their monthly appointments and a questionnaire applied to the mothers. The material collected was processed at the microbiology laboratory of the hospital in accordance with National Committee for Clinical Laboratory Standards (NCCLS) regulations and serotyping was performed at the Centers for Diseases Control and Prevention (CDC). Data were analyzed statistically using the chi-square test and with univariate and multivariate analysis with multiple logistic regression. RESULTS: The prevalence rate of nasopharyngeal colonization by pneumococci was 28.6%, with a 15.6% rate of resistance to penicillin (6.2% intermediate resistance and 9.4% full resistance). The serotypes identified were 6A, 6B, 7C, 9V, 11A, 13, 14, 15A, 16F, 18C, 19B, 19F, 23B, 23F, and 34. In this population there were no associations between pneumococcal colonization and the risk factors studied. CONCLUSIONS: The prevalence of pneumococcal colonization among HIV-infected children at our service was not higher than prevalence rates observed in healthy children and reported in the literature.

Estudio comparativo de la IgA secretora / Comparative study of secretor IgA

Objetivo: medir y comparar los niveles de IgA secretora (SIGA) en la mucosa del árbol respiratorio. Diseño: estudio transversal descriptivo. Lugar de realización: Departamento de Neumología, Hospital General del CMN L Raza, IMSS. Material y métodos: se incluyeron 35 sujetos voluntarios con consentimiento informado para someterse a lavado nasal y lavado bronquial, cuyas mustras junto con la expectoración se analizaron para determinar niveles de SIgA por el método nefelométrico, reportándose como la concentración relativa de SIgA/concentración entre los tres tipos de muestras. Resultados: los valores de SIgA en expectoración, lavado nasofaríngeo y lavado bronquial fueron similares. La media y error estándar a nivel nosofaríngeo fue 0.ñ064 0.007, a nivel de esputo 0.073 ñ 0.01 y a nivel bronquial 0. 082 ñ 0.017. La correlación obtuvo r= 0.508 (p < 0.01)

Staphylococcus aureus: incidência em pacientes hospitalizados e profissionais de saúde vinculados ao hospital das clínicas de Goiânia/UFG - Caracterizaçäo das amostras isoladas pela fagotipagem e antibiograma / Staphylococcus aureus: incidence in hospitalized patients and health professionals from the Hospital das Clínicas de Goiânia-UFG - Caracterization of isolated samples by the phage typing and antibiogram

Com a finalidade de detectar portadores de Staphylococcus aureus relacionados a ambiente hospitalar, foram amostrados, em duas ou três áreas corporais diferentes, 112 indivíduos ligados ao Hospital das Clínicas de Goiânia/UFG, sendo 92 pacientes hospitalizados e 20 profissionais, internados e lotados nas enfermarias de Obstetrícia, Ginecologia, Pediatria e Dermatologia. O percentual de portadores foi 39,1 pôr cento entre os pacientes internados e de 20,0 pôr cento entre os profissionais. Os pacientes internados forneceram um percentual de 20,9 pôr cento de amostras positivas para Staphylococcus aureus e os profissionais 12,5 pôr cento. A área anatômica que apresentou o maior frequencial de colonizaçäo foram as fossas nasais, para as quais encontrou-se um índice de 54,7 pôr cento entre os pacientes internados e 80,0 pôr cento entre os profissionais. A identificaçäo das amostras de Staphylococcus aureus pela fagotipagem revelou que 69,9 pôr cento das amostras isoladas dos pacientes internados foram tipáveis, havendo maior percentual (35,1 pôr cento) de cepas pertencentes ao grupo fágico III, além dos experimentais (32,5 pôr cento). Entre os profissionais, 60,0 pôr cento das amostras tipáveis, todas pertencentes ao grupo fágico III. O antibiograma demonstrou que, tanto as amostras provenientes dos pacientes internados como a dos profissionais, apresentaram resistência mais acentuada à Penicilina G cristalina, à Ampicilina e à Tetraciclina como também, maior sensibilidade à Amicacina, Cefalotina e Associaçäo Trimetoprim-sulfatoxazol (Bactrim)

La otitis media aguda en el niño / Acute otitis media in children

La otitis media aguda constituye una patología frecuente en el niño. La calidad de su tratamiento influirá no sólo en la curación de la infección, sino también en el buen estado futuro del oído medio, en la tendencia o no a recidivar y en la predisposición a evolucionar a otitis crónica, eventualmente colesteatomatosa. El autor analiza la incidencia y gérmenes implicados, importancia del estado de la rinofaringe, senos paranasales y mastoides y su relación con episodios de otitis media aguda. Se revisan conceptos y se proponen medidas terapéuticas, de acuerdo a diversos estudios realizados estos últimos años