Effects of public health measures during the SARS-CoV-2 pandemic on the winter respiratory syncytial virus epidemic: An interrupted time series analysis.

BACKGROUND: Public health measures (PHM) designed to contain the spread of COVID-19 pandemic have influenced the epidemiological characteristics of other viral infections. Its impact on acute RSV bronchiolitis in infants of ≤24 months old has not been systematically studied in our setting. OBJECTIVES: To describe the monthly pattern of visits to the Paediatric Emergency Department (PED) of patients 0 to 14 years of age, the rate of patients diagnosed with RSV acute bronchiolitis per thousand inhabitants of 0 to 24 months, and the rate of them requiring hospital admission during the winter 2020-2021, in the context of local and national COVID-19 restrictions and compare them to the four previous seasons. METHODS: Interrupted time series analysis of patients assisted in the PED and diagnosed with or admitted for RSV acute bronchiolitis in a tertiary University Hospital from January 2016 to February 2020 (pre-intervention period) and from March 2020 to June 2021 (post-intervention period). INTERVENTION: Preventive PHM implemented by the Spanish government weighted by the Containment and Health Index of the Oxford COVID-19 Government Response Tracker. RESULTS: The intervention was followed by an immediate reduction of the rate of visits to the PED of -19.5 (95% confidence interval [CI] -24.0, -14.9) per thousand, and the rate of diagnoses and admissions for RSV acute bronchiolitis of -44.3 (95% CI -73.8, -14.8) and -1.4 (95% CI -2.7, -0.1) per thousand, respectively, with a delayed rebound. CONCLUSIONS: After the implementation of PHM to prevent the spread of SARS-CoV-2 infection, an immediate and important decline in the visits to the PED was observed, with an upward change thereafter. There was also an initial reduction in the diagnoses of and admissions by RSV acute bronchiolitis. An upward trend was observed six to nine months after the usual time of the winter RSV epidemic, coinciding with the relaxation of the preventive PHM.

Fluticasone furoate inhibits cytokine secretion from nasal epithelial cells and reduces eosinophil survival in an in vitro model of eosinophilic inflammation.

BACKGROUND: Fluticasone furoate (FF) is an intranasal corticosteroid indicated for the treatment of allergic rhinitis (AR). However, the anti-inflammatory effects of FF in the nasal mucosa have yet to be investigated thoroughly. The aim of this study was to investigate the effect of FF on eosinophil survival and cytokine secretion from nasal mucosa epithelial cells. METHODS: Epithelial cells obtained from nasal mucosa were stimulated with 10% fetal bovine serum (FBS) in the presence of FF (from 10(-12) to 10(-7)M) for 6-24 h. Cytokine [granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin (IL)-6 and IL-8] concentrations in supernatants were measured by ELISA. Peripheral blood eosinophils were incubated for 4 days with epithelial cell secretions in the presence or absence of FF (from 10(-12) to 10(-7)M) and survival was assessed by Trypan blue dye exclusion. Results are expressed as medians of the minimum effective concentration and IC values. RESULTS: FBS stimulated the secretion of GM-CSF, IL-6 and IL-8. FF significantly inhibited GM-CSF (up to 10(-10)M, IC25 = 12.6 pM), IL-6 (up to 10(-10)M, IC25 = 65.8 pM) and IL-8 (up to 10(-11)M, IC25 = 8.6 pM) secretion induced by FBS (n = 8). Epithelial cell secretions induced eosinophil survival from day 1 to day 4 (n = 6). This effect was significantly inhibited by FF (up to 10(-12)M) at day 3 (IC50 = 3.22 nM) and day 4 (IC50 = 1.29 nM). CONCLUSIONS: The results obtained in this in vitro model suggest that FF may reduce upper airway eosinophilic inflammation through decreasing cytokine secretion from epithelial cells and reducing eosinophil survival.

Surfactant protein A genetic variants associate with severe respiratory insufficiency in pandemic influenza A virus infection.

INTRODUCTION: Inherited variability in host immune responses influences susceptibility and outcome of Influenza A virus (IAV) infection, but these factors remain largely unknown. Components of the innate immune response may be crucial in the first days of the infection. The collectins surfactant protein (SP)-A1, -A2, and -D and mannose-binding lectin (MBL) neutralize IAV infectivity, although only SP-A2 can establish an efficient neutralization of poorly glycosylated pandemic IAV strains. METHODS: We studied the role of polymorphic variants at the genes of MBL (MBL2), SP-A1 (SFTPA1), SP-A2 (SFTPA2), and SP-D (SFTPD) in 93 patients with H1N1 pandemic 2009 (H1N1pdm) infection. RESULTS: Multivariate analysis showed that two frequent SFTPA2 missense alleles (rs1965708-C and rs1059046-A) and the SFTPA2 haplotype 1A(0) were associated with a need for mechanical ventilation, acute respiratory failure, and acute respiratory distress syndrome. The SFTPA2 haplotype 1A(1) was a protective variant. Kaplan-Meier analysis and Cox regression also showed that diplotypes not containing the 1A(1) haplotype were associated with a significantly shorter time to ICU admission in hospitalized patients. In addition, rs1965708-C (P = 0.0007), rs1059046-A (P = 0.0007), and haplotype 1A(0) (P = 0.0004) were associated, in a dose-dependent fashion, with lower PaO2/FiO2 ratio, whereas haplotype 1A(1) was associated with a higher PaO2/FiO2 ratio (P = 0.001). CONCLUSIONS: Our data suggest an effect of genetic variants of SFTPA2 on the severity of H1N1pdm infection and could pave the way for a potential treatment with haplotype-specific (1A(1)) SP-A2 for future IAV pandemics.

Low prostaglandin E2 and cyclooxygenase expression in nasal mucosa fibroblasts of aspirin-intolerant asthmatics.

BACKGROUND AND OBJECTIVE: Anomalies in the regulation of cyclooxygenase (COX)-1 and -2 have been described in nasal polyps of aspirin-induced asthma (AIA). Whether these anomalies are specific to nasal polyps or affect all the nasal mucosa (NM) of upper airways is still unclear. The objective of this study was to compare the COX pathway in NM of AIA patients with the NM of control subjects. METHODS: Fibroblasts were isolated from NM of five AIA patients (AIA-NM) and five control subjects (control-NM). Cells were treated with 10 ng/mL interleukin (IL)-1ß for up to 72 h. Prostaglandin E2 (PGE2 ) production was measured by enzyme-linked immunosorbent assay (ELISA), expression of COX-1 protein by Western blot and COX-2 protein by ELISA, Western blot and immunofluorescence techniques. RESULTS: IL-1ß increased PGE2 production and COX-1 protein expression in control-NM fibroblasts, but no changes were found in AIA-NM. IL-1ß provoked a significant time-dependent increase in COX-2 protein expression in control-NM fibroblasts but had a very mild effect on COX-2 protein expression in AIA-NM. CONCLUSIONS: Our data suggest that abnormalities in the COX pathway are not a phenomenon exclusive to nasal-polyp mucosa as they are also present in all the NM of AIA patients. These anomalies may be involved in the pathogenesis of airway inflammation and non-steroidal anti-inflammatory drug intolerance in asthma patients with chronic rhinosinusitis and nasal polyposis.

Upregulation of Platelet-Activating Factor Receptor Expression and Lyso-Platelet-Activating Factor Isoforms in Human Nasal Polyp Tissues.

BACKGROUND: The Platelet-Activating Factor (PAF)/receptor (PAFR) system is involved in asthma and allergic rhinitis; however, its role in chronic rhinosinusitis (CRS) is still unclear. This study aimed to assess the expression of PAFR and the concentration of Lyso-PAF isoforms in the nasal polyps (NP) of patients suffering from CRS with/without comorbidities such as asthma and NSAID-exacerbated respiratory disease (N-ERD) compared to healthy nasal mucosa (NM) from control subjects. METHODS: NM (n = 8) and NP tissues were obtained from patients undergoing surgery for septal deviation/turbinate hypertrophy or endoscopic sinus surgery, respectively. Three phenotypes were studied: CRSwNP with no asthma (n = 6), CRSwNP with non-steroidal anti-inflammatory drug (NSAID)-tolerant asthma (n = 6), and CRSwNP with NSAID-exacerbated respiratory disease (n = 6). PAFR protein and mRNA were assessed via immunochemistry, immunofluorescence, Western blot, and real-time quantitative PCR. Lyso-PAF isoforms (C16, C18, and C18:1) were quantified via mass spectrometry. RESULTS: PAFR protein was expressed in the NM and NP, concretely in epithelial cells and submucosal glands. Compared to NM, PAFR mRNA expression was higher in all NP phenotypes (p < 0.05) while all Lyso-PAF isoform concentrations were higher in the NP from asthmatic patients (p < 0.05). Lyso-PAF C16 and C18 concentrations were higher in the NP from asthmatic patients than in the NP from patients without asthma. CONCLUSIONS: The PAF/PAFR system could play a pathophysiological role in CRSwNP pathogenesis.

Public policy guidelines for a comprehensive, territorial and sustainable development to improve productivity and competitiveness. Case Tungurahua province-Ecuador.

In this work we elaborate a proposal for policy guidelines for the improvement of productivity and competitiveness of the province of Tungurahua -Ecuador-, such proposal is based on the theoretical foundations about the concept of a comprehensive, territorial and sustainable development applied to the territorial diagnosis. Herein three analysis techniques were used as a methodological strategy: The Rasmussen Method, which consists of a multisector model based on the Input-Output Tables-; the technique of focus groups for the analysis of perception on the prioritization of key sectors by the population and by the productive sectors; and the Shift-Share Analysis, to determine the level of growth of some sectors with respect to others. The results have allowed the identification of the strengths and weaknesses, as well as, the opportunities and threats associated with the levels of productivity and competitiveness of the province of Tungurahua. Therefore, strategies have been formulated aimed at the comprehensive, territorial and sustainable development of the province, which are built on the strengthening of endogenous capacities in science, technology and innovation, the encouragement of a coordination and articulation between the actors, the strengthening of the local business web and the internationalization of the territory.

Reduced expression of COXs and production of prostaglandin E(2) in patients with nasal polyps with or without aspirin-intolerant asthma.

BACKGROUND: Researchers have debated whether regulation of the COX enzymes (COX-1 and COX-2), which mediate production of prostaglandins (PGs), affects the pathogenesis of nasal polyps (NPs) and aspirin-intolerant asthma (AIA). OBJECTIVE: We investigated the roles of PGE(2), COX-1 and COX-2, and PGE(2) receptors in the development of NPs and AIA by measuring their expression in fibroblasts derived from nasal mucosa (NM) and NPs. METHODS: Fibroblasts were isolated from the NM of subjects without asthma who had septal deviation, turbinate hypertrophy, or both (control subjects, n = 7); NPs of aspirin-tolerant nonasthmatic patients (n = 7); and NPs of patients with asthma who were intolerant of aspirin (n = 7). Polyp samples were collected during endoscopic surgery. Cultures were stimulated with IL-1ß (10 ng/mL) for 72 hours. We used ELISA, immunoblotting, and immunofluorescence analyses to measure secretion of PGE(2), expression of COX-1 and COX-2, and expression of the PGE(2) receptors EP1 to EP4. RESULTS: Compared with NM from control subjects, PGE(2) concentrations were significantly lower in IL-1ß-stimulated fibroblasts from patients with NPs who were tolerant to aspirin and even lower in polyps from patients with AIA. Similarly, IL-1ß exposure induced the expression of COX-1 and COX-2 in fibroblasts from NM of control subjects, had only moderate effects on fibroblasts from NPs of aspirin-tolerant nonasthmatic patients, and almost no effect on fibroblasts from NPs of patients with AIA. IL-1ß also induced expression of EP2 in fibroblasts from control NM but not in fibroblasts from NPs of aspirin-tolerant nonasthmatic patients or those with AIA. CONCLUSION: Alterations in the COX pathway (ie, reduced production of PGE(2) and lack of upregulation of COX-1, COX-2, and EP2 under conditions of inflammation) are associated with NPs in patients with or without AIA.

Nanostructured oleic acid/polysorbate 80 emulsions with diminished toxicity in NL-20 cell line: Insights of potential drug carriers.

Nanoemulsions (NE) are nowadays required drug nanocarriers. We have selected i) oleic acid (OA) as oil (O), ii) polysorbate 80 (PS80) as surfactant (S), and iii) water (W) in a prototype NE. Our best formulation had O:S ratio [OA]/[PS80] = 0.0708/0.0382 = 1.85 [mol·L-1], implying 1.85 parts of OA covered/stabilized by 1 part of PS80, giving 71.86 nm and 0.42 polydispersity index (PDI) in NE, determined by DLS and TEM. These nanosystems stored at room temperature/darkness stabilized up to 12 months (measured by DLS and TEM) maintaining very similar particle sizes and sometimes decreasing PDI. NE stability was determined by DSC, evidencing reversibility upon heating from 25 to 100 °C, increasing to 125 °C (sealed systems) produced more attenuated heating profiles in second and third cycles, compared with first, indicating partial but enough stability for storage means. NE cytotoxicity tests were conducted on immortalized normal lung epithelial cells (NL-20), as reference. The results show 50 % inhibitory concentrations (IC50,µM) of 1100, OA, and 2.6, PS80. The IC50 was 20.5, PS80 (PS80@NE) and 37.9, OA (OA@NE) clearly indicating that components changed their toxicities upon nanostructuring, OA exhibited 30-fold increase (IC50(OA) 1100.0→37.9) while PS80, decreased 7.9-fold (IC50(PS80) 2.6→20.5). PS80 is the most toxic component but when is included in PS80@NE, less toxic nanocarriers were generated.

Superior effect of MP-AzeFlu than azelastine or fluticasone propionate alone on reducing inflammatory markers.

BACKGROUND: MP-AzeFlu, intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP), is superior to AZE or FP alone for treatment of allergic rhinitis (AR). However, the precise anti-inflammatory mechanism of action of MP-AzeFlu has not been characterized. OBJECTIVE: To investigate the anti-inflammatory effects of MP-AzeFlu compared with AZE or FP alone in an established in vitro model of eosinophilic inflammation. METHODS: Nasal mucosal epithelial cells and peripheral blood eosinophils were obtained from human volunteers. Epithelial cells were stimulated with 10% fetal bovine serum (FBS) in the presence of MP-AzeFlu, AZE, or FP (1:102 to 1:105 dilution). Concentrations of interleukin (IL)-6, IL-8, and granulocyte-macrophage colony-stimulating factor (GM-CSF) were measured by ELISA. Eosinophils were incubated in 10% human epithelial cell-conditioned medium (HECM) and survival assessed by trypan blue dye exclusion. Results are expressed as mean ± SEM percentage secretion/survival compared with FBS/HECM (respectively). RESULTS: FP and MP-AzeFlu (all dilutions) and AZE (1:102) significantly reduced IL-6 secretion and eosinophil survival compared with positive controls. At 1:102 dilution, IL-6 secretion was significantly lower with MP-AzeFlu (38.3 ± 4.2%, compared with FBS = 100%) than with AZE (76.1 ± 4.9%) or FP (53.0 ± 4.9%). At 1:102 dilution, eosinophil survival was significantly lower with MP-AzeFlu at day 3 (17.5 ± 3.0%) and day 4 (2.4 ± 1.4%, compared with HECM = 100%) than with AZE (day 3: 75.2 ± 7.2%; day 4: 44.0 ± 9.7%) or FP (day 3: 38.5 ± 3.5%; day 4: 14.6 ± 4.0%). CONCLUSION: Greater reductions in cytokine secretion and eosinophil survival observed with MP-AzeFlu in vitro may underlie MP-AzeFlu's superior clinical efficacy vs. AZE or FP alone observed in AR patients.

[Pain management nursing in hospitalized patients with non-oncological diseases]. / Gestión enfermera del dolor en pacientes hospitalizados con patologías médicas no oncológicas.

AIM: To assess pain management in patients hospitalized with a non-oncological disease and evaluate factors involved in pain assessment. METHODS: A descriptive, cross-sectional study. We reviewed pain episodes documented in the medical records of 105 patients aged>18 years admitted to the medical units of a regional hospital between September and December 2014. Reports of pain episodes were evaluated by assessing 22 variables related to pain management quality criteria. RESULTS: A total of 184 reports were reviewed. Pain was measured using the visual analogue scale (VAS) in 70.1% of patients (n=129); pain was reassessed in 44.3% (n=54) of patients. Pain reassessment was significantly more frequent in patients aged<70 years, as compared to older patients (53.1 vs. 26.8%, respectively; p=0.01). Pain was more frequently considered to be unrelated to the cause of admission in women as compared to men (50 vs. 25.7% p=0.027). Pain was identified in the patient care plan as a collaborative problem by the nurse for 21.1% of the patients. CONCLUSIONS: Some aspects of pain management should be improved, especially those regarding pain description and reassessment. The age and sex of patients significantly influence the approach of pain.

Signal transduction pathways (MAPKs, NF-κB, and C/EBP) regulating COX-2 expression in nasal fibroblasts from asthma patients with aspirin intolerance.

BACKGROUND: Recent studies have revealed that cyclooxygenase-2 (COX-2) expression is down-regulated in aspirin-induced asthma (AIA). Various signal pathways (MAPKs, NF-κB and C/EBP) are involved in COX-2 regulation. OBJECTIVE: To investigate the regulation of COX-2 expression through MAP-kinase pathway activation and nuclear factor translocation in aspirin-induced asthma (AIA). METHODS: Fibroblasts were isolated from specimens of nasal mucosa (NM, N = 5) and nasal polyps (NP, N = 5). After IL-1ß (1 ng/ml) incubation, COX-2 and phosphorylated forms of ERK, JNK and p38 MAPK were measured by Western blot. MAPK's role in IL-1ß-induced COX-2 expression was assessed by treating cells with ERK (PD98059), JNK (SP600125) and p38 MAPK (SB203580) inhibitors (0.1-10 µM) prior to IL-1ß exposure. NF-κB and C/EBP nuclear translocation was measured by Western blot and TransAM® after IL-1ß (10 ng/ml) exposure. RESULTS: No differences were observed in the MAPK phosphorylation time-course between NM and NP-AIA fibroblasts. The p38 MAPK inhibitor at 10 µM significantly reduced IL-1ß-induced COX-2 expression in NM fibroblasts (85%). In NP-AIA fibroblasts the COX-2 inhibition (65%) at 1 and 10 µM was not statistically significant compared to non-treated cells. ERK and JNK inhibitors had no significant effect in either the NM or NP-AIA cultures. The effect of IL-1ß on NF-κB and C/EBP subunits' nuclear translocation was similar between NM and NP-AIA fibroblasts. CONCLUSIONS: These results suggest that p38 MAPK is the only MAPK involved in IL-1ß-induced COX-2 expression. NM and NP-AIA fibroblasts have similar MAPK phosphorylation dynamics and nuclear factor translocation (NF-κB and C/EBP). COX-2 downregulation observed in AIA patients appears not to be caused by differences in MAPK dynamics or transcription factor translocation.

[Etiology of acute viral respiratory tract infections in children from Gran Canaria, the Canary Islands (Spain)]. / Diagnóstico etiológico de las infecciones respiratorias agudas de origen vírico en un hospital pediátrico de Gran Canaria.

OBJECTIVE: Acute respiratory tract infections (ARTI) of viral origin are a frequent cause of pediatric consultations and hospital admissions. The aim of this study was to investigate the etiology of these infections in Gran Canaria, the Canary Islands, (Spain). METHODS: From May 2002 through May 2005, 1957 nasopharyngeal washings were collected from 1729 children presenting with ARTI to the Pediatric Emergency Unit. A rapid antigen detection method was performed in every sample to identify respiratory syncytial virus (RSV). An immunofluorescence assay (IFA) and cell culture (CC) was used in RSV-negative samples. RESULTS: Median age was 2 months (range, 0.03-119). A viral agent was identified in 1032 children (59.7%). RSV was detected in 769 children (74.5%). Other viruses identified, in order of frequency, were parainfluenza viruses, rhinoviruses, adenoviruses, influenza viruses, enteroviruses, and coronaviruses. Statistical differences were found between age and the type of virus detected: Adenoviruses caused respiratory infections in older children (median age: 6 months; range: 1-74). There were 6 mixed infections. Sensitivity of IFA as compared to CC was 55.8%, and specificity was 99.2%. CONCLUSIONS: Respiratory viruses are responsible for a large number of ARTI cases in children from Gran Canaria, RSV being the major cause. Viral identification is determinant for managing these patients and making a proper use of antibacterial and antiviral drugs.

Gestión enfermera del dolor en pacientes hospitalizados con patologías médicas no oncológicas / Pain management nursing in hospitalized patients with non-oncological diseases

OBJETIVO: Evaluar la gestión del dolor en los pacientes hospitalizados con patologías médicas no oncológicas y analizar los factores que influyen en su valoración. MÉTODO: Estudio transversal descriptivo. Se evaluaron de forma retrospectiva los episodios de dolor reflejados en las historias clínicas de 105 pacientes mayores de 18 años ingresados en unidades médicas de un hospital comarcal entre septiembre y diciembre de 2014. Se examinó la documentación y gestión de los episodios de dolor a través de 22 variables definidas en base a los criterios de calidad del proceso de manejo del dolor. RESULTADOS: Se llevaron a cabo un total de 184 mediciones. En el 70,1% de los casos (n = 129) se evaluó y reflejó el valor de la escala visual analógica EVA, y en el 44,3% de los episodios (n = 54) se reevaluó el dolor. En el grupo de pacientes menores de 70 años el dolor se reevaluó de forma significativa superior a los mayores de 70 años; 53,1 vs.26,8% (p = 0,01), y en las mujeres fue considerado un dolor puntual sin relación con el motivo de ingreso (50 vs.25,7% p = 0,027). En el 21,1% de los casos (n = 26) la enfermera incluyó el diagnóstico de dolor como problema de colaboración en el plan de cuidados. CONCLUSIÓN: Se desprenden áreas de mejora en la gestión del dolor, fundamentalmente en lo referente al registro de sus características y reevaluación. La edad y el sexo de los pacientes influyen significativamente en su abordaje

AIM: To assess pain management in patients hospitalized with a non-oncological disease and evaluate factors involved in pain assessment. METHODS: A descriptive, cross-sectional study. We reviewed pain episodes documented in the medical records of 105 patients aged > 18 years admitted to the medical units of a regional hospital between September and December 2014. Reports of pain episodes were evaluated by assessing 22 variables related to pain management quality criteria. RESULTS: A total of 184 reports were reviewed. Pain was measured using the visual analogue scale (VAS) in 70.1% of patients (n = 129); pain was reassessed in 44.3% (n = 54) of PATIENTS: Pain reassessment was significantly more frequent in patients aged < 70 years, as compared to older patients (53.1 vs.26.8%, respectively; p = 0.01). Pain was more frequently considered to be unrelated to the cause of admission in women as compared to men (50 vs.25.7% p = 0.027). Pain was identified in the patient care plan as a collaborative problem by the nurse for 21.1% of the PATIENTS: CONCLUSIONS: Some aspects of pain management should be improved, especially those regarding pain description and reassessment. The age and sex of patients significantly influence the approach of pain

[Hepatitis B virus genotypes in chronic carriers on the island of Gran Canaria. Clinical and epidemiological characteristics]. / Genotipos del virus de la hepatitis B en portadores crónicos en la isla de Gran Canaria. Características clinicoepidemiológicas.

OBJECTIVE: To investigate the prevalence of hepatitis B virus (HBV) genotypes in Spanish hepatitis B carriers, and to study the differences in epidemiological characteristics, e antigen (HBeAg) seroconversion, serum DNA viral levels (VL) and liver function alterations. METHODS: This study included 108 patients. Genotyping was carried out in 84 with the INNO-LiPA HBV genotyping assay (Innogenetics). RESULTS: There were 41 women and 67 men, with a mean age of 44.1 years. The source of transmission was family contact in 26 patients (24.1%); transfusions in 10 (9.3%); sexual promiscuity in 9 (8.3%), intravenous drug use in 3 (2.8%), health care accident in 2 (1.8%); and unknown causes in 58 (53.7%). Forty patients had chronic hepatitis and 68 (63%) were healthy carriers. The time of evolution of the infection was known in only in 45 patients, and was over 10 years in 42 of them. One hundred patients (92.6%) were HbeAg-negative and 90 (83.3%) had detectable viral DNA. Genotype A was present in 46 (54.8%), D in 20 (23.8%), F in 2 (2,4%), C in 1 (1.2%), A-G coinfection in 7 (8.3%), A-D in 4 (4.8%), D-G in 2 (2,4%), A-C in 1 (1.2%), and A-D-G in 1 (1.2%). There were no significant differences between genotypes. A trend towards an association was found between VL

Diagnóstico etiológico de las infecciones respiratorias agudas de origen vírico en un hospital pediátrico de Gran Canaria / Etiology of acute viral respiratory tract infections in children from Gran Canaria, the Canary Islands (Spain)

Objetivo. Las infecciones respiratorias agudas (IRA) de origen vírico son una causa frecuente de consulta y hospitalización pediátrica. El objetivo de este estudio fue conocer la etiología de dichas infecciones en la isla de Gran Canaria. Métodos. Durante 3 años (de mayo de 2002 a mayo de 2005) se recogieron 1957 lavados nasofaríngeos de 1.729 niños atendidos en Urgencias con síntomas compatibles con IRA. En todas las muestras se realizó una técnica rápida de detección de antígeno de virus respiratorio sincitial (VRS) y, en las que se obtuvo resultado negativo, inmunofluorescencia (IF) y cultivo celular (CC). Resultados. La mediana de edad fue de 2 meses (intervalo: 0,03-119). Se identificó el agente causal del cuadro respiratorio en 1.032 niños (59,7%). El VRS se detectó en 769 niños (74,5%). Los demás virus identificados, por orden de frecuencia, fueron: virus parainfluenza, rinovirus, adenovirus, virus de la gripe, enterovirus y coronavirus. Se encontraron diferencias estadísticamente significativas al comparar la edad y el tipo de virus detectado: los adenovirus fueron responsables de cuadros en niños de mayor edad (mediana: 6 meses; intervalo: 1-74). Hubo 6 casos de infección mixta. La sensibilidad de la IF en relación con el CC fue del 55,8%, y la especificidad del 99,2%. Conclusiones. Los virus respiratorios son responsables de un alto número de casos de IRA, principalmente el VRS. Su identificación es determinante en el tratamiento clínico de los pacientes y en el empleo adecuado de antibacterianos y antivirales (AU)

Objective. Acute respiratory tract infections (ARTI) of viral origin are a frequent cause of pediatric consultations and hospital admissions. The aim of this study was to investigate the etiology of these infections in Gran Canaria, the Canary Islands, (Spain). Methods. From May 2002 through May 2005, 1957 nasopharyngeal washings were collected from 1729 children presenting with ARTI to the Pediatric Emergency Unit. A rapid antigen detection method was performed in every sample to identify respiratory syncytial virus (RSV). An immunofluorescence assay (IFA) and cell culture (CC) was used in RSV-negative samples. Results. Median age was 2 months (range, 0.03-119). A viral agent was identified in 1032 children (59.7%). RSV was detected in 769 children (74.5%). Other viruses identified, in order of frequency, were parainfluenza viruses, rhinoviruses, adenoviruses, influenza viruses, enteroviruses, and coronaviruses. Statistical differences were found between age and the type of virus detected: Adenoviruses caused respiratory infections in older children (median age: 6 months; range: 1-74). There were 6 mixed infections. Sensitivity of IFA as compared to CC was 55.8%, and specificity was 99.2%. Conclusions. Respiratory viruses are responsible for a large number of ARTI cases in children from Gran Canaria, RSV being the major cause. Viral identification is determinant for managing these patients and making a proper use of antibacterial and antiviral drugs (AU)

Genotipos del virus de la hepatitis B en portadores crónicos en la isla de Gran Canaria. Características clinicoepidemiológicas / Hepatitis B virus genotypes in chronic carriers on the island of Gran Canaria. Clinical and epidemiological characteristics

Objetivo. Conocer la distribución de genotipos del virus de la hepatitis B (VHB) de pacientes españoles portadores crónicos y su relación con las características epidemiológicas, la presencia de antígeno e, el nivel sérico del ADN viral (CV) y la alteración de la función hepática. Métodos. Se estudiaron 108 pacientes. El genotipo se realizó en 84 mediante INNO-LiPA HBV Genotyping-Innogenetics. Resultados. De los pacientes, 41 fueron mujeres y 67 hombres, con una edad media de 44,1 años. Las fuentes de transmisión fueron: contacto familiar, 26 pacientes (24,1%); transfusiones, 10 (9,3%); promiscuidad sexual, 9 (8,3%); adicción a drogas parenterales, 3 (2,8%); accidente sanitario, 2 (1,8%) y en 58 (53,7%) se desconocía. Cuarenta pacientes (37%) presentaron una hepatitis crónica (HC) y 68 (63%) eran portadores asintomáticos. Sólo en 45 pacientes se conocía el tiempo de evolución de la infección y en 42 fue mayor de 10 años. Cien pacientes (92,6%) presentaron antígeno e-negativo y 90 (83,3%) tuvieron ADN viral detectable. La distribución de genotipos fue: A, 46 (54,8%); D, 20 (23,8%); F, 2 (2,4%); C, 1 (1,2%), coinfección A-G, 7 (8,3%); A-D, 4 (4,8%); D-G, 2 (2,4%); A-C, 1 (1,2%) y A-D-G, 1 (1,2%). No se observaron diferencias significativas entre genotipos. Se observó una tendencia en el genotipo A a presentar HC cuando la CV ≤ 10 5 copias/ml (28,9% de los casos) frente al genotipo D (7,7%) (p no significativa). Conclusiones. En nuestra área predomina el genotipo A, D y las coinfecciones con G. Observamos una tendencia del genotipo A a producir una mayor actividad inflamatoria cuando la CV ≤ 10 5 copias/ml (AU)

Objective. To investigate the prevalence of hepatitis B virus (HBV) genotypes in Spanish hepatitis B carriers, and to study the differences in epidemiological characteristics, e antigen (HBeAg) seroconversion, serum DNA viral levels (VL) and liver function alterations. Methods. This study included 108 patients. Genotyping was carried out in 84 with the INNO-LiPA HBV genotyping assay (Innogenetics).Results. There were 41 women and 67 men, with a mean age of 44.1 years. The source of transmission was family contact in 26 patients (24.1%); transfusions in 10 (9.3%); sexual promiscuity in 9 (8.3%), intravenous drug use in 3 (2.8%), health care accident in 2 (1.8%); and unknown causes in 58 (53.7%). Forty patients had chronic hepatitis and 68 (63%) were healthy carriers. The time of evolution of the infection was known in only in 45 patients, and was over 10 years in 42 of them. One hundred patients (92.6%) were HbeAg-negative and 90 (83.3%) had detectable viral DNA. Genotype A was present in 46 (54.8%), D in 20 (23.8%), F in 2 (2,4%), C in 1 (1.2%), A-G coinfection in 7 (8.3%), A-D in 4 (4.8%), D-G in 2 (2,4%), A-C in 1 (1.2%), and A-D-G in 1 (1.2%). There were no significant differences between genotypes. A trend towards an association was found between VL ≤ 10 5 copies/mL and the presence of chronic hepatitis in genotype A (28.9%) as opposed to genotype D (7.7%) (p non significant). Conclusions. HBV genotypes A and D, and coinfections with G are predominant in our area. Genotype A showed a tendency to produce greater inflammatory activity when VL was ≤ 10 5 copies/ml (AU)

Insuficiencia renal aguda: inicio clínico del mieloma multiple / Kidney failure chronic: clinical beginning of multiple myeloma

Se presenta el caso de una paciente de 59 años, de raza negra, aparentemente sana, la cual desarrolló un fallo renal agudo de evolución tórpida, por el queestuvo sometida a régimen dialítico durante dos meses. La biopsia percutánea renal demostró una nefropatía mielomatosa. En el caso registrado llamó laatención que antes del episodio renal la paciente se encontraba asintomática, así como el grado de insuficiencia renal alcanzado y la posterior recuperación de la función renal(AU)