Pneumonia eosinofilic in pediatrics, clinical cases. / Neumonía eosinofílica en pediatría, a propósito de dos casos clínicos.

INTRODUCTION: Eosinophilic Pneumonia (EP) is a very rare disorder in Pediatrics. It is characterized by the infiltra tion of eosinophils in the pulmonary and alveolar interstitium, and may be primary or secondary as well as present an acute or chronic progress. OBJECTIVE: to present 2 pediatric EP clinical cases which were diagnosed at the pediatric intensive care unit of Clinica Indisa in Santiago, Chile between 2014 and 2017. CLINICAL CASES: Two older infants, who were hospitalized due to respiratory failure with a diagnosis of viral pneumonia. Both have asthmatic mothers. Additionally, they both had febrile syn drome, persistent condensation images in the chest x-rays, and peripheral eosinophilia throughout the course of the disease. One of the infants required oxygen for more than one month, and there was no eosinophilia in the bronchoalveolar lavage (BAL). In this case, the diagnosis of EP was reached via pulmonary biopsy. The other infant required mechanic ventilation for 28 days, and was diagnosed due to eosinophilia greater than 25% in the bronchoalveolar lavage. Both patients had excellent res ponse to systemic corticosteroids. CONCLUSION: After ruling out other causes, EP should be suspected in children with pneumonia diagnosis, and persistent symptoms that do not respond positively to treatment, especially if associated with peripheral eosinophilia. The diagnosis of EP in pediatrics is confirmed with eosinophilia greater than 20% in BAL and, in some cases, it is necessary to perform a lung biopsy.

Spectrally-resolved measurement of concentrated light distributions for Fresnel lens concentrators.

A test method that measures spectrally resolved irradiance distribution for a concentrator photovoltaic (CPV) optical system is presented. In conjunction with electrical I-V curves, it is a means to visualize and characterize the effects of chromatic aberration and nonuniform flux profiles under controllable testing conditions. The indoor characterization test bench, METHOD (Measurement of Electrical, Thermal and Optical Devices), decouples the temperatures of the primary optical element (POE) and the cell allowing their respective effects on optical and electrical performance to be analysed. In varying the temperature of the POE, the effects on electrical efficiency, focal distance, spectral sensitivity, acceptance angle and multi-junction current matching profiles can be quantified. This work presents the calibration procedures to accurately image the spectral irradiance distribution of a CPV system and a study of system behavior over lens temperature.

Effect of Chondroitin Sulphate on Pro-Inflammatory Mediators and Disease Activity in Patients with Inflammatory Bowel Disease.

BACKGROUND/AIMS: To evaluate the incidence rate of relapse in patients with inflammatory bowel disease (IBD) undergoing chondroitin sulphate (CS) treatment and its effect on the concentrations of several pro-inflammatory proteins. METHODS: Prospective, observational, 12-month follow-up study in patients with IBD in remission, starting CS (Condrosan®, Bioiberica S.A.) treatment for osteoarthritis (OA). Crohn's Disease Activity Index and modified Truelove-Witts severity index were calculated for Crohn's disease and ulcerative colitis (UC) respectively. Levels of vascular endothelial growth factor (VEGFA), -C, fibroblast growth factor 2, hepatocyte growth factor, angiopoietin (Ang)-1, Ang-2, transforming growth factor beta, tumour necrosis factor alpha, interleukin (IL)-1ß, IL-6, IL-12, IL-17, IL-23, intracellular adhesion molecule-1, vascular adhesion molecule-1, matrix metalloproteinase-3 and PGE2 were quantified by ELISA. OA joint pain was evaluated using a visual analogue scale. RESULTS: A total of 37 patients (19 UC and 18 Crohn's disease) were included. The mean values for OA joint pain decreased after 12 months from 5.9 ± 2.8 to 3.0 ± 2.3 (p < 0.05). Only 1 patient (with UC) flared during follow-up. The incidence rate of relapse was 3.4% per patient-year of follow-up. Mean serum VEGFA levels increased between baseline (492 pg/ml) and 12-month treatment (799 pg/ml; p < 0.05). CONCLUSION: The incidence of IBD relapse in patients under CS treatment was lower than that generally reported. This treatment might modulate VEGFA. CS decreases OA-related pain in patients with IBD.

Gamification: Basic concepts and applications in radiology.

Gamification is the use of elements from games in non-game environments, such as education. It is an alternative educational focus that promotes students' motivation and participation in the learning process. Gamification had proven effective in training health professionals and can play an important role in diagnostic radiology training, both at the undergraduate and postgraduate levels. Gamification activities can be carried out in real environments, such as classrooms or session rooms, but there are also interesting online modalities that favor remote access and user management. The possibilities of gamification in virtual worlds to teach undergraduate students radiology are very promising and deserve to be explored in training residents. This article aims to review general concepts in gamification and to present the main types of gamification used in medical training, pointing out its applications and advantages and disadvantages and emphasizing experiences in radiology education.

Accuracy of the S100ß protein as a marker of brain damage in traumatic brain injury.

INTRODUCTION: This study tested the hypothesis that S100ß is a useful screening tool for detecting intracranial lesion (IL) in patients with a normal level of consciousness after traumatic brain injury (TBI). METHODS: One hundred and forty-three post-TBI patients without a decrease in consciousness (GCS = 15) and with at least one neurological symptom (e.g. transitory loss of consciousness, amnesia, headache, dizziness or vomiting) were prospectively included. A blood sample was drawn at 6-hours post-TBI. A routine CT scan was obtained within 24 hours post-injury. Diagnostic properties of S100ß for IL prediction in CT scan findings were tested using ROC-analysis. RESULTS: A total of 15 patients (10.5%) had IL. Serum levels were significantly higher in these patients. Significant differences were found between S100ß levels and CT scan findings (p = 0.007). ROC-analysis showed that S100ß is a useful tool for detecting the presence of IL in CT scans (p = 0.007). In this series, the best cut-off for S100ß is 0.130 µg L(-1), with 100% sensitivity and 32.81% specificity. CONCLUSION: Within the first 6 hours post-TBI, serum S100ß seems to be an effective biochemical indicator of IL in patients without a decrease in consciousness. These results indicate that higher S100ß cut-off values substantially improve the clinical relevance of this protein.

Magic syndrome and true aortic aneurysm.

Magic syndrome is a very uncommon disease, and vascular involvement is exceptional; only one case has been reported in the literature associated to a true aortic aneurysm. The treatment of aneurysms recommended in these patients is based on isolated cases and includes corticosteroids, other immunosuppressant drugs, and surgery. We report a case of a patient with Magic syndrome who developed aneurysm at the end of the aorta during treatment with infliximab, corticosteroids, and cyclosporine and who needed endovascular prosthesis implantation. After 12 months, she suffered an aneurysm of the ascending aorta, dilatation of the sinotubular junction, and severe aortic insufficiency, which forced surgery. During this time, the patient finally died.

Pain assessment in individuals with dementia and communication problems in Spain. A systematic review. / Valoración del dolor en personas con demencia y problemas de comunicación en España. Revisión sistemática.

BACKGROUND AND OBJECTIVE: Pain assessment in individuals with advanced dementia and communication problems continue to be underdiagnosed and undertreated due to the difficulty in performing this assessment. This review explores and synthesises how pain in individuals with advanced dementia and communication problems are being assessed in the context of Spanish healthcare. MATERIALS AND METHODS: A systematic review of the literature was conducted following the PRISMA criteria. We reviewed the databases of PubMed, Web of Science, Cinahl, Scopus, Dialnet and Cuitatge up to December 2017. Four independent reviewers identified studies that included instruments to assess pain in individuals with dementia and communication problems in the Spanish healthcare context. We performed a narrative synthesis of the included articles. RESULTS: After applying the inclusion criteria, 10 studies were included. Of these, 4 were methodological studies validating Spanish versions of scales (Abbey, Algoplus, Doloplus and PAINAD-Sp), and 1 was on the development of the original EDAD scale. We also identified 3 studies conducted in Spain that used a translation of the PAINAD, 1 study that used a Spanish translation of Doloplus2 and 1 publication that included the use in Spain of a scale not validated for this patient profile (Pain-VAS). CONCLUSIONS: There are currently several instruments validated in Spanish to assess pain in individuals with advanced dementia and communication problems (Abbey, Algoplus, Doloplus y PAINAD-Sp). However, these instruments have still not been widely used in research, and their psychometric properties could be improved.

Caracterización de la displasia broncopulmonar según dos definiciones en prematuros chilenos / Characterization of bronchopulmonary dysplasia in relation with two definitions in chilean preterm infants

Existen controversias en la definición de la displasia broncopulmonar, siendo las más utilizadas el requerimiento de O2 durante 28 días o a las 36 semanas de edad gestacional corregida (EGC). Nuestro objetivo fue determinar la incidencia y características clínicas de los prematuros nacidos antes de las 32 semanas (RNP≤ 32s) con requerimiento de O2 a los 28 días de vida (DBP28d) y a las 36 semanas de EGC (DBP36s) en una unidad neonatal de Santiago, Chile, entre los años 2012 y 2019. Es un estudio descriptivo, retrospectivo con componente analítico. La población estudiada incluyó 535 RNP≤ 32s, vivos a las 36 semanas o dados de alta después de las 34 semanas de EGC. De los 242 prematuros DBP28d, 203 (83,88%) fueron DBP36s; 16 de los 242 (6%) requirió O2 durante menos de 28 días consecutivos, de los cuales 7, aún lo requerían a las 36 semanas. Los predictores de DBP36s fueron: sexo masculino (OR 2,42, IC del 95%: 1,24-4,69), peso al nacer (OR 1, IC del 95%: 0,99-1), edad gestacional (OR 0,75, IC del 95%: 0,57-0,97), APGAR a los 5 min, (OR 0,01, IC del 95%: 0,003-0,05), el requerimiento de presión positiva continua o cánula nasal de alto flujo (OR 1,1, IC del 95%: 1,04-1,17) y días de ventilación mecánica invasiva (OR 1,1,95% IC: 1-1,2). Conclusiones: No encontramos una diferencia significativa en la incidencia de DBP entre las definiciones de DBP28d y DBP36s; y la mayoría de los RNP< 32s con diagnóstico de DBP36s se pudieron identificar a los 28 días de vida.

Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in premature newborns. It is commonly defined as a need for supplemental O2 for 28 days or at 36 weeks postmenstrual age (PMA) (BPD36w). Our objective was to determine the incidence and clinical characteristics of premature neonates born at less than 32 weeks (PNB< 32w) with O2 requirement at 28 days of life (DBP28d) and DBP36w in a neonatal unit of Santiago, Chile, between 2012 and 2019. This is a descriptive, retrospective study with an analytical component. The study population included 535 PNB< 32w, alive at 36 weeks or discharged after 34 PMA. Of the 242 premature BPD28d, 203 (83,88%) were BPD36w; 16 (6%) required O2 for less than 28 consecutive days, of which 7 still required it at 36 weeks. The predictors of BPD36w were: male (OR 2.42, 95% CI: 1.24-4.69), birth weight (OR 1, 95% CI: 0.99-1), gestational age (OR 0.75, 95% CI: 0.57-0.97), APGAR at 5 min, (OR 0.01, 95% CI: 0.003-0.05), continuous positive pressure or high-flow nasal cannula requirement (OR 1.1, 95% CI: 1.04-1.17) and days of invasive mechanical ventilation (OR 1.1, 95% CI: 1-1.2). Conclusions: We did not find a significant difference in the incidence of BPD between the definitions of BPD28d and BPD36s; and the majority of PNB < 32w diagnosed with BPD36w can be identified at 28 days of life.

A Phase II Study of Pembrolizumab in EGFR-Mutant, PD-L1+, Tyrosine Kinase Inhibitor Naïve Patients With Advanced NSCLC.

BACKGROUND: Despite the significant antitumor activity of pembrolizumab in NSCLC, clinical benefit has been less frequently observed in patients whose tumors harbor EGFR mutations compared to EGFR wild-type patients. Our single-center experience on the KEYNOTE-001 trial suggested that pembrolizumab-treated EGFR-mutant patients, who were tyrosine kinase inhibitor (TKI) naïve, had superior clinical outcomes to those previously treated with a TKI. As TKI naïve EGFR-mutants have generally been excluded from pembrolizumab studies, data to guide treatment decisions in this patient population is lacking, particularly in patients with programmed death ligand 1 (PD-L1) expression ≥50%. METHODS: We conducted a phase II trial (NCT02879994) of pembrolizumab in TKI naive patients with EGFR mutation-positive, advanced NSCLC and PD-L1-positive (≥1%, 22C3 antibody) tumors. Pembrolizumab was administered 200 mg every 3 weeks. The primary endpoint was objective response rate. Secondary endpoints included safety of pembrolizumab, additional pembrolizumab efficacy endpoints, and efficacy and safety of an EGFR TKI after pembrolizumab. RESULTS: Enrollment was ceased due to lack of efficacy after 11 of 25 planned patients were treated. Eighty-two percent of trial patients were treatment naïve, 64% had sensitizing EGFR mutations, and 73% had PD-L1 expression ≥50%. Only 1 patient had an objective response (9%), but repeat analysis of this patient's tumor definitively showed the original report of an EGFR mutation to be erroneous. Observed treatment-related adverse events were similar to prior experience with pembrolizumab, but two deaths within 6 months of enrollment, including one attributed to pneumonitis, were of concern. CONCLUSIONS: Pembrolizumab's lack of efficacy in TKI naïve, PD-L1+, EGFR-mutant patients with advanced NSCLC, including those with PD-L1 expression ≥50%, suggests that it is not an appropriate therapeutic choice in this setting.

Fluorimetric differential-kinetic determination of silicate and phosphate in waters by flow-injection analysis.

A flow-injection analysis (FIA) method for simultaneous determination of silicate and phosphate, based on the different rates of formation of their molybdate heteropoly acids is suggested. The fluorimetrically monitored product is thiochrome, formed by oxidation of thiamine by the heteropoly acid. The FIA configurations designed allow performance of two measurements at different times on each sample injected. The method permits the determination of these anions in the range 30-600 ng ml in ratios from 1:10 to 10:1 and can be applied to samples of running and bottled water with good results. The sampling frequency achievable is 60 hr .

Increased TNFA*2, but not TNFB*1, allele frequency in Spanish atopic patients.

Tumor necrosis factor (TNF) is a potent proinflammatory cytokine involved in asthma and atopy. Increased TNF-alpha levels have been found in airway biopsies and bronchoalveolar lavage fluids from asthmatic patients. Constitutional variations in the TNF-alpha secretion levels in vitro are associated with molecular polymorphisms located within and around the TNF loci. Our study objective was to investigate the association between atopy and two described di-allelic polymorphisms in the TNF locus: a G to A transition at position -308 in the 5'-promoter region of the TNFA gene (TNFA*1 and TNFA*2 alleles) and an Ncol restriction fragment length polymorphism (RFLP) in the first intron of the TNFB gene (TNFB*1 and TNFB*2 alleles). The genetic study was performed in 65 unrelated atopic patients and 60 healthy controls. The regions of interest were amplified from genomic DNA using specific primers and polymerase chain reaction. SSP-PCR analysis for TNFA -308 polymorphism genotyping and endonuclease digestion analysis for the TNFB Ncol RFLP were used. The frequency of the TNFA*2 allele was significantly higher in atopic subjects compared to the control group (38.5% vs. 10.5%; chi2 = 32.06; p <0.0001). The TNFA*2 allele is associated with a higher risk for the development of atopy (risk ratio = 9.44; EF = 0.65; chi2 = 30.06 p <0.0005). On the other hand, no significant association between the TNFB alleles and atopy was found. In conclusion, the TNFA*2 allele could be also a genetic risk marker for the predisposition to atopy in our population, as has been reported in other studies. Either the TNFA gene itself or a linked gene on chromosome region 6p21, which has yet to be identified, is a candidate gene for susceptibility to atopy.

Enzymatic determination of ethanol in saliva by flow injection analysis.

Enzymatic photometric and fluorimetric methods are proposed for the determination of ethanol in saliva with determinative ranges of 2.5-15.0 mug ml(-1) and 1.0-20.0 mug ml(-1) respectively, i.e. covering the legal ranges after 1 : 100 dilution. A comparison between the ethanol content in saliva, breath and blood has been carried out on 12 individuals; the determination in saliva has been shown to be a good option.

Development of a statistical model for predicting the ethanol content of blood from measurements on saliva or breath samples.

Blood, saliva and breath samples from a population of males and females subjected to the intake of preselected amounts of ethanol, whilst in different physical conditions (at rest, after physical exertion, on an empty stomach and after eating), were analysed by automatic methods employing immobilized (blood) or dissolved (saliva) enzymes and a breathanalyser. Treatment of the results obtained enabled the development of a statistical model for prediction of the ethanol concentration in blood at a given time from the ethanol concentration in saliva or breath obtained at a later time.

[Dilatation of the papilla of Vater in the treatment of choledocholithiasis in selected patients]. / Dilatación de la papila de Vater en el tratamiento de la coledocolitiasis en pacientes seleccionados.

OBJECTIVE: To prospectively analyze the results obtained with papillary balloon dilatation (PBD) in the treatment of common bile duct stones in patients at risk of complications if endoscopic sphincterotomy (ES) were performed. PATIENTS AND METHOD: Thirty-three patients were included between January 2001 and June 2003 (mean age 76.2 years). The criteria for PBD were: choledocholithiasis < or =10 mm in patients with peripapillary diverticula, hemostatic alterations, Billroth-II, and preservation of Oddi's sphincter. In 79% of the patients sedation was performed by an anesthetist. PBD was performed with a balloon catheter dilator with a diameter of 8 or 10 mm for 2 minutes. The efficacy and duration of the procedure as well as complications at 30 days and patient satisfaction were evaluated. RESULTS: Stone extraction was achieved in all patients (100%). The mean duration of the procedure was 26 minutes. Two patients (6%) presented mild pancreatitis. Serum amylase was elevated in 16 patients (48%): > or =3 times (post-PBD hyperamylasemia) in 11 (33%). The procedure caused no discomfort in 25/26 (96%) of the patients sedated by an anesthetist vs 2/5 patients (49%) who underwent endoscopic sedation. CONCLUSIONS: PBD is an effective and simple therapeutic option in the treatment of small common bile duct stones (< or =10 mm) and in patients at high risk. The duration of endoscopic retrograde cholangiopancreatography is not prolonged. Complications are infrequent (6%) and mild. Post-PBD hyperamylasemia is frequent and generally without clinical importance. Sedation by an anesthetist improves patient satisfaction.

Long-term results of the Boytchev procedure for the treatment of recurrent dislocation of the shoulder.

The authors present the long-term results obtained with the Boytchev technique in the treatment of recurrent anterior dislocation of the shoulder. Recurrence, clinical outcome and functional limitations were evaluated. A total of 27 shoulders in 25 patients were studied. The average follow-up period was 13.3 years. There were no immediate neurovascular complications and no residual pain. The average recovery time was 4.3 months. Dislocation recurred in five shoulders (18%) and 18.5% of the patients were left with restricted mobility. All patients resumed their previous employment although sporting capacity recovered to pre-injury levels in only 9 of 15 patients. The results were classified as good in 18.5% and as excellent in 40.7% of the patients, but the remaining 40.7% had a fair or poor result. In conclusion, the recurrence rate is high and nearly 20% of the patients are left with limited shoulder mobility. Furthermore, although all the patients were able to return to their job, only 60% of those engaged in sports regained their previous level. This technique, although attractive, is better avoided.

Pequeña reseña histórica y nuevos objetivos de la Revista Chilena de Neumología Pediátrica / Short historical review and new objectives of the Chilean Neumología Pediátrica journal

The Chilean Neumologia Pediátrica journal is 13 years old. Starting with a brief historical review and emphasizing the importance of the journal for professional work dedicated to children's respiratory health, new challenges are posed to increase its diffusion and quality. New objectives are aimed at improving their indexation and impact.

La revista Chilena de Neumología Pediátrica está cumpliendo 13 años. Partiendo con una breve reseña histórica y recalcando la importancia de la revista para el quehacer profesional dedicado a la salud respiratoria infantil, se plantean nuevos desafíos para aumentar su difusión y calidad. Los nuevos objetivos están dirigidos a mejorar su indexación e impacto.

Spinal neurons bursting in phase with fictive scratching are not related to spontaneous cord dorsum potentials.

Spontaneous cord dorsum potentials (spontaneous CDPs) are produced by the activation of dorsal horn neurons distributed along the L4 to S1 spinal cord segments, in Rexed's laminae III-VI, in the same region in which there are interneurons rhythmically bursting during fictive scratching in cats. An interesting observation is that spontaneous CDPs are not rhythmically superimposed on the sinusoidal CDPs generated during fictive scratching episodes, thus suggesting that the interneurons producing both types of CDPs belong to different spinal circuits. In order to provide experimental data to support this hypothesis, we recorded unitary activity of neurons in the L6 spinal cord segment. We found that the neurons firing rhythmically during the sinusoidal CDPs associated with the extensor, flexor or intermediate phases of scratching were not synchronized with the spontaneous CDPs. Moreover, we found that the neurons firing during the spontaneous CDPs were not synchronized with the sinusoidal CDPs. These results suggest that the neurons involved in the occurrence of spontaneous CDPs are not part of the spinal cord central pattern generators (CPGs). This study will be relevant for understanding the relationships between the spinal cord neuronal populations firing spontaneously and the CPGs, in the intact and injured spinal cord.

Histological correlates of N40 auditory evoked potentials in adult rats after neonatal ventral hippocampal lesion: animal model of schizophrenia.

The neonatal ventral hippocampal lesion (NVHL) is an established neurodevelopmental rat model of schizophrenia. Rats with NVHL exhibit several behavioral, molecular and physiological abnormalities that are similar to those found in schizophrenics. Schizophrenia is a severe psychiatric illness characterized by profound disturbances of mental functions including neurophysiological deficits in brain information processing. These deficits can be assessed by auditory evoked potentials (AEPs), where schizophrenics exhibit abnormalities in amplitude, duration and latency of such AEPs. The aim of the present study was to compare the density of cells in the temporal cerebral cortex and the N40-AEP of adult NVHL rats versus adult sham rats. We found that rats with NVHL exhibit significant lower amplitude of the N40-AEP and a significant lower number of cells in bilateral regions of the temporal cerebral cortex compared to sham rats. Because the AEP recordings were obtained from anesthetized rats, we suggest that NVHL leads to inappropriate innervation in thalamic-cortical pathways in the adult rat, leading to altered function of cortical networks involved in processing of primary auditory information.

Neumonía eosinofílica en pediatría, a propósito de dos casos clínicos / Pneumonia eosinofilic in pediatrics, clinical cases

INTRODUCCIÓN: La Neumonía Eosinofílica (NE) es una entidad muy poco frecuente en pediatría y se caracteriza por infiltración de eosinófilos en el intersticio pulmonar y alveolar, pudiendo ser primaria o secundaria, así como también presentar un curso agudo o crónico. OBJETIVO: Presentar dos casos clínicos de NE diagnosticados en el período 2014-2017 en una Unidad de Cuidados Intensivos pediátricos. CASOS CLÍNICOS: Dos lactantes mayores, ambos con antecedente de madre asmática, hospitalizados por in suficiencia respiratoria y diagnóstico de neumonía viral en Clínica Indisa, Santiago, Chile. Ambos presentaron síndrome febril, imágenes de condensación persistentes en la radiografía de tórax y eosinofilia periférica en el transcurso de su enfermedad. Uno de ellos con requerimiento de oxígeno por más de un mes, sin eosinofilia en el lavado broncoalveolar (LBA), al que se le hizo el diagnóstico de NE por biopsia pulmonar. El otro niño requirió ventilación mecánica por 28 días y se hizo diag nóstico de NE por eosinofilia mayor a 20% en LBA. Los dos casos presentaron excelente respuesta a corticoides sistémicos. CONCLUSIÓN: La NE se debe sospechar en el niño con diagnóstico de neumonía con síntomas persistentes sin respuesta al tratamiento, habiéndose descartado otras causas, sobre todo si se asocia a eosinofilia periférica. El diagnostico de NE en pediatría se confirma por eosinofilia mayor a 20% en LBA y en algunos casos es necesaria la biopsia pulmonar.

INTRODUCTION: Eosinophilic Pneumonia (EP) is a very rare disorder in Pediatrics. It is characterized by the infiltra tion of eosinophils in the pulmonary and alveolar interstitium, and may be primary or secondary as well as present an acute or chronic progress. OBJECTIVE: to present 2 pediatric EP clinical cases which were diagnosed at the pediatric intensive care unit of Clinica Indisa in Santiago, Chile between 2014 and 2017. CLINICAL CASES: Two older infants, who were hospitalized due to respiratory failure with a diagnosis of viral pneumonia. Both have asthmatic mothers. Additionally, they both had febrile syn drome, persistent condensation images in the chest x-rays, and peripheral eosinophilia throughout the course of the disease. One of the infants required oxygen for more than one month, and there was no eosinophilia in the bronchoalveolar lavage (BAL). In this case, the diagnosis of EP was reached via pulmonary biopsy. The other infant required mechanic ventilation for 28 days, and was diagnosed due to eosinophilia greater than 25% in the bronchoalveolar lavage. Both patients had excellent res ponse to systemic corticosteroids. CONCLUSION: After ruling out other causes, EP should be suspected in children with pneumonia diagnosis, and persistent symptoms that do not respond positively to treatment, especially if associated with peripheral eosinophilia. The diagnosis of EP in pediatrics is confirmed with eosinophilia greater than 20% in BAL and, in some cases, it is necessary to perform a lung biopsy.

Actualización en espirometría y curva flujo / volumen en escolares y adolescentes / School and adolescent spirometry and flow / volume curve update

Spirometry is the most commonly used test to evaluate lung function in children and adults. To obtain good quality results, several requirements must be fulfilled: professional capacity of the technician, the quality of the equipment, the patient's collaboration, the use of appropriate reference standards. The purpose of spirometry is to define types of ventilatory alterations of the central and peripheral airways, to evaluate the response to bronchodilators and to guide the presence of restrictive diseases. The new consensus of national and international experts are described, which have been perfecting several aspects of this test.

La espirometría es el examen más comúnmente utilizado para evaluar la función pulmonar en niños y adultos. Para obtener resultados de buena calidad deben cumplirse varios requisitos, desde la capacidad profesional del técnico, calidad de los equipos, colaboración del paciente y utilización de patrones de referencia adecuados. La espirometría tiene como utilidad definir alteraciones ventilatorias obstructivas de vía aérea central y periférica, evaluar respuesta a broncodilatador y orientar al diagnóstico de enfermedades restrictivas. Se describen los nuevos consensos de expertos nacionales e internacionales, los cuales han ido perfeccionando varios aspectos de este examen.