Clinical Presentations and Outcomes Related to Tuberculosis in Children Younger Than 2 Years of Age in Catalonia.

Introduction: Children younger than 2 years have an increased risk of complications associated with tuberculosis (TB) due to the immaturity of the innate and adaptive immune response. We aimed to identify TB clinical presentations and outcomes as well as risk factors for complications in this age group. Materials and Methods: Multicenter, retrospective, cross-sectional study of TB cases in children aged <2 years in Catalonia (2005-2013). Epidemiological and clinical data were collected from the hospital medical records. TB complications, sequelae included, were defined as any tissue damage generating functional or anatomical impairment after being diagnosed or after TB treatment being completed. Statistical analyses were based on bivariate chi-square and multivariate logistic regression, and it was carried out with Stata® version 13.1. Odds ratios (OR) and its 95% confidence intervals were calculated (CI). Results: A total of 134 patients were included, 50.7% were male, the median [IQR] age was 13[8-18] months, and 18.7% (25/134) showed TB-associated complications. Pulmonary TB was diagnosed in 94.0% (126/134) of children, and the most common complications were lobar collapse (6/126). TB meningitis was diagnosed in 14/134 (10.4%), and hydrocephalus and mental impairment occurred in 1 and 2 patients, respectively. Two patients with spinal TB developed vertebral destruction and paraplegia, respectively. Only one of the patients died. At multivariate level, tachypnea (OR = 4.24; 95% CI 1.17-15.35) and meningeal (OR = 52.21; 95% CI 10.05-271.2) or combined/extrapulmonary forms (OR = 11.3; 95% CI 2.85-45.1) were associated with the development of TB complications. Discussion: TB complications are common in children under 2 years old. Extrapulmonary TB forms in this pediatric age remain a challenge and require prompt diagnosis and treatment in order to prevent them. The presence of tachypnea at the time of TB diagnosis is an independent associated factor to the development of TB complications in infants. This clinical sign should be closely monitored in patients in this age group. It is necessary to perform further studies in this age group in a prospective design in order to understand whether there are other factors associated to TB complications.

Epidemiology and Management of Acute, Uncomplicated Septic Arthritis and Osteomyelitis: Spanish Multicenter Study.

BACKGROUND: Acute osteoarticular infection (OAI) is a potentially severe disease. The aim of this study was to evaluate the etiology, clinical characteristics and therapeutic approach of OAI in children in Spain. METHODS: Medical records from children <14 years with OAI from 25 hospitals between 2008 and 2012 were reviewed. Confirmed osteomyelitis (OM) and septic arthritis (SA) required a positive bacterial isolate; otherwise, they were considered probable. Probable SA with <40,000 cells/mm in joint fluid was not included. RESULTS: A total of 641 children were evaluated. Two hundred and ninety-nine cases (46%) were OM, 232 (36%) SA, 77 (12%) osteoarthritis and 33 (5%) spondylodiscitis. Children with OM were older (63 vs. 43 months for SA; P < 0.001). Magnetic resonance imaging and bone scintigraphy had the highest yield for OM diagnosis (94%). Arthrocentesis was performed in 96% of SA. A microorganism was isolated in 246 patients (38%: 33% OM vs. 55% SA; P < 0.001): Staphylococcus aureus was the most common (63%), followed by Kingella kingae (15%) and Streptococcus pyogenes (9%). Ninety-five percent of children initially received IV antibiotics, mostly cefotaxime + cloxacillin (60%) or cloxacillin (40%). Total treatment duration was 38 (±31) days for OM and 28 (±16) days for SA (P < 0.0001). Twenty percent of children with OM (46% because of complications) and 53% with SA (95% initial arthrotomy) underwent surgery. Patients with SA were compared according to initial arthrotomy (n = 123) versus arthrocentesis (n = 109), and no clinical differences were observed, except for higher rate of hip SA in the former (50% vs. 9%; P < 0.001). Children with arthrocentesis had less sequelae [6.6% vs. 1%; P = 0.03, odds ratio = 0.58 (95% confidence interval: 0.45-0.76)], but not in the multivariate analysis. CONCLUSIONS: This is the largest pediatric cohort of OAI in Spain. S. aureus was the most common isolate, although K. kingae was recovered in a high proportion of cases. Conservative management was applied in half of the patients. There was a low rate of sequelae, even with nonsurgical approaches.

Immediate and delayed memory recall patterns of chronic hemodialysis adult hispanic patients.

OBJECTIVE: To determine the most effective time to administer nutrition education to hemodialysis patients by evaluating memory recall scores before, during, and after treatment. DESIGN: Prospective, quasi experimental cohort. SUBJECTS: Sixty-two adult Hispanic hemodialysis patients (38 men and 24 women, 29 <65 years of age and 32 >65 years of age). Patients, between 18 and 85 years of age, who have been on hemodialysis at least one month. Patients were literate and able to see and hear without impairment. SETTING: Hemodialysis clinic. INTERVENTION: Fifteen simple words (English and Spanish) in large print on 5 x 8 laminated 2-sided cards that were shown to the patient before, during, and after dialysis. METHODS: Patients were shown 5 different words before going on dialysis, 5 more words during dialysis, and 5 more words after dialysis. Each time, the patient was asked for immediate recall to assess short-term memory recall. Patients were then asked 5 to 10 minutes later (before, during, and after dialysis) what words were seen to assess long-term memory recall. MAIN OUTCOME MEASURE: Did patients remember more before, during, or after dialysis? RESULTS: There were no significant differences in memory recall scores between diabetic and nondiabetic subjects or by gender with respect to memory recall scores. Results imply that time of recall in relation to dialysis treatment may be important for those above 65 years of age. A significant difference was found when comparing those subjects completing elementary school to those subjects completing high school and college. The evidence found in this study was in accordance with the findings of Smith and Winslow in their 1990 study showing subjects required less time to complete a task measuring cognitive function when it was given before hemodialysis treatment, as compared with during the treatment. CONCLUSION: As age increases, recall ability likely will decrease. As education level increases, recall ability will likely increase. Providing nutrition education before the hemodialysis treatment occurs may be more beneficial than during and after the treatment. The educational information that a hemodialysis patient retains after treatment may be seriously impacted by the patient's education level and age.