Revista de la Sociedad Boliviana de Pediatría

Hand hygiene and risk of infections

Direct immunofluorescence assay performance in diagnosis of the Influenza A(H1N1) virus

El 25 de abril de 2009, a menos de un mes de la detección en México del primer humano con virus Influenza A(H1N1), la enfermedad ya se había propagado a más de 40 países superando los 10 000 casos notificados. Dada su naturaleza impredecible, este tipo de virus requiere métodos diagnósticos apropiados, confiables y seguros, pero que también estén al alcance de los laboratorios clínicos. Mediante el estudio de 291 muestras de pacientes con sospecha de infección por virus Influenza A(H1N1) en Neuquén, Argentina, el presente trabajo compara los dos métodos de diagnóstico utilizados simultáneamente: la prueba de inmunofluorescencia directa (DFA) y la de reacción en cadena de la polimerasa en tiempo real (RT-PCR). La DFA dio una sensibilidad de 44,4%, especificidad de 99,6%, valor predictivo positivo de 95,2% y valor predictivo negativo de 90,7%. Los resultados positivos de la metodología pueden considerarse verdaderos positivos. Un resultado negativo no excluye la presencia del virus y la muestra debe examinarse mediante RT-PCR. Del total de 291 muestras, 45 resultaron positivas por RT-PCR y 21 por DFA.

By 25 April 2009, less than one month after the first human with Influenza A(H1N1) virus was detected in Mexico, the disease had already spread to more than 40 countries, with over 10 000 cases reported. Due to its unpredictability, this type of virus requires appropriate, reliable, and safe diagnostic methods that are also accessible to clinical laboratories. Through the analysis of 291 samples taken from patients with suspected Influenza A(H1N1) virus infection in Neuquén, Argentina, this study compares the two diagnostic methods used simultaneously: direct immunofluorescence assay (DFA) and real-time polymerase chain reaction (RT-PCR). DFA had a sensitivity of 44.4%, a specificity of 99.6%, a positive predictive value of 95.2%, and a negative predictive value of 90.7%. Positive results obtained with this method can be considered true positives. A negative result does not rule out the presence of the virus. In this case, the sample should be examined by RT-PCR. Out of a total of 291 samples, there were 45 positive results with RT-PCR and 21 positive results with DFA.

Mycoplasma pneumoniae infection complicated by necrotizing pneumonia

La Neumonía producida por Mycoplasma pneumoniae es una patología normalmente benigna y auto limitada, sin embargo existe un porcentaje de casos que cursan con complicaciones respiratorias severas. Presentamos el caso de una niña de 5 años de edad con neumonía necrotizante por Mycoplasma Pneumonía y que necesitó atención en la Unidad de Cuidados Intensivos Pediátricos.

The pneumonía caused by Mycoplasma pneumoniae is a usually benign and self-limiting condition. However there are a percentage of cases tends to produce severe respiratory complications. We present the case of a girl of 5 years of age with necrotizing pneumonía by Mycoplasma pneumoniae, and needed attention in the Intensive Care Unit.

Precocious puberty

Historical review of the social pediatric in Bolivia

Pain prevention in term neonates: randomised trial for three methods

Introducción. Por norma legal, a todos los recién nacidos se les debe extraer sangre durante los primeros días de vida, para la pesquisa neonatal de hipotiroidismo congénito y fenilcetonuria. El procedimiento de extracción supone cierto dolor para el neonato y aún no existe un método sencillo y eficaz para disminuirlo. Objetivos. Evaluar si la administración de glucosa, paracetamol o EMLA, disminuyen individualmente el dolor en recién nacidos, provocado por punción de talón, en un ambiente ambulatorio. Material y métodos. Estudio prospectivo y aleatorizado, a doble ciego, en el cual setenta y seis recién nacidos de término y sanos fueron asignados a recibir placebo, glucosa por vía oral, EMLA en talón o paracetamol por vía oral. Se realizó punción de talón para extraer sangre y dos observadores independientes midieron el dolor con dos escalas (NIPS y PIPP). La variable de resultado fue la cantidad de niños con valores de dolor por debajo de las cifras consideradas dolor moderado en cada grupo. Resultados. NIPS < 4: placebo (9/19= 47%), glucosa (16/19= 84%), paracetamol (8/19= 42%) y EMLA (12/19=63%). PIPP < 8: placebo (9/19= 47%), glucosa (12/19= 63%), paracetamol (5/19= 26%) y EMLA (8/19= 42%). Con el uso de glucosa oral, encontramos: RAR: 0,37 (IC 95%: 0,09-0,64), RRR: 44% (IC 95%: 6-67), NNT: 2,7(IC95% 1,5-11). Conclusiones. Con el uso de la solución glucosada por vía oral se obtuvieron los mejores resultados. Sólo con una de las escalas utilizadas fueron estadísticamente significativos. Con paracetamol y EMLA, no observamos disminución del dolor. Deberán considerarse otros métodos complementarios y combinados, junto con la glucosa, para aliviar esta experiencia dolorosa a miles de niños diariamente.

Introduction. Every newborn infant is screened for hypothyroidism and phenilketonuria by blood sampling, during the first week of life, but there is not a simple and efficient method to reduce pain during the procedure. Objectives. Prospective randomised trial, to assess if the administration of oral glucose, paracetamol or EMLA, given individually, can reduce the pain caused in newborns by heel prick, in an outpatient setting. Methods. Double-blind study in which seventy six healthy newborns at term were randomly assigned to receive placebo, oral glucose, EMLA in the heel, or oral paracetamol. Heel prick was performed to get a blood sample, and pain was measured by two independent observers, using two scales (NIPS and PIPP). Results. NIPS <4: placebo (9/19= 47%), glucose (16/19= 84%), paracetamol (8/19= 42%) and EMLA (12/19= 63%); PIPP <8: placebo (9/19= 47%), oral glucose (12/19= 63%), paracetamol (5/19= 26%) and EMLA (8/19= 42%). With the use of oral glucose we found RAR: 0.37 (IC 95% 0.09-0.64), RRR: 44% (IC 95% 6-67%), NNT: 2.7 (IC 95% 1.5-11). Conclusions. The best results were obtained with the use of oral glucose, being statistically significant with only one of the scales. The administration of paracetamol or EMLA did not reduce pain. Other complementary and/or combined methods, added to oral glucose, should be considered daily to diminish this painful experience in thousands of children.

Epidemiology of co-sleeping and nighttime waking at 12 months in a birth cohort

Objetivo: Investigar a prevalência e os fatores associados ao co-leito e ao despertar noturno entre as crianças da coorte de Pelotas de 2004, aos 12 meses de idade. Métodos: Todas as crianças nascidas em 2004 em Pelotas (RS) foram incluídas em um estudo longitudinal. Ao nascer e aos 12 meses de idade, as mães foram entrevistadas sobre características sociodemográíicas e reprodutivas e sobre o sono e o ambiente em que a criança dorme. Co-leito foi definido como o compartilhamento habitual da camacomoutra pessoa. As análises multivariáveis foram realizadas por regressão de Poisson. Resultados: Aprevalência de co-leito aos 12mesesfoi de 45,8% (IC95% 44,2-47,3).O co-leito foi maior entre as mães de baixo nível socioeconômico, menos escolarizadas, mais jovens, com maior paridade e entre crianças que acordam à noite. A prevalência de despertar noturno foi de 46,1% (IC95% 44,6-47,7). O despertar noturno foi mais frequente entre os meninos e entre filhos de mães commaior paridade, e menos frequente entre mães que trabalharam fora durante a gravidez. Conclusão: O co-leito e o despertar noturno são frequentes na população estudada, indicando a necessidade de acompanhamento para observar a persistência destes hábitos ao longo da infância e investigar suas consequências sobre o comportamento e o desenvolvimento infantis.

Objective: To investigate the prevalence and factors associated with co-sleeping and nighttime waking among the children of the Pelotas 2004 cohort at 12 months of age. Methods: Ali children born in the city of Pelotas,RS,Brazil during 2004 were enrolled on a longitudinal study. Mothers were interviewed at delivery and once more at 12 months of age to obtain information on their sociodemographic and reproduetive characteristies and on their children's sleep and the environment in which their children sleep. Co-sleeping was defined as habitually sharing the bed with another person. Multivariate analysis was performed using Poisson regression. Results: The prevalence of co-sleeping at 12 monthswas 45.8% (95%CI 44.2-47.3). Co-sleeping was more common among mothers with low socioeconomic status, less education, younger mothers, mothers with more previous births and among children who wake at night. The prevalence of nighttime waking was 46.1% (95%CI 44.6-47.7). Nighttime waking was more common among boys and among the offspring of mothers who had had a greater number of previous pregnancies and of mothers who had been employed while pregnant. Conclusion: Co-sleeping and nighttime waking are common among this study population, indicating a need to continue follow-up in order to observe how long these habits persist through childhood and to investigate their consequences for child development and behavior.

Thyroid Function in Pediatric Patients with Chronic Renal Failure

Objetivo: Caracterizar la función tiroidea y la respuesta a test de TRH (thyroid releasing hormone), en niños con enfermedad renal crónica (ERC) leve (L), moderada (M), peritoneodiálisis (PD), hemodiálisis (HD) y trasplantados renales (TX). Pacientes y Método: Se estudiaron 46 pacientes con ERC (10 L, 10 M, 10 PD, 6 HD y 10 TX), 9,3 + 3,7 años. Se midió t4t, t41, t3t, t31, TBG basal y test de TRH (TSH a 0, 30 y 60 min). Se evaluó función renal, antropometría y se consignó tratamiento inmunosupresor (IS) en el grupo TX. Se utilizó anova para comparar los resultados entre los grupos y coeficiente de correlación para las variables estudiadas. Resultados: Los valores básales de hormonas tiroideas fueron normales en todos los grupos, sólo TSH fue significativamente mayor en L aunque dentro del rango normal (p < 0,01). La respuesta al test de TRH fue predominantemente prolongada en L, M, PD y HD y deficiente en TX; los 3 pacientes TX con tacrolimus, micofenolato y prednisona en días alternos tuvieron respuesta normal a diferencia del resto TX que recibían prednisona continua, ciclosporina y micofenolato. La prolongación de respuesta a TRH se correlacionó con creatininemia, BUN y clearance de creatinina (p < 0,01). Conclusiones: Los niveles de hormonas tiroideas básales se encuentran normales en todos los grupos de ERC. La respuesta a TRH fue predominantemente prolongada en L, M, PD y HD, demostrando un fenómeno adaptativo a nivel terciario del eje hipotálamo-hipofisis-tiroides. Los TX presentan una respuesta mayoritoriamente deficiente a TRH, sugerente de disfunción hipofisiaria, la que podría estar relacionada con el tipo de tratamiento inmunosupresor y al uso de corticoides en días continuos.

Objective: To characterize the thyroid function in mild (L), moderate (M), hemodialysis (HD), peritoneal dialysis (PD), chronic renal failure (CRF) and post kidney transplant (TX). Method: 46 children between 9.3 + 3.7 years-old with CRF (10 mild (L), 10 modérate (M), 10 peritoneodialysis (PD), 6 hemodialysis (HD), 10 transplants (TX)) were evaluated. Basal total T4 and free T3, TRH test (TSH at 0-30-60 min), creatinine, BUN, creatinine clearance and anthropometric parameters were measured. The statistics analysis included Anova Test to compare group results and correlation coefficients for studied variables. Results: Basal thyroid hormone levéis were normal in all groups and no differences between groups (except higher TSH in L (p < 0.01)) were found. TRH test response was prolonged on L, M, PD and HD and deficient in TX, except 3 TX patients who had normal TRH response, all using Tacrolimus, Micofenolate and Prednisone on alternate day treatment versus the remaining TX who where on Cyclosporine or Azathioprine, Micofenolate and continuous corticoid régimen. Prolonged TRH response correlates with creatinine (p < 0.001) and creatinine clearance (p < 0,01). Conclusions: Basal thyroid hormones were normal in all groups. TRH test response was predominantly prolonged in L, M, PD and HD, suggesting adaptative phenomena at tertiary level, and correlates with renal function. TX patients had deficient TRH response, suggesting hypofisial dysfunction.

Interpretation of lactate dehydrogenase

CUESTIONARIO NUMERO 39 - PREGUNTAS CORRESPONDIENTES AL TEMA: INTERPRETACIÓN DE LA DESHIDROGENASA LÁCTICA

COMUNICADO DE LA SOCIEDAD PACEÑA DE PEDIATRÍA: Informe de gestión 2007-2009