According to medical literature, nasal carriage of Staphylococcus aureus in pediatric age in the general population ranges between 10 and 40 %, not being clearly established in children with cancer. In order to determine the prevalence in this group and its possible increment through successive hospitalizations, we studied the Calvo Mackennas oncologic patients below 19 years of age, with a series of nasal cultures. We took four samples for each patient in a period of one year. Of 80 patients initially included, 10 died, 9 returned to their city of origin before the end of the study and in 8 cases it was not possible to complete the follow-up. Prevalence of nasal carriage was 21.2% (17/80). From 17 children colonized, 14 lost this condition, 2 abandoned the follow-up and only 1 was positive at the end of the study. Incidence of hospitalization due to febrile neutropenia was 28.7% (23/80) and the relation between nasal carriage and the number of these events was not significant (p = 0.59). The relation between the number of hospitalizations and an increment in nasal colonization (p = 0,80) was also not significant. In conclusion, nasal carriage of Staphylococcus aureus in children with cancer is similar to carriage described for healthy children. Carriage would be a transitory condition, variable through time for each patient, without relation to a greater number of febrile neutropenia episodes.
Objective:To describe our experience with sixteen children treated for pulmonary sequestration at the Children's Hospital Roberto del Rio, between 2000 and 2012. Method: We reviewed retrospectively the clinical charts of all those patients up to 15 years old, who were treated for pathologically proven pulmonary sequestration in our hospital, between 2000 and 2012. Results: Sixteen patients were recorded, 8 boys and 8 girls that were diagnosed and/or treated between the newborn period and 14 years old. Nine of them had extralobar sequestration and 7 intralobar. The diagnosis was suspected for persisting pneumonia in 44%, neonatal respiratory distress in 25%, prenatal ultrasound in 19%, and recurrent pneumonia in 12%. Seventy-five percent of sequestrations were located in the left lower lobe, 19% in the right lower lobe and 6% in the right upper lobe and all of them were operated via thoracotomy. Fifty-six percent underwent surgery before one year of age (31.5% before 2 weeks of life) and 69% of patients did well postoperatively. Postoperative atelectasis were detected in 12.5%, bronchopleural fistula in 12.5% and residual pneumothorax in 6%. The average hospital stay was 9 days and no mortality was registered. Conclusions: Our experience is similar to the previously reported series and emphasizes the importance of early diagnosis in the treatment of pulmonary sequestration in children. ResumenObjetivo: Describir los hallazgos clínicos de pacientes tratados por secuestro pulmonar en el Hospital de Niños Roberto del Río, entre los años 2000 y 2012. Métodos: Estudio descriptivo retrospectivo. Se revisaron las fichas clínicas de todos los pacientes atendidos en el Hospital entre el año 2000 y 2012 con diagnóstico de secuestro pulmonar confirmado por anatomía patológica. Resultados: Se registraron 16 pacientes, 8 niños y 8 niñas. Del total 9 fueron secuestros extralobares y 7 intralobares. La sospecha diagnóstica fue por imagen de neumonía persistente en el 44% de los casos, distrés respiratorio neonatal en el 25%, ecografía antenatal en el 19% y neumonía repetida en el 12%. El 75% de los secuestros estaba ubicado en el lóbulo inferior izquierdo, el 19% en lóbulo inferior derecho y el 6% en lóbulo superior derecho. La técnica quirúrgica de elección fue la toracotomía abierta. El 56% de los pacientes se operó antes del año de vida (31,5% antes de las 2 semanas de vida). La evolución postoperatoria fue buena en el 69% de los casos, mientras que un 12,5% presentó atelectasia, 12,5% fístula broncopleural y 6% neumotórax residual. La mediana de estadía hospitalaria fue de 9 días. No se registró mortalidad. Conclusiones: Se presenta la experiencia de esta patología en el Hospital Roberto del Río enfatizándose la importancia de la sospecha diagnóstica.
Apnea as a presenting symptom in human metapneumovirus infectionHuman metapneumovirus (hMPV), a recently described pathogen of lower respiratory tract infections (LRTI), has been detected in 5,4% of Chilean infants hospitalized for LRTI whom are negative for adenovirus, respiratory syncytial virus, influenza and parainfluenza viruses. hMPV may cause bronchiolitis or pneumonia in hospitalized patients, and ocassionally require admission to intensive care units and mechanical ventilation. The infection has been associated with apnea, especially in preterm infants. Nosocomial dissemination has also been described. We present the case of a one-month-of age premature infant with apnea, and infection caused by hMPV of probable nosocomial aquisition. Clinical features of hMPV infection are reviewed and its association with apnea and nosocomial transmission is discussed. hMPV should be included in the routine diagnosis of respiratory viruses in infants with apnea and should be considered among the respiratory pathogens associated with nosocomial transmission.
Follow-up of infants hospitalized for bronchiolitis by respiratory syncytial virus. Clinical evolution, inflammatory response and markers of atopy. Preliminary results Background: Respiratory syncytial virus infection (RSV) alone or associated to rhinovirus (RV) in the infant has been linked with more likelihood to develop asthma and atopy. Aim: Analyze clinical and immunological markers of patients with RSV or RV bronchiolitis that determine their evolution. Patients and Methods: We studied previously healthy infants hospitalized for bronchiolitis during the fall-winter period of 2009 and 2010. RSV and RV by qPCR, and proinflammatory interleukins (IL). IL-6, IL-8, TNF-α, IL-1β and IL-12, were determined in nasopharyngeal aspirate (NPA). A follow-up clinical, indoor pollution and immunological study was done at 4 or 5 years. Results are expressed in median and range. Mann-Whitney's test was used in the nonparametric statistical analysis. Results: Eight out of 22 patients (36%) are currently with recurrent wheezing (RW) in treatment with budesonide 400 µg per day as a mean dose. In the IL assessment significant changes were detected only in IL-1β that was increased and in IL-12 that was decreased in the RW group versus the non RW (NRW) group. There were not significant differences in both groups in age at hospitalization, infection severity, presence of personal or family atopy, co-infection with RSV and RV, presence of older siblings or indoor air pollution. Conclusions: The determination of IL-1β and IL-12 in NPA for bronchiolitis could be an early marker of subsequent inflammation of the airway. Co-infection of RSV and RV does not get worse the clinical evolution. The group RW of preschool children had no further development of atopy than the NRW group. There could be other factors that contribute to the manifestation of bronchial inflammation in the RW group.
Profile perception of ideal characteristics in postgraduate professor of pediatrics Introduction: The ideal characteristics of the Graduate Professor of Pediatrics at the Medical School of the Universidad de Chile are yet not defined. Objective: To determine these characteristics from members' perception. Methodology: Qualitative research. Focus groups for Professors, alumni and Pediatrics students and interviews to three authorities took place at the Campus Oriente. Once the profile was elaborated, Directors of Departments of Pediatrics of other Campuses were interviewed for validation. Results: A teaching profile was elaborated differentiating the role of the professional as a person (committed, responsible, honest, respectful, tolerant, friendly, empathetic, assertive, leader, role model and able to maintain good interpersonal relationships), as a teacher (trained in teaching, planner, evaluator, with protected time for teaching, with capacities for self-reflection and self-assessment, learning facilitator, motivator, facilitator of a climate that encourages learning, communicator, with vocation, challenging, accessible, knowledgeable and user of new technologies and with ability to review the teaching process) and as a clinician (expert in his discipline, updated, researcher, identified and committed to the institution, able to work in a team). Conclusions: An ideal profile of the Graduate Professor of Pediatrics was created.
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