Background There is a critical need for additional validation studies of questionnaires designed to assess the level of control of asthma in pediatric patients. Objective To validate the Spanish version of the Childhood Asthma Control Test (cACT) in children aged between 4 and 11 years with physician-diagnosed asthma Methods In a prospective cohort validation study, asthmatic children aged between 4 and 11 years and their parents, attended both a baseline and a follow-up visit 2 to 6 weeks later. In these two visits, they completed the information required to assess the criterion validity, construct validity, test-retest reliability, sensitivity to change, internal consistency, and usability of the cACT. Results At baseline, cACT scores were significantly different between patients with controlled, partly controlled, and uncontrolled asthma [24.0 (23.0-26.0), 18.0 (18.0-22.0), and 17.5 (13.0-20.0) respectively, p<0.001], and also between patients for whom this visit resulted in a step-up, no change, or step-down in therapy [18.0 (15.0-21.0), 24.0 (23.0-24.0), and 26.0 (23.5-26.0) respectively, p<0.001]. The score of the cACT correlated positively and significantly with the score of the Pediatric Asthma Caregivers Quality of life Questionnaire - PACQLQ (Spearman’s rho = 0.50, p<0.001).The intraclass correlation coefficient of the measurements in patients with no change in clinical status was 0.849 (95% CI: 0.752-0.908). There were statistical significant differences between baseline and follow-up cACT scores in patients with an improvement in clinical status [19.0 (18.0-22.0) vs. 24.5 (24.0-25.0), p<0.001]. Cronbach’s α was 0.8276 for the questionnaire as a whole. Conclusion The Spanish version of the cACT has adequate criterion validity, adequate construct validity, adequate sensitivity to change, good internal consistency, good test-retest reliability, and excellent usability when administered to asthmatic children aged between 4 and 11 years.

Cytomegalovirus (CMV) is a prevalent pathogen in the immunocompromised host and invasive pneumonia is a feared complication of the virus in this population. In this pediatric case series we characterized CMV lung infection in 15 non-HIV infected children (median age 3 years; IQR 0.2–4.9 years), using current molecular and imaging diagnostic modalities, in combination with respiratory signs and symptoms. The most prominent clinical and laboratory findings included cough (100%), hypoxemia (100%), diffuse adventitious breath sounds (100%) and increased respiratory effort (93%). All patients had abnormal lung images characterized by ground glass opacity/consolidation in 80% of cases. CMV was detected in the lung either by CMV PCR in bronchoalveolar lavage (82% detection rate) or histology/immunohistochemistry in lung biopsy (100% detection rate). CMV caused respiratory failure in 47% of children infected and the overall mortality rate was 13.3%. Conclusion: CMV pneumonia is a potential lethal disease in non-HIV infected children that requires a high-index of suspicion. Common clinical and radiological patterns such as hypoxemia, diffuse adventitious lung sounds and ground-glass pulmonary opacities may allow early identification of CMV lung infection in the pediatric population, which may lead to prompt initiation of antiviral therapy and better clinical outcomes.

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Objetivo: evaluar la evidencia disponible en cuanto a tamizaje de cáncer de cuello uterino en tópicos tales como pruebas disponibles, cuándo iniciarlo, a qué intervalos, cuándo suspenderlo e indicaciones en mujeres sometidas a histerectomía por patología benigna.Metodología: se revisó la literatura publicada entre enero de 1999 y diciembre de 2003 en MEDLINE, PROQUEST y revistas que usualmente publican artículos referentes al tema, como el British Medical Journal, The Lancet y JAMA.Resultados: en programas de tamizaje organizados, las campañas educativas y las invitaciones por carta son las estrategias que dan mejores resultados; pese a las limitaciones de la citología convencional, no hay suficiente evidencia para recomendar de rutina el uso de nuevas tecnologías como la citología en base líquida, pruebas de virus de papiloma humano (VPH) o la inspección visual del cuello uterino con ácido acético (IVAA). Lo importante es lograr con ésta, una cobertura del 80% y un adecuado seguimiento. El tamizaje debe iniciarse en los primeros tres años posteriores al inicio de las relaciones sexuales, con un intervalo de un año en el caso de mujeres de alto riesgo, mientras que en las de bajo riesgo se puede hacer cada 2 ó 3 años. En quienes han tenido tamizaje regular y tres o mas citologías negativas en los últimos diez años es posible suspenderlo después de los 65 ó 70 años. En mujeres que han sido sometidas a histerectomía por patologías benignas se debe individualizar el manejo y practicar evaluación citológica periódica de la cúpula vaginal en mujeres con factores de riesgo.Conclusiones: la citología cervicouterina continúa siendo el pilar en los programas de tamizaje de cáncer de cuello uterino.

BackgroundAcute respiratory failure is a life-threatening medical condition, associated with a variety of conditions and risk factors, including acute respiratory diseases which are a frequent cause of pediatric morbidity and mortality worldwide. In Colombia, the literature related to ARF is scarce.ObjectiveTo determine the incidence, causes, and sociodemographic and clinical characteristics of ARF in three hospitals in Bogota, a high-altitude city located in Colombia, during the COVID-19 pandemic.MethodsA multicenter prospective cohort study called the FARA cohort was developed between April 2020 – December 2021. Patients older than one month and younger than 18 years with respiratory distress who developed ARF were included.Results685 patients with respiratory distress were recruited in 21 months. The incidence density of ARF was found to be 41.7 cases per 100 person-day CI 95%, (37.3–47.7). The median age was 4.5 years.. Most of the patients consulted during the first 72 h after the onset of symptoms. Upon admission, 67.2% were potentially unstable. The most frequent pathologies were asthma, bronchiolitis, pneumonia, and sepsis. At admission, 75.6% of the patients required different oxygen delivery systems, 29,5% a low-flow oxygen system, 36,8% a high-flow oxygen system, and 9,28% invasive mechanical ventilation. SARS-COV-2, respiratory syncytial virus, rhinovirus/enterovirus, and adenovirus were the most frequently isolated viral agents. The coinfection cases were scarce.ConclusionsThis multicenter study, the FARA cohort, developed at 2,600 meters above sea level, shows the first data on incidence, etiology, sociodemographic and clinical characterization in a pediatric population with ARF that also concurs with the COVID-19 pandemic. These results, not only have implications for public health but also contribute to the scientific and epidemiological literature on a disease developed at a high altitude.

Purpose of Review-Pulmonary cytomegalovirus (CMV) infection is a potential lethal disease in children, but it remains a diagnostic challenge. The differentiation between latent CMV infections with viral shedding and active infections is difficult and may lead to false positives in bronchoalvolar lavage (BAL) PCR detection. This review summarizes current diagnostic approaches for CMV lung infection in children including progress in the identification of underlying immune defects linked to this condition. Recent Findings-There is increasing literature supporting that the combined assessment of host risk factors and lung disease pattern is essential for the diagnosis of pulmonary CMV infection in children. The most important host risk factor is an immunecompromised state that has expanded from primary or acquired immunodeficiency (e.g., HIV) to include a myriad of immunedysregulation syndromes (e.g., CTLA4, PIK3 defects). Newborns, paricularly those born premature, are also a high-risk group. At the pulmonary level, active CMV infection is typically characterized by alveolar compromise leading to hypoxemia, ground-glass opacities, and intraalveolar infiltrates with CMV inclusions in lung biopsy. The identification of active CMV lung infection should trigger additional evaluation of immune defects (primary or secondary) impairing T and NK cell function or innate antiviral responses as well as other immune dysregulation disorders. Summary-Lung CMV infections in children are more prevalent in immunocompromised hosts and premature newborns. Lung CMV infections should prompt further investigation into conditions altering immune mechanisms usually in place to contain CMV infections. Common ✉ Gustavo Nino,

Objectives:To describe, in infants aged 1-4 months old living at 3200 meters above sea level (MASL), oxygen saturation (SpO 2 ), sleep apnea indices, and periodic breathing (PB) during sleep. Polysomnographies were done in 18 healthy infants. Results: The median SpO 2 was 87%, and the median PB was 7.2% for the total sleep time. The median central sleep apnea index was 30.5/hour, which decreased to 5.4/hour once sleep apneas associated with PB were excluded. The 5 th percentile for SpO 2 was 76% among awake infants, and 66% among asleep infants. Conclusions: The SpO 2 was lower than that observed at sea level, whereas PB and the central sleep apnea index were higher, once sleep apneas associated with PB were excluded. The latter was similar to that observed at sea level. At 3200 MASL, different cut-off points are required for a normal SpO 2 , one for infants during the waking state and one for infants during sleep.

Objectives We aimed to validate a Spanish version of the Sleep‐Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (SRBD‐PSQ) in children living in a high‐altitude Colombian city. Methods In a prospective cohort validation study, patients aged between 2 and 17 years who attended the Ear, Nose, and Throat pediatric department of our institution for symptoms related to sleep‐related breathing disorders had a baseline visit at enrollment, a second visit the day scheduled for the surgical intervention, and a follow‐up visit at least 3 months after the surgical intervention. In these three visits, we gathered the necessary data for assessing the criterion validity, construct validity, test–retest reliability, internal consistency, and sensitivity to change of the Spanish version of the SRBD‐PSQ. Results In total, 121 patients were included in the analyses. The exploratory factor analysis (generalized least squares method, varimax rotation) yielded a four‐factor structure, explaining 65.93% of the cumulative variance. The intraclass correlation coefficient (ICC) of the measurements was 0.887 (95% CI: 0.809–0.934), and the Lin concordance correlation coefficient was 0.882 (95% CI, 0.821–0.943). SRBD‐PSQ scores at baseline were significantly higher than those obtained after adenotonsillectomy surgery (median [IQR] 11.0 [9.0– 14.0] vs. 4.00 [1.50–7.0]; p < 0.0001). Cronbach's α was 0.7055 for the questionnaire as a whole. Conclusions The Spanish version of the SRBD‐PSQ has acceptable construct validity, excellent test–retest reliability and sensitivity to change, and adequate internal consistency‐reliability when used in pediatric patients living at high altitude with symptoms related to sleep‐related breathing disorders.