RESUMEN
Species of Leishmania and Trypanosoma genera are the causative agents of relevant parasitic diseases. Survival inside their hosts requires the existence of a potent antioxidant enzymatic machinery. Four iron superoxide dismutases have been described in trypanosomatids (FeSODA, FeSODB1, FeSODB2, and FeSODC) that hold a potential as therapeutic targets. Nonetheless, very few studies have been developed that make use of the purified enzymes. Moreover, FeSODC remains uncharacterised in Leishmania. In this work, for the first time, we describe the purification and enzymatic activity of recombinant versions of the four Leishmania FeSOD isoforms and establish an improved strategy for developing inhibitors. We propose a novel parameter [(V*cyt. c - Vcyt. c)/Vcyt. c] which, in contrast to that used in the classical cytochrome c reduction assay, correlates linearly with enzyme concentration. As a proof of concept, we determine the IC50 values of two ruthenium carbosilane metallodendrimers against these isoforms.
Asunto(s)
Antiprotozoarios , Relación Dosis-Respuesta a Droga , Leishmania infantum , Pruebas de Sensibilidad Parasitaria , Superóxido Dismutasa , Leishmania infantum/enzimología , Leishmania infantum/efectos de los fármacos , Relación Estructura-Actividad , Estructura Molecular , Superóxido Dismutasa/metabolismo , Superóxido Dismutasa/antagonistas & inhibidores , Superóxido Dismutasa/química , Antiprotozoarios/farmacología , Antiprotozoarios/química , Antiprotozoarios/síntesis química , Inhibidores Enzimáticos/farmacología , Inhibidores Enzimáticos/química , Inhibidores Enzimáticos/síntesis química , Leishmaniasis/tratamiento farmacológico , Leishmaniasis/parasitologíaRESUMEN
Cells have evolved a robust and highly regulated DNA damage response to preserve their genomic integrity. Although increasing evidence highlights the relevance of RNA regulation, our understanding of its impact on a fully efficient DNA damage response remains limited. Here, through a targeted CRISPR-knockout screen, we identify RNA-binding proteins and modifiers that participate in the p53 response. Among the top hits, we find the m6A reader YTHDC1 as a master regulator of p53 expression. YTHDC1 binds to the transcription start sites of TP53 and other genes involved in the DNA damage response, promoting their transcriptional elongation. YTHDC1 deficiency also causes the retention of introns and therefore aberrant protein production of key DNA damage factors. While YTHDC1-mediated intron retention requires m6A, TP53 transcriptional pause-release is promoted by YTHDC1 independently of m6A. Depletion of YTHDC1 causes genomic instability and aberrant cancer cell proliferation mediated by genes regulated by YTHDC1. Our results uncover YTHDC1 as an orchestrator of the DNA damage response through distinct mechanisms of co-transcriptional mRNA regulation.
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Daño del ADN , Proteína p53 Supresora de Tumor , Humanos , Proteína p53 Supresora de Tumor/metabolismo , Proteína p53 Supresora de Tumor/genética , Factores de Empalme de ARN/metabolismo , Factores de Empalme de ARN/genética , Proteínas de Unión al ARN/metabolismo , Proteínas de Unión al ARN/genética , Adenosina/metabolismo , Adenosina/análogos & derivados , Inestabilidad Genómica , Proliferación Celular , Regulación de la Expresión Génica , Proteínas del Tejido NerviosoRESUMEN
BACKGROUND: Successful antiretroviral therapy (ART) has dramatically reduced mortality among HIV-infected children. However, there is growing concern about long-term effects associated to ART. The aim of this study was to determine the prevalence of metabolic abnormalities in a cohort of perinatally HIV-infected adolescents and young adults and to identify associated factors. METHODS: We present results from a cross-sectional analysis including individuals 12 to 20 years of age, from a prospective, longitudinal cohort of perinatally-acquired HIV-infected children, adolescents and young adults in Madrid. Clinical and immunological data were recorded and complete lipid and glycemic profiles were determined. RESULTS: Ninety-nine adolescents were included, with a median age of 15.3 years [13.6-16.7]. Patients with abnormal levels of lipids were as follows: 27.2% total cholesterol ≥200 mg/dl, 25.9% LDL cholesterol (LDL-c) ≥ 130 mg/dl, 14.1% HDL-C < 35 mg/dl and 39.8% triglycerides ≥ 150 mg/dl. Current use of protease inhibitors (PI) was associated with higher triglyceride values (p = 0.022). Four (4.6%) patients showed fasting glucose ≥ 100 mg/dl and 30.6% presented with insulin resistance (IR) (HOMA-IR over the 90th centile). In the multivariate logistic regression analysis adjusted for sex, age, weight, Tanner stage, protease inhibitors (PI) and nucleoside reverse transcriptase inhibitors (NRTI) treatment length and CD4 nadir, IR was associated with higher waist circumference Z score; OR: 3.92(CI95%: 1.15-13.4) (p = 0.03). CONCLUSION: There was a high prevalence of insulin resistance and lipid abnormalities in this cohort of perinatally-acquired HIV-infected adolescents. A simple clinical measurement like waist circumference Z score might be a reliable marker and predictor of insulin resistance in these patients.
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Glucemia/metabolismo , HDL-Colesterol/metabolismo , LDL-Colesterol/metabolismo , Dislipidemias/metabolismo , Infecciones por VIH/metabolismo , Transmisión Vertical de Enfermedad Infecciosa , Resistencia a la Insulina , Triglicéridos/metabolismo , Adolescente , Terapia Antirretroviral Altamente Activa , Niño , Estudios de Cohortes , Estudios Transversales , Dislipidemias/epidemiología , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Metabolismo de los Lípidos , Modelos Logísticos , Estudios Longitudinales , Masculino , Prevalencia , Estudios Prospectivos , Inhibidores de Proteasas/uso terapéutico , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Adulto JovenRESUMEN
BACKGROUND: The rates of isoniazid (INH) and multidrug-resistant (MDR) tuberculosis (TB) among European children vary between 10.4% and 3.5%. Spain is a low endemic country with reported rates of 4.9% of INH resistance and 1.3% of MDR in adults. However, data regarding patterns of TB resistance in children are scarce. Our aim is to determine the incidence and risk factors for pediatric-resistant TB in our setting to help developing age-targeted guidelines. METHODS: A multicenter, retrospective study including 22 hospitals from Madrid region (EREMITA study group) was performed from January 2005 to June 2010. Medical records from children diagnosed with TB were reviewed for demographic characteristics, clinical presentation and outcomes. Risk factors for INH and MDR TB were identified. RESULTS: Of 396 children diagnosed with TB, 72.4% were born to foreign parents. Microbiologic confirmation by culture (n = 200) or PCR (n = 8) was documented in 208 children (52.5%). Drug susceptibility results were available in 188 children: 9.6% (n = 18) were resistant to INH and 3.1% (n = 6) were MDR. INH resistance was more common in immigrants compared with native families (11.9% vs. 0%; P = 0.013), as was also MDR (4.5% vs. 0%; P = 0.34). Extrapulmonary TB and previous antituberculous treatment were significantly associated with INH and MDR, while immunosuppression was associated only with MDR. CONCLUSIONS: The rates of INH and MDR TB were different according to the parents' origin, with higher rates among children born to foreign parents. Local surveillance of drug-resistant TB is critical to develop appropriate guidelines for treatment.
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Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Antituberculosos/farmacología , Antituberculosos/uso terapéutico , Niño , Preescolar , Trazado de Contacto , Emigrantes e Inmigrantes , Salud de la Familia , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Mycobacterium tuberculosis/efectos de los fármacos , Estudios Retrospectivos , Factores de Riesgo , España/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/microbiologíaRESUMEN
Early cardiovascular disease is a major concern for ART-suppressed vertically HIV-infected children; however, evidence is lacking regarding specific preventive measures. In this study, a complete panel of biomarkers was determined together with carotid intima-media thickness (IMT), in a cohort of 64 HIV-infected children and 30 controls. Mean age of participants was 14.1±5 years. HIV-infected patients showed normal lipid profile, with only slightly higher triglycerides, and no differences between groups were found regarding IMT. HIV-infected patients displayed higher levels of soluble CD14 (sCD14) and soluble vascular cell adhesion molecule-1 (sVCAM) (all p<0.05). However, levels of C-reactive protein, interleukin-6, myeloperoxidase, monocyte chemoattractant protein-1, P-selectin and tissue plasminogen activator were similar between groups. Vertically HIV-infected subjects on ART with no significant metabolic disturbances displayed increased sCD14 and sVCAM but not up-regulation of proinflammatory pathways. Larger studies are warranted to assess the impact of a strict metabolic control on cardiovascular risk and to define specific cardiovascular disease preventive strategies in this population.
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Enfermedades Cardiovasculares/epidemiología , Infecciones por VIH/sangre , Receptores de Lipopolisacáridos/sangre , Molécula 1 de Adhesión Celular Vascular/sangre , Adolescente , Terapia Antirretroviral Altamente Activa , Biomarcadores , Glucemia/análisis , Índice de Masa Corporal , Enfermedades Cardiovasculares/sangre , Arteria Carótida Común/diagnóstico por imagen , Grosor Intima-Media Carotídeo , Niño , Citocinas/sangre , Susceptibilidad a Enfermedades , Endotelio Vascular/patología , Femenino , Estudios de Seguimiento , Infecciones por VIH/congénito , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Hemostasis , Humanos , Hipertensión/sangre , Hipertensión/epidemiología , Transmisión Vertical de Enfermedad Infecciosa , Lípidos/sangre , Masculino , Estudios Prospectivos , Método Simple Ciego , Fumar/sangre , Fumar/epidemiología , España/epidemiologíaRESUMEN
INTRODUCTION: Much effort has been put in the past years to create and assess accurate tools for the management of febrile infants. However, no optimal strategy has been so far identified. A sequential approach evaluating, first, the appearance of the infant, second, the age and result of the urinanalysis and, finally, the results of the blood biomarkers, including procalcitonin, may better identify low risk febrile infants suitable for outpatient management. OBJECTIVE: To assess the value of a sequential approach ('step by step') to febrile young infants in order to identify patients at a low risk for invasive bacterial infections (IBI) who are suitable for outpatient management and compare it with other previously described strategies such as the Rochester criteria and the Lab-score. METHODS: A retrospective comparison of three different approaches (step by step, Lab-score and Rochester criteria) was carried out in 1123 febrile infants less than 3â months of age attended in seven European paediatric emergency departments. IBI was defined as isolation of a bacterial pathogen from the blood or cerebrospinal fluid. RESULTS: Of the 1123 infants (IBI 48; 4.2%), 488 (43.4%) were classified as low-risk criteria according to the step by step approach (vs 693 (61.7%) with the Lab-score and 458 (40.7%) with the Rochester criteria). The prevalence of IBI in the low-risk criteria patients was 0.2% (95% CI 0% to 0.6%) using the step by step approach; 0.7% (95% CI 0.1% to 1.3%) using the Lab-score; and 1.1% (95% CI 0.1% to 2%) using the Rochester criteria. Using the step by step approach, one patient with IBI was not correctly classified (2.0%, 95% CI 0% to 6.12%) versus five using the Lab-score or Rochester criteria (10.4%, 95% CI 1.76% to 19.04%). CONCLUSIONS: A sequential approach to young febrile infants based on clinical and laboratory parameters, including procalcitonin, identifies better patients more suitable for outpatient management.
Asunto(s)
Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/diagnóstico , Fiebre de Origen Desconocido/etiología , Factores de Edad , Atención Ambulatoria , Infecciones Bacterianas/metabolismo , Biomarcadores/sangre , Calcitonina/sangre , Péptido Relacionado con Gen de Calcitonina , Femenino , Fiebre de Origen Desconocido/metabolismo , Fiebre de Origen Desconocido/terapia , Humanos , Lactante , Masculino , Selección de Paciente , Precursores de Proteínas/sangre , Estudios Retrospectivos , Riesgo , Sensibilidad y Especificidad , UrinálisisRESUMEN
BACKGROUND: HIV-infected adults display increased cardiovascular disease, probably driven by inflammation and immune activation. These relationships have not been addressed in vertically HIV-infected children and adolescents, a population at very high risk for long-term non-AIDS complications. METHODS: Carotid intima media thickness (IMT) was measured in a cohort of HIV-infected children and adolescents and healthy controls. C-reactive protein and markers of immune activation (CD38âºHLA-DRâº) and immune senescence (CD28â»CD57âº) were determined. RESULTS: One hundred fifty HIV-infected patients and 150 controls were included, 64.8% female. IMT was thicker in HIV-infected patients (0.434 mm ± 0.025 vs. 0.424 mm ± 0.018, P < 0.001). After adjustment by age, sex, body mass index, and smoking status, HIV infection was independently associated with thicker IMT (odds ratio, 2.28; 95% confidence interval: 1.25 to 4.13; P = 0.007). Among HIV-related variables, a low CD4 nadir was related to an increased IMT. Although HIV-infected subjects presented higher frequencies of activated CD4⺠and CD8⺠T cells (P = 0.002 and P = 0.087, respectively), no relation was found between IMT and inflammation, immune activation, or senescence. CONCLUSIONS: Structural changes of the vasculature present early in vertically HIV-infected subjects as well as immune activation and senescence. These patients should be carefully monitored for the prompt detection and early treatment of cardiovascular disease.
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Aterosclerosis/etiología , Grosor Intima-Media Carotídeo/estadística & datos numéricos , Infecciones por VIH/complicaciones , Adolescente , Factores de Edad , Biomarcadores/sangre , Biomarcadores/metabolismo , Proteína C-Reactiva/análisis , Recuento de Linfocito CD4 , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Infecciones por VIH/inmunología , Humanos , Masculino , Factores Sexuales , Adulto JovenRESUMEN
AIM: To determine whether the treatment with oseltamivir improves the outcome of children with confirmed influenza infection and no other underlying disease. METHODS: Multicentric, retrospective study performed in 10 hospitals of Madrid between September 2010 and June 2012. All children admitted to the hospitals with confirmed influenza infections were eligible. Children with risk factors for serious disease and nosocomial influenza infections were excluded. Asthma was not considered an exclusion factor. The study compared patients treated and untreated with oseltamivir. Fever duration, oxygen support, antibiotics administration, length of hospital stay, intensive care admission and bacterial complications were analyzed. To compare variables, χ(2) test, Fisher exact test, ANOVA or Mann-Whitney U test were used. RESULTS: Two hundred eighty-seven children were included and 93 of them were treated with oseltamivir (32%). There were no significant differences between treated and untreated patients in days of fever after admission (1.7 ± 2; 2.1 ± 2.9, P > 0.05), length of stay (5.2 ± 3.6; 5.5 ± 3.4, P > 0.05), days of hypoxia (1.6 ± 2.3; 2.1 ± 2.9, P > 0.05), diagnosis of bacterial pneumonia (10%; 17%, P > 0.05), intensive care admission (6.5%; 1.5%,P > 0.05) or antibiotic prescription (44%; 51%, P > 0.05). There were no differences when the population was stratified by age (below or over 1 year) or by the presence or absence of asthma. CONCLUSIONS: There were no proven benefits of treatment with oseltamivir in hospitalized pediatric patients without the underlying diseases or risk factors for developing a serious illness, including those with asthma.
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Antivirales/uso terapéutico , Gripe Humana/tratamiento farmacológico , Oseltamivir/uso terapéutico , Análisis de Varianza , Distribución de Chi-Cuadrado , Preescolar , Femenino , Fiebre/virología , Hospitalización , Humanos , Lactante , Tiempo de Internación , Masculino , Estudios RetrospectivosRESUMEN
Introducción: La infección por citomegalovirus (CMV) es la infección congénita más frecuente en Europa. El 10% de los niños infectados presentan síntomas al nacimiento, y hasta el 30-40% tienen algún grado de hipoacusia. Métodos Se ha realizado un estudio descriptivo retrospectivo incluyendo todos los pacientes diagnosticados de infección congénita por CMV fuera del período neonatal a lo largo de 4 años a partir de las muestras de sangre del talón en papel de filtro del cribado metabólico neonatal. Resultados Presentamos 5 pacientes diagnosticados de infección congénita por CMV fuera del periodo neonatal. Los principales motivos de consulta fueron la hipoacusia y/o el retraso psicomotor en los primeros meses de vida. Conclusión La infección por CMV puede ser poco sintomática al nacimiento y presentarse como un déficit auditivo y/o retraso psicomotor en la infancia. Es preciso un alto grado de sospecha para establecer un diagnóstico temprano que permita ofrecer tratamiento específico y mejorar el pronóstico a largo plazo (AU)
Introduction: Cytomegalovirus (CMV) infection is the most common congenital infection in Europe. Symptoms are present at birth in 10% of infected children, and up to 30-40% have some degree of hearing loss after the newborn period. Methods: A retrospective study was performed over a period of 4 years and included all patients with congenital CMV infection diagnosed after the neonatal period using the dried blood spots from neonatalmetabolic screening. Results: We present 5 patients diagnosed with congenital CMV infection outside the neonatal period. The main reasons for consultation were hearing loss and/or neurological impairment in the first few months of life. Discussion: Congenital CMV infection may be mildly symptomatic at birth, and present as hearing loss and/or neurological impairment in infancy. Therefore, a high degree of suspicion is necessary in order to make an accurate diagnosis and start specific treatment to improve the outcome (AU)
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Humanos , Masculino , Femenino , Recién Nacido , Infecciones por Citomegalovirus/diagnóstico , Citomegalovirus/aislamiento & purificación , Infecciones por Citomegalovirus/congénito , Diagnóstico Precoz , Estudios Retrospectivos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Sordera/prevención & control , Tamizaje NeonatalRESUMEN
INTRODUCTION: Cytomegalovirus (CMV) infection is the most common congenital infection in Europe. Symptoms are present at birth in 10% of infected children, and up to 30-40% have some degree of hearing loss after the newborn period. METHODS: A retrospective study was performed over a period of 4 years and included all patients with congenital CMV infection diagnosed after the neonatal period using the dried blood spots from neonatal metabolic screening. RESULTS: We present 5 patients diagnosed with congenital CMV infection outside the neonatal period. The main reasons for consultation were hearing loss and/or neurological impairment in the first few months of life. DISCUSSION: Congenital CMV infection may be mildly symptomatic at birth, and present as hearing loss and/or neurological impairment in infancy. Therefore, a high degree of suspicion is necessary in order to make an accurate diagnosis and start specific treatment to improve the outcome.
Asunto(s)
Infecciones por Citomegalovirus/congénito , Infecciones por Citomegalovirus/diagnóstico , Diagnóstico Precoz , Humanos , Lactante , Recién Nacido , Estudios RetrospectivosRESUMEN
BACKGROUND AND OBJECTIVE: Procalcitonin (PCT) has been introduced in many European protocols for the management of febrile children. Its value among young, well-appearing infants, however, is not completely defined. Our objective was to assess its performance in diagnosing serious bacterial infections and specifically invasive bacterial infections (IBIs) in well-appearing infants aged <3 months with fever without source (FWS). METHODS: Well-appearing infants aged <3 months with FWS admitted to 7 European pediatric emergency departments were retrospectively included. IBI was defined as the isolation of a bacterial pathogen in blood or cerebrospinal fluid culture. RESULTS: We included 1112 infants who had PCT measured and a blood culture performed. IBI was diagnosed in 23 cases (2.1%). In the multivariate analysis including clinical and laboratory data, PCT was the only independent risk factor for IBI (odds ratio 21.69; 95% confidence interval [CI] 7.93-59.28 for PCT ≥ 0.5 ng/mL). Positive likelihood ratios for PCT ≥ 2 ng/mL and C-reactive protein (CRP) >40 mg/L were 11.14 (95% CI 7.81-15.89) and 3.45 (95% CI 2.20-5.42), respectively. Negative likelihood ratios for PCT <0.5 ng/mL and CRP <20 mg/L were 0.25 (95% CI 0.12-0.55) and 0.41 (95% CI 0.22-0.76). Among patients with normal urine dipstick results and fever of recent onset, areas under the receiver operator characteristic curve for PCT and CRP were 0.819 and 0.563, respectively. CONCLUSIONS: Among well-appearing young infants with FWS, PCT performs better than CRP in identifying patients with IBIs and seems to be the best marker for ruling out IBIs. Among patients with normal urine dipstick results and fever of recent onset, PCT remains the most accurate blood test.
Asunto(s)
Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/diagnóstico , Calcitonina/sangre , Fiebre de Origen Desconocido/sangre , Fiebre de Origen Desconocido/etiología , Precursores de Proteínas/sangre , Péptido Relacionado con Gen de Calcitonina , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND AND OBJECTIVES: The "Lab-score" combining C-reactive protein, procalcitonin and urine dipstick results has recently been derived and validated as an accurate tool for predicting severe bacterial infections (SBIs) in children with fever without source. We aimed to assess the Lab-score usefulness in predicting SBI, especially invasive bacterial infections (IBIs), in well-appearing infants <3 months with fever without source. METHODS: A multicenter retrospective study was conducted in 7 pediatric emergency departments in Spain and Italy. An SBI was defined as isolation of a bacterial pathogen from urine, blood, cerebrospinal fluid or stools, an IBI as isolation of a bacterial pathogen from blood or cerebrospinal fluid. The diagnostic characteristics of the Lab-score for detection of SBI and IBI were calculated. RESULTS: An SBI was diagnosed in 287 (28.3%) of 1012 patients and an IBI in 23 (2.1%) of 1098. The positive and negative likelihood ratios of a score ≥3 for SBI prediction were 10.2 (95% confidence interval [CI]: 9.5-10.9) and 0.5 (95% CI: 0.5-0.5), respectively. The area under the receiver operating characteristic curve was 0.83 (95% CI: 0.80-0.86). The same diagnostic accuracy measures for identification of IBI were 4.3 (95% CI: 4-4.6), 0.4 (95% CI: 0.3-0.5) and 0.85 (95% CI: 0.76-0.94), respectively. Use of Lab-score would have resulted in misdiagnosis of 7 (30%) infants with IBI. CONCLUSIONS: In well-appearing infants with fever without source, the Lab-score seems a more useful tool for ruling in, rather than ruling out, SBI. Its accuracy for IBI prediction was unsatisfactory.
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Infecciones Bacterianas/diagnóstico , Proteína C-Reactiva/análisis , Calcitonina/sangre , Técnicas y Procedimientos Diagnósticos , Fiebre de Origen Desconocido/diagnóstico , Precursores de Proteínas/sangre , Índice de Severidad de la Enfermedad , Orina/química , Péptido Relacionado con Gen de Calcitonina , Femenino , Humanos , Lactante , Recién Nacido , Italia , Masculino , Estudios Retrospectivos , EspañaRESUMEN
BACKGROUND: Congenital cytomegalovirus (CMV) is an important cause of sensorineural hearing loss. Ganciclovir treatment in the neonatal period may prevent hearing deterioration in infants with central nervous system (CNS) involvement. However, there are hardly any data regarding antiviral treatment begun beyond the neonatal period. OBJECTIVES: To describe the hearing outcome of infants with congenital CMV infection and CNS involvement treated beyond the neonatal period. To assess the tolerability and toxicity of prolonged valganciclovir treatment in these patients. STUDY DESIGN: Retrospective case series of infants with congenital CMV infection and CNS involvement who started antiviral treatment beyond the neonatal period in Spain between 2008 and 2010. Hearing was tested by brainstem-evoked response at the time of diagnosis, 6 and 12 months after the beginning of treatment. RESULTS: Thirteen cases were included. All received oral valganciclovir, and 4 also intravenous ganciclovir. Median valganciclovir treatment duration was 6 months and it was well tolerated. Six patients developed neutropenia, none requiring granulocyte colony-stimulating factor. Eleven children (85%) had hearing defects at baseline, compared to 50% at 12 months. By ears, 18 ears showed hearing loss at baseline (7 mild, 3 moderate, 8 severe). At 12 months, 9 remained stable, 7 had improved and none had worsened. In 8 normal ears at baseline, no deterioration was found at 12 months. CONCLUSIONS: Valganciclovir treatment is well tolerated. It may improve or preserve the auditory function of congenitally cytomegalovirus-infected patients treated beyond the neonatal period for at least one year after the beginning of antiviral treatment.
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Antivirales/administración & dosificación , Infecciones por Citomegalovirus/congénito , Infecciones por Citomegalovirus/tratamiento farmacológico , Ganciclovir/análogos & derivados , Antivirales/efectos adversos , Infecciones por Citomegalovirus/sangre , Esquema de Medicación , Ganciclovir/administración & dosificación , Ganciclovir/efectos adversos , Pérdida Auditiva Sensorineural/virología , Humanos , Lactante , Neutropenia/virología , Estudios Retrospectivos , Resultado del Tratamiento , ValganciclovirRESUMEN
OBJECTIVE: The objective of this study was to evaluate the use of combined inhaled nitrous oxide (NO), hematoma block (HB), and transmucosal fentanyl (TMF) as sedoanalgesia in the reduction of radioulnar fractures in children in a pediatric emergency department (PED). METHODS: A retrospective, analytical observational study examining the cases of radioulnar fracture reduction in PED from 2007 to 2009 in children from 4 to 15 years old. The cases were divided into 2 groups: those in which only NO + HB was used and those in which TMF was combined with NO + HB. The pain perceived by the child, the doctor, and the nurse was studied during the procedure with 0- to 10-point scales (10 being severe pain). Satisfaction of the medical professionals, duration of the procedure, and the adverse effects that appeared were also studied. RESULTS: Eighty-one children were included. Sixty-four children (79%) received NO + TMF + HB, and 17 children (21%) received NO + HB only. The pain perceived by the child during the procedure in the group receiving NO + TMF + HB was 2.5 (95% confidence interval [CI], 1.8-3.1) compared with 3.9 (95% CI, 2.3-5.5) in the NO + HB group (P = 0.035), the pain perceived by the doctor was 2.6 (95% CI, 2-3.2) compared with 4 (95% CI, 1.6-4), and by the nurse was 2.7 (95% CI, 2-3.3) compared with 3.9 (95% CI, 2.3-5.5), respectively. Adverse events appeared in 15.3% of the NO + TMF + HB group and in 40% of the NO + HB group. CONCLUSIONS: The association of NO + TMF + HB in the reduction of radioulnar fractures in PED improves pain control compared with the NO + HB combination. New studies are required to confirm the benefit and safety of this drug combination.
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Analgésicos Opioides/uso terapéutico , Fentanilo/administración & dosificación , Fracturas Óseas/terapia , Óxido Nitroso , Manejo del Dolor/métodos , Adolescente , Analgésicos Opioides/administración & dosificación , Niño , Preescolar , Terapia Combinada , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Óxido Nitroso/administración & dosificación , Dimensión del Dolor , Pediatría , Fracturas del Radio/terapia , Estudios Retrospectivos , España , Fracturas del Cúbito/terapiaRESUMEN
Introducción El aumento de las gestantes extranjeras está modificando la prevalencia de las enfermedades de transmisión vertical. El objetivo de nuestro estudio es determinar el perfil serológico de las madres extranjeras frente a estas infecciones. Métodos Estudio descriptivo retrospectivo transversal en un hospital terciario de Madrid entre agosto de 2007 y octubre de 2008. Se determinó la seroprevalencia frente a VIH, VHB, VHC, rubéola, T. pallidum, T. gondii, T. cruzi en todas las gestantes extranjeras y en un grupo representativo de españolas. Resultados Se estudiaron 2.526 madres extranjeras y 157 españolas. Ninguna española y un 0,5% de las extranjeras presentaron anticuerpos frente al VIH, siendo el 18,9% de origen subsahariano. Se detectó antígeno HBs en un 2% de las extranjeras y en un 1,1% de las españolas. Las asiáticas mostraron la tasa mayor de hepatitis B (10,9%). Se encontró un 0,9% de infecciones por hepatitis C entre las extranjeras y un 1% entre las españolas. Un 1,6% de las extranjeras presentó (..) (AU)
The increase in immigration is changing the prevalence of mother to child infectious diseases. Our aim is to determine the serological profile of foreign pregnant women against these infections. Methods A retrospective cross sectional study was performed in a tertiary hospital from Madrid between August 2007 and October 2008. The seroprevalence against HIV, HBV, HCV, rubeola, T. gondii, T. pallidum and T. cruzi was determined in every pregnant immigrant, as well as in a representative group of Spanish pregnant women. Results A total of 2526 immigrant and 157 Spanish pregnant women were studied. None of the Spanish and 0.5% of the foreigners showed antibodies against HIV; 18.9% of them were Sub-Saharan women. Antigen HBs was detected in 2% of the immigrant women and in 1.1% of the Spanish women. Asian women had the highest rate of type B Hepatitis (10.9%). There was 0.9% of type C Hepatitis among the immigrants and 1% among the Spanish. Within the cases with (..) (AU)
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Humanos , Femenino , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Pruebas Serológicas , VIH/aislamiento & purificación , Virus de la Hepatitis B/aislamiento & purificación , Hepacivirus/aislamiento & purificación , Virus de la Rubéola/aislamiento & purificación , Toxoplasma/aislamiento & purificación , Treponema pallidum/aislamiento & purificación , Trypanosoma cruzi/aislamiento & purificación , Emigrantes e Inmigrantes/estadística & datos numéricos , Control de Enfermedades Transmisibles/estadística & datos numéricos , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricosRESUMEN
AIMS: To compare the QuantiFERON-TB GOLD In Tube test (QTF) and the tuberculin skin test (TST) in children. METHODS: A prospective study was carried out in nine hospitals in Madrid, Spain. TST and QTF were performed in immigrants, tuberculosis (TB) contacts and patients with TB disease (TBD). RESULTS: 459 children were included. Disagreement between the tests was more frequently observed among latent tuberculosis infection (LTBI) cases (54%; 38/70) than in non-infected or TBD cases (0.8%; 3/369) (p<0.01). There were more BCG-vaccinated children among LTBI cases with negative QTF (76%) than among LTBI cases with positive QTF (40%) (p<0.001). Agreement between tests in BCG-vaccinated children was lower than in non-vaccinated cases (p<0.05). Tests in TB exposed patients showed better agreement than in non-exposed children (p<0.05). CONCLUSIONS: Agreement of both tests was excellent in TBD cases, non-vaccinated children and non-infected patients. A significant number of QTF negative results were observed among LTBI cases, especially in BCG-vaccinated children. Agreement was better in exposed children.
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Ensayo de Inmunoadsorción Enzimática , Ensayos de Liberación de Interferón gamma , Tamizaje Masivo/métodos , Prueba de Tuberculina , Tuberculosis/diagnóstico , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática/métodos , Humanos , Ensayos de Liberación de Interferón gamma/métodos , Análisis Multivariante , Mycobacterium tuberculosis , Estudios Prospectivos , Prueba de Tuberculina/métodos , Tuberculosis/prevención & controlRESUMEN
INTRODUCTION: The increase in immigration is changing the prevalence of mother to child infectious diseases. Our aim is to determine the serological profile of foreign pregnant women against these infections. METHODS: A retrospective cross sectional study was performed in a tertiary hospital from Madrid between August 2007 and October 2008. The seroprevalence against HIV, HBV, HCV, rubeola, T. gondii, T. pallidum and T. cruzi was determined in every pregnant immigrant, as well as in a representative group of Spanish pregnant women. RESULTS: A total of 2526 immigrant and 157 Spanish pregnant women were studied. None of the Spanish and 0.5% of the foreigners showed antibodies against HIV; 18.9% of them were Sub-Saharan women. Antigen HBs was detected in 2% of the immigrant women and in 1.1% of the Spanish women. Asian women had the highest rate of type B Hepatitis (10.9%). There was 0.9% of type C Hepatitis among the immigrants and 1% among the Spanish. Within the cases with RPR ≥ 1/8, 1.6% were immigrants, most of whom were Latin American. Thirty-one per cent of the immigrants showed antibodies against T. gondii (37.5% from Central America, 2.5% from the Far East). More than 95% of the Spanish women had antibodies against Rubella, this being lower in the rest of the areas (75.5% in Sub-Saharan Africa). T. cruzi infection was detected in 12.1% of the Bolivian women studied. CONCLUSION: The prevalence of mother-to-child transmitted infections depends on the origin of pregnant women. Knowledge of these differences may lead to improved control these diseases.
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Anticuerpos Antibacterianos/sangre , Anticuerpos Antiprotozoarios/sangre , Anticuerpos Antivirales/sangre , Emigrantes e Inmigrantes , Complicaciones Infecciosas del Embarazo/etnología , Adulto , África del Sur del Sahara/etnología , Asia Sudoriental/etnología , Estudios Transversales , Europa Oriental/etnología , Femenino , Anticuerpos Anti-VIH/sangre , Anticuerpos contra la Hepatitis B/sangre , Anticuerpos contra la Hepatitis C/sangre , Humanos , Transmisión Vertical de Enfermedad Infecciosa , América Latina/etnología , Marruecos/etnología , Embarazo , Complicaciones Infecciosas del Embarazo/sangre , Complicaciones Infecciosas del Embarazo/microbiología , Complicaciones Infecciosas del Embarazo/parasitología , Complicaciones Infecciosas del Embarazo/virología , Estudios Retrospectivos , Virus de la Rubéola/inmunología , España/epidemiología , Toxoplasma/inmunología , Treponema pallidum/inmunología , Trypanosoma cruzi/inmunologíaRESUMEN
Lichtheimia corymbifera (syn. Absidia corymbifera, Mycocladus corymbifer) is an ubiquitous cosmopolitan mold that can cause primary cutaneous and deep tissue infection in healthy individuals. We report a subcutaneous L. corymbifera infection in a 13-year-old immune-competent child, with a severe traumatic injury, with a successful outcome after early diagnosis and treatment with lipid amphotericin B, early debridement, and vacuum-assisted closure (VAC).