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Introducción: Existe un gran desconocimiento acerca de la evolución del sistema inmune en la mucosa respiratoria del niño prematuro a largo plazo. La inmadurez y las infecciones respiratorias pueden influir sobre la respuesta inmune de las mucosas. El propósito de este estudio era evaluar la secreción respiratoria de los mediadores inmunológicos al año de vida en niños prematuros. Pacientes y métodos: Desde octubre de 2008 hasta abril de2009 se reclutaron 77 prematuros nacidos en 6 servicios de pediatría de Castilla y León, así como 14 controles sanos a término. Los prematuros fueron citados al año de edad gestacional corregida y los niños a término al año de vida, momento en el cual se les realizó un lavado nasal para determinar los niveles de 27 mediadores inmunológicos mediante un ensayo de Biorad®. Resultados: Los niños prematuros tenían niveles más elevados de quimiocinas (eotaxina, IP-10), citocinas Th-1 (IFN-epsilon), Th-2 (IL-13), Th-17 (IL-17) y factores de crecimiento celular (PDGF-bb, VEGF, FGF-b, G-CSF y GM-CSF) que los niños a término. Cuando se compararon los niveles de mediadores entre los niños que habían recibido profilaxis para el virus respiratorios incitial con palivizumab y los que no, los segundos tenían niveles significativamente más altos de MCP-1, IL-1RA, IL-10,IL-12p70 y VEGF (p <0,05) que los primeros. Conclusiones: Este trabajo demuestra por vez primera la influencia de la prematuridad sobre los perfiles de secreción respiratoria de las citocinas y quimiocinas a largo plazo. Por otra parte, nuestros resultados indican que la evaluación del impacto de la profilaxis de la infección respiratoria es un camino interesante para comprender la maduración de la respuesta inmune de la mucosa respiratoria del prematuro(AU)

Introduction: There is a big unawareness about a long term respiratory mucous immune system evolution in the preterm infant. Immaturity and respiratory infections can have a big influence on the mucous immune responses. This investigation’s purpose is the evaluation of respiratory secretion of inflammatory immunological mediators in the first year of a preterm infant. Patients and methods: Between October 2008 and April 2009, 77 preterm infants were born in 6 pediatric services of Castilla y Leon, plus to another 14 healthy controls results. Children were invited on their first corrected gestational age and the ones of healthy controls results. Nasal washing were applied to determine 27 immunological mediators’ levels by applying a Biorad test. Results: The preterm infants has higher chemokine (eotaxin,IP-10), cytokines Th-1 (IFN-epsilon), Th-2 (IL-13), Th-17 (IL-17) and cell growing factors (PDGF-bb, VEGF, FGF-b, G-CSF and GM-CSF)levels than a healthy control results children. When a comparison was made between children that received prophylaxis for their respiratory syncytial virus with palivizumab and the ones that did not receive it, the second group showed higher MCP-1, IL-1RA, IL-10, IL-12p70 and VEGF (p <0,05) levels. Conclusions: This work proves, for the first time, the influence of the premature birth on chemokine and cytokines respiratory secretion levels in a long term concepts. On other hand, our results indicate that prophylaxis impact in the respiratory infection is an interesting way to understand respiratory mucous immune response maturation in the preterm infant(AU)

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Los delitos contra la agresión sexual constituyenuno de los temas de mayor interés en el momento actualy en diferentes campos sociales (judicial, médico,policial, criminológico...). La importancia radica en lafrecuencia de los mismos y las repercusiones legales,físicas y psicológicas que conllevan.Debido a ello es importante tener clara la pauta deactuación en urgencias frente a tales delitos, siendo minuciosoen la realización del informe ginecológico y enla toma de muestras, ofertando profilaxis de enfermedadesde transmisión sexual y embarazos no deseados yprestando apoyo psicológico(AU)

Offences involving sexual assault are an issue ofthe greatest current interest in different social fields(legal, medical, police, criminological…). They are significantdue to their frequency and to the legal, physicaland psychological repercussions involved.It is therefore important to clearly understand thepattern of action in Accidents and Emergencies facingsuch cases. Great detail is required in the gynaecologicalreport and the taking of samples, prophylaxes forsexually transmitted diseases and unwanted pregnanciesmust be given and psychological support provided(AU)

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Offences involving sexual assault are an issue of the greatest current interest in different social fields (legal, medical, police, criminological...). They are significant due to their frequency and to the legal, physical and psychological repercussions involved. It is therefore important to clearly understand the pattern of action in Accidents and Emergencies facing such cases. Great detail is required in the gynaecological report and the taking of samples, prophylaxes for sexually transmitted diseases and unwanted pregnancies must be given and psychological support provided.

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Fifteen Corynebacterium ureicelerivorans isolates were recovered in pure culture from six patients during a five-year period. Five patients had bacteremia and the other was an infection of ascitic fluid. The API Coryne numerical profile obtained corresponds to the profile for C. bovis, while Biolog GP2 identified four out of the six isolates as C. jeikeium. The organisms were molecular identified by 16S rDNA and rpoB. The present report also includes information on new phenotypic tests and, for the first time, antimicrobial susceptibility data of C. ureicelerivorans and their rpoB sequences. All macrolide-resistant isolates presented a constitutive MLS phenotype. This organism must be differentiated from other slow-growing, lipophilic, and urea-splitting corynebacteria.

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Fourteen Corynebacterium coyleae isolates were recovered from 12 in-patients during a 5-years period. In six patients, the isolates were considered as clinically significant, three definite (sepsis), two probable (sepsis and soft tissue infection), and one possible (post-transfusional bacteremia). In the remaining 6 patients (all neonatal bacteremias), there was not enough data for considering the isolates as clinical significant. API Coryne identified all isolates as C. jeikeium, while Biolog GP2 correctly identified 7 out of the 14 isolates. Definitive identification was achieved in all isolates by the sequencing of a fragment of 724 to 1423 pb of 16S rDNA. Successive isolations from two patients presented identical random amplified polymorphic DNA (RAPD) profiles. All of the isolates were in-vitro-sensitive to beta-lactams, gentamicin, rifampin, tetracycline, vancomycin, linezolid, and resistant to clindamycin. Resistance to erythromycin occurred in 83.3% of isolates, all of them presenting phenotype cMLS and harboring the gene ermX.

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En el número anterior aprendimos a manejar Pubmed. Ahora vamos a limitar mejor nuestra búsqueda, usando la base de datos de palabras clave y las preguntas clínicas; también aprenderemos cómo buscar artículos en unas determinadas revistas, así como los recursos de Pubmed para conseguir el artículo completo online (AU)

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Respiratory syncytial virus (RSV) infection is common in young children, but only a few develop severe bronchiolitis. The relationship between bronchiolitis, asthma, and atopy has been debated for a long time, but the pathogenesis of wheezing remains unclear. A Th1 and Th2-type lymphocyte imbalance seems to be involved in asthma and atopic disease. Serum interleukin-12 (IL-12), IL-10, and soluble CD30 (sCD30) levels were measured by enzyme-linked immunosorbent assay (ELISA) in 23 cord blood samples kept frozen since birth: 11 from normal term newborns who several months later were admitted to the hospital with bronchiolitis, and 12 from newborns who did not develop the disease (controls). The study was also performed on 28 additional children (1-16 months old) suffering an episode of acute bronchiolitis. IL-12 was clearly increased in all cases at birth, but newborns who later developed bronchiolitis showed low IL-12 levels in cord blood compared to newborns who did not develop the disease (median 295 vs. 507 pg/mL; P = 0.001). sCD30 levels were also decreased in the first group (15 vs. 26 U/mL; P = 0.007). During episodes of bronchiolitis, a clear rise of IL-12, IL-10, and sCD30 was observed. None of the factors studied in the acute phase showed statistical differences in children who were later readmitted to the hospital due to repeated wheezing crises. Children who develop acute bronchiolitis with wheezing may have an immunological imbalance that is expressed at the time of delivery by a lower concentration of serum IL-12.

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Advances in Immunology are continuously occurring, specially in the knowledge of normal and pathological mechanisms. Many new diagnostics tests are frequently proposed but these techniques must been in order to evaluate real usefulness and specificity. In this review we reported some of immunologic areas in which some advance has been recently achieved or which are matter of discussion, such as rheumatic, celiac, integrins and allergic diseases.

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A long-term study of six children suffering idiopathic pulmonary hemosiderosis (IPH) was realized, in order to evaluate prognostic factors and the best therapy. The treatment was initiated with prednisone 1-2 mg/kg/day which was gradually decreased until total suppression. Clinical remission was always achieved but relapses were frequently observed. All but one of the patients suffered more episodes which were controlled by the initial treatment. In three cases the additional use of immunosuppressors drugs was needed, chlorambucil 0.2 mg/kg/day during a period of 3-6 months or cyclophosphamide 2.5 mg/kg/day for four months, thereby obtaining a better control of the disease and also a decreased number of crises. Two patients died during acute exacerbations. It is suggested that the main risk factors are the male sex and onset before three years of age. The outcome was also worse when the first crisis was more severe.

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