This population-based study evaluated the incidence of virologically confirmed influenza-related hospitalisation in children aged <5 years between July 2001 and June 2004 in a region of southern ...Europe. Forty-nine children with influenza virus infection were hospitalised. The annual hospitalisation rates per 1000 inhabitants for each period were 5.1, 0 and 7.3 for infants aged less than 6 months, 0.9, 0.2 and 0.9 for children aged 6–23 months, and 0.7, 0.1 and 0.8 for those aged 24–59 months. Most of the children were hospitalised in the epidemic waves caused by the influenza A/H3N2 virus and were previously healthy. This study supports the need to introduce measures to reduce the burden of disease due to influenza virus infection in young children. New vaccines or vaccination strategies that could be applied in infants should be developed.
Nitric oxide can be measured at multiple flow rates to determine proximal (maximum airway nitric oxide flux; JawNO) and distal inflammation (alveolar nitric oxide concentration; CANO). The main aim ...was to study the association among symptoms, lung function, proximal (maximum airway nitric oxide flux) and distal (alveolar nitric oxide concentration) airway inflammation in asthmatic children treated and not treated with inhaled glucocorticoids.
A cross-sectional study with prospective data collection was carried out in a consecutive sample of girls and boys aged between 6 and 16 years with a medical diagnosis of asthma. Maximum airway nitric oxide flux and alveolar nitric oxide concentration were calculated according to the two-compartment model. In asthmatic patients, the asthma control questionnaire (CAN) was completed and forced spirometry was performed. In controls, differences between the sexes in alveolar nitric oxide concentration and maximum airway nitric oxide flux and their correlation with height were studied. The correlation among the fraction of exhaled NO at 50 ml/s (FENO50), CANO, JawNO, forced expiratory volume in 1 second (FEV1) and the CAN questionnaire was measured and the degree of agreement regarding asthma control assessment was studied using Cohen's kappa.
We studied 162 children; 49 healthy (group 1), 23 asthmatic participants without treatment (group 2) and 80 asthmatic patients treated with inhaled corticosteroids (group 3). CANO (ppb) was 2.2 (0.1-4.5), 3 (0.2-9.2) and 2.45 (0.1-24), respectively. JawNO (pl/s) was 516 (98.3-1470), 2356.67 (120-6110) and 1426 (156-11805), respectively. There was a strong association (r=0.97) between FENO50 and JawNO and the degree of agreement was very good in group 2 and was good in group 3. There was no agreement or only slight agreement between the measures used to monitor asthma control (FEV1, CAN questionnaire, CANO and JawNO).
The results for CANO and JawNO in controls were similar to those found in other reports. There was no agreement or only slight agreement among the three measure instruments analyzed to assess asthma control. In our sample, no additional information was provided by CANO and JawNO.
To evaluate the reliability, and construct validity of the Spanish version of the TNO-AZL preschool children quality of life (TAPQOL).
A consecutive sample of children (3 months to 5 years old) was ...recruited from primary care centers and two teaching hospitals in Spain. The TAPQOL and a set of questions related to their child's health status were administered to parents. Clinical diagnoses were collected from clinical records. Principal component analysis (PCA) with varimax rotation was used to analyze the instrument's structure. Effect size (ES) and analysis of variance (ANOVA) were used to analyze differences between subgroups known to be in poor health compared to the healthy subgroup.
A total of 228 children participated in the study (response rate
=
95%). Ten of the 12 scales showed more than 30% ceiling effect. All dimensions except one had Cronbach's alpha coefficients greater than 0.7. PCA explained 75% of the variance. Healthy children in general had better scores than the other subgroups. Children at risk of poor health outcomes and those with respiratory problems scored lower in several scales than the healthy subgroup.
Although the Spanish TAPQOL shows a non-negligible ceiling effect, it seems to be a reliable and valid instrument for Spanish infants and toddlers, and with similar psychometric characteristics to the original version. Future studies should try to improve questionnaire's structure and assess its sensitivity to change.
The incidence of hospitalization for acute gastroenteritis (AGE) is a useful parameter to assess the utility of the new rotavirus vaccines in high-income countries. Children hospitalized for AGE were ...identified by searching hospital discharge data and the records of the microbiology laboratory of Hospital Donostia. Rotavirus antigen was investigated in 96·1% of the 1114 children aged 1 month to <5 years hospitalized for AGE in the study period. Nearly 40% were rotavirus positive (44·9% of the 798 children aged 1 month to <2 years), with G1P8 being the predominant genotype. The mean annual incidence rate of hospitalization due to rotavirus AGE was 29·8 and 63·7 cases/10 000 inhabitants in the <5 and <2 years age groups, respectively, in 1996–1999, decreasing to 13·6 and 27·4 cases/10 000 inhabitants in <5 and <2 years age groups, respectively, in 2002–2005 (P<0·001). This decrease coincided with a significant increase in the consumption of oral rehydration solutions.
•Genetic characterization of historical mumps virus strains of southern Europe.•Analysis of the complete small hydrophobic and hemagglutinin-neuraminidase genes.•Epidemic due to the infrequently ...detected mumps virus genotype K.
The mumps virus (MuV) is genetically diverse and is divided into 12 genotypes. The World Health Organization has recommended expanding virological surveillance for MuV, and therefore molecular characterization of circulating strains (i.e. genotypes) is increasingly performed. Nevertheless, little is known about the genotypes circulating before the massive vaccination of children and adolescents. The present study analyzed the strains causing the 1988–1989 mumps epidemic in the Basque Country, northern Spain, which occurred in the early vaccination period, before the endemic circulation of mumps virus was blocked. The epidemic reached an annual incidence rate of more than 400 cases/100,000 inhabitants, and caused a large number of cases of mumps meningitis. MuV RNA was amplified from the cerebrospinal fluid of 15 infected patients during the epidemic and from three more patients affected shortly before or after this epidemic (1987, early 1988 and 1990). Genotyping of the complete small hydrophobic gene (316 nucleotides), amplified in the 18 strains, as well as of the entire hemagglutinin-neuraminidase gene (1749 nucleotides), amplified in four strains, assigned all strains to genotype K, a genotype infrequently detected at present. Although the putative HN protein sequence differed by 4.8–5.5% in relation to Jeryl Lynn 5 strain (the main strain used in the vaccination program in this region), the vaccine was effective, and dramatically reduced the incidence of mumps over the following years. The presence of genotype K strains in Spain in the 1980s, together with their contemporary detection in Scandinavia, suggests that this genotype could have caused the Spanish epidemic and was also circulating widely in Europe at that time.
Objective. The aim of this post hoc analysis was to establish the relationship between FENO levels and the asthma predictive index (API) among infants with recurrent wheezing. Methods. Infants with ...recurrent wheezing (three or more episodes) were recruited consecutively and online FENO tests at tidal breathing with multiple breaths were performed. Results. Twenty-seven (84%) out of 32 infants (median age of 12 months) who met the inclusion criteria for this post hoc analysis, successfully performed the FENO determinations. Eighteen (66%) infants were classified with positive stringent API. FENO levels were significantly higher among patients with positive API than those with negative (median IQR of 12.3 14.8 ppb vs. 4.1 7.9 ppb, respectively, p = .016). Furthermore, FENO and positive API had a significant correlation (Spearman's rho, ρ = 0.4741, p = .0125). After logistic regression analysis including FENO levels, gender, age, and use of controller therapy, FENO was the only variable that was marginally related to API (OR = 1.12, 95% CI: 0.99-1.27, p = .07). Conclusion. Infants with recurrent wheezing who had a positive stringent API already had higher FENO levels than those with a negative API. This finding needs to be corroborated in a larger prospective study.
We have studied the effect of N-(4-hydroxyphenyl)retinamide on either malignant human leukaemia cells or normal cells and investigated its mechanism of action. We demonstrate that 4HPR induces ...reactive oxygen species increase on mitochondria at a target between mitochondrial respiratory chain complex I and II. Such oxidative stress causes cardiolipin peroxidation which in turn allows cytochrome c release to cytosol, caspase-3 activation and therefore apoptotic consumption. Moreover, this apoptotic pathway seems to be bcl-2/bax independent and count only on malignant cells but not normal nor activated lymphocytes.
A 15-h stay in a paediatric intensive care unit by a girl with generalized dermal lesions superinfected with Streptococcus pyogenes led to four streptococcal infections in healthcare workers. ...Phenotypic and molecular analyses of the strains revealed that four isolates, characterized as emm87/ST62/T28, were identical to the isolate obtained from the index case. The occurrence of this outbreak, despite of the girl's brief hospital stay and appropriate patient management, highlights the high transmissibility of this pathogen.
Asthma is characterized by chronic inflammation of the central and distal airways. The aim of this study was to assess the small airway (SA) of children with moderate-severe asthma with normal FEV1.
...This was an open-label, prospective, observational, cross-sectional study with consecutive inclusion of patients with moderate-severe asthma, receiving standard clinical treatment, with normal baseline FEV1. We determined multiflow FEno (CAno), oscillatory resistance and reactance (R5–R20, X5), forced spirometry (FEV1, FEF25–75), total body plethysmography (RV/TLC) and bronchodilation test. SA involvement was defined as: CAno >4.5ppb, R5–R20 >0.147kPa/L/s, X5 <−0.18kPa/L, FEF25–75 <−1.65 z-score, RV/TLC >33%. Poor asthma control was defined as ≤19 points on the ACT questionnaire or ≤20 on the c-ACT.
In a cohort of 100 cases, 76 had moderate asthma and 24 had severe asthma; 71 children were classified as poorly controlled and 29 were well-controlled. In total, 77.78% of the group with all the correct determinations (n=72) showed ≥ 1 altered SA parameter and 48.61% ≥ 2 parameters. There were no differences between well-controlled or poorly controlled cases.
Children with moderate-severe asthma, with normal FEV1, show a phenotype of dysfunctional SA. In our series, the evaluation of SA using the techniques described above did not provide information on disease control.
El asma se caracteriza por una inflamación crónica de las vías respiratorias centrales y distales. El objetivo de este estudio ha sido evaluar la vía aérea pequeña (VAP) en niños con asma moderada y/o grave con FEV1 normal.
Estudio abierto, prospectivo, observacional y transversal con inclusión consecutiva de casos con asma moderada o grave, bajo tratamiento clínico habitual con FEV1 basal normal. Se ha determinado la FEno a flujos múltiples (CAno), resistencias y reactancia oscilatorias (R5-R20, X5), espirometría forzada (FEV1, FEF25–75), pletismografía corporal total (RV/TLC) y prueba de broncodilatación. La afectación de la VAP se definió por: CAno>4,5ppb, R5-R20>0,147kPa/L/s, X5<−0,18kPa/L, FEF25–75<−1,65 z-score, RV/TLC>33%. El mal control de asma se definió por≤19 puntos en el cuestionario ACT o≤20 en c-ACT.
Cohorte de 100 casos, 76 con asma moderada y 24 con asma grave, 71 niños clasificados como mal controlados y 29 bien controlados. El 77,78% del grupo con todas las determinaciones correctas (n=72) mostró≥1 parámetro alterado de VAP y el 48,61%≥2 parámetros. No hubo diferencias entre los casos bien y mal controlados.
Los niños con asma moderada y grave, con el FEV1 preservado, muestran un fenotipo de VAP disfuncionante. En nuestra muestra, la evaluación de la VAP mediante las técnicas descritas, no aporta información sobre el control habitual de la enfermedad.
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