Scielo RSS <![CDATA[Revista chilena de pediatría]]> https://scielo.conicyt.cl/rss.php?pid=0370-410620000006&lang= vol. 71 num. 6 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[Revista Chilena de Pediatría "on line"]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0370-41062000000600001&lng=&nrm=iso&tlng= <![CDATA[<B>Microbial genomes and diagnosis</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0370-41062000000600002&lng=&nrm=iso&tlng= En este artículo se exponen los principales descubrimientos de la nueva ciencia denominada genómica y sus principales repercusiones para el diagnóstico microbiológico, tales como la nueva tecnología de los ADN chips.<hr/>This article explores the principal discoveries of the science of genomics, placing emphasis on those related with DNA microassays and microbiological diagnosis <![CDATA[<B>The microbial genome</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0370-41062000000600003&lng=&nrm=iso&tlng= El genoma microbiano comprende la secuencia completa de los genes de un microorganismo. Su conocimiento permite una mejor comprensión de la patogenia, con aplicaciones en la prevención, en el diagnóstico y en el tratamiento de las enfermedades infecciosas. Conocida la dinámica de los mecanismos de invasión, producción de toxinas, capacidad de adaptación a ecosistemas adversos y otras múltiples posibilidades de variación, pueden diseñarse nuevas vacunas más específicas, así como establecerse combinaciones interespecies, o utilizarse bacterias avirulentas de muy fácil cultivo para producir en forma industrial antígenos de gérmenes de crecimiento fastidioso. En el campo de los antibióticos, se abren perspectivas hacia líneas absolutamente distintas, con drogas capaces de bloquear determinados pasos en cadenas metabólicas vitales. Ya existen múltiples aplicaciones de la genética en diagnóstico microbiológico, con técnicas que indudablemente se irán simplificando y perfeccionando con el conocimiento de la entera secuencia del genoma bacteriano: hibridación, reacción de polimerasa en cadena, etc. Por último, el conocimiento del genoma también permitirá la utilización benéfica, a escala industrial, de algunos microorganismos en la producción de hormonas, vitaminas, aminoácidos y antibióticos<hr/>The microbial genome is the complete sequence of all the microbial genes. Its knowledge permits a better understanding of the pathology caused by the organism, with applications in the prevention, diagnosis and treatment of infeccious diseases. Understanding the dynamics of invasion mechanisms, toxin production, capacities to adapt to adverse ecosystems and other possibilities of variation could be used to design more specific vaccines and/or inter-species combinations. Furthermore using avirulent forms which can be easily cultivated on an industrial scale to produce antigens of bacteria with a more fastidious growth. In the field of antibiotics it opens the possibilities of new absolutely distinct lines of drugs capables of blocking determined vital metabolic chains. There already exists multiple applications of genetics in microbiological diagnosis, with techniques that undoubtably will be simplified and perfectioned with the knowledge of the complete gene sequence, using hybridization, PCR, etc. Ultimately the knowledge of the genome permits the beneficial utilization on an industrial scale of some microbes in the production of hormones, vitamins, amino-acids and antibiotics <![CDATA[<B>Quality of the nutritional attention in children under 2 years old enrolled in the "risk of malnutrition programme" in Santiago, Chile</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0370-41062000000600004&lng=&nrm=iso&tlng= Objetivo: evaluar el cumplimiento de las normas del Ministerio de Salud de diagnóstico y tratamiento del lactante con riesgo de desnutrir. Material y método: estudio retrospectivo de una cohorte de 189 lactantes de 6 a 18 meses de edad con peso para la edad entre -1 y -2 DE. Se evaluó el cumplimiento de las normas ministeriales en tres Servicios de Salud y se construyó un índice de calidad de atención incluyendo 14 actividades. Resultados: 35% de los niños recibió su primera atención nutricional en el plazo estipulado. Se observó un cumplimiento superior al 85% en tres de las 6 acciones normadas en el diagnóstico, siendo menor para antropometría de los padres (23%), análisis de la situación socioeconómica (57%) y de la morbilidad (65%). Se comprobó buen cumplimiento de las normas de tratamiento, salvo en visitas domiciliarias (7%), derivaciones (54%) y consulta social (60%). La antropometría de los padres y el plazo para la primera atención mostraron diferencias significativas por servicios de salud (p < 0,001). El índice promedio de calidad de atención fue 10,4 ± 1,7 sobre un máximo de 14. La tasa de recuperación del riesgo nutricional fue inferior al 50%. Conclusiones: existe un bajo cumplimiento de algunas actividades, déficit en la oportunidad de atención, ausencia de un enfoque más preventivo y de una política de seguimiento de casos críticos. Se pueden mejorar las deficiencias observadas con mayor autonomía, capacitación, auditoría, coordinación y supervisión.<hr/>Objective: to evaluate the accomplishment of ministerial norms in the diagnosis and treatment of children at risk of malnutrition. Patients and methods: a retrospective study of a cohort of 189 children aged between 6 and 18 months in the Metropolitan area with a weight for age index between -1 and -2 SD. Using medical records the percentage of children fulfilling ministerial norms were evaluated in three health services. An attention quality index including 14 activities defined by the norms was made and the nutritional evolution during the intervention period was evaluated. Results: 35% of children received their 1st atention within the time stipulated. 3 out of 6 activities considered in the diagnosis obtained a high accomplishment. Being less in parents anthropometry (23%), analysis of socio-economic status (57%) and morbidity (65%). Good accomplishment of treatment norms was proven except for home visits (7%), referrals (54%) and social consultations (60%). There were significant differences between health services, p < 0.001. The average attention quality index was 10.4 + 1.7, the maximum being 14. Only 45% of cases had a satisfactory outcome. Conclusion: there is low accomplishment of certain activities of ministerial norms that must improve with greater training and supervision. Some aspects of these norms should be reviewed and modified <![CDATA[<B>The value of anatomo-pathological studies in paedriatric ICUs</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0370-41062000000600005&lng=&nrm=iso&tlng= El estudio necrópsico es utilizado cada vez con menos frecuencia en pediatría, pese a aportar una valiosa y a veces insospechada información. Lo anterior tendría su explicación en la mayor disponibilidad actual de medios diagnósticos no invasivos y fundamentalmente en la dificultad de obtener el consentimiento de los padres -y en ocasiones de familiares cercanos- para realizarlo. Sin embargo, el clarificar el o los diagnósticos de fallecimiento es de gran importancia tanto para el equipo médico como para la familia del paciente. Se revisó retrospectivamente la mortalidad ocurrida durante un período de cuatro años, clasificando la patología de acuerdo a grandes grupos diagnósticos y los hallazgos de la necropsia de acuerdo a los criterios de Goldman. Fallecieron 87 pacientes. Se efectuó autopsia en 61 pacientes, siendo 47 practicadas en el Hospital Dr. Sótero del Río y 14 en el Instituto Médico Legal. En 26 pacientes (36%) no se obtuvo el consentimiento de los padres. No hubo correlación entre los hallazgos anatomopatológicos y las variables diagnóstico primario, edad, estadía en UCIP y PRISM (Pediatric Risk of Mortality), indicador de gravedad de uso más difundido en pediatras. En el 26% de las autopsias se encontró algún tipo de error mayor, siendo el 11% catalogado como Goldman I (diagnóstico revelado por la autopsia y que podría haber modificado la terapia y la sobrevida), y 15% como error Goldman II. Así, la autopsia debe seguir siendo considerada como parte integral en la evaluación médica del paciente pediátrico.<hr/>Autopsy is being used less and less frequently in paedriatrics inspite of giving valuable and at times unsuspected clinical information. This could partly be explained in the greater availibility of non-invasive diagnostic techniques and fundamentally in the difficulty of obtaining parental consent to perform them. However, to clarify the cause of death is of great importance not only for the medical team but also for the family. We performed a retrospective analysis of mortality during a 4 year period, classifying the pathology in accordance with the criteria of Goldman with respect to diagnostic groups and autopsy findings. 87 patients died, autopsy being performed in 61, 47 in the hospital Dr. Sótero del Rio and 14 in the Medico-Legal Institute. Parental consent was not obtained in 26 patients (36%). There was no correlation between autopsy findings and the primary diagnostic variables, age, time spent in ITU, and PRISM (Paedriatric Risk of Mortality scale). In 26% of cases there were some type of diagnostic error, 11% corresponding to Goldman type I (diagnosis revealed at autopsy and which could have modified the treatment and outcome, and 15% type II. Thus autopsy should still be considered as an integral part of medical evaluation of the paedriatric patient <![CDATA[<B>Headache in children</B>: <B>the utility of the International Classification of Headaches (IHS) 1988</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0370-41062000000600006&lng=&nrm=iso&tlng= El objetivo de este estudio prospectivo de cefalea en el niño fue conocer la prevalencia de consultas por cefalea en el policlínico de Neurología del Hospital Roberto del Río, las características clínicas, el tipo de cefalea y la utilidad en niños de la clasificación internacional de cefalea dada por la International Headache Society 1988. Entre enero y junio 1994, tuvimos 114 consultas por cefalea, de un total de 5 612, al policlínico de Neurología del Hospital de Niños Roberto del Río, lo que dio una prevalencia de 2%. Hubo 68 mujeres y 46 hombres, edades entre 3,5 y 14,8 años. Todos sufrían cefaleas recurrentes. La aplicación de la clasificación internacional nos permitió clasificar el 75% de los casos, con una distribución de 66% vascular, 8% tensional y 26% no definida.<hr/>The purpose of this prospective study of headache in children was to determine the prevalence of headache in a Paedriatric Neurology outpatient clinic, clinical features, type of headache and the utility of using the classification of headaches by the IHS in 1988 in children. Between january and june 1994 we assessed 114 patients with headache out of a patient population of 5,612 in the Roberto del Rio Children’s Hospital, a prevalence of 2%. There were 68 females, 46 males aged between 3.5 and 14.8 years. All suffered recurrent headaches, using the IHS classifcation 74% of patients had a defined cause, 66% vascular, 8% tensional. 26% of children could not be classified <![CDATA[<B>Haemolytic uraemic syndrome (HUS) associated with Streptococcus pneumoniae infection</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0370-41062000000600007&lng=&nrm=iso&tlng= El síndrome hemolítico urémico, causa más importante de insuficiencia renal aguda parenquimatosa en pediatría, se asocia habitualmente (90%) a un pródromo de diarrea. Dentro del 10% restante, se encuentra el SHU asociado a enfermedad invasiva por Streptococo pneumoniae productor de neuroaminidasa, entidad rara no descrita en Chile, relatándose 22 casos en la literatura. Por lo anterior, nos ha parecido de interés presentar 2 casos ocurridos en nuestro hospital, uno asociado a meningitis y el otro a pleuroneumonía, comentando su forma de inicio, evolución a corto y mediano plazo y ahondar en los mecanismos patogénicos involucrados y las características propias de esta enfermedad<hr/>HUS is the most important cause of acute renal failure in childhood, mostly associated with an infectious diarrhoea (90%). Within the remaining 10% we know that HUS is associated with invasive neuraminidase-producing S. pneumoniae, an uncommon aetiological organism in HUS. There are only 22 cases reported internationally and not previously described in Chile. We present 2 cases that occurred in our hospital, one associated with meningitis and the other with pneumonia and pleural effusion. Commenting on the clinical features, evolution and pathogenic mechanism of this rare disease <![CDATA[<B>Serologic survey of rubella in the pre-vaccine era in child-care centers, schools and maternity units of Fortaleza</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0370-41062000000600008&lng=&nrm=iso&tlng= Objetivo: Identificar a prevalência de rubéola em diversas idades e grupos populacionais e a suscetibilidade de mulheres gestantes e puérperas segundo idade, número de filhos e aborto espontâneo. Métodos: Estudo transversal de tipo inquérito sorológico. Pré-escolares e escolares foram selecionados em creches e escolas públicas distribuídas por distritos sanitários de Fortaleza. As gestantes e puérperas saudáveis foram recrutadas em duas grandes maternidades e três ambulatórios públicos de pré-natal. Indivíduos previamente vacinados e portadores de doenças crónicas ou agudas foram excluídos. Foi obtido consentimento escrito de todos os participantes ou responsáveis. Para detecção qualitativa de IgG sérica anti-rubéola utilizou-se o método de Elisa-indireto. Resultados: As soroprevalências médias por idade de 999 amostras foram 2 a 5 anos = 59% (136/23l); 6 a 9 anos = 53% (109/204); 10 a 19 anos = 56% (243/432); e 20 a 39 anos = 80% (106/132). A idade média de 187 gestantes e puérperas foi de 23 anos (10-39) com soroprevalência de 76% (142/187), 62% no grupo de 15-19 anos e 83% no grupo de 26-39 anos. Uma maior soroprevalência esteve associada à maior idade materna (p < 0,001), a história de aborto espontâneo (p = 0,03) e a 2 ou mais filhos (p = 0,01). Conclusões: A elevada soroprevalência em preescolares revela a intensa transmissão do vírus nas creches. A alta suscetibilidade nos adolescentes (45%), entre os quais a gravidez é freqüente, enfatiza a necessidade de se introduzir a vacina precocemente e manter elevada cobertura nos jovens, visando erradicar a rubéola congênita. Igualmente, a vacinação rotineira das puérperas nesse grupo etário é particularmente benéfica<hr/>Objectives: To identify rubella prevalence in different ages and population groups and rubella susceptibility of pregnant and post-partum women according to age, number of children and spontaneous abortion. Methods: Cross-sectional study of sero-survey type. Children and students were selected in day-care centers and schools distributed by health districts of Fortaleza. Pregnant and postpartum healthy women were recruited in two large maternity units and three antenatal clinics; individuals previously vaccinated and presenting chronic or acute diseases where excluded. Written consent was obtained from participants or their caretakers. Anti-rubella IgG qualitative detection was performed with an Elisa-sandwich assay. Results: Mean age-specific sero-prevalence rates of 999 samples 2 to 5 years = 59% (136/23l); 6 to 9 years = 47% (95/204); 10 to 19 years = 56% (243/432) and 20 lo 39 years = 80% (106/132). The mean age of 187 pregnant and postpartum women was 23 years (10-39) with a sero-prevalence of 76% (142/187), where 62% sero-positives aged 15 to 19 and 83% aged 26 to 39 years. A higher sero-prevalence was related to women’s age (p < 0.001), history of spontaneous abortion (p = 0.03), and two or more children (p = 0.01). Conclusions: The high sero-prevalence of rubella in preschool age children reflects the intense viral transmission in child-care centers. The high susceptibility in adolescents (45%), among whom pregnancy is common, emphasizes the need to introduce rubella vaccine early and keep high immunization coverages in youngsters in order to eradicate congenital rubella syndrome. Also, postpartum routine immunization against rubella in this age group is of particular benefit. <![CDATA[Reseña de libros]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0370-41062000000600009&lng=&nrm=iso&tlng= Objetivo: Identificar a prevalência de rubéola em diversas idades e grupos populacionais e a suscetibilidade de mulheres gestantes e puérperas segundo idade, número de filhos e aborto espontâneo. Métodos: Estudo transversal de tipo inquérito sorológico. Pré-escolares e escolares foram selecionados em creches e escolas públicas distribuídas por distritos sanitários de Fortaleza. As gestantes e puérperas saudáveis foram recrutadas em duas grandes maternidades e três ambulatórios públicos de pré-natal. Indivíduos previamente vacinados e portadores de doenças crónicas ou agudas foram excluídos. Foi obtido consentimento escrito de todos os participantes ou responsáveis. Para detecção qualitativa de IgG sérica anti-rubéola utilizou-se o método de Elisa-indireto. Resultados: As soroprevalências médias por idade de 999 amostras foram 2 a 5 anos = 59% (136/23l); 6 a 9 anos = 53% (109/204); 10 a 19 anos = 56% (243/432); e 20 a 39 anos = 80% (106/132). A idade média de 187 gestantes e puérperas foi de 23 anos (10-39) com soroprevalência de 76% (142/187), 62% no grupo de 15-19 anos e 83% no grupo de 26-39 anos. Uma maior soroprevalência esteve associada à maior idade materna (p < 0,001), a história de aborto espontâneo (p = 0,03) e a 2 ou mais filhos (p = 0,01). Conclusões: A elevada soroprevalência em preescolares revela a intensa transmissão do vírus nas creches. A alta suscetibilidade nos adolescentes (45%), entre os quais a gravidez é freqüente, enfatiza a necessidade de se introduzir a vacina precocemente e manter elevada cobertura nos jovens, visando erradicar a rubéola congênita. Igualmente, a vacinação rotineira das puérperas nesse grupo etário é particularmente benéfica<hr/>Objectives: To identify rubella prevalence in different ages and population groups and rubella susceptibility of pregnant and post-partum women according to age, number of children and spontaneous abortion. Methods: Cross-sectional study of sero-survey type. Children and students were selected in day-care centers and schools distributed by health districts of Fortaleza. Pregnant and postpartum healthy women were recruited in two large maternity units and three antenatal clinics; individuals previously vaccinated and presenting chronic or acute diseases where excluded. Written consent was obtained from participants or their caretakers. Anti-rubella IgG qualitative detection was performed with an Elisa-sandwich assay. Results: Mean age-specific sero-prevalence rates of 999 samples 2 to 5 years = 59% (136/23l); 6 to 9 years = 47% (95/204); 10 to 19 years = 56% (243/432) and 20 lo 39 years = 80% (106/132). The mean age of 187 pregnant and postpartum women was 23 years (10-39) with a sero-prevalence of 76% (142/187), where 62% sero-positives aged 15 to 19 and 83% aged 26 to 39 years. A higher sero-prevalence was related to women’s age (p < 0.001), history of spontaneous abortion (p = 0.03), and two or more children (p = 0.01). Conclusions: The high sero-prevalence of rubella in preschool age children reflects the intense viral transmission in child-care centers. The high susceptibility in adolescents (45%), among whom pregnancy is common, emphasizes the need to introduce rubella vaccine early and keep high immunization coverages in youngsters in order to eradicate congenital rubella syndrome. Also, postpartum routine immunization against rubella in this age group is of particular benefit. <![CDATA[RESUMENES DE TRABAJOS PRESENTADOS EN EL XL CONGRESO CHILENO DE PEDIATRIA I CONGRESO CHILENO DE ADOLESCENCIA]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0370-41062000000600010&lng=&nrm=iso&tlng= Objetivo: Identificar a prevalência de rubéola em diversas idades e grupos populacionais e a suscetibilidade de mulheres gestantes e puérperas segundo idade, número de filhos e aborto espontâneo. Métodos: Estudo transversal de tipo inquérito sorológico. Pré-escolares e escolares foram selecionados em creches e escolas públicas distribuídas por distritos sanitários de Fortaleza. As gestantes e puérperas saudáveis foram recrutadas em duas grandes maternidades e três ambulatórios públicos de pré-natal. Indivíduos previamente vacinados e portadores de doenças crónicas ou agudas foram excluídos. Foi obtido consentimento escrito de todos os participantes ou responsáveis. Para detecção qualitativa de IgG sérica anti-rubéola utilizou-se o método de Elisa-indireto. Resultados: As soroprevalências médias por idade de 999 amostras foram 2 a 5 anos = 59% (136/23l); 6 a 9 anos = 53% (109/204); 10 a 19 anos = 56% (243/432); e 20 a 39 anos = 80% (106/132). A idade média de 187 gestantes e puérperas foi de 23 anos (10-39) com soroprevalência de 76% (142/187), 62% no grupo de 15-19 anos e 83% no grupo de 26-39 anos. Uma maior soroprevalência esteve associada à maior idade materna (p < 0,001), a história de aborto espontâneo (p = 0,03) e a 2 ou mais filhos (p = 0,01). Conclusões: A elevada soroprevalência em preescolares revela a intensa transmissão do vírus nas creches. A alta suscetibilidade nos adolescentes (45%), entre os quais a gravidez é freqüente, enfatiza a necessidade de se introduzir a vacina precocemente e manter elevada cobertura nos jovens, visando erradicar a rubéola congênita. Igualmente, a vacinação rotineira das puérperas nesse grupo etário é particularmente benéfica<hr/>Objectives: To identify rubella prevalence in different ages and population groups and rubella susceptibility of pregnant and post-partum women according to age, number of children and spontaneous abortion. Methods: Cross-sectional study of sero-survey type. Children and students were selected in day-care centers and schools distributed by health districts of Fortaleza. Pregnant and postpartum healthy women were recruited in two large maternity units and three antenatal clinics; individuals previously vaccinated and presenting chronic or acute diseases where excluded. Written consent was obtained from participants or their caretakers. Anti-rubella IgG qualitative detection was performed with an Elisa-sandwich assay. Results: Mean age-specific sero-prevalence rates of 999 samples 2 to 5 years = 59% (136/23l); 6 to 9 years = 47% (95/204); 10 to 19 years = 56% (243/432) and 20 lo 39 years = 80% (106/132). The mean age of 187 pregnant and postpartum women was 23 years (10-39) with a sero-prevalence of 76% (142/187), where 62% sero-positives aged 15 to 19 and 83% aged 26 to 39 years. A higher sero-prevalence was related to women’s age (p < 0.001), history of spontaneous abortion (p = 0.03), and two or more children (p = 0.01). Conclusions: The high sero-prevalence of rubella in preschool age children reflects the intense viral transmission in child-care centers. The high susceptibility in adolescents (45%), among whom pregnancy is common, emphasizes the need to introduce rubella vaccine early and keep high immunization coverages in youngsters in order to eradicate congenital rubella syndrome. Also, postpartum routine immunization against rubella in this age group is of particular benefit.