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Automatic detection activities in indoor spaces has been and is a matter of great interest. Thus, in the field of health surveillance, one of the spaces frequently studied is the bathroom of homes and specifically the behaviour of users in the said space, since certain pathologies can sometimes be deduced from it. That is why, the objective of this study is to know if it is possible to automatically classify the main activities that occur within the bathroom, using an innovative methodology with respect to the methods used to date, based on environmental parameters and the application of machine learning algorithms, thus allowing privacy to be preserved, which is a notable improvement in relation to other methods. For this, the methodology followed is based on the novel application of a pre-trained convolutional network for classifying graphs resulting from the monitoring of the environmental parameters of a bathroom. The results obtained allow us to conclude that, in addition to being able to check whether environmental data are adequate for health, it is possible to detect a high rate of true positives (around 80%) in some of the most frequent and important activities, thus facilitating its automation in a very simple and economical way.

The biopurification systems (BPS) or biobeds are employed for the treatment of pesticide-containing wastewater of agricultural origin. The use of these devices for pesticide removal requires the proper optimization of the composition of biomixtures (BPS active matrix) according to the target pesticides applied on a specific crop and the available materials used in their elaboration. This work aims to design a biomixture for the simultaneous treatment of several pesticides applied in coffee crops, according to local practices in Costa Rica. Three biomixtures containing either coffee husk, coconut fiber or rice husk (as the lignocellulosic substrate) were applied for the removal of 12 pesticides. The profiles of pesticide elimination and the mineralization of radiolabeled chlorpyrifos (14C-chlorpyrifos) revealed that the best performance was achieved with the coconut fiber biomixture, even though similar detoxification patterns were determined in every biomixture (according to immobilization in Daphnia magna and germination tests in Lactuca sativa). The optimization of this biomixture’s composition by means of a central composite design permitted the definition of two optimal compositions (compost:soil:coconut fiber, % v/v) that maximized pesticide removal: i. 29:7.3:63.7 and ii. 11:7.3:81.7. The validation of these optimized compositions also included the use of an alternative soil from another coffee farm and resulted in overall DT50 values of 7.8–9.0 d for the pesticide mixture. Considering the removal kinetics in the optimized biomixture, a 1 m3 BPS prototype was dimensioned to be eventually used in local coffee farms. This work provides relevant information for the design and implementation of BPS at on-farm conditions for the treatment of pesticide-containing wastewater of a major crop.

Purpose. The aim of the study is to describe the genotype and phenotype of a Mexican cohort with PCARE-related retinal disease. Methods. The study included 14 patients from 11 unrelated pedigrees with retinal dystrophies who were demonstrated to carry biallelic pathogenic variants in PCARE. Visual assessment methods included best corrected visual acuity, color fundus photography, Goldmann visual field test, kinetic perimetry, dark/light adapted chromatic perimetry, full-field electroretinography, autofluorescence imaging, and spectral domain-optical coherence tomography imaging. Genetic screening was performed either by gene panel sequencing or by exome sequencing. Results. According to the results of multimodal imaging and functional tests, all 14 patients were diagnosed with cone-rod dystrophy. Six different PCARE pathogenic alleles were identified in our cohort, including three novel mutations: c.3048_3049del (p.Tyr1016∗), c.3314_3315del (p.Ser1105∗), and c.551A > G (p.His184Arg). Notably, alleles p.His184Arg, p.Arg613∗, and p.Arg984∗ were present in 18 of the 22 (82%) PCARE alleles from probands in our cohort. Conclusion. Our work expands the PCARE mutational profile by identifying three novel pathogenic variants causing retinal dystrophy. While phenotypic variations occurred among patients, a cone-rod dystrophy pattern was observed in all affected individuals.

Iridoid compounds are an important class of natural products. Here, the authors report on the discovery and engineering of nepetalactol-related short chain reductases and their application for the biosynthesis of nepetalactol or nepetalactone stereoisomers, as a versatile system for the production of the iridoid natural product scaffold.

Background: Latino men who have sex with men (LMSM) experience HIV and behavioral health disparities. Yet, evidence-based interventions, such as pre-exposure prophylaxis (PrEP) and behavioral health treatments, have not been equitably scaled up to meet LMSM needs. To address quality of life and the public health importance of HIV prevention, implementation strategies to equitably scale-up these interventions to LMSM need to be developed. This study identifies themes for developing culturally grounded implementation strategies to increase the uptake of evidence-based HIV-prevention and behavioral health treatments among LMSM. Methods: Participants included 13 LMSM and 12 stakeholders in Miami, an HIV epicenter. Feedback regarding the content, design, and format of an implementation strategy to scale-up HIV-prevention and behavioral health services to LMSM were collected via focus groups ( N = 3) and individual interviews ( N = 3). Themes were inductively identified across the Health Equity Implementation Framework (HEIF) domains. Results: Analyses revealed five higher order themes regarding the design, content, and format of the implementation strategy: cultural context, relationships and networks, navigation of health information and systems, resources and models of service delivery, and motivation to engage. Themes were applicable across HEIF domains, meaning that the same theme could have implications for both the development and implementation of the implementation strategy. Conclusions: Findings highlight the importance of addressing culturally specific factors, leveraging relational networks, facilitating navigation of health systems, tailoring to available resources, and building consumer and implementer motivation in order to refine an implementation strategy for reducing mental health burden and achieving HIV health equity among LMSM. Plain Language Summary Latino men who have sex with men (LMSM) are diagnosed with HIV and experience mental health and substance use problems more than their non-Latino/non-MSM peers. This means there is a disparity: one group is burdened by a disease more than another group. There are interventions, like pre-exposure prophylaxis and mental health/substance use treatment that can address this disparity. But, LMSM do not have enough access to these. This means there is a healthcare disparity: one group does not have as much access to healthcare as another group. The purpose of this study was to create a program to help LMSM get these services and consider how to implement it. LMSM and potential implementers talked about factors to consider in developing this program and implementation. They said the program and implementation need to (1) consider the cultural context in which LMSM are embedded, (2) leverage LMSM and implementers’ networks, (3) increase LMSM and implementers’ ability to navigate complex health systems, (4) be tailored to the resources available to consumers and implementers, and (5) build consumer and implementer motivation. These factors are important to address when developing and implementing programs to help LMSM get HIV-prevention and behavioral health treatments.

The transition from conventional to organic agriculture is often challenged by the adaptation of biological control agents to environments heavily exposed to agrochemical pollutants. We studied Trichoderma species isolated from living leaf tissues of wild Rubiacaeae (coffee family) plants to determine their fungicide tolerance and potential for bioremoval. First, we assessed the in vitro tolerance to fungicides of four Trichoderma isolates (Trichoderma rifaii T1, T. aff. crassum T2, T. aff. atroviride T3, and T. aff. strigosellum T4) by placing mycelial plugs onto solid media supplemented with seven different systemic and non-systemic fungicides. After a week, most of the fungicides did not significantly inhibit the growth of the isolates, except in the case of cyproconazole, where the only isolate able to grow was T1; however, the colony morphology was affected by the presence of fungicides. Second, biological removal potential was established for selected isolates. For this experiment, the isolates T1, T2, and T4 were independently inoculated into liquid media with the fungicides azoxystrobin, chlorothalonil, cyproconazole, and trifloxystrobin. After 14 days of incubation, a removal of up to 89% was achieved for chlorothalonil, 46.4% for cyproconazole, and 33.1% for trifloxystrobin using viable biomass. In the case of azoxystrobin, the highest removal (82.2%) occurred by adsorption to fungal biomass. Ecotoxicological tests in Daphnia magna revealed that T1 has the highest removal potential, achieving significant elimination of every fungicide, while simultaneously detoxifying the aqueous matrix (except in the case of cyproconazole). Isolate T4 also exhibited an intermediate efficiency, while isolate T2 was unable to detoxify the matrix in most cases. The removal and detoxification of cyproconazole failed with all the isolates. These findings suggest that endosphere of wild plants could be an attractive guild to find new Trichoderma species with promising bioremediation capabilities. In addition, the results demonstrate that attention should be placed when combining certain types of agrochemicals with antagonistic fungi in Integrated Pest and Disease Management strategies or when transitioning to organic agriculture.

Caracterizar la transmitancia térmica de fachadas es uno de los pasos más importantes en los trabajos de auditoría energética. Para ello, existe una amplia variedad de métodos experimentales. Uno de los métodos de mayor utilización es el método termométrico. Sin embargo, existe una brecha de conocimiento en relación con el planteamiento de análisis de datos. Por este motivo, en este estudio se analizó la viabilidad de utilizar diferentes planteamientos para el método termométrico. Para ello, se analizaron 20 fachadas y se plantearon 9 formulaciones diferentes utilizando aproximaciones para el coeficiente total de transferencia de calor existentes en la literatura científica. Asimismo, se evaluaron dos planteamientos de análisis de datos (media aritmética de las medidas instantáneas, y media del sumatorio del numerador y del denominador), así como el filtrado de datos necesario de aplicar. Los resultados permitieron determinar la configuración de análisis más adecuada para aplicar el método.

Las funciones de seguridad de las barreras de bentonita para residuos nucleares dependen principalmente del valor de su densidad seca (o porosidad). La evolución de esta variable durante la fase transitoria de la barrera es compleja. El artículo presenta una formulación teórica para calcular, mediante análisis numéricos acoplados, los cambios de densidad seca debidos a la hidratación de la barrera, prestando una especial atención a los procesos de homogenización. Se ha adoptado un modelo constitutivo de doble estructura para representar de forma más realista el comportamiento mecánico (tensión-deformación) de la bentonita. Utilizando la formulación presentada, se han simulado satisfactoriamente dos ensayos de hidratación, con distintas condiciones de contorno, sobre muestras que exhibían un elevado grado de heterogeneidad inicial. Los análisis predicen correctamente la saturación final de la muestra, el valor de la presión final de hinchamiento y, sobre todo, el proceso de homogenización que se produce durante los ensayos. El modelo de doble estructura utilizado ha permitido examinar los fenómenos de hidratación y homogenización desde una perspectiva más amplia.

Background: Early rhinovirus (RV) infection is a strong risk factor for asthma development. Airway remodeling factors play a key role in the progression of the asthmatic condition. We hypothesized that RV infection in young children elicits the secretion of growth factors implicated in airway remodeling and asthma progression.Methods: We examined the nasal airway production of remodeling factors in children ( ≤ 2 years old) hospitalized due to PCR-confirmed RV infection. Airway remodeling proteins included: MMP-1, MMP-2, MMP-7, MMP-9, MMP-10, TIMP-1, TIMP-2, EGF, Angiopoietin-2, G-CSF, BMP-9, Endoglin, Endothelin-1, Leptin, FGF-1, Follistatin, HGF, HB-EGF, PLGF, VEGF-A, VEGF-C, VEGF-D, FGF-2, TGF-β1, TGF-β2, TGF-β3, PDGF AA, PDGF BB, SPARC, Periostin, OPN, and TGF-α.Results: A total of 43 young children comprising RV cases (n = 26) and uninfected controls (n = 17) were included. Early RV infection was linked to (1) enhanced production of several remodeling factors (e.g., HGF, TGFα), (2) lower MMP-9/TIMP-2 and MMP-2/TIMP-2 ratios, and (3) increased MMP-10/TIMP-1 ratios. We also found that relative to term infants, severely premature children had reduced MMP-9/TIMP-2 ratios at baseline.Conclusion: RV infection in young children elicits the airway secretion of growth factors implicated in angiogenesis, fibrosis, and extracellular matrix deposition. Our results highlight the potential of investigating virus-induced airway remodeling growth factors during early infancy to monitor and potentially prevent chronic progression of respiratory disorders in all ages.

Despite scientific evidence proving that inhaled β2-adrenergic receptor (β2-AR) agonists can reverse bronchoconstriction in all ages, current guidelines advocate against the use of β2-AR bronchodilators in infants with viral bronchiolitis because clinical trials have not demonstrated an overall clinical benefit. However, there are many different types of viral bronchiolitis, with variations occurring at an individual and viral level. To discard a potentially helpful treatment from all children regardless of their clinical features may be unwarranted. Unfortunately, the clinical criteria to identify the infants that may benefit from bronchodilators from those who do not are not clear. Thus, we summarised the current understanding of the individual factors that may help clinicians determine the highest probability of response to β2-AR bronchodilators during viral bronchiolitis, based on the individual immunobiology, viral pathogen, host factors and clinical presentation.

Introduction: Viral bronchiolitis is a term often used to group all infants with the first episode of severe viral respiratory infection. However, this term encompasses a collection of different clinical and biological processes. We hypothesized that the first episode of severe viral respiratory infection in infants can be subset into clinical phenotypes with distinct outcomes and underlying airway disease patterns.Methods: We included children (≤2 years old) hospitalized for the first time due to PCR-confirmed viral respiratory infection. All cases were categorized based on primary manifestations (wheezing, sub-costal retractions and hypoxemia) into mild, hypoxemia or wheezing phenotypes. We characterized these phenotypes using lung-X-rays, respiratory outcomes and nasal protein levels of antiviral and type 2 cytokines (IFNγ, IL-10, IL-4, IL-13, IL-1β, and TNFα).Results: A total of 50 young children comprising viral respiratory infection cases (n = 41) and uninfected controls (n = 9) were included. We found that 22% of viral respiratory infection cases were classified as mild (n = 9), 39% as hypoxemia phenotype (n = 16) and 39% as wheezing phenotype (n = 16). Individuals in the hypoxemia phenotype had more lung opacities, higher probability of PICU admission and prolonged hospitalizations. Subjects in the wheezing phenotype had higher probability of recurrent sick visits. Nasal cytokine profiles showed that individuals with recurrent sick visits in the wheezing phenotype had increased nasal airway levels of type 2 cytokines (IL-13/IL-4).Conclusion: Clinically-based classification of the first episode of severe viral respiratory infection into mild, hypoxemia or wheezing phenotypes provides critical information about respiratory outcomes, lung disease patterns and underlying airway immunobiology.

While at first it can be thought that the auxiliary elements of facades are merely ornamental with little practical function, this study shows that these components of the building envelope have a high impact on the envelope’s functioning and performance. This is carried out through the analysis of all relevant lawsuits filed in Spain over a 10 year period, a data set in which a surprisingly high number of 1033 cases of defects was found to affect external windowsills, exterior wainscots or cornices (the three auxiliary elements considered) was found. Considering the total number of lawsuits, this is an objectively unprecedented study. An analysis is carried out regarding the interrelations between elements, defects, causes, and types of buildings, with the aim of obtaining a sorted classification of the data. This constitutes a useful tool to prevent future problems arising from either the design, execution, or maintenance of facades. These include various issues resulting from humidities, one of the most frequent envelope defects, which are found to significantly affect the auxiliary elements of facades.

Background: Most pharmacists have not received formal training or education in the provision of care for transgender patients. Nonetheless, pharmacists have the potential to be valuable partners in the care of transgender patients, and a continuing education course might be valuable in addressing this knowledge gap. Objective: The aim of this study was to examine the impact of a three-hour continuing education course in improving the knowledge of pharmacists to provide pharmaceutical care for transgender patients. Methods: A quasi-experimental, one-group pre-test/post-test study design was used to measure the impact of a three-hour continuing pharmacy education course on the knowledge of pharmacists on transgender care. The course was divided into three units: (1) Transgender Patient Care Introduction, (2) General Health Issues of Transgender Patients, and (3) Gender Affirming Hormone Therapy. A total of 68 pharmacists participated in the study, of which 54 completed both the pre- and post-test. An ANOVA was used to compare differences in knowledge in the group before and after the educational intervention. Results: The majority of the participating pharmacists were cisgender, heterosexual women who had not received any formal training related to transgender care. Participants demonstrated the largest increase in execution score in the third unit, with a percent improvement of 25.22% (pre-test 45.06%, post-test 70.28%; p

One year ago, Hurricane Maria passed over the archipelago of Puerto Rico, leaving widespread disruption of nearly all human services, including the health care sector. In the aftermath of the hurricane, limited access to medical care and prescription medications presented a serious challenge to maintaining control of preexisting chronic diseases. Many patients did not have access to refrigeration for heat-sensitive medications. Significant dietary changes due to the limited availability of shelf-stable foods further exacerbated chronic conditions such as heart failure and diabetes. The role of community pharmacists following a natural disaster has previously been documented, and may include the triage of evacuees, assessment of immunization needs, and provision of prescription medications under a collaborative practice agreement. However, our experience in Puerto Rico demonstrated a variety of barriers limited pharmacists’ ability to adequately respond to the magnitude of this disaster. These included medication shortages, extended loss of power, and limited telecommunications for contacting prescribers, disaster relief agencies, and third-party payers. Ultimately, the lack of preexisting emergency protocols made overcoming such barriers difficult. As the first and sometimes only accessible health care provider to many patients following a natural disaster, we must build a solid evidence base and better understanding of the individual, interpersonal, and environmental factors that contribute to the community pharmacist response. To date, however, a paucity of data exists on both the pharmacist and patient factors, which may contribute to an effective immediate response to patient needs at the community pharmacy following a natural disaster. Future research must focus on these multi-level factors to better inform public policy and effective disaster planning. Ultimately, such research and planning will lead to increased resiliency in our primary health care systems in the face of future disasters.

El hongo Aspergillus spp. causa infecciones oportunistas en huéspedes inmunocomprometidos. Cursa con una variedad de síndromes clínicos en el pulmón, que incluyen aspergilosis invasiva, aspergilosis pulmonar necrótica crónica, aspergilosis broncopulmonar alérgica y aspergiloma, cuya manifestación depende del tipo de relación con el huésped. El aspergiloma resulta de lesiones colonizadas por Aspergillus spp. en el árbol bronquial, en tanto que las formas invasivas se caracterizan por la presencia de hifas por debajo de la membrana basal del árbol bronquial. El objetivo de este trabajo es describir el caso de una paciente con aspergilosis pulmonar invasiva en su forma de traqueobronquitis seudomembranosa, considerando el curso clínico, el diagnóstico y el manejo paraclínico. Se trató de una paciente de cinco años de edad con antecedentes de anemia de Fanconi, que fue llevada a consulta con neutropenia febril y neumonía. Se inició el tratamiento antibiótico con cefepime, sin mejoría clínica. La tomografía computadorizada (TC) de tórax reveló opacidades parenquimatosas en ambas bases pulmonares. En una fibrobroncoscopia se encontró una lesión exofítica blanquecina en el bronquio principal derecho, que se sometió a biopsia, y se practicó un lavado broncoalveolar. En el examen de histopatología se hallaron hifas tabicadas a 45°, y el resultado del cultivo reveló la presencia del complejo Aspergillus flavi, por lo que se inició la administración de voriconazol. Se revisaron los reportes en la literatura científica sobre la infección pulmonar por Aspergillus spp. en niños, con énfasis en los síndromes clínicos, y en su manejo y tratamiento. Ante la presencia de síntomas respiratorios en pacientes pediátricos con enfermedades hematológicas que cursen con neutropenia febril, es indispensable considerar como agentes etiológicos los hongos, entre los cuales Aspergillus spp. se presenta frecuentemente causando diferentes síndromes clínicos.

Objetivo: Descripción clínica y sociodemográfica de un grupo de ancianos de la comunidad que asistieron a las actividades de Mantenimiento y Conservación de la Memoria. Materiales y métodos: Serie de 21 ancianos catalogados por su estado cognoscitivo según la prueba de NEUROPSI, presencia de síntomas somáticos, ansiedad, disfunción social y depresión mediante el Cuestionario General de Salud (GHQ-28), además de determinar el grado de satisfacción de acuerdo con la Escala de Satisfacción con la Vida). Resultados: Veintiuna personas con edad promedio de 73,5 años (DE: 7,3 años), rango: 57-82; el 90,5% mujeres, sin relación de pareja vigente el 71,4%, con escolaridad de 1 a 5 años el 66,5%, asistieron asiduamente durante los últimos 6 años el 42,9%, sin deterioro cognoscitivo el 76,2%, sin síntomas somáticos el 90,5% ni ansiedad el 90,5%, sin disfunción social el 95,2% ni depresión el 95,2%, satisfechos con la vida el 76,1%. Conclusiones: La ausencia de deterioro cognoscitivo es semejante a la de la población general. No muestran trastornos depresivos, ansiedad ni quejas somáticas, tienen un buen nivel de funcionamiento e integración sociales y están satisfechos con la vida. A pesar de las limitaciones de la descripción de una muestra pequeña, los resultados nos animan a continuar este trabajo e implementar investigaciones más rigurosas.

Background: Although bronchiolitis poses a significant health problem in low- and middle-income countries (LMICs), to the best of our knowledge, to date it has not been determined whether evidence-based bronchiolitis clinical practice guidelines (CPGs) complemented by standardized educational strategies reduce the use of unnecessary diagnostic tests and medications and improve clinically important outcomes in LMICs. Methods: In an uncontrolled before and after study, we assessed the impact of the implementation of an evidence-based bronchiolitis CPG on physician behavior and the care of infants with bronchiolitis by comparing pre-guideline (March to August 2014) and post-guideline (March to August 2015) use of diagnostic tests and medications through an electronic medical record review in a children’s hospital in Bogota, Colombia. We also sought to assess the impact of the implementation of the CPG on clinically important outcomes such as lengths of stay, hospital admissions, intensive care admissions, and hospital readmissions. Results: Data from 662 cases of bronchiolitis (pre-guideline period) were compared with the data from 703 cases (post-guideline period). On comparing the pre- and post-guideline periods, it was seen that there was a significant increase in the proportion of patients with an appropriate diagnosis and treatment of bronchiolitis (36.4% versus 44.5%, p = 0.003), and there were statistically significant decreases in the use of a hemogram (33.2% versus 26.6%, p=0.010), procalcitonin (3.9% versus 1.6%, p =0.018), nebulized beta-2 agonists (45.6% versus 3.4%, p < 0.001), nebulized anticholinergics (3.3% versus 1.4%, p= 0.029), and nebulized epinephrine (16.2% versus 7.8%, p < 0.001). Likewise, a significant increase in the use of nebulized hypertonic saline was seen (79.6% versus 91.7%, p < 0.001). However, implementation of the CPG for bronchiolitis was not associated with significant changes in clinically important outcomes. Conclusions: The development and implementation of a good quality bronchiolitis CPG is associated with a significant increase in the proportion of cases with an appropriate diagnosis and treatment of the disease in the context of a university-based hospital located in the capital of an LMIC. However, we could not demonstrate an improvement in clinically important outcomes such as any of the bronchiolitis severity parameters.

Nowadays, the building sector is one of the main sources emitting pollutant gases to the atmosphere due to its deficient energy behaviour. Among the elements of the envelope, the thermal bridges are where the heat losses and gains mainly occur, depending on the season of the year. To reduce the effect of the thermal bridges, there are different patented technologies which give provide solutions. In this paper, the thermal behaviour of five patented slab front (slab-façade) thermal bridges are analysed in a case study located in the south of Spain. Moreover, the influence of the thermal bridge on the energy demand from the building analysed was evaluated, both in the current scenario and future ones (2020, 2050 and 2080). The results reveal that the use of the patents in slab fronts can mean reductions by up to 95.74% in the linear thermal transmittance. Likewise, due to the improvement of the thermal bridge of slab fronts by using the patented designs which offered the best features, a savings in the global energy demand for heating higher than 18% as well as a savings in the global energy demand for cooling higher than 2.80% could be achieved in all the time scenarios considered.

In the present work the extraction efficiency of in-tube solid-phase microextraction (IT-SPME) for polar herbicides has been evaluated using extractive capillaries coated with different polymeric sorbents. For this purpose, aqueous solutions of herbicides with a wide range of polarities, including some highly polar compounds (log Kow < 1), have been directly processed by IT-SPME coupled on-line to capillary liquid chromatography with UV-diode array detection. For extraction, commercially available capillary columns coated with polydimethylsiloxane (PDMS) and polyetilenglicol (PEG)-based phases have been used, and the results have been compared with those obtained with a synthesized tetraethyl orthosilicate (TEOS)-trimethoxyethylsilane (MTEOS) polymer, as well as the same polymer reinforced with silica nanoparticles (SiO2 NPs). The SiO2 NPs functionalized TEOS-MTEOS coating provided the best results for most herbicides, especially for the most polar compounds. On the basis of the results obtained, conditions for the quantification of the herbicides tested are described using a SiO2 NPs reinforced TEOS-MTEOS coated capillary. The proposed method provided satisfactory linearity up to concentrations of 200 μg/L. The precision was also suitable, with relative standard deviations (RSDs) values ≤9% (n = 3), and the limits of detection (LODs) were within the 0.5–7.5 µg/L range. The method has been applied to different water samples and the extract obtained from an agricultural soil.

INTRODUCCIÓN Aunque las principales guías de manejo del asma resaltan la importancia de lograr el control de la enfermedad como objetivo terapéutico, y recomiendan evaluar periódicamente el grado de control logrado para guiar la terapia escalonada de la enfermedad, y de que la magnitud de la carga de enfermedad generada por el asma entre los pacientes pediátricos es especialmente significativa en menores de 5 años, hasta la fecha no se ha validado ningún cuestionario para evaluar el grado de control del asma en pacientes de habla hispana menores de 5 años. OBJETIVO Validar la versión en español del Test for Respiratory and Asthma Control in Kids (TRACK) en una población de preescolares con síntomas sugestivos de asma en la ciudad de Bogotá. MATERIALES Y MÉTODOS En un estudio de cohorte prospectiva y de validación de escala los padres y/o cuidadores de pacientes menores de 5 años con síntomas sugestivos de asma asistieron a una consulta basal y a una consulta de seguimiento 2 a 6 semanas después. En estas consultas se recolectó la información necesaria para evaluar la validez de criterio, la validez de constructo, la fiabilidad test-retest, la sensibilidad al cambio, la consistencia interna y la usabilidad del TRACK. RESULTADOS Se incluyeron 240 pacientes con edad media de 40,02 ± 10,9 meses. La mediana (RIC) de la puntuación del TRACK fue significativamente diferente entre los pacientes con asma bien controlada, asma parcialmente controlada y asma no controlada (90,0 [75,0-95,0], 75,0 [55,0-85,0] y 35,0 [25,0-55,0], respectivamente, p < 0,001). La puntuación del TRACK fue significativamente diferente entre los pacientes clasificados como sintomáticos actuales y como sintomáticos en el pasado reciente (42,5 [25,0-55,0] vs. 85,0 [75,0-90,0], p < 0,001). El coeficiente de correlación intraclase (CCI) de las mediciones fue de 0,755 (IC 95%: 0,503-1,00). Todos los pacientes que presentaron mejoría en su condición clínica tuvieron un incremento de 10 o más puntos entre la medición basal y la de seguimiento del TRACK. El alfa de Cronbach fue de 0,77 para la totalidad del cuestionario. CONCLUSIONES La versión en español del Test for Respiratory and Asthma Control in Kids (TRACK) tiene adecuadas validez de criterio, validez de constructo, fiabilidad test-retest, sensibilidad al cambio y usabilidad, y una moderada consistencia interna, cuando se utiliza en menores de 5 años con síntomas sugestivos de asma para determinar el control de su enfermedad.

INTRODUCCIÓN El virus respiratorio sincitial (VRS) es una de las principales causas de infección respiratoria aguda baja (IRAB) en lactantes y niños pequeños. Aunque existe evidencia que sugiere asociación entre ciertos parámetros meteorológicos y la actividad del VRS en la comunidad, para el caso de países tropicales de ingresos bajos y medios (PIBM) solamente existe una cantidad limitada de información acerca de esta asociación. MÉTODOS Estudio de corte transversal con componente analítico en el que se examinaron las asociaciones entre el número mensual de infecciones por VRS y variables meteorológicas (temperatura, humedad relativa, precipitación, velocidad del viento y radiación solar) en una población de niños hospitalizados menores de 36 meses con infección respiratoria aguda por VRS. RESULTADOS Del total de 1.548 niños incluidos (edad promedio: 9,2 ± 8,5 meses), 1.194 (77,1%) presentaron infección por VRS durante el período comprendido entre enero y abril de 2010, periodo que corresponde a la primera temporada anual de lluvias en la ciudad. En el análisis multivariado, tras controlar por la velocidad del viento, la humedad relativa y la radiación solar, la temperatura (IRR 3,14; IC 95%: 1,56-6,30; p = 0,001) y la precipitación (IRR 1,008; IC 95% 1,00-1,01; p = 0,048) se asociaron de forma independiente con el número mensual de infecciones por VRS. CONCLUSIONES En Bogotá, una ciudad tropical latinoamericana, el VRS es una causa importante de la IRAB en lactantes y niños pequeños, especialmente durante el período de 3 meses, desde marzo a mayo, la primera temporada anual de lluvias en la ciudad. El promedio de temperatura y la precipitación fueron las variables meteorológicas más fuertemente asociadas con el aislamiento de VRS en niños hospitalizados con IRAB de la ciudad.

INTRODUCCIÓN A pesar de los múltiples beneficios que se han demostrado con la administración continua de esteroides inhalados para el tratamiento del asma persistente, está surgiendo una nueva estrategia para dicho propósito, que consiste en utilizar los esteroides de manera intermitente o a necesidad, junto con beta-2 de acción corta, para aliviar los síntomas del asma. Sin embargo, no se han hecho evaluaciones económicas que comparen estas dos estrategias terapéuticas. OBJETIVO Hacer un estudio de costo-utilidad para comparar el uso diario con el intermitente de esteroides inhalados para el tratamiento de pacientes con asma leve persistente. MÉTODOS Se desarrolló un modelo de Markov para comparar los desenlaces y los costos de las dos estrategias en una cohorte simulada de pacientes pediátricos con asma persistente tratados por un período de 12 meses. Los parámetros de efectividad se obtuvieron de una revisión sistemática de la literatura. Los datos de costos se obtuvieron de bases de datos suministradas por el Ministerio de Salud y Protección Social. El desenlace principal fue la variable “años de vida ajustados por calidad” (AVAC o QALYs). RESULTADOS Para el análisis del caso base, el modelo mostró que comparado con el uso intermitente de esteroides inhalados, su uso continuo se asoció con menores costos ($807.612,96 vs. $1.081.135,44 y $1.302.137,76 vs. $1.385.648,88 promedio por paciente, en escolares y en preescolares respectivamente), y con una mayor ganancia en AVAC (0,9629 vs. 0,9392 AVAC y 0,9238 vs. 0,9130 AVAC, en escolares y preescolares respectivamente), por lo que se consideró la terapia continua como la estrategia dominante. CONCLUSIONES El presente análisis muestra que, comparada con la terapia intermitente, la terapia diaria con esteroides inhalados para tratar pacientes pediátricos con asma leve persistente es una estrategia dominante (más costo-efectiva), debido a que se asocia con una mayor ganancia de AVAC con menores costos totales de tratamiento.

INTRODUCCIÓN El citomegalovirus (CMV) es un patógeno frecuente en los hospederos inmunocomprometidos, en los que puede causar neumonía grave. Existen pocas descripciones de la neumonía por CMV en pacientes inmunocomprometidos y aún menos en inmunocompetentes tanto adultos como niños. Dada la importancia que reviste establecer las pautas diagnósticas tempranas, por su gravedad, se hace necesario documentar el comportamiento clínico, paraclínico y radiológico, y los antecedentes de los pacientes pediátricos con este diagnóstico. OBJETIVOS Describir las características clínicas, paraclínicas y radiológicas de una serie de pacientes pediátricos con diagnóstico de neumonía por CMV atendidos en el Hospital de la Misericordia en el período comprendido entre enero de 2010 y diciembre de 2013. MÉTODOS Se revisaron los registros clínicos, radiológicos y de laboratorio de los niños con neumonía por CMV. RESULTADOS En esta serie de casos pediátricos caracterizamos la infección pulmonar por CMV en 15 niños no infectados por el VIH (mediana de edad de 3 años), con el uso de modalidades de diagnóstico molecular y de imagen, en combinación con los signos y síntomas respiratorios. Los hallazgos clínicos y de laboratorio más importantes incluyeron tos (100%), hipoxemia (100%), estertores (100%) y aumento del esfuerzo respiratorio (93%). Todos los pacientes tenían imágenes anormales del parenquima pulmonar; en 80% de los casos estas correspondían a opacidad en vidrio esmerilado/consolidación. Se detectó CMV en el pulmón, por reacción en cadena de la polimerasa en el lavado broncoalveolar o por histología/ inmunohistoquímica en biopsias de pulmón. El CMV causó insuficiencia respiratoria en 47% de los niños infectados y la tasa de mortalidad global fue del 13,3%. CONCLUSIÓN La neumonía por CMV es una enfermedad potencialmente fatal en los niños no infectados por el VIH por lo que se requiere un alto índice de sospecha. Patrones clínicos y radiológicos comunes como la hipoxemia, los estertores y las opacidades pulmonares en vidrio esmerilado podrían permitir la identificación temprana de la infección pulmonar por CMV en la población pediátrica, lo que puede conducir a la pronta iniciación de la terapia antiviral y a mejores resultados clínicos.

INTRODUCCIÓN A pesar de la importancia de la valoración periódica del control del asma, del adecuado control de la enfermedad como un objetivo terapéutico y de la alta prevalencia de asma pediátrica que tienen varios países de habla hispana, no hay suficientes estudios de validación de cuestionarios destinados a evaluar el control del asma en pacientes pediátricos asmáticos de habla hispana. OBJETIVO Validar la versión en español del Childhood Asthma Control Test (cACT) en una población de pacientes pediátricos asmáticos en la ciudad de Bogotá. MATERIALES Y MÉTODOS En un estudio de cohorte prospectiva y de validación de escala, pacientes asmáticos con edades comprendidas entre 4 y 11 años, y sus padres, asistieron a una consulta basal y a una de seguimiento 2 a 6 semanas después. En estas consultas se recolectó la información necesaria para valorar la validez de criterio, la validez de constructo, la fiabilidad test-retest, la sensibilidad al cambio, la consistencia interna y la usabilidad del cACT. RESULTADOS Se incluyeron 143 pacientes con edad media de 7,9 ± 9,1 años. En la consulta basal, la mediana (rango intercuartílico) de la puntuación del cACT fue significativamente diferente entre los pacientes con asma bien controlada, parcialmente controlada y no controlada (24,0 [23,0-26,0]; 18,0 [18,0-22,0] y 17,5 [13,0-20,0], respectivamente, p < 0,001), y entre los pacientes a los que en esta consulta basal se les aumentó, se les mantuvo igual o se les disminuyó la terapia controladora (18,0 [15,0-21,0]; 24,0 [23,0- 24,0] y 26,0 [23,5-26,0], respectivamente, p < 0,001). El coeficiente de correlación intraclase (CCI) de las mediciones de los pacientes sin cambio en su condición clínica fue de 0,755 (IC 95%: 0,503-1,00). La puntuación basal del cACT fue significativamente diferente de la puntuación medida en el seguimiento de los pacientes con mejoría en su condición clínica (19,0 [18,0-22,0] vs 24,5 [24,0-25,0], p < 0,001). El alfa de Cronbach fue de 0,8276 para la totalidad del cuestionario. CONCLUSIONES La versión en español del Childhood Asthma Control Test (cACT) tiene adecuadas validez de criterio, validez de constructo, fiabilidad test-retest, sensibilidad al cambio y consistencia interna, y una excelente usabilidad, cuando se utiliza en pacientes pediátricos asmáticos con edades comprendidas entre los 4 y los 11 años.