Search

espanolIntroduccion: El Modelo de Aceptacion Tecnologica (TAM), ha sido ampliamente utilizado para predecir el uso de bases de datos cientificas (BDC). No obstante, es preciso indagar el peso de otras variables identificadas en la revision de la literatura. Objetivo: Identificar los factores influyentes en la aceptacion y uso de las bases de datos cientificas por parte de los estudiantes de la carrera de enfermeria de una universidad privada. Metodo: El estudio tiene un diseno no experimental, transversal de tipo descriptivo y correlacional. Se aplico un cuestionario a estudiantes de la carrera de Enfermeria (Chile). Se realizo un analisis basado en regresion de minimos cuadrados parciales en SmartPLS. Resultados: Se corroboran como variables predictoras del uso de BDC a las variables TAM (intencion de uso, utilidad y facilidad de uso) y a otras variables externas al modelo (obligatoriedad, las habilidades informacionales y el entrenamiento en tecnologias). Discusion: La evidencia identifica que una de las principales barreras en el uso de las BDC son las habilidades informacionales y digitales para su utilizacion. Conclusiones: Se hace necesario incorporar nuevas metodologias para aumentar la competencia de los estudiantes con el uso de estas bases, para este efecto se consideraron las variables que resultaron predictoras. EnglishIntroduction: The Technology Acceptance Model (TAM) has been extensively utilized to predict the use of scientific databases; nevertheless, it is necessary to further inquire on the weight of other literature review identified variables. Objective: To identify factors influencing the acceptance and use of scientific databases by nursing students in a private university. Method: This is a correlational, descriptive, transversal, and non-experimental study. A corresponding questionnaire was distributed among nursing students in Chile. A partial least squares regression analysis was performed using SmartPLS. Results: TAM predicting variables to the usage of scientific databases, including intention to use, usefulness, and ease of use, were corroborated. Other TAM-external predicting variables such as obligatoriness, information-handling skills, and technology training, were also found. Discussion: Evidence suggested that a main barrier to the use of scientific databases refers to the skills to handle digital information. Conclusions: Considering the related predicting variables, it is necessary to incorporate new methodologies aimed at enhancing the competence of students to use scientific databases. portuguesIntroducao: O Modelo de Aceitacao Tecnologica (TAM), tem sido bastante utilizado para predizer o uso de bases de dados cientificas (BDC). No entanto, e preciso investigar o peso de outras variaveis identificadas na revisao da literatura. Objetivo: Identificar os fatores influentes na aceitacao e uso das bases de dados cientificas por parte dos estudantes da carreira de enfermagem de uma universidade privada. Metodo: O estudo tem um desenho nao experimental, transversal de tipo descritivo e correlacional. Aplicou-se um questionario a estudantes da carreira de Enfermagem (Chile). Realizou-se uma analise baseada em regressao de minimos quadrados parciais em SmartPLS. Resultados: Corroboram-se como variaveis preditoras do uso de BDC as variaveis TAM (intencao de uso, utilidade e facilidade de uso) e a outras variaveis externas do modelo (obrigatoriedade, as habilidades informacionais e o treinamento em tecnologias). Discussao: A evidencia identifica que uma das principais barreiras no uso das BDC sao as habilidades informacionais e digitais para sua utilizacao. Conclusoes: E necessario incorporar novas metodologias para aumentar a competencia dos estudantes com o uso destas bases, para tal efeito consideraram-se as variaveis que resultaram preditoras.

Resumen: La lectina de unión a la manosa (mannose-binding lectin [MBL]) es una proteína sérica perteneciente al sistema inmunitario innato. Se une a los azúcares de las membranas de múltiples microorganismos, favoreciendo su opsonización y eliminación. El déficit de MBL resulta del polimorfismo del gen MBL2 y se asocia a una amplia variedad de infecciones recurrentes, incluidas las infecciones del tracto respiratorio. Presentamos un caso de displasia ectodérmica anhidrótica asociada a un déficit de MBL, inmunodeficiencia nunca descrita en pacientes afectados de displasia ectodérmica anhidrótica. Abstract: Mannose-binding lectin (MBL) is a serum protein of the innate immune system. MBL enhances opsonophagocytosis by binding to carbohydrates expressed by multiple pathogens. MBL deficiency is due to polymorphisms in the structural and promoter sequences of the MBL2 gene and is associated with variety of recurrent infections, including respiratory tract infections. We present a case of anhidrotic ectodermal dysplasia associated with severe mannose-binding lectin deficiency, never described in patients with anhidrotic ectodermal dysplasia.

Resumen: Introducción: Los abscesos retro y parafaríngeos son procesos infrecuentes aunque asociados con morbilidad significativa y potencial mortalidad. El objetivo del estudio es revisar nuestra experiencia en el manejo diagnóstico y terapéutico de los abscesos retro y parafaríngeos y comparar el resultado entre los pacientes tratados con antibioterapia exclusiva con aquellos que requirieron drenaje quirúrgico. Pacientes y métodos: Estudio retrospectivo de pacientes diagnosticados de abscesos retro y parafaríngeos en nuestro hospital terciario durante el periodo 2000-2009. Resultados: Treinta y un casos fueron identificados. Diecisiete presentaron absceso retrofaríngeo, 11 abscesos parafaríngeos y 3 ambos. Encontramos un incremento de la frecuencia media anual (1,4 casos/años en el periodo 2000-2004 versus 4,8 casos/año en el periodo 2005-2009, p = 0,006). La mediana de edad fue 3 años (rango 1-10). Dieciocho (58%) pacientes recibieron antibioterapia por vía oral previa al ingreso (betalactámicos 84%). La clínica de presentación fue: fiebre (93%), linfadenopatías cervicales (93%), dolor cervical (90%), tortícolis (74%), odinofagia (64%), trismus (32%), sialorrea (22%) y estridor (6%). En 13 niños se realizó drenaje quirúrgico, siendo positivo el cultivo microbiológico en 8 casos; Streptococcus pyogenes fue el germen más frecuente (n = 4). Todos los pacientes recibieron antibioterapia por vía intravenosa. No hubo diferencias en la estancia hospitalaria, complicaciones o recurrencias al comparar los tratados con antibioterapia exclusiva y los tratados con cirugía. Conclusiones: La frecuencia media anual de casos se incrementó durante la segunda mitad del periodo de estudio. La mayoría de niños fueron tratados satisfactoriamente con manejo conservador. La indicación quirúrgica debe basarse en la presentación clínica y la respuesta al tratamiento antibiótico. Abstract: Introduction: Retropharyngeal and parapharyngeal abscesses are rare but associated with significant morbidity and potential mortality. This study reviews our experience in the diagnosis and management of retro- and parapharyngeal abscesses and compares children treated conservatively with those undergoing surgical intervention. Material and methods: A retrospective analysis of children diagnosed with retro- and parapharyngeal abscess from 2000 to 2009 in our tertiary-care centre. Results: Thirty-one children were identified. There were 17 retropharyngeal abscesses and 11 parapharyngeal abscesses; 3 children suffered from both conditions. The mean annual frequency increased significantly from 1.4 cases/year during 2000-2004 to 4.8 cases/year during 2005-2009 (P = .006). Median age was 3 years (range 1-10). A total of 18 (58%) children had received pre-admission oral antibiotics (beta-lactams in 84%). Clinical findings at presentation were: fever (93%), cervical lymphadenopathy (93%), neck pain (90%), torticollis (74%), odynophagia (64%), trismus (32%), drooling (22%) and stridor (6%). Thirteen (42%) children underwent surgical intervention, of those, microbiological culture was positive in 8 children; S. pyogenes being the most commonly isolated organism (n = 4). All the patients received parenteral antibiotic therapy. There were no significant differences in the length of hospital stay, complication or recurrence rates between children treated conservatively compared to those undergoing surgical intervention. Conclusions: Retro- and parapharyngeal abscesses were increasingly observed during the 2nd part of the study period. The majority of children (58%) were treated conservatively with excellent clinical response. Indication for surgical intervention should be made based on the clinical presentation and response to antibiotic therapy.

Resumen: Introducción: Recientemente se ha descrito en diversas áreas geográficas un incremento tanto en la incidencia de mastoiditis agudas como en su gravedad, sin que sus causas hayan sido del todo aclaradas.El objetivo de nuestro estudio es revisar nuestra experiencia reciente y compararla con aquello que otros autores han descrito. Paciente y métodos: Estudio retrospectivo de 145 pacientes diagnosticados de mastoiditis aguda en hospital terciario durante el periodo 1999–2008. Se analizan variables epidemiológicas, clínicas, microbiológicas, tratamiento y resultado. Resultados: La frecuencia anual de mastoiditis aguda presentó importantes variaciones a lo largo del estudio. La media anual fue de 14,5 casos/año. La mediana de edad fue de 3 años. Un 57,9% fueron varones. Un 53,8% recibió antibioterapia oral previa, principalmente B-lactámicos. La clínica más frecuente fue fiebre (77,9%), desplazamiento pabellón auricular (73,8%), otalgia (71,7%) edema/hinchazón retroauricular (70,3%). Se realizó cultivo exudado ótico en 53 pacientes, siendo Streptococcus pneumoniae el germen más frecuente. Se realizó TC en el 56,6% casos. El 100% de pacientes recibió antibioterapia intravenosa con una mediana de duración de 5 días. La cirugía otorrinolaringológica se realizó en 47 (32,4%) pacientes. Diecinueve (13,1%) pacientes presentaron complicaciones extracraneales. Doce (8,2%) pacientes presentaron complicaciones intracraneales, observándose un incremento significativo en su proporción al comparar los primeros con los segundos 5 años del estudio. Conclusiones: Encontramos importantes variaciones interanuales en la frecuencia de mastoiditis aguda. Subrayamos el aumento de la proporción de complicaciones intracraneales en los segundos 5 años del estudio. Abstract: Introduction: An increase in both the incidence and severity of acute mastoiditis (AM) has been recently recorded in many different geographical areas. Causes remain unclear.This study aims to evaluate our clinical and epidemiological data in paediatric patients with AM and to compare them with recent reports. Material and methods: Retrospective chart review of 145 patients diagnosed of AM from 1999 to 2008 in our tertiary-care centre, including clinical, epidemiological, microbiological, treatment and outcome data. Results: The annual incidence showed a changeable trend throughout the study period. The average number of cases was 14.5 cases per year, with a median age of 3 years, and 57.9% males. A total of 53.8% received pre-admission oral antibiotics, mainly beta-lactamics. Most frequent presenting clinical findings were fever (77.9%), ear displacement (73.8%), otalgia (71.7%), and postauricular swelling (70.3%). Microbiological cultures were performed in 53 cases; S. pneumoniae was the most isolated microorganism. CT scans were performed in 56.6% cases. All patients received parenteral antibiotic treatment with a median duration of treatment of 5 days. Surgery was performed on 32.6%. Complications were seen in 20% of patients: 13.1% had extracranial complications, and 8.2% had intracranial complications. A significant increase in intracranial complications was detected in the second half of the study period. Conclusions: A changeable trend in the annual incidence of AM throughout the time of study was observed. A higher proportion of intracranial complications was detected in the last five years of the study period.

Resumen: Introducción: las complicaciones intracraneales (CI) secundarias a otitis media son procesos infrecuentes aunque potencialmente graves. Recientemente hemos encontrado una frecuencia inusualmente elevada, cuyas características clínicas y epidemiológicas describimos. Material y método: estudio descriptivo retrospectivo de pacientes con complicaciones intracraneales secundarias a otitis media ingresados en nuestro hospital terciario durante el periodo abril de 2004-noviembre de 2007. Resultados: 8 pacientes han presentado CI: trombosis de seno sigmoideo (4), trombosis de seno lateral (1), meningitis (2), absceso epidural (1) e hidrocefalia otítica (1); 4 de los pacientes presentaban otomastoiditis. El 87,5% de los pacientes había recibido antibioterapia oral previa a la complicación. Los síntomas más frecuentes fueron fiebre, otalgia, cefalea, parálisis del VI par y parálisis facial. Se aisló el germen causal en 3 pacientes: Streptococcus pyogenes (2) y Proteus mirabillis (1). Los demás pacientes tuvieron cultivos negativos. Se realizó mastoidectomía radical en 2 pacientes y tratamiento médico con antibioterapia intravenosa de amplio espectro en todos los pacientes. Se produjo la curación sin secuelas en 6 casos y ninguna muerte. Conclusiones: hemos detectado un incremento en la frecuencia de CI secundarias a otitis media aguda. Para confirmarlo se requieren estudios prospectivos multicéntricos a fin de valorar si se ha producido un cambio epidemiológico en la incidencia de este tipo de complicaciones. Abstract: Introduction: Intracranial complications (ICC) secondary to otitis media are unusual but potentially life-threatening. We report an unusually high frequency of these events, and describe their clinical and epidemiological features. Material and method: A retrospective study of all pediatric patients with ICC admitted to our tertiary hospital from April 2004 to November 2007. Results: Eight patients had ICC: Sigmoid sinus thrombosis (4), lateral sinus thrombosis (1), meningitis (2), epidural abscess (1), otitic hydrocephalus (1). Four of the patients had acute mastoiditis. Pre-admission oral antibiotics were administered in 87.5% of the patients. Fever, otalgia, headache and VI and VII cranial nerves paralysis were the most frequent symptoms associated. The microorganism could be isolated in 3 patients: S pyogenes (2) and P mirabilis (1); the remaining patients had negative cultures. All of the patients received broad-spectrum parenteral antibiotics and 2 of them underwent a radical mastoidectomy. Conclusions: We report an unusually high incidence of cranial complications secondary to acute otitis media. Multicenter studies are needed in order to assess whether there is an increase in the incidence of these events.

Community Acquired Pneumonia (CAP) is a common childhood disease, involving several paediatric subspecialties in its diagnosis and treatment. This has prompted the Spanish Society of Paediatric Pulmonology (SENP) and the Spanish Society of Paediatric Infectious Diseases (SEIP) to prepare a consensus document on the diagnosis of CAP, assessing the practical aspects by means of evidence-based medicine. It discusses the aetiology and epidemiology, with the current changes and the validity of certain laboratory tests, such as acute phase reactants, microbiological and imaging techniques, guiding the paediatricians in the real value of these tests.

Retropharyngeal and parapharyngeal abscesses are rare but associated with significant morbidity and potential mortality. This study reviews our experience in the diagnosis and management of retro- and parapharyngeal abscesses and compares children treated conservatively with those undergoing surgical intervention.A retrospective analysis of children diagnosed with retro- and parapharyngeal abscess from 2000 to 2009 in our tertiary-care centre.Thirty-one children were identified. There were 17 retropharyngeal abscesses and 11 parapharyngeal abscesses; 3 children suffered from both conditions. The mean annual frequency increased significantly from 1.4 cases/year during 2000-2004 to 4.8 cases/year during 2005-2009 (P=.006). Median age was 3 years (range 1-10). A total of 18 (58%) children had received pre-admission oral antibiotics (beta-lactams in 84%). Clinical findings at presentation were: fever (93%), cervical lymphadenopathy (93%), neck pain (90%), torticollis (74%), odynophagia (64%), trismus (32%), drooling (22%) and stridor (6%). Thirteen (42%) children underwent surgical intervention, of those, microbiological culture was positive in 8 children; S. pyogenes being the most commonly isolated organism (n=4). All the patients received parenteral antibiotic therapy. There were no significant differences in the length of hospital stay, complication or recurrence rates between children treated conservatively compared to those undergoing surgical intervention.Retro- and parapharyngeal abscesses were increasingly observed during the 2(nd) part of the study period. The majority of children (58%) were treated conservatively with excellent clinical response. Indication for surgical intervention should be made based on the clinical presentation and response to antibiotic therapy.

La evidencia muestra los trastornos menores en salud en estudiantes universitarios como un factor relevante de ser estudiado. Una variable asociada al rendimiento académico, no tan sólo por las características individuales de ellos, sino también por lo que significa el integrarse a un sistema que impone una serie de exigencias y demandas, por ejemplo un cambio en el desempeño de roles, organización del tiempo, entre otras, que deben compatibilizar con sus hábitos de adolescentes, actitudes y cambios orgánicos. De modo de dimensionar el problema, aplicamos un cuestionario diseñado en la Universidad de Barcelona, adaptado por nosotros, a una muestra de estudiantes que ingresaron en primer año de enfermería en una universidad privada en Chile. 62 personas participaron voluntariamente del estudio. 94% corresponde a mujeres. De los 18 problemas presentados en el instrumento, los participantes contestaron en promedio afirmativamente a 7,5 de ellos y negativamente a 12,5. Dolor osteomuscular, cefalea y trastornos del sueño son los trastornos más frecuentes, presentes en más de la mitad de los estudiantes encuestados. Encontramos algunas correlaciones entre los trastornos: correlación positiva intermedia entre „dificultades para mantener el sueño? e „ingerir menos calorías que las necesarias?; esta última variable tiene asociaciones débiles con varios otros trastornos menores. Se obtuvo una correlación negativa, aunque baja, con ingerir más calorías que las necesarias. Resultados similares encontramos en lo relativo a la higiene del sueño. La ingesta calórica superior a los requerimientos es mayor en la muestra estudiada que en otras investigaciones. ABSTRACT Evidence shows that minor health disorders are a relevant factor to be researched among students at universities. This is an issue not only related to individual characteristics, but also might be associated to academic performance. This problem could be influenced by requirements imposed by the educational system, such as a change in students‟ roles and organization of their own time, among others. These elements must be made compatible with adolescent habits, their attitudes and biologic changes. To gauge this problem, we have used a survey designed at the University of Barcelona, and modified it for our own purposes. The sample is composed of 62 first year students of a nursing program in a private university in Chile. 94% of the sample was female. On average, participants answered affirmatively to 7.5 of the problems presented on the list, and negatively to 12.5 (Total = 18). Musculoskeletal pain, headache and sleep disorders are the most common disorders present in over half of the students surveyed. We found correlations between some disorders: Intermediate correlation between “Difficulties in maintaining sleep” and “Eating fewer calories than the body needs.” This second variable is associated to some other disorders. There was a low negative correlation between “Difficulties in maintaining sleep” and “Eating more calories than the body needs.” Similar results related to sleep hygiene were obtain.

Se describe un niño de 5 meses inmunocompetente con meningitis por Haemophilus influenzae tipo f (Hif). Había recibido previamente dos dosis de vacuna frente a Haemophilus influenzae tipo b (Hib) con polirribosilribitol fosfato conjugado con la proteína de toxoide tetánico (PRP-T). Aunque inicialmente se sospechó un fracaso vacunal a partir de los hallazgos del Gram en líquido cefalorraquídeo, se identificó posteriormente un Hif no cubierto por la vacuna conjugada.Los serotipos no b (Hinb) deberían ser tenidos en cuenta como patógenos potenciales en niños menores de 5 años con enfermedades invasoras. Un programa de vigilancia epidemiológico sería de utilidad para monitorizar posibles incrementos futuros en la frecuencia de estos serotipos como patógenos significativos. : We report an immunocompetent 5-month-old boy with Haemophilus influenzae type f (Hif) meningitis. The patient had previously been immunized with two doses of Hib conjugate vaccine (PRP-T). Vaccination failure was initially suspected based on Gram stain report. The results of culture identified a non-b Haemophilus influenzae capsular serotype (Hif).Non-Hib serotypes should be considered as potential pathogenic agents in children under the age of 5 years with invasive diseases. An adequate epidemiological surveillance system would be helpful in detecting the role of these non-b Hif serotypes as significant pathogens, which appear to be on the increase.

An increase in both the incidence and severity of acute mastoiditis (AM) has been recently recorded in many different geographical areas. Causes remain unclear. This study aims to evaluate our clinical and epidemiological data in paediatric patients with AM and to compare them with recent reports.Retrospective chart review of 145 patients diagnosed of AM from 1999 to 2008 in our tertiary-care centre, including clinical, epidemiological, microbiological, treatment and outcome data.The annual incidence showed a changeable trend throughout the study period. The average number of cases was 14.5 cases per year, with a median age of 3 years, and 57.9% males. A total of 53.8% received pre-admission oral antibiotics, mainly beta-lactamics. Most frequent presenting clinical findings were fever (77.9%), ear displacement (73.8%), otalgia (71.7%), and postauricular swelling (70.3%). Microbiological cultures were performed in 53 cases; S. pneumoniae was the most isolated microorganism. CT scans were performed in 56.6% cases. All patients received parenteral antibiotic treatment with a median duration of treatment of 5 days. Surgery was performed on 32.6%. Complications were seen in 20% of patients: 13.1% had extracranial complications, and 8.2% had intracranial complications. A significant increase in intracranial complications was detected in the second half of the study period.A changeable trend in the annual incidence of AM throughout the time of study was observed. A higher proportion of intracranial complications was detected in the last five years of the study period.

SummaryBrucellosis is a relatively common disease in the Mediterranean area and may present with prolonged fever without focus, however it remains an important diagnostic challenge to most pediatricians. We report the case of a 10-year-old male patient who presented with fever without a focus of 10-day duration, hepatomegaly, ascites, a small elevation in transaminases and acute-phase reactants indicating cholestasis, leukopenia, and thrombocytopenia. Imaging tests showed many small, rounded, hypodense focal lesions in the liver and spleen. After eliminating a wide range of diseases, positive results for the Rose Bengal test and indirect immunofluorescence assay for Brucella melitensis made it possible to establish a diagnosis of hepatosplenic brucellosis. A review of the family history revealed direct contact with farm animals. The patient made good progress on treatment with doxycycline and streptomycin, with complete resolution of both clinical symptoms and imaging signs. The prevalence of brucellosis is gradually increasing, mainly due to migratory movements. It should always be eliminated as a source of unknown fever in endemic areas and should also be taken into account in other geographical areas where it is not common whenever a patient presents with prolonged fever and unspecific symptoms. Standard therapy is highly effective, even in relapse cases, and early diagnosis leads to a rapid recovery and favorable outcome. The unusual presentation in the case reported here reminds us that it is possible to encounter a Brucella infection in a case of fever without a focus, irrespective of the existence of a clear epidemiological history, which is very often omitted by the family. All differential diagnostic protocols for fever without a focus should include a diagnostic test for Brucella in order to achieve early detection of the disease and initiate therapy promptly.

Intracranial complications (ICC) secondary to otitis media are unusual but potentially life-threatening. We report an unusually high frequency of these events, and describe their clinical and epidemiological features.A retrospective study of all pediatric patients with ICC admitted to our tertiary hospital from April 2004 to November 2007.Eight patients had ICC: Sigmoid sinus thrombosis (4), lateral sinus thrombosis (1), meningitis (2), epidural abscess (1), otitic hydrocephalus (1). Four of the patients had acute mastoiditis. Pre-admission oral antibiotics were administered in 87.5% of the patients. Fever, otalgia, headache and VI and VII cranial nerves paralysis were the most frequent symptoms associated. The microorganism could be isolated in 3 patients: S pyogenes (2) and P mirabilis (1); the remaining patients had negative cultures. All of the patients received broad-spectrum parenteral antibiotics and 2 of them underwent a radical mastoidectomy.We report an unusually high incidence of cranial complications secondary to acute otitis media. Multicenter studies are needed in order to assess whether there is an increase in the incidence of these events.

Background Kawasaki disease (KD) is an acute, self-limited vasculitis commonly affecting children Methods Retrospective descriptive study of patients diagnosed with KDSS in our hospital (January 2009 - December 2014). KDSS was defined as those patients with KD who showed clinical signs of hypoperfusion (cold extremities, oliguria, reduced pulse amplitude, prolonged capillary refill time >2 second, tachycardia and/or hypotension for age ( Results During a six-year period a total of 5 patients met the criteria for KDSS. 4/5 of the children presented at an atypical age ( 5 years). 3/5 of the children presented with incomplete KD. 3/5 did not respond to the first dose of IVIG and 4/5 received high dose steroids. All children achieved full remission of symptoms. Only one patient has cardiac sequelae Conclusions KDSS is an unusual but severe form of KD presentation. In children with suspected toxic shock, negative cultures and/or poor response to antibiotics, KDSS should be considered as possible differential diagnosis, even when the classical criteria of KD are not met. Early diagnosis is essential in order to initiate appropriate and aggressive therapy thereby reducing the risk of coronary arteries aneurysm, more frequently occurring in children with KDSS. References Dominguez et al. Pediatrics 2008; 122; e786e790. Kanegaye et al. Pediatrics 2009; 123;e783-e789. Disclosure of Interest None declared

We report an immunocompetent 5-month-old boy with Haemophilus influenzae type f (Hif) meningitis. The patient had previously been immunized with two doses of Hib conjugate vaccine (PRP-T). Vaccination failure was initially suspected based on Gram stain report. The results of culture identified a non-b Haemophilus influenzae capsular serotype (Hif).Non-Hib serotypes should be considered as potential pathogenic agents in children under the age of 5 years with invasive diseases. An adequate epidemiological surveillance system would be helpful in detecting the role of these non-b Hif serotypes as significant pathogens, which appear to be on the increase.

Background Staphylococcus aureus is a frequent cause of infections in children, ranging from skin and soft tissue to invasive life-threatening infections (1). Sacroiliac (SI) joint is a rare site of septic arthritis although more frequent in children than adults patients (2). Non-specific symptoms make diagnosis challenging whilst radiological imaging and cultures confirm clinical suspicion. Objectives We report two case reports of otherwise healthy girls who presented to us with aggressive septic sacroiliitis and pyomyositis. Results Case report 1: 13-year-old obese girl presents with a 5-day history of left gluteus pain. Examination showed furuncles of lower extremities, inability to walk and positive FABERE test. X-ray and US of hips were normal. Symptomatic treatment was started and 2 days later she developed worsening symptoms with high fever. Blood test: WBC 6290, neutrophils 64.8%; CRP 287 mg/L. She commenced empiric therapy with cloxacillin and improved clinically. MRI showed left sacroiliitis with extensive inflammatory disease affecting pelvic area, psoas and paravertebral muscles with abscess formation (image 1). Blood cultures remained negative; however due the aggressiveness of the illness clindamycin was added to treatment. Echocardiography ruled out endocarditis and a bone scan was negative. After 4 weeks of empiric iv antibiotic therapy and continuous clinical, laboratory and radiological improvement antibiotics were changed to oral for a total of 6 weeks. Long-term follow-up showed SI osteoarthritis. Case report 2: 11-year-old obese girl with a 2-day history of right lumbar and gluteus pain. Examination revealed furuncles of lower extremities, inability to walk and positive FABERE test. Normal hip x-ray and US. 2 hours after initiation of anti-inflammatory therapy she developed high fever with worsening clinical symptoms including arthritis of elbow and ankle, appearance of vasculitic lesions on palm and septic emboli lesions of lower extremities. Blood test: WBC 19100, neutrophils 89%; CRP 303 mg/L. Empiric therapy with vancomycin plus clindamycin for suspected methicillin resistant S. aureus was initiated. MRI of hips and SI showed right SI septic arthritis with iliac and sacral osteomyelitis and pyomyositis and multiple abscesses formation (image 2) requiring US guided drainage. Echocardiography ruled out endocarditis. Blood cultures continued to be positive for methicillin susceptible S. aureus with induced resistance to clindamycin and therapy was changed to high dose cloxacillin plus rifampicin with slow but continuous clinical improvement. Conclusions Cutaneous lesions and rarely but importantly septic sacroiliitis can be presenting features of life-threatening infections due to S. aureus . Early diagnosis and initiation of appropriate management can be lifesaving. References Sattler CV, Correa AG. Coagulase-positive staphylococcal infections (Staphylococcus aureus). In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL, eds. Textbook of Pediatric Infectious Diseases. 5th ed. Philadelphia, PA:Saunders; 2004:1099-1129 Wu MS, Chang SS, Lee SH and Lee CC. Pyogenic sacroiliitis-a comparison between paediatric and adult patients. Rheumatology 2007;46:1684-1687 Disclosure of Interest None Declared

Resumen: La neumonía adquirida en la comunidad (NAC) es una enfermedad frecuente en la infancia, en cuyo diagnóstico y tratamiento participan diversas especialidades pediátricas. Esto ha motivado que la Sociedad Española de Neumología Pediátrica (SENP) y la Sociedad Española de Infectología Pediátrica (SEIP) elaboren un documento de consenso sobre el diagnóstico de la NAC, revisando mediante la medicina basada en la evidencia aquellos aspectos prácticos sobre el mismo. Se analizan la etiología y la epidemiología, con los cambios actuales, así como la validez de ciertas pruebas complementarias, como los reactantes de fase aguda, los métodos microbiológicos y los métodos de imagen, orientando al pediatra en la utilidad real de los mismos. Abstract: Community Acquired Pneumonia (CAP) is a common childhood disease, involving several paediatric subspecialties in its diagnosis and treatment. This has prompted the Spanish Society of Paediatric Pulmonology (SENP) and the Spanish Society of Paediatric Infectious Diseases (SEIP) to prepare a consensus document on the diagnosis of CAP, assessing the practical aspects by means of evidence-based medicine. It discusses the aetiology and epidemiology, with the current changes and the validity of certain laboratory tests, such as acute phase reactants, microbiological and imaging techniques, guiding the paediatricians in the real value of these tests.

IgG2 deficiency has been reported in two recent years as an antibody deficiency associated mainly with recurrent acute and chronic ORL and lower respiratory and recurrent otitis media in children evaluated. We discuss the most rational approach to the treatment with special reference to the replacement therapy with intravenous immunoglobulin.

Homozygous familiar hypercholesterolemia (FH) is a serious inherited disease caused by a genetic defect in the cell surface receptor that controls the degradation of low density lipoprotein (LDL). These patients often have myocardial infarction in their teens or early adulthood and are usually unresponsive to drugs. Recently it has been reported promising results using combined drugs regimens in patients with residual receptor activity. We report a new additional patient with receptor-defective homozygous FH treated with a combination of lovastatin and cholestyramine. The cholesterol levels were reduced in a 67% and there were adverse events related to treatment during a 7 month period of follow-up.