Etiology of acute respiratory infection in children under 5 years in the provinces Comunera and García Rovira of Santander

Introducción: La infección respiratoria aguda es una causa importante de morbimortalidad en menores de cinco años en los municipios de las provincias de Santander. La etiología viral en esos municipios no es bien conocida. Objetivo: El objetivo del estudio fue determinar la etiología viral de la infección respiratoria aguda en menores de cinco años en las provincias Comunera y García Rovira del departamento de Santander entre diciembre de 2012 y diciembre de 2013. Materiales y métodos: Estudio descriptivo en población usuaria de servicios de urgencias. Se obtuvieron muestras por hisopado nasofaríngeo y se realizó amplificación por reacción en cadena de polimerasa con el test Seeplex® RV15 OneStep ACE Detection, multiplex para 15 virus. Resultados: Participaron 64 niños, 57,8% niños de sexo masculino. El 26,6%, de los niños eran menores de un año. La positividad para virus fue del 37,5% de las muestras. El 75% de las muestras positivas fueron de la provincia Comunera y 25% de la provincia de García Rovira. Hubo co-infección por dos virus en 8,3% de las muestras positivas. Los virus más identificados fueron Rhinovirus (29%), Parainfluenza 4 (20,8%) e Influenza (12,5%). También se identificó Coronavirus, Adenovirus, Virus Sincitial Respiratorio, Metapneumovirus y otros virus Parainfluenza. Conclusiones: En las dos provincias de Santander evaluadas circula una amplia cantidad de virus respiratorios en menores de cinco años. El Rhinovirus fue identificado como el más frecuente. Se encontró presencia de Metapneumovirus y Coronavirus humano.Introduction: Acute respiratory infection is a major cause of morbidity and mortality in children under 5 years in Santander (Colombia). Viral etiology in municipalities from this department is not well known. Objective: To determine the viral etiology of acute respiratory infection in children under five years in the provinces Comunera and García Rovira (Santander) from December 2012 to December 2013. Methodology: Descriptive study in pediatric population who attended the emergency services studied. Nasopharyngeal swab samples were obtained and a polymerase chain reaction was performed with Seeplex® OneStep RV15 ACE Detection, which is a multiplex test for 15 virus. Results: 64 children were enrolled, 57,8% being boys. 26.6% of participants were under one year. Virus positivity was present in 37.5% of the samples and 75% of the positive samples were from the province Comunera. Besides, 8.3% from positive samples were co-infected with two viruses. The most common virus were Rhinovirus (29%), Parainfluenza 4 (20.8%) and influenza (12.5%). Coronavirus, Adenovirus, respiratory syncytial virus, Metapneumovirus and other Parainfluenza virus were also identified. Conclusions: There is a wide circulation of respiratory virus in children under five in these two provinces of Santander (Colombia). Rhinovirus was the most frequent. Human Metapneumovirus and Coronavirus were also found

Clinical standards for drug-susceptible TB in children and adolescents

BACKGROUND: These clinical standards aim to provide guidance for diagnosis, treatment, and management of drug-susceptible TB in children and adolescents. METHODS: Fifty-two global experts in paediatric TB participated in a Delphi consensus process. After eight rounds of revisions, 51/52 (98%) participants endorsed the final document. RESULTS: Eight standards were identified: Standard 1, Age and developmental stage are critical considerations in the assessment and management of TB; Standard 2, Children and adolescents with symptoms and signs of TB disease should undergo prompt evaluation, and diagnosis and treatment initiation should not depend on microbiological confirmation; Standard 3, Treatment initiation is particularly urgent in children and adolescents with presumptive TB meningitis and disseminated (miliary) TB; Standard 4, Children and adolescents should be treated with an appropriate weight-based regimen; Standard 5, Treating TB infection (TBI) is important to prevent disease; Standard 6, Children and adolescents should receive home-based/community-based treatment support whenever possible; Standard 7, Children, adolescents, and their families should be provided age-appropriate support to optimise engagement in care and clinical outcomes; and Standard 8, Case reporting and contact tracing should be conducted for each child and adolescent. CONCLUSION: These consensus-based clinical standards, which should be adapted to local contexts, will improve the care of children and adolescents affected by TB.National Institutes of HealthRevisión por pare

Essential Medicines at the National Level : The Global Asthma Network's Essential Asthma Medicines Survey 2014

Patients with asthma need uninterrupted supplies of affordable, quality-assured essential medicines. However, access in many low- and middle-income countries (LMICs) is limited. The World Health Organization (WHO) Non-Communicable Disease (NCD) Global Action Plan 2013-2020 sets an 80% target for essential NCD medicines' availability. Poor access is partly due to medicines not being included on the national Essential Medicines Lists (EML) and/or National Reimbursement Lists (NRL) which guide the provision of free/subsidised medicines. We aimed to determine how many countries have essential asthma medicines on their EML and NRL, which essential asthma medicines, and whether surveys might monitor progress. A cross-sectional survey in 2013-2015 of Global Asthma Network principal investigators generated 111/120 (93%) responses41 high-income countries and territories (HICs); 70 LMICs. Patients in HICs with NRL are best served (91% HICs included ICS (inhaled corticosteroids) and salbutamol). Patients in the 24 (34%) LMICs with no NRL and the 14 (30%) LMICs with an NRL, however no ICS are likely to have very poor access to affordable, quality-assured ICS. Many LMICs do not have essential asthma medicines on their EML or NRL. Technical guidance and advocacy for policy change is required. Improving access to these medicines will improve the health system's capacity to address NCDs.Peer reviewe

Contaminación biológica intradomiciliaria y su relación con síntomas respiratorios indicativos de asma bronquial en preescolares de Bucaramanga, Colombia

Introduction. Indoor air pollution may play an important role in development and exacerbation of asthma in children.Objective. The association between the presence of indoor biological contaminants and respiratory symptoms related to asthma was assessed in preschool children.Materials and methods. This cross-sectional study was undertaken in Bucaramanga, Colombia, and included children <7 years of age living in two urban areas of with different levels of outdoor air pollution. The 678 children were an average of 3.5 years of age. Respiratory symptoms indicative of asthma and indoor air pollutants were assessed by previously validated questionnaires.. Biological samples potentially containing mites and fungi were collected by standardized laboratory methods. The log binomial regression model was used for multivariate analysis, using adjusted prevalence ratios (PR).Results. The prevalence of asthmatic respiratory symptoms was 8.0%; (95% C.I: 5.6-9.6), without significant differences between the two areas. Binomial model analysis showed that asthma symptoms were associated with mites (PR 1.78; 95% C.I. 1.0-3.0), Acremonium sp (PR 6.24; 95 C.I.: 3.8-10.0) and a history of child pneumonia (PR 4.0; 95% C.I. 2.5-6.4), allergic rhinitis (PR 1.9; 95% C.I.: 1.2-3.1), prematurity (PR 3.4; 95% C.I. 1.8-6.5), parents with asthma (PR 2.6; 95% C.I. 1.4-5.0) and pet ownership (PR 0.4; 95% C.I. 0.2-0.9).Conclusions. The indoor exposure to biological contaminants (dust mites and fungi), history of prematurity, pneumonia, rhinitis and family history of asthma increased the occurence of symptoms suggestive of asthma in young children.Introducción. La contaminación en el hogar puede desempeñar un papel importante en el desarrollo y exacerbación del asma infantil, sobre todo entre niños genéticamente predispuestos.Objetivos. Evaluar la asociación entre la presencia de contaminantes biológicos intradomiciliarios y síntomas indicativos de asma, en preescolares de Bucaramanga, ColombiaMateriales y métodos. Se hizo un estudio de corte transversal analítico, en menores de 7 años, en dos zonas de la ciudad con niveles diferentes de contaminación atmosférica por material particulado. Se evaluaron los síntomas respiratorios indicativos de asma y los contaminantes intradomiciliarios mediante cuestionarios previamente validados, las mediciones biológicas de ácaros y hongos por métodos de laboratorio estandarizados, y se usó el modelo log binomial para el análisis multivariado, que permitió evaluar asociaciones mediante la estimación de las razones de prevalencia.Resultados. Participaron 678 niños, con edad media de 42 meses. La prevalencia de síntomas respiratorios indicativos de asma fue 8,0 % (IC95%: 5,6-9,6), sin diferencias significativas entre las dos zonas de contaminación extradomiciliaria. El modelo binomial mostró que los síntomas de asma se asociaron con la presencia de: ácaros [razón de prevalencia (RP)=1,78; IC95%: 1,0-3,0] y Acremonium sp. (RP=6,2; IC95%: 3,8-10,0), y antecedentes de neumonía (RP=4,0; IC95%: 2,5-6,4), de rinitis alérgica (RP=1,9; IC95%: 1,25-3,1), de prematuridad (RP=3,4; IC95%: 1,7-6,5), de padres con asma (RP=2,6; IC95%: 1,4-5,0) y de tenencia de mascotas (RP=0,4; IC95%: 0,2-0,9).Conclusiones. La exposición a contaminantes biológicos intramurales (ácaros y hongos), los antecedentes personales de prematuridad, neumonía o rinitis y el antecedente familiar de asma, incrementan la probabilidad de presentación de síntomas indicativos de asma bronquial en la población estudiada

Introduction to: Ethics with Ontology. A Debate in Ethical Nonnaturalism

\u201cEthics With Ontology\u201d both alludes to and contrasts with Hilary Putnam\u2019s book Ethics Without Ontology (2004). In this book, Putnam proposes that there can be moral objectivity without objects, or moral truth without any descrip- tion of a moral realm. Since then, many others (for instance, T. Scanlon, R. Dworkin, C. Korsgaard, and D. Parfit have claimed that the view that there are moral truths has no ontological implications. They opt instead for a metaethical cognitivism without moral realism. On the other hand, one of the most striking developments in the metaethical debate of the past 15 years has been the renewal of nonnaturalist moral realism\u2014the view which (at least in its so-called \u201crobust\u201d versions) presents the strongest ontological and metaphysical commitments, namely commitments to the existence of non-natural properties and facts

Facing the future - effects of short-term climate extremes on isoprene-emitting and non-emitting poplar.

Isoprene emissions from poplar plantations can influence atmospheric chemistry and regional climate. These emissions respond strongly to temperature, [CO2] and drought but the superimposed effect of these three climate change factors are, for the most part, unknown. Performing predicted climate change scenario simulations (periodic and chronic heat and drought spells (HDS) applied under elevated [CO2]), we analyzed volatile organic compound (VOC) emissions, photosynthetic performance, leaf growth and overall carbon (C) gain of poplar genotypes emitting (IE) and non-emitting (NE) isoprene. We aimed (i) to evaluate the proposed beneficial effect of isoprene emission on plant stress mitigation and recovery capacity and (ii) to estimate the cumulative net C gain under the projected future climate. During HDS, the chloroplastidic electron transport rate of NE plants became impaired, while IE plants maintained high values similar to unstressed controls. During recovery from HDS episodes, IE plants reached higher daily net CO2 assimilation rates compared to NE genotypes. Irrespective of the genotype, plants undergoing chronic HDS showed the lowest cumulative C gain. Under control conditions simulating ambient [CO2], the C gain was lower in the IE than NE plants. In summary, the data on the overall C gain and plant growth suggest that the beneficial function of isoprene emission in poplar might be of minor importance to mitigate predicted short-term climate extremes under elevated [CO2]. Moreover, we demonstrate that an analysis of the canopy-scale dynamics of isoprene emission and photosynthetic performance under multiple stresses is essential to understand the overall performance under proposed future conditions

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