[Peak flow rate (PFR) in children measured by the Wright's Peak Flow Meter (author's transl)].
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Biomedical subjects
Publications and source records attributed to E Ceruti.
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As a contribution to knowledge about the etiology of lower respiratory tract infections (LRI) in infants, 235 patients aged one year or less admitted to a children's hospital at northern metropolitan area of Santiago, Chile along years 1987 throughout 1989 with radiologically confirmed diagnosis were studied. Infants were eligible only if their symptoms lasted for not more than five days and their hospital stay was less than two days. Controls consisted on 74 healthy infants. A search for presumptive etiology was done by means of usual bacteriological procedures (pharyngeal swabs and blood cultures), plus latex test for type b Haemophilus influenzae (Hib) and Streptococcus pneumoniae (SP) in concentrated urine specimens; indirect immunofluorescence (IF) for specific Chlamydia trachomatis (CT) IgM; serological tests, isolation and IF in pharyngeal aspirates for syncytial respiratory virus (SRV), influenza, parainfluenzae and adenoviruses were also used. Evidence of viral infection was detected from 135/235 (57.5%) of cases and 21/74 (28.3%) controls, SRV being the most common. From 18/119 and 2/119 studied patients Hib and SP antigens were respectively detected, but urinary antigens were also present in 6/24 controls, raising questions about this test's specificity. IF titers of 1:32 or higher for CT were found in 5/80 patients, all younger than 5 months. It was possible to perform the whole set of available methods in 80 patients, in 70% of which some evidence of a known etiologic agent was found. Serology alone gave etiological clues in only 30% of these cases and usual microbiological cultures of throat swabs and blood from none of them. No combinations of age, fever, respiratory rate, apnea, bronchial obstructive syndrome, white blood cell counts over 15,000 or of band forms over 500 per cu mm, erythrocyte sedimentation rates, reactive C protein and x-ray findings allowed differential diagnosis between presumptive bacterial or viral etiology, except in one case of an infant presenting with pleural effusion and positive antigenuria for Hib.
Five infants with Chlamydia trachomatis associated pneumonia are analyzed. They were diagnosed out of 80 infants admitted to the hospital with pneumonia whose etiology was studied for virus, bacteria and Chlamydia trachomatis. Serum IgM antibodies to Chlamydia tr. were measured by indirect immunofluorescence (IIF), which is considered to be specific in high titers (1 greater than or equal to 32). The five cases represented 10.4% of infants studied younger than six months. One child was born by cesarean section suggesting the possibility of other non oculogenital still undefined mechanism of transmission. Clinical symptoms and laboratory findings were characteristics of those described in Chlamydia tr. pneumonia. Chlamydia trachomatis must be considered an etiologic agent in infantile pneumonia specially in the first six months of life. The high specificity and sensitivity of the IFF makes this serologic test the best non-invasive method for diagnosis of Chlamydia tr. pneumonia currently available.
Demonstration of bacterial antigens in biological fluids has been used for early detection of bacterial infections. Recent evidence suggests that higher detection rates of these antigens can be obtained from concentrated urine than from serum samples of patients. Evidence of bacterial infection by antigen detection was looked for from 50 fold concentrated urine samples by means of an ultrafilter system (Minicom) and latex agglutination for Haemophilus influenzae B (HiB) and Streptococcus pneumoniae (Sp) in three groups of patients. Group A (Positive controls), included 7 patients whose blood culture were positive for HiB (n = 5) and Sp (n = 2). Group B (Healthy controls) involved 16 children without clinical and laboratory signs of infection, coming from ambulatory well baby clinics and surgical wards, and group C was formed by 77 patients with negative blood cultures but with clinical and X ray evidence of lower respiratory tract infection. The corresponding antigen was demonstrated in urine samples from all group A patients. Three group B subjects gave positive results for HiB antigen. HiB antigen was detected from 10 and Sp antigen from 2 group C patients. These results suggest that the search for bacterial antigens in urine would be useful for etiological diagnosis and management of patients with bacterial pneumoniae. There is no definite explanation for the finding of HiB antigen in urine from apparently healthy children but the possibility of previous or actual asymptomatic infections must be taken into account.
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The incidence of the gastroesophageal reflux was studied in 39 healthy infants with ages between 2 and 24 months. X-ray studies of gastroesophageal passage and esophageal manometry were practiced in all cases. Only 3 infants showed radiological reflux. The pressure in the gastroesophageal sphincter was normal in all babies and the highest pressures were reached less--than 6 months--old infants. Older infants showed lesser pressures. The same was true for the length of the gastroesophageal sphincter. The factors involved in the genesis of the gastroesophageal reflux are discussed.
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Acid-base equilibrium parameters were studied in 11 full-term newborns with adequate weights for their gestational age and in 10 with deficit in their intrauterine growth, during the first 72 hours of life. Significant differences were found. Apparently, malnourished subjects who overcome chronic asphyxia are able to compensate the metabolic disturbances brought about through hyperventilation. The low figures of PaO2 found in babies show they will need higher concentration of oxygen in the air they inhale.
The study comprised 458 infants complaining of recurrent obstructive bronchitis from the clinical, chest X-rays and gastroesophageal reflux investigation view points. Spontaneous radiological reflux was found in 49.1% of the patients, although a history of vomiting was present only in 26.6%. In infants with positive radiological reflux, manometrics showed a shorter gastroesophageal sphincter and with lesser pressures than a group of normal infants. With medical treatment of the reflux, remission of the respiratory symptoms was seen in 63.5% of the patients. In a group of infants treated, control X-rays, and manometrics were practiced at the end of the medical treatment showing significant improvement of pressure and length of the gastroesophageal sphincter. The long-term follow-up in infants showing failure of the medical treatment, bronchial asthma appeared in 56.6%.